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PROVINCE OF BRITISH COLUMBIA Second Report of the DEPARTMENT OF HEALTH AND WELFARE (HEALTH BRANCH) YEAR… British Columbia. Legislative Assembly 1948

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Full Text

 PROVINCE OF BRITISH COLUMBIA
Second Report of the
DEPARTMENT OF HEALTH
AND WELFARE
(HEALTH BRANCH)
YEAR ENDED DECEMBER 31st
1947
VICTORIA,   B.C. :
Printed by Don McDiarmid, Printer to the King's Most Excellent Majesty.
1948.  Office of the Minister of Health and Welfare,
Victoria, B.C., March 31st, 1948.
To His Honour C. A. Banks,
Lieutenant-Governor of the Province of British Columbia.
May it please Your Honour:
The undersigned has the honour to present the Report of the Department of Health
and Welfare (Health Branch) for the year ended December 31st, 1947.
G. S. PEARSON,
Minister of Health and Welfare. Department of Health and Welfare (Health Branch),
Victoria, B.C., March 31st, 1948.
The Honourable Geo. S. Pearson,
Minister of Health and Welfare, Victoria, B.C.
Sir,—I have the honour to submit the Second Report of the Department of Health
and Welfare (Health Branch) for the year ended December 31st, 1947.
I have the honour to be,
Sir,
Your obedient servant,
G. F. AMYOT, M.D., D.P.H.,
Deputy Minister of Health. DEPARTMENT OF HEALTH AND WELFARE
(HEALTH BRANCH).
Hon. G. S. Pearson ------    Minister of Health and Welfare.
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.C.Sc. -       -       -       -
Miss D. E. Tate, R.N., B.A.Sc, M.A.
Miss M. Frith, R.N., B.A., B.A.Sc, M.P.H.
A. H. Cameron, B.A., M.P.H.   -       -       -       -
Mrs. K. Beard, B.Sc, M.S.P.H
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.
Geo. Elliot, M.D., CM., D.P.H.
Deputy Minister of Health and Provincial Health Officer.
Deputy Provincial Health Officer.
Assistant Provincial Health Officer.
Public Health Engineer.
Consultant in Milk and Food Control.
Director, Public Health Nursing.
Consultant, Public Health Nursing.
Director, Public Health Education.
Consultant, Public Health Education.
Consultant in Nutrition.
Director, Division of Laboratories.
Director, Division of Tuberculosis
Control.
Director, Division of Vital Statistics.
Director, Division of Venereal Disease Control.  TABLE OF CONTENTS.
Page.
Introduction    11
Longevity and Causes of Death in British Columbia  15
Bureau of Local Health Services  16
School Health Services  16
Notifiable Diseases  18
Full-time Health Services  20
Preventive Dentistry  23
Table I.—Table showing Return of Cases of Notifiable Disease  24
Report of the Director of Public Health Nursing—
Introduction    27
Table II.—Comparison of Provincial Public Health Nursing Staff Changes  27
Student Nursing Programme  28
Report of the Nutrition Service—
Introduction  29
Consultant Service to Local Public Health Personnel  30
Staff Education  30
Provision of Technical Information, Guidance, and Assistance  31
Provision of Nutrition Materials for Distribution by the Local Health
Service  31
Consultant Service to Hospitals and Institutions  32
Co-ordination  33
General Comments and Observation  34
Report of the Division of Vital Statistics—
Introduction  34
Completeness of Registration-—
Indians  35
Doukhobors  36
Registration of Births  36
Effect of Family Allowance .  36
Registration of Deaths  37
Registration of Marriages  37
District Registrar's Offices, etc  37
Vital Statistics Information for Health Units  39
Statistical Services  39
Mechanical Tabulation  40
Vital Statistics Council for Canada  40
Model Marriage Act  40
The International List of Diseases, Injuries, and Causes of Death  40
Model Vital Statistics Act  41
National Register of Vital Statistics  41
Plasticized Birth Certificates  42
Administration of the " Marriage Act "  42
General Office Procedure  42
Problems outstanding at the End of the Year—
Goal in Registration  43
Instruction Manuals  43
Certification   43
Development of Further Services to the Provincial Department of Health.. 44 II 8 BRITISH COLUMBIA.
Report of the Division of Laboratories— Page.
Introduction  44
Tests relating to Venereal Disease Control  44
Tests relating to Tuberculosis Control  45
Tests relating to Gastro-intestinal Infections  45
Bacteriological Tests of Milk and Water Supplies  46
Other Types of Tests  46
General Comments  47
Table III.—Division of Laboratories Statistical Report of Examinations done
during the Year 1947  49
Table IV.—Number of Tests performed by Branch Laboratories in 1947  50
Report of the Division of Venereal Disease Control—
Introduction  51
Treatment . .  51
Epidemiology  51
Social Service  52
" Venereal Diseases Suppression Act " .__  52
Co-operation with other Departments and Agencies  52
Publications of the Division in 1947  53
Education  53
General ,  53
Report of the Division of Tuberculosis Control—
Introduction  54
Clinics  56
Institutions  57
Nursing  57
Social Service  59
Statistics  59
Local Health Services  59
Budget  59
Conclusion  60
Report of the Division of Public Health Engineering—
Introduction  60
Water-supply .  60
Sewage-disposal  61
Garbage-disposal  62
Milk Sanitation  62
Shell-fish Sanitation  63
Industrial-camp Sanitation  63
Sanitation of Tourist Resorts  64
Summer Camps  64
Environmental Sanitation of Schools  65
Sanitation of Eating and Drinking Places  65
Frozen Food Locker Plants  65
General Observations  66 DEPARTMENT OF HEALTH AND WELFARE, 1947. II 9
Report of the Division of Public Health Education— Page.
Introduction .  66
Development of the Field in North America  66
Functions in Health Education  67
Development of the Field in British Columbia  69
Activities of the Division of Public Health Education during 1947  70
Pre-service Training  70
In-service Training  71
School Health  72
Materials  72
Work with Voluntary Agencies  73
Informational Service  73
Press Releases and Radio Programmes  73
Objectives and Plans  74
Conclusion .  74
Report of the Provincial Infirmary—
Introduction  75
Patients  75
Employees  75
Continuing Problems     75
Infirmary Institutions—
Marpole  76
Mount St. Mary  76
Allco  77
Conclusion  77  Second Report of the Department of Health and Welfare
(Health Branch)
YEAR ENDED DECEMBER 31st, 1947.
G. F. Amyot, Deputy Minister of Health.
INTRODUCTION.
Although this is the second annual report of the Health Branch of the
Department of Health and Welfare, it represents the fifty-first annual report
of public health services in British Columbia. These services began in 1895
and continued under the authority of the Provincial Board of Health, a branch
of the Provincial Secretary's Department, until 1946, when the Department of
Health and Welfare was formed.
The introduction to the present report deals with certain phases and activities of the Health Branch as a whole. Major accomplishments and problems
and suggested solutions for the latter are outlined.
The body of the report consists of eleven sections which have been prepared
by the heads of the bureaux, divisions, and services which constitute the
Provincial Department of Health.
LOCAL PUBLIC HEALTH SERVICES.
It is gratifying to note that the expansion and stimulation of full-time
local public health services continued throughout the year. These may be
summarized as follows:—
(a) The East Kootenay Health Unit, with headquarters at Cranbrook,
was opened in August.    This unit serves the areas covered by
School Districts Nos. 1, 2, 3, and 5.
(6)  The North Okanagan Health Unit was extended to include Revelstoke and district.
(c) The Okanagan Valley Health Unit was extended southward to the
International Boundary to include the villages of Oliver and
Osoyoos and the surrounding territory.
(d) The Cariboo Health Unit, with headquarters at Prince George,
was established and, at the year's end, awaited only the arrival of
the new director. It was definitely planned that he would assume
control by the middle of January, 1948.
(e) Plans are laid for the development of two further health units.
These await the availability of trained public health physicians
as directors.
Inasmuch as such expansion is made at the request, even the strong and
insistent demand, of the local citizens through their official spokesmen, these
11 II 12 BRITISH COLUMBIA.
developments indicate a continuing and increasing awareness of the value of
public health services.
In those areas of the Province where it has not yet been possible to establish health units there was a considerable expansion in the services provided
by public health nurses. Six new public health nursing districts were opened,
four previously organized districts were extended geographically, and the service in other districts was expanded. The field staff was increased by twenty-
six public health nurses and thirteen appointments to supervisory positions
were made.
ACCOMMODATIONS.
Overcrowding in the office accommodations of the Provincial Department
of Health's headquarters staff in the Parliament Buildings continued throughout the year. The construction of new accommodations was well advanced at
the time of writing this report, however. It is planned to allot certain of the
new offices to the Division of Environmental Sanitation and the Division of
Public Health Education. This will provide these Divisions with much needed
space and allow for more efficient functioning oh the part of personnel who
remain in the Parliament Buildings proper.
Certain of the accommodations used by those Divisions located in Vancouver are far from satisfactory. The Division of Laboratories, in particular,
labours under a very considerable handicap because of the poor physical
surroundings in which its personnel carry out their duties. The Division of
Venereal Disease Control is housed in temporary buildings in which much
improvement is indicated. Certain building projects, partly completed at the
end of the year, place the Division of Tuberculosis Control in a more advantageous position. In spite of the addition of the Jericho Beach Hospital,
however, there is still an urgent need for more hospital beds for tuberculosis
patients. Plans are well advanced, however, to provide new and modern
accommodations for all Vancouver Divisions of the Provincial Department of
Health. These plans, when implemented, should make the efficient performance of duties easier, not only by providing greater and more suitable space,
but also by grouping together the three Vancouver Divisions, and by making
possible the establishment of branch offices in Vancouver of some of the services
now located in Victoria.
MOBILE TUBERCULOSIS SURVEY CLINICS.
During the year suitable arrangements were made with the British
Columbia Tuberculosis Society in the matter of planning for and preparing
communities to receive the services of the mobile X-ray survey clinics. Although
the operating costs of these clinics are borne entirely by the Division of Tuberculosis Control of the Provincial Department of Health, the Tuberculosis Society
had rendered a great humanitarian service by providing, through its sales of
Christmas Seals, the expensive equipment used in the surveys. It had also
accepted the responsibility of planning the itineraries of the mobile clinics and
playing a major role in organizing the communities where the clinics were to
appear. Toward the end of the year the society was given relief from these
duties when they were assumed by public health personnel.    Under the new DEPARTMENT OF HEALTH AND WELFARE, 1947. II 13
arrangements the planning of itineraries and the formulation of general policy
have become the responsibility of the central office staff of the Provincial
Department of Health. Education and organization of any community in
which the X-ray survey is to be held have become the responsibility of the
public health field staff serving that community.
INSTITUTE FOR PUBLIC HEALTH WORKERS.
As in previous years, the Institute for Public Health Workers of British
Columbia—an intensive refresher course in all phases of public health—provided
activities and discussions which were stimulating to those attending and which
materially advanced the cause of public health in the Province. Conducted for
four days in April, the sessions were attended by both central office and field
staff, as well as representatives of other Provincial organizations interested in
public health.
The 1947 meetings were of special significance because Dr. C. E. A. Wins-
low, Professor Emeritus of Public Health, Yale University, and editor of the
Journal of the American Public Health Association, presented a series of eight
lectures during the sessions. Dr. Winslow is a world authority on public health.
His keen insight, his long experience in science, administration, and teaching,
and his command of language make his contribution to any such gathering an
experience of outstanding and lasting importance to his listeners.
CANCER.
The formation of the National Institute for Cancer was effected during
the early part of 1947. The Deputy Minister of Health for British Columbia
has, for many years, given much thought and time to the development of such
an organization. He took an active part in the discussions and planning conferences which began in January and ended in May, 1947, with the first aim,
the formation of the Institute, realized. This organization will undoubtedly
provide for more effective cancer-work, not only in British Columbia but
throughout Canada as a whole.
The Provincial Department of Health continued to work in close co-operation with the Cancer Committee of the British Columbia Medical Association,
the Provincial Branch of the Canadian Cancer Society, and the British Columbia
Cancer Foundation.
Funds to aid the Cancer Institute, operated by the Cancer Foundation, in
its work in prevention, diagnosis, and treatment, were again provided.
Follow-up work and education of the public in cancer control were an
important part of the duties of the field staff in health units and public health
nursing districts.
Again the Welfare Branch of the Provincial Department of Health and
Welfare has included persons with cancer among those who have received
assistance. Facilities for all types of patients, including those suffering from
cancer, have been made available by the Hospital Branch through its aid to
general hospitals. II 14 BRITISH COLUMBIA.
ARTHRITIS.
During 1947, as in previous years, the Provincial Department of Health,
especially through its Deputy Minister's relations with the Dominion Council
of Health, shared fully in the laying of plans for a national organization for
the study of arthritis and its control. Early in the year the Dominion Council
passed a resolution calling for a special conference on arthritis. This conference was held in October, and at it specific recommendations for the formation
of the national organization were made. Definite plans were also made for a
final meeting in January, 1948, when the organization would be consummated.
Thus, at the year's end, a national organization for the study of arthritis and
its control awaited only one further and imminent meeting to make it a reality.
It is anticipated that this organization will give direction to the logical
development of research and co-ordination to the activities of all agencies
concerned with the treatment and control of arthritis.
RED CROSS BLOOD TRANSFUSION SERVICE.
This service, which was outlined in last year's Annual Report and whose
establishment was predicted at that time, came into effect in January, 1947.
The Canadian Red Cross, the Provincial Department of Health, the Department of Veterans' Affairs, the hospitals, and the medical profession have all
co-operated closely in this very important public health development.
It must be repeated, however, that this service can be maintained only if
the citizens of British Columbia take an active part by serving as blood donors.
The people of the Province should bear in mind that the transfusion service is
their service. In order to use it effectively, they must keep the supply of blood
at a high level.
CO-OPERATION WITH OTHER DEPARTMENTS OF GOVERNMENT,
PROFESSIONS, AND VOLUNTARY AGENCIES.
In concluding this introduction, the Deputy Minister of Health, on behalf
of his co-workers, wishes to express sincere appreciation of the great co-operation and material assistance given during the year by all those departments of
government with which the Provincial Department of Health has worked in
the interests of the public.
Official lay groups and members of the many professions throughout the
Province have given great aid in the advancement of public health. Their help
is much appreciated.
Those voluntary agencies interested in public health have, through their
splendid efforts in both service and education, simplified the work of the official
agencies.
The Deputy Minister of Health also wishes to make special mention of the
professional, technical, and clerical personnel who constitute the staff of the
Provincial Department of Health. Their loyal and co-operative services have
done much to make possible the continued advancement, on a high plane, of
public health in British Columbia. DEPARTMENT OF HEALTH AND WELFARE, 1947. II 15
LONGEVITY AND CAUSES OF DEATH IN
BRITISH COLUMBIA.
Mortality rates and the causes of death are an important criterion of the
state of health in any community. A study of the deaths that occurred in this
Province during the year reflects the continuing improvement in the over-all
physical condition of the people and the lengthening life-span. However, mortality figures alone do not purport to give a complete account of the health of
the people. Extensive data on morbidity—the incidence of sickness and disease
of all kinds—would also be required to portray such a picture.
The crude death-rate in British Columbia has not changed over the last
two decades. The highest rate during this period occurred in 1943 when it
was 11.1 per 1,000 population. Since that time slight decreases in each yearly
rate have been effected. Preliminary mortality figures, excluding Indians, for
the first eleven months of 1947 indicate that for this year British Columbia
experienced a death-rate slightly lower than that of 1946. The provisional
death-rate for 1947 was 9.8 per 1,000 population.
An analysis of deaths by age-groups reveals the lengthening life-span of
the population and the reduction in deaths in the earlier years of life. The
preliminary mortality rates per 1,000 population in specific age-groups for 1947
were 3.6 in the age-group 0-19 years, 2 in the group 20-39 years, 7.7 in group
40-59 years, and 45 in the group 60 years and over. The 1947 death-rate in
the age-group 20-39 was only 55 per cent, of the corresponding rate recorded
for the year 1921. Considerable decreases were also noted in the rates for the
age-groups 0-19 and 40-59 as compared to the corresponding rates only twenty-
five years ago. In the age-group 60 years and over, the death-rate per 1,000
population in 1947 was nearly 20 per cent, higher than in 1921. This fact
again reflects the increasing longevity of the population. Persons who would
have died in the earlier age-groups under the conditions of life only two decades
ago are now surviving to a more advanced age, thus increasing the mortality
rates in the older age-groups.
There was a slight increase in the infant mortality rate from the previous
year. The death-rate for children under 1 year of age increased from 29.5 in
1942 to 34.3 in 1945. This rising trend reversed in 1946 when the rate dropped
to 29.9. The infant mortality rate, excluding Indians, for 1947 was 30.6 per
1,000 live births.
The all-time low in maternal mortality rates reached in 1946 was retained
in the year 1947. The preliminary maternal death-rate, excluding Indians, for
1947 was 1.2 per 1,000 live births, compared with 1.4 for 1946.
Diseases of the heart and arteries continued to be the leading cause of
death for 1947. Statistics for the first eleven months of 1947 reveal that the
death-rate for these diseases was slightly higher than in 1946. A preliminary
rate of 370 per 100,000 population compares with 366.2 in 1946.
Cancer was the second leading cause of death. The preliminary cancer
mortality rate for 1947 was 143.5, whereas in 1946 it was 148.5.
Accidents remained the third leading cause of death in 1947. The rate of
accident fatality in 1947 was higher than in 1946. A rate of 78.1 per 100,000
population in 1947 compares with 72.4 per 100,000 population in 1946.    Motor- II 16 BRITISH COLUMBIA.
vehicle accidents accounted for 25.7 per cent, and drownings for 12.2 per cent,
of the 728 accidental deaths registered from January to November in 1947.
Both of these percentages were higher than the corresponding figures for 1946,
which were 21.8 per cent, and 11.8 per cent, respectively.
In 1947 the preliminary mortality rate for communicable diseases among
the white population was 50.5 per 100,000 population. This compares with
58.5 per 100,000 population in 1946. Tuberculosis, a major communicable
disease and the fourth leading cause of death, had a mortality rate of 37.9 per
100,000 population in 1947, whereas the rate for 1946 was 39.9. From 1944
to 1946, inclusive, there was a slight increase in the tuberculosis mortality rate.
Deaths from venereal diseases decreased in 1947. During the first eleven
months of 1947 such diseases accounted for 0.6 per cent, of all deaths, compared
with 0.8 per cent, in 1946.
Intracranial lesions of vascular origin was the fifth leading cause of death
in the non-Indian population, followed by nephritis, pneumonia, diabetes, and
suicides.
Although diarrhoea and enteritis is not a major cause of death, a notable
decrease in this cause of infant mortality is worthy of mention. From January
to November, 1947, there were only forty-one deaths from diarrhoea and
enteritis, compared with a total of seventy-one deaths for the year 1946.
BUREAU OF LOCAL HEALTH SERVICES.
It has been mentioned frequently in previous reports of this Department
that one of the chief functions of a Provincial Health Department should be the
stimulation toward and the development of full-time local health services. The
year 1947 has been one of progress in this regard in that several new public
health nursing districts were opened, two new health units were organized, and
two established health units were extended to take in contiguous territory.
In addition, plans are under way for additional health units to be opened during
1948. Unfortunately, the shortage of public health physicians, which has been
mentioned in previous reports, still continues to hinder the more rapid development of health units in this Province. Fortunately, the number of available
public health nurses has increased somewhat, although the demand for this type
of personnel still exceeds the supply. The details concerning developments in
public health nursing are dealt with in the report of the Director of Public
Health Nursing.
SCHOOL HEALTH SERVICES.
School health services have been carried on effectively during the year by
the public health nurses, the part-time School Health Inspectors and the Health
Unit Directors. It is of interest to note that approximately 92 per cent, of the
population of the Province now receives the benefit of public health nursing
service. This means that the majority of the schools now have regular and
periodic visits from a public health nurse, who forms not only a valuable liaison
between school and home but a person with whom the teacher in the rural areas
can discuss the health problems incident to the pupils, the school building, and
its environment. DEPARTMENT OF HEALTH AND WELFARE, 1947. II 17
While further detail concerning physical examination by physicians is
given in the Medical Inspection of Schools report, it is worth noting that the
policy is being continued of having only children in Grades I, IV, VII, and X
examined routinely by the School Health Inspector each year. The pupils of
the intervening grades are examined by the public health nurse, and any pupils
who, in her opinion, require a more detailed examination are referred to the
School Health Inspector. In this connection it is reasonable to expect that in
the light of current trends and school health practices the time is not far distant
when those pupils ready to commence school or those in Grade I will be the only
ones examined routinely by the School Health Inspector. The pupils in other
grades under such a plan would be screened by the public health nurse in cooperation with the teachers, and only those pupils showing evidence of the need
for further checking or examination would be referred to the School Health
Inspector.
The school health record cards 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 no serious criticism has
been forthcoming. However, in a biological process which involves such complex factors as human growth and nutrition, it is essential for public health
authorities to keep constantly abreast of new developments and to be willing
to change existing practices and procedures where critical evaluation of new
methods has shown them to possess merit in whole or in part. An attempt to
carry out such evaluation of new methods is in process at the present time
through a survey which is being conducted in the Central Vancouver Island
Health Unit district jointly by this Department and the Child and Maternal
Health Division of the Department of National Health and Welfare. This has
reference to the use and application of the Wetzel Grid in assessing the physical
status of the school child.
The Department of National Health and Welfare has very materially contributed to this survey in that it has purchased some 8,000 grids (charts) and
has supplied the services of a pediatrician to supervise the work. This contribution by the Federal Health Department is sincerely appreciated. The Provincial
Department has provided clerical assistance and has made available the offices
and the services of the staff of the Central Vancouver Island Health Unit.
By way of explanation it can be pointed out that the grid provides a pictorial record of the child's growth as reflected by height and weight. However,
what is more important and practical is that it gives a visual demonstration of
whether growth is, or is not, progressing satisfactorily, and of the extent to
which this is so. This particular type of grid or chart was developed after
several years of research and the study of the growth records of hundreds of
thousands of children by Dr. N. C. Wetzel, a paediatrician-mathematician of
Cleveland, Ohio.
Experience has shown that when a child deviates from his normal pattern
or channel of growth and development, the basic causes fall into three major
groups—nutritional, emotional, or pathological (disease). It follows logically
that it is the group of children who are showing deviation from their normal
and expected growth-pattern to which the school health service should direct its II 18 BRITISH COLUMBIA.
time and attention, in order to bring these children back to their normal health
status as rapidly as possible. When such a child is discovered from the pictorial
record of changes in his height and weight, the child is given a thorough
physical examination and the situation discussed with the parents and with the
family physician where necessary. The interest and co-operation of the parents
and physicians has been very gratifying.
The survey was commenced in September and some 8,000 children have
now had their records plotted on the grids. The interpretation of the findings
is proceeding as rapidly as possible, but it is still too early to hazard an opinion
on the new method and its relationship to the procedure in effect in the rest of
the Province. Considerable follow-up work must still be carried on, possibly
for a period of twelve months, together with statistical analysis of the findings
and the results. In next year's report it will be possible to give further details
on the survey and perhaps an evaluation of its practicability in comparison with
the present school health record cards.
Mention was made in last year's report of an effort to establish school
health committees with representation from the local health service and the
educational authorities. The purpose of such a committee was to provide a
medium for discussion of all phases of school health in order to bring about
better integration of health and educational facilities. For various reasons it
has not been possible to embark on this programme during the past year, but
it is anticipated that School Health Committees will be formed in a number of
areas during the coming months.
This Department would again like to take this opportunity to express
thanks to the part-time School Health Inspectors throughout the Province for
their interest, help, and co-operation during the past year. Without the help
of these physicians in areas not served by health units, it would be impossible
to bring the benefits of medical advice and opinion to school-teachers and public
health nurses in many rural areas with regard to the health of the school child
and the sanitary environment of the school building. The immunization which
the School Health Inspectors have carried on has played no small part in
reducing the incidence of preventable disease in the school population.
NOTIFIABLE DISEASES.
Table I, on page 24, shows the number of reported cases of notifiable
diseases. The total number reported—namely, 36,066—represents an increase
over the number reported during the previous year. In 1946 the figures showed
a total of 27,958 cases reported. This increase is chiefly represented by a large
number of individuals having suffered from influenza, whooping-cough, poliomyelitis, or measles during the year.
While the number of individuals who suffered from influenza did not represent any widespread epidemic, nevertheless, in some centres of the Province,
the infected individuals represented a very sizeable portion of the total population in the local area. During 1946 there were 1,086 reports on influenza, while
there have been 3,522 during the year just ended. Individuals suffering from
mumps showed some decrease, there being just over 5,500 cases reported in
1946 and in 1947 just under 4,800 cases. DEPARTMENT OF HEALTH AND WELFARE, 1947. II 19
Whooping-cough cases rose from 167 during 1946 to a little more than
1,500 during last year. However, in spite of the rise, 1947 was not an epidemic
year. Nevertheless, it is unfortunate that even this number of individuals
should have to suffer from an insidious and often prolonged disease like this
when, in the majority of instances, three simple immunizations in the pre-school
period will prevent the infection.
The year 1947 was very definitely an epidemic year in so far as poliomyelitis was concerned. All told there were reported some 312 individuals suffering
from this infection. It is interesting to note, however, that while there were
only 172 reported cases in 1927, that this represents approximately the same
number of infected individuals in proportion to the population of the Province
at that time, as does this higher figure for 1947'in relationship to population of
the Province at present. The first report was received during the first week in
January, and reports continued to be received at irregular intervals until the
early summer, when new cases were being reported each week. The peak of
the epidemic was reached during the week of September 6th, when a report of
twenty-five new cases was received. From that time on the number of new
cases decreased. However, it was well into November before one week went
by without a new case being reported. A special report is being prepared on
the epidemic as it existed in British Columbia and will be available in a few
months.
Previous reports have made mention of the fact that measles frequently
occurs in epidemic cycles of four to five years. This has been fairly generally
true in British Columbia, with definite peaks in 1937, 1941, and 1945. However, the intervening years may show a considerably varying incidence and on
occasion the usual periodicity may even vary. For example, in 1947 there were
approximately 9,300 reported cases of the disease. This is roughly the same
incidence as in 1945. However, in other peak years there have been 15,000 or
more cases reported. It should be pointed out that these figures give only a
general idea of the trend since, as with other of the more common communicable
diseases, all of the individuals suffering from the infection are not reported to
the local health authorities.
Reported cancer cases reached a total of 2,620 in 1947 compared with 2,521
in the previous year. Again it must be emphasized that this number of
reported cases gives no real indication of the actual incidence of this disease,
since no very accurate figures are yet available as to the general incidence of
cancer in the population.
Cerebrospinal meningitis, chicken-pox, scarlet fever, typhoid fever, salmonellosis—including paratyphoid fever—septic sore throat, and epidemic hepatitis
also showed decreases of varying degree from the previous year.
No cases of botulism or tick paralysis were reported.
It is of interest to note that for the first time for several years in this
Province two cases of Rocky Mountain spotted fever were reported, one from
Quesnel and one from Wells. The first patient died very rapidly from the infection, and information has just been received that the second patient has made a
satisfactory recovery. II 20 BRITISH COLUMBIA.
The number of individuals who developed diphtheria during 1947 was considerably reduced. There were 63 cases reported during 1946 and 34 during
the year just ended. However, it is still regrettable that this disease has to
occur, when it is realized that it is a preventable disease and can be practically
eliminated when parents assume their responsibility in seeing that their children
receive the benefits available through immunization from either their family
physican or their local health service.
FULL-TIME HEALTH SERVICES.
The full-time local health services in the Province, which include the Greater
Vancouver Metropolitan Health Department, the Victoria-Esquimalt Health
Department, and the various health units, have continued to make substantial
progress during the year. Progressive programmes are in effect. Practices
and procedures have been reviewed from time to time and every effort made to
provide as effective a health service as possible to the people within the territory
served by the local health adminstration. Although an acute shortage of trained
and qualified public health personnel still exists, the Department has been extremely fortunate in being able to secure four more public health physicians
during the year. This made it possible to open the East Kootenay Health Unit
in August. With headquarters at Cranbrook, this unit serves School Districts
Nos. 1, 2, 3, and 5 and includes Cranbrook, Fernie, Kimberley, Creston, and the
surrounding unorganized territory. This was the only new health unit that
it was possible to open in 1947.
Because of the need for a full-time Director in the Division of Venereal
Disease Control it was necessary to allocate the Director of the North Okanagan
Health Unit to this position. However, with the new public health physicians
available it was possible to have one of them assume the Directorship of the
North Okanagan Health Unit and thus maintain the continuity of this service.
The Revelstoke area, because of its geographical location, has always been
considered to be a logical part of the North Okanagan Health Unit. Because
of the interest in full-time local health service in this area it was possible to
make arrangements to extend the service of this health unit to Revelstoke and
district during the year. This completed the consolidation of the North Okanagan Health Unit, which now serves the entire district in the northern portion of
the Okanagan Valley, including Revelstoke in the north-east and Salmon Arm to
the north-west and south to, and including, Vernon and Coldstream Municipality.
The consolidation of the area planned for the Okanagan Valley Health Unit
was also completed during the year when arrangements were made for this
service to extend south to the International Boundary and include the villages
of Oliver and Osoyoos and the surrounding unorganized territory. It was also
possible to add another public health nurse to the staff of this health unit in
order to relieve the heavy load which the two public health nurses in the
Kelowna area were carrying. The community housekeeper service, which was
commenced in 1946 in the City of Kelowna, has appeared to meet the problems
for which it was developed. This organization provided a service for " shut-
ins " or hospitalized residents who might require help in the home for varying
periods. The service has proven to be of assistance in enabling certain types of
patients to leave hospital earlier than they might have otherwise, and has also DEPARTMENT OF HEALTH AND WELFARE, 1947. II 21
allowed other types of patients to remain home who would have required hospitalization if the service were not available. Interest in a similar type of
service is being shown by two or three other communities throughout the Province, and it is possible that there may be a number of such plans in operation
before long. Experience would indicate that this is a practical type of community plan rather than the development of an expensive bedside nursing
service which would not meet as well the type of problem which is present in
various communities. In Kelowna the Okanagan Valley Health Unit co-operated in the service through the provision of a limited bedside nursing service.
If such a housekeeper service is commenced in other unit areas, it will be possible to work out a co-operative plan whereby the health unit staff in these areas
would also provide a limited bedside nursing service.
Last year it was anticipated that it would be possible to provide a Director
for the Prince Rupert Health Unit. This became an accomplished fact early
in 1947. The staff was also increased by an additional public health nurse.
This health unit also serves the district east of Prince Rupert to and including
Hazelton, but in view of the interest in full-time local health service in Smithers
and district it is now anticipated that it will not be long before this unit is
extended to include the Smithers School District, and so will complete the area
which was originally planned for this unit.
Requests for health unit service have now been received from all City or
Municipal Councils and District School Boards in the area to be served by a
Cariboo Health Unit with headquarters at Prince George. Such a health unit
will serve the immediate Prince George district and extend south to include
Quesnel, Williams Lake, and the Lac la Hache district, somewhat eastward from
Prince George, and westward to include Vanderhoof and the surrounding unorganized territory. It is anticipated that this health unit will commence operation early in 1948.
Requests have also been received from most of the official organizations in
the Chilliwack area, and it is likely that a health unit will also be established in
that section of the Fraser Valley early in 1948. This health unit will serve
Chilliwack City, Chilliwack Municipality, Kent Municipality, Harrison Hot
Springs as well as the Village of Abbotsford and the Municipalities of Sumas
and Matsqui. This will be the first health unit to be established in the Lower
Fraser Valley outside of the Greater Vancouver Metropolitan Health Department. It is hoped that it will not be too long before personnel will be available
to provide additional full-time local health service for the other municipalities
in this part of the Province. Requests for such service have been received from
most of the areas, and again shortage of personnel is the major factor in hindering this development. All health units operating in the Province at the present
time are now financed on a uniform basis along the lines which were outlined
in the report for 1946. As mentioned at that time the local area pays 30 cents
per capita per annum and the remainder of the finances are provided by the
Provincial Health Department. Federal grants to assist in financing local
health services have not yet become available, but it is hoped that such financial
assistance will become a reality. At the present time the Provincial Health
Department provides approximately 70 cents per capita per annum toward the
support of health unit service. II 22 BRITISH COLUMBIA.
The population figures which are used for organized territory are a compromise between those of the last census (1941) and the 1944 municipal estimates
published by the Department of Municipal Affairs. For unorganized territory
the figure used is a compromise between those of the last census and the 1944
estimate of population for the area made by the Division of Vital Statistics.
These population figures are corrected every two years, thus making the local
cost for health service follow as closely as possible the increase or decrease of
population in an area. As a matter of fact the only reasons for a change in the
local health cost are, first, increase or decrease in population and, second, the
addition of a children's preventive dentistry programme to the already existing
service.
Reference has been made in an earlier section of this report to the Annual
Institute for Public Health Workers which is held around Easter time each year
for a period of three or four days. At the meeting in 1947 it was decided that
it would be worth while to have quarterly meetings of the full-time Medical
Health Officers of the Province together with the senior medical officers of this
Department, such meetings to be held for one or two days in the office of the
Deputy Minister of Health. The first of such meetings was held in September
for two days and proved to be well worth while. Numerous problems were discussed, both as seen from the view-point of the local health workers and also as
seen from the central office of the Department. A much better integration and
correlation of services as between the Divisions and the technical consultants of
the Department in their relationship to the field health worker has resulted.
The next of such meetings will be held in January, 1948, for two or possibly
three days, when it is hoped that it may be possible to have the Director of Field
Studies of the American Public Health Association present to discuss the question of evaluation of local health services. It is essential that health work and
programmes be appraised or evaluated from time to time if one is to avoid a
static and routine procedure. In view of the fact that the American Public
Health Association has developed a very practical evaluation schedule which
this Department plans to use during the coming year, it is felt wise to have the
Field Director, who has been responsible for the development of this schedule,
consult with the health unit Directors at as early a date as possible.
While this section of the report deals with full-time health services, nevertheless the Department desires to take this opportunity of expressing its appreciation of the work which has been carried out by the many part-time Medical
Health Officers throughout the Province. These physicians are to be commended for the time and effort which they have given in the matter of investigations and communicable disease control. Their help has been of very material assistance in the public health programme throughout the Province in the
areas where health units are not yet established. Every effort has been made
to give them as much help as possible, not only from the public health physicians
in the field but also from the central office of the Department, in order to cope
with some of the more urgent problems that have occurred. It has again been
possible to arrange for senior officials from the Department to visit many local
areas and discuss health problems with the Medical Health Officers from time
to time. DEPARTMENT OF HEALTH AND WELFARE, 1947. fl 23
PREVENTIVE DENTISTRY.
It is anticipated that it may be possible to have a full-time dentist attached
to the Department early in 1948. This will assist in a small way in being able
to bring the benefits of preventive dentistry to children in some of the rural
areas of the Province where there is not a resident dentist. However, it will
hardly be scratching the surface of the tremendous health problem which is
building up year after year because of the lack of widespread dental care for
school and pre-school children throughout many of the rural areas. The dental
clinics in Victoria and Greater Vancouver areas have continued to carry on a
successful planned programme of preventive dentistry. There is, however, a
constantly increasing and urgent need either for a considerable number of
dentists to be appointed to the staff of the Department and attached to health
units or for numerous local dental clinics to be established throughout the
Province. There is still room and need for many additional dentists in the
Interior of the Province, because those dentists who are located there at the
present time are still too busy with the backlog of work accumulated during the
war years to find time for children's clinics. It is to be hoped that new dental
graduates will come to realize that this field is uncrowded and presents an
excellent opportunity to bring definite benefits and an improved oral health to
the citizens of the future. II 24
BRITISH COLUMBIA.
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II 25
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II 26                                                        BRITISH COLUMBIA.
Table I.—Table showing Return of Cases of Notifiable Disease in the Province of British Columbia
for the Year 1947—Continued:
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Island Health Unit	
Salmo	
Saltspring Island	
South Shalalth	
Squamish	
Telegraph Creek	
Tofino	
E
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Greater Vancouver Metropolitan Health Committee	
Vanderhoof	
1                          Wells 
Williams Lake 
Woodflbre	
Whole Province—
Syphilis	
Tuberculosis	
Totals	 DEPARTMENT OF HEALTH AND WELFARE, 1947.
II 27
REPORT OF THE   DIRECTOR OF PUBLIC
HEALTH NURSING.
Dorothy E. Tate, Director.
INTRODUCTION.
Accomplishment in the past year's activities in public health nursing has
repaid public health nurses for the effort expended in reaching new goals.
Larger numbers of people in the Province are receiving public health service
than in previous years. The services of allied agencies are now being made
more easily available to individuals through local public health service. The
efficiency and uniformity of the work is making more headway through the
efforts of a new group of senior public health nurses.
It is encouraging to note that in the past year the percentage of people
receiving public health service has increased to 92 per cent. The increase was
made through the organization of public health nursing services in new districts.
Requests for service in additional districts have been received and will be filled
in the future as qualified public health nurses become available.
The field staff made a very definite contribution during 1947 in interpreting
public health services, with the result that thirty-seven public health nurses
have been attracted this year to the generalized public health field in British
Columbia.
The number of public health nurses joining the staff made it possible to
replace the public health nurses who left for further study, to replace those who
left to be married, and also to increase the numbers of workers in given areas
to conform, in part at least, with population increase. There were sufficient
public health nurses to open six new public health nursing districts and to
expand in four previously organized districts.
Table II provides the information relative to the number of appointments,
the number of positions as compared to the previous four years, and the number
of resignations which had to be filled before it was possible to meet the expansion
programme.
Table II.—Comparison of Provincial Public Health Nursing Staff
Changes during the Five-year Period 1943-47.
Year.
1943.
1944.
1945.
1946.
1947.
52
37
71
17
12
8
56
33
59
13
11
9
64
48
75
22
16
10
77
88
117
42
27
19
98
65
65
37
11
17
The increased number is only one measure of the growth of a staff.
Administration and guidance of larger numbers of members must keep pace
with new developments. Thirteen appointments of senior public health nurses
have been made.    They are working in districts with groups of public health II 28 BRITISH COLUMBIA.
nurses, helping with the problems as they arise, and devising more efficient
methods for carrying on the ever-expanding public health nursing programme.
Such a step not only prevents some problems from occurring, but also
improves the speed at which problems are overcome. More concentrated
assistance to the staff has already shown good results. Thus, in the case of
epidemics, public health procedures have been available more readily to meet
emergencies. The people in the districts have seized the opportunities for the
service, as it has been timely, effective, and efficient.
STUDENT NURSING PROGRAMME.
The student programme has expanded. There were fifty-four postgraduate public health nurses from the University of British Columbia who gained
experience in the rural and semi-urban areas. Undergraduate nursing students
from the various training-schools were placed in areas in the Fraser Valley for
one week to see public health nurses in action. They gained an appreciation
of the work carried on for people in the community. During a series of six
lectures given to the nursing students at St. Joseph's Hospital, Victoria, on
public health, one day was spent by each student in accompanying a public
health nurse in her work. The Royal Inland Hospital students had the advantage of a series of lectures on public health and an opportunity of viewing a
public health project.
The awakening of community conscience toward social services has been
shown through the frequent requests for new type of health service not
previously included in public health work. Attempts to meet the demands have
been made by broadening the field of public health nursing duties and in one
instance establishing an emergency housekeeping service. The experiment in
the centre has proven so successful that investigation as to the feasibility of a
similar plan in other centres is under way. Relieving the head of a household
of home management, and expanding public health service to supervise and
practise home care of the sick, is proving a boon to family groups.
Tools have been made available this last year to assist public health nurses
to keep pace with the trends and newer emphasis in public health. Periodic
time studies, including public health nursing activities and a review of case
loads, provided a measure which showed the need for statistical clerks. The
relieving of the public health nurses of clerical duties has enabled them to spend
additional hours each week to participate in active public health nursing, for
which they are especially trained. Further review of the services of the public
health nurse revealed the emphasis given to certain phases of the work and
provided some index of the balance of the work in the various phases of the
public health nursing programme. For example, the tuberculosis work has
outweighed other public health nursing activities because of the concentrated
efforts to carry out survey programmes in an attempt to discover and treat the
minimal tuberculosis cases. The programme itself is important, but changes
are being considered in the organization and management locally so that less
time will be required to accomplish the same end.
It can readily be seen that through new scientific discoveries there must
always be a flexible public health programme, in order that the people of the DEPARTMENT OF HEALTH AND WELFARE, 1947. II 29
Province may have the benefits. The constant change in approaches to maintain physical and mental health and care for the sick required a staff of people
who are adaptable. In the past year, public health nurses demonstrated, as an
adaptable group of workers, an effective programme which was made possible
through changes in administration.
Now, as a preview is made of activities for 1948, it would appear that many
further developments could be made. The active co-operation of allied agencies
and the Department in the services offered by the British Columbia Cancer
Institute, the British Columbia branch of the Cancer Society, those of the
Hospital for Sick and Crippled Children, and the Solarium augurs well for the
services in the coming year.
Developments in other related professional fields are anticipated. The
public health nurses of the Provincial Department of Health are anxious to
co-operate when it is beneficial to the people of the Province.
REPORT OF THE NUTRITION SERVICE.
Miss E. M. Yvonne Love and Miss Doris L. Noble, Consultants.
INTRODUCTION.
The report of the progress and activities of the Nutrition Service may well
be prefaced by a brief resume of the significance and place of nutrition in the
public health programme in British Columbia.
Food is an important environmental factor affecting the health of the individual. Although this fact has long been recognized, continuing research has
now proven the importance of adequate food at every age. Within the year,
further conclusive evidence of the importance of the food factor has been
graphically illustrated in many studies related to maternal and infant mortality,
child development, and positive health at all ages.
Nutrition education is recognized as an essential part of the public health
programme in this Province. The ultimate objective of the Nutrition Service
is to benefit the health of the people by improving their food habits. To attain
this objective, nutrition education must reach the people through every phase of
the public health programme, because it affects every phase of healthful living.
This is exemplified in the programme at present being carried on whereby nutrition education is an integral part of the local public health programme and,
therefore, is directed toward the needs of the people in the community. The
nutritionists serve as consultants to public health staff of health units, public
health nursing areas, and all divisions of the service. The actual programme of
the Nutrition Service is developed in close co-operation with the Directors of
Public Health Nursing, Public Health Education, Environmental Sanitation,
and other Divisions.
During 1947 the Nutrition Service has met increased responsibilities. In
addition to consultant service to public health workers, the programme has been
further developed to include consultant service to hospitals and institutions.
This has been accomplished by reorganization of the duties and responsibilities
of the nutritionists, without an increase in personnel. Within the year, as well,
current price changes have brought to the fore an important function of the II 30 BRITISH COLUMBIA.
Nutrition Service—namely, assistance in meeting food costs by guidance in
economical choice, purchase, and service of food.
CONSULTANT SERVICE TO LOCAL PUBLIC HEALTH
PERSONNEL.
Many health problems encountered by local public health personnel are
directly or indirectly affected by nutrition. Because of the importance of adequate food to the promotion and maintenance of health, nutrition education is
included as an integral part of the generalized public health programme. Information concerning the wise selection, preparation, and use of foods is therefore
correlated with other aspects of health education carried on during home and
school visits, clinics, and daily activities of the local health service.
The importance of a nutrition consultant service for the purpose of providing technical assistance to public health personnel with the various nutritional
aspects of their programme has been recognized by this Department. This service is therefore being provided to all local public health staff by a consultant in
nutrition working under the direction of the Bureau of Local Health Services.
The consultant programme is based on meeting the needs and problems relative
to nutrition which are encountered by public health workers throughout the
Province.
During 1947 the following services have been provided to local health
personnel:—
1. Staff Education.
An important responsibility of the nutritionist is that of carrying out a
continuous programme of nutrition education for all local public health personnel.    During the year this programme has included:—
(a)  Distribution and interpretation of nutrition reference material,
the most important of which was a Nutrition Reference Manual
prepared and made available by Dr. E. W. McHenry, Professor
of Public Health Nutrition at the School of Hygiene, Toronto.
This manual has been distributed to all health unit directors,
public health nurses, and sanitarians.
(6)  Attendance at staff meetings of local health units during field trips
of a nutritionist.    At this time, reviews of nutrition information
and reports on recent developments in public health nutrition suitable for application or emphasis in the community were given
during these meetings.    Similar discussions were held at study
meetings of public health nurses in the Fraser Valley and East
Kootenay districts,
(c) Preparation of articles on progress and problems in nutrition for
publication in " Public Health News and Views," which is distributed to all local public health staff.
Conferences and meeting with local health personnel have been found the
most effective method of staff education and therefore worthy of emphasis
during the coming year. department of health and welfare, 1947. ii 31
2. Provision of Technical Information, Guidance, and Assistance.
During activities such as home and school visits, clinics, and conferences,
the health unit director and public health nurse are meeting with problems such
as those related to selection, preparation, and use of basic foods, low-cost meal
planning, child and infant feeding. In assisting local workers with special
problems encountered, the nutritionists have provided the following technical
services during the year:—
(a) Compilation of low-cost meal plans and recipes, equipment for
school cafeterias, suggestions for food economies, and recommended substitutes for foods difficult to obtain due to price or
availability. Recently, material dealing with the selection of food
at low cost has been prepared for the guidance of both local public
health and welfare personnel.
(b) Provision of specific information relative to food dislikes and fallacies, feeding problems, food preservation, and other individual
problems.
(c) Advice and assistance with nutritional aspects of special projects
and studies being carried out by the local health service.
(d) Provision of information and assistance with school lunch problems.
Guidance with school lunches is part of the school health programme of
the local public health worker. During the year the Nutrition Service has
provided information regarding types of school lunch programmes, menu plans,
lunch supplements, selection and arrangement of cafeteria equipment for the
guidance of public health personnel. Through the local health service, emphasis
is given to the importance of developing, in co-operation with teachers and other
local groups concerned, a programme suited to the needs and conditions of the
school and community in question. In addition to the nutritional aspects of the
school lunch, special attention is being directed toward school lunch sanitation.
In order to co-ordinate policies regarding school lunch activities, meetings
were held during the year with the Department of Education and Provincial
Executive of the Parent-Teacher Federation. During the summer the Parent-
Teacher Federation was given assistance in preparing a school lunch questionnaire for the guidance of local parent-teacher groups. This project provided
an excellent opportunity to encourage and facilitate the closest co-operation of
local teachers, public health personnel, and parent-teacher organizations who
are directly concerned with school lunch problems in the community.
Further co-operation was encouraged in school lunch articles prepared for
bulletins of the Department of Education, Parent-Teacher Federation, and
Women's Institute.
3. Provision of Nutrition Materials for Distribution by the
Local Health Service.
Nutrition pamphlets, posters, films, and exhibits suitable for distribution
to the public by local health services have been collected or compiled in collaboration with the Division of Health Education. In an attempt to meet the needs
of the local health service for practical nutrition education material, the pamph- II 32 BRITISH COLUMBIA.
lets and posters in use have been continually revised and evaluated during the
year.
Studies carried out through the local health service this year are proving
the importance of adequate food to the health of the individual and the need for
continuous nutrition education through the local public health programme.
Requests from local public health workers for nutrition consultant services have
increased progressively during the year. The Nutrition Service has endeavoured to assist with the promotion of better food habits through answering
requests from local health services in a practical manner. Due to changes and
increase in staff, as well as further development in the field of nutrition research,
a continuous programme of staff education in nutrition is recognized as an
important requisite to a consistent service for local public health personnel in
the future.
CONSULTANT SERVICE TO HOSPITALS AND INSTITUTIONS.
It has been recognized that problems in the field of hospital and institutional food service merit the attention of public health personnel. Each year
an estimated 14 per cent, of our population receive hospital services, including
acute and long-term cases. In addition to hospitals and aside from day care
centres for children, there are in this Province 119 licensed institutions, including orphanages, boarding-homes, and shelters, with a capacity of 1,813. It is
important that there be efficient and adequate food service in such establishments for three reasons: First, numbers of persons are affected through one
central food service; second, the meals serve as a pattern for an adequate diet;
and third, standards of efficient operation can be set up by hospitals and
institutions.
Services in this field are now being developed by a nutritionist with training
and experience in this work, administered through the Bureau of Special Preventive and Treatment Service and directed through local health service. The
service has already involved the following:—
(a) Analysis of existing conditions relative to food value and economy
of food service.
(b) Staff problems in food service.
(c) Selection and arrangement of equipment.
(d) Adequate space, in relation to the whole institution, for efficient
food service.
(e) Organization and administration of the food service.
(/)  The place of food service in relation to other services and the
whole hospital or institution.
(g) Assistance in developing healthful attitude of staff and patients
toward the food service.
(h) Suggested adjustments based on analysis of the food service.
(i)   Assistance in implementing the adjustments in order to change
established habits and patterns of procedure.
In the short time in which this service has been available, work has been
done in the Vancouver Unit of the Division of Tuberculosis Control, Royal
Jubilee Hospital, Oakalla Prison Farm, Newhaven, Queen Alexandra Solarium,
and Fairbridge Farm School.    The service requested by each institution has DEPARTMENT OF HEALTH AND WELFARE, 1947. II 33
varied with the type of institution and existing conditions. However, the
nature of the studies is similar, in that an initial analysis of existing conditions
and a report of suggested adjustments followed by discussion of the practical
adaptation to the hospital or institution and assistance in implementing the
adjustment has been given. Many of the improvements involve considerable
time; for example, change of food patterns, established patterns of operation,
rearrangement of equipment, and purchase of new equipment. Therefore each
of these studies is progressive in nature, and assistance is given for as long
a period as necessary.
This service is carried out in line with the general policy of the Department and is co-ordinated with the generalized programme of the local public
health staff in the area concerned. Assistance is available on request to local
public health personnel, other Divisions of this Department, and other branches
and departments of Government. Of the work already under way, advantage
has been taken of each of these approaches to provide service to hospitals and
institutions.
At the time of writing this report, there are on file other requests from
hospitals in which studies will be carried on in the near future. As this service
develops, it is possible that a background of information will be made available
for all those institutions interested. Although the material may be useful for
all establishments serving food, it should be pointed out that the circumstances
in each require further individual analysis and adaptation of the material to
existing conditions.
CO-ORDINATION.
Nutritionists with this Department, and those with other agencies in this
Province, have met together at regular' intervals during the year to discuss
programmes and to work jointly on special projects. The group has included
personnel from the Greater Vancouver Metropolitan Health Department, Extension Service and Department of Home Economics of the University of British
Columbia, and dietary departments of hospitals. A major project has been
that of compiling an adequate standard for weekly food purchase. The list,
based on Canada's Food Rules, will be useful as a general guide in computing
requirements and cost of food for families or groups. This information will
therefore be of value to public health personnel as well as others directly concerned with the problem of adequate food for families in British Columbia.
During the year there have been opportunities to discuss the nutrition service available through local public health personnel. On several occasions
nutritionists have addressed such groups as Junior Red Cross Summer School
Course, Welfare Personnel, British Columbia Hospital Association, and university students in public health nursing.
In collaboration with the Division of Public Health Education, assistance
has been given to the Department of Education with the revision of the health
curriculum for schools. The assistance given by the Nutrition Service has been
that of guidance relative to co-ordination of nutrition with all other aspects of
health outlined in the curriculum.
Nutritionists employed in Provincial Departments of Health meet with
nutritionists from the Federal Department of Health and Welfare at annual II 34 BRITISH COLUMBIA.
Dominion-Provincial conferences. A nutritionist attended the 1947 meeting
of the committee, which was held in May concurrently with that of the Canadian
Public Health Association. The exchange of information and discussion of
mutual problems has been found to be beneficial in evaluating the programme
outlined in this report.
GENERAL COMMENTS AND OBSERVATION.
Consultant service to hospitals and institutions, developed during the year,
has been made possible by the fact that Miss Yvonne Love rejoined the staff in
June, after completion of a certificate course in public health at the school of
Hygiene, University of Toronto. The purpose of the course was to provide
a general knowledge of public health, and to afford special advanced training
in nutrition. The latter studies were under the direction of Dr. E. W. McHenry,
Professor in Public Health Nutrition, who is one of the outstanding authorities
in this field. The course stressed the practical application of nutrition research
and nutrition principles in the public health programme. Further experience
was gained in two months' field-work, in which time there was an opportunity
to compare the programme and organization in a number of county and State
health departments throughout the Southern and Eastern United States, to
observe research projects, and to discuss community nutrition activities with
many specialists in the field of public health nutrition.
During 1947 there has been considerable progress as well as further
development of the Nutrition Service. This is exemplified by the fact that
services have been extended to hospitals and institutions. Through the programme carried out this year it has been possible to evaluate and further to
clarify problems and to offer guidance and assistance in their solution. Although
many problems remain to be met in the future, it has been possible to foresee
methods by which this may be accomplished.
REPORT OF THE DIVISION OF VITAL STATISTICS.
J. D. B. Scott, Director.
INTRODUCTION.
Generally speaking, the work of the Division increased over the previous
year. As in other years Indian and Doukhobor registrations still are among
the most difficult of the problems to be met by the Division. Definite progress
has been made on the former, but the latter is still virtually unsolved.
A definite advance was made in the redefining of the boundaries of the
Vital Statistics Registration Districts. These were drafted in such a way as
to coincide as much as possible with the school district boundaries.
The value of inspection was again proved worth while.
A successful trial was made of notification by the District Registrars of
births, deaths, and still-births to health units.
The statistical section acted as a workshop for the whole Department of
Health in regard to statistical problems, and also supplied considerable data
not only to other Government agencies but to the public as well. DEPARTMENT OF HEALTH AND WELFARE, 1947. II 35
The Vital Statistics Council for Canada was most active during the year
in prominent vital statistics matters. The most important items are reported
hereunder.
The new plastic birth certificate, a wallet-sized card laminated in plastic,
was successfully introduced by the Division.
COMPLETENESS OF REGISTRATION.
Indians.
Current Registration.
The marked improvement in the number and quality of registrations of
Indian births, still-births, marriages, and deaths noted in the latter part of
1946 continued throughout 1947. This condition appears to be largely due to
the payment of family allowance to Indians, the increased vigilance regarding
vital statistics matters stressed by the administrative officers of the Indian
Affairs Branch, and the payment of a commission by the Division to the Indian
Agents for each statutory return filed. Due to the increased volume of work
being undertaken by the Dominion Government to improve conditions generally
for the Indian population, there is every reason to assume that the proper
recording of vital statistics will continue to be given priority attention by the
Indian Agents. Vital statistics records are so closely related to the other records
of every agency that the importance of complete and accurate registration cannot be overlooked.
An excellent liaison exists between the office of the Indian Commissioner
for British Columbia and the Division. Results of inspections by officials of
both Departments are compared and efforts can be made to remedy many undesirable situations, thus exercising a much better control than heretofore. Inspections were made by the Division in eight of the eighteen agencies during the
year.
Many difficulties still confront the Indian Agents in all their efforts to
secure completeness of registration, but it is felt that an improvement in transportation and educational facilities will go far to reduce these problems in the
future. The nomadic nature of the Indians and their lack of understanding of
registration appear to be the basis of the difficulties presently existing.
Documentary Revision.
It had become apparent to the Division that due to a lack of the realization
of the importance of Indian registration in the years gone by, many inaccuracies
existed in the records, and the only practical way to overcome this awkward
situation would be to compare agency copies of registrations with the originals
on file in the Division and then to make whatever notations would be necessary
to bring the records up to date. This work, which was commenced in January,
1947, involves a tremendous amount of checking, typing, re-indexing, and similar procedures. Owing to the nature of the undertaking, only birth records are
being called in at present, thereby reducing to a minimum the time that the
agency copies of registrations are required at the central office. Every effort
is made to reduce the amount of work as much as possible for the Indian Agents II 36 BRITISH COLUMBIA.
by completing forms for corrections, making notations, and preparing up-to-
date indexes at the central office.
DOUKHOBORS.
Current Registration.
A special field representative of the Division, after completing a two
months' course in the central office, commenced work in January, 1947, gathering registrations of Doukhobor vital statistics.
Owing to the religious beliefs of the Doukhobors, it has not been possible
to achieve more than a small measure of success. The year was marked by an
extraordinary number of outbreaks of violence which led to a full inquiry by
a Royal Commission, beginning in October and continuing through November
and December. These events had a definite effect in increasing the difficulties
in securing registrations.
This remains the most serious problem in accomplishing completeness of
registration in the Province. It appears that much depends on the results of
the Royal Commission report as to whether or not a solution can be found.
Registration of Births.
Except in the instances mentioned under the heading of Indians and Doukhobors, and in a very small number of other isolated cases, there is no lack
of proper birth registration. Though food rationing has ceased, the stimulus
of family allowance has proven sufficient to ensure promptness and completeness
of registration.
Much appreciation is again extended to the medical practitioners for their
co-operation in forwarding notifications of births and still-births to the appropriate District Registrars, thus assisting all concerned to file registrations with
a minimum of delay. Likewise, the hospitals have performed a valuable service
to the Division in the submission of their monthly returns of births. Gratitude
is hereby expressed to the hospital officials for the assistance they have rendered
in this connection.
Results of constant checking have indicated that there was no necessity to
continue requiring a return from all schools of the Province showing particulars
of children attending school for the first time. Consequently, the practice of
obtaining such a return was discontinued.
Effect of Family Allowance.
Since the inception of family allowances a most effective check on completeness of birth registration has been automatically in existence due to the desire
of parents to obtain the allowance, combined with the vigilance of the officials
of the Family Allowance Branch in insisting upon prompt verification of
particulars of birth. An excellent liaison exists between the Family Allowance
Branch and the Division, thus bringing to light numerous inaccuracies in registration, such as fraudulent records, mis-spelling of names, and incorrect dates
of event, in such a manner that those responsible for filing the registrations can
be contacted and the errors amended. Gratitude is here expressed for the
spirit of co-operation shown at all times by the Family Allowance Branch. department of health and welfare, 1947. ii 37
Registration of Deaths.
No difficulty is encountered in obtaining completeness of death registration
except amongst Indians and Doukhobors. However, some improvement has
been noted among the former people during the past year as Indian Agents have
been made more aware of the importance of death registration. Due to expansion in the medical services of the Indian Affairs Branch and the need for
statistics on cause of death, a considerable improvement may be expected in
the forthcoming year.
Further improvements in a revised form of burial permit were made and
the new form was taken into general use in May, 1947. Some of the advantages
of the form are as follows:—
(a) It reduces the amount of work required of the District Registrar.
(6)  It is of a size and shape which make it very easy to handle.
(c) Each form contains complete instructions as to its own disposition.
(d) It provides the cemetery official with proof that registration of
death has been made, which service was not heretofore provided.
(e) It provides an acknowledgment to the funeral director, clergyman, and cemetery official that registration has been made, in
addition to providing an excellent cemetery return; all this is
accomplished in one operation.
(/) It provides an up-to-date record of all cemeteries in use in the
Province.
(g) The saving in clerical time far offsets the additional cost of printing as contrasted to that of the previous forms used.
Registration of Marriages.
Registration of marriages has not presented any new problems in 1947.
A certain amount of difficulty is encountered in obtaining completeness of registration of marriage of Indians, but steady improvement is being made to rectify
the situation. Doukhobors most usually persist in marrying according to their
own customs; consequently, in such cases, no record of the event is made.
There appears to be no delinquency where the marriage is performed by a
clergyman.
Completed marriage registers are checked routinely at the time of issuance
of each new register. A number of old registers were located during the year,
but there are still some which were issued many years ago and which cannot be
located.    Efforts will continue to be made to locate as many as possible.
DISTRICT REGISTRARS' OFFICES, ETC.
During the year the boundaries of all districts which were not reviewed
in the previous year were given consideration, and as a result certain alterations and consolidations were made to facilitate the handling of registrations.
In most cases the boundaries of the vital statistics registration districts now
coincide with those of the school districts, which ultimately will be common to
the health districts; in the majority of cases where the boundaries differ from those of the school districts, the variations are not sufficiently great to cause
difficulty in compiling statistics for any given district.
An amended map of his own district, indicating the districts immediately
surrounding it, was supplied to every District Registrar in the Province and
to the offices of the Deputy District Registrars.
Due to the changes involved in the redefinition of boundaries, it was necessary to prepare a revised " Guide to Cities, Villages, and Municipalities in
British Columbia." This publication has yet to be printed and distributed to
the various persons concerned.
At the close of the year there were seventy-three registration districts
under the supervision of a District Registrar, and in addition there were
twenty-three sub-offices within these districts. Forty of the District Registrars
were Government Agents, thirty-five District Registrars and Deputy District
Registrars were members of the British Columbia Police, and the remainder
were Mining Recorders, Gold Commissioners, notaries, etc. In addition, there
are eighteen Indian Agents acting as District Registrars for Indians.
Twenty-six district offices and sub-offices were inspected during the year,
plus the offices of eight Indian Agencies. Although this represents a decrease
over last year in the number of offices inspected, this year's programme included
many isolated areas, such as the west coast of Vancouver Island, the coastal
area north to Prince Rupert, the Queen Charlotte Islands, and Peace River
District northward to the British Columbia-Yukon Boundary.
This was the first occasion on which an inspection had been made in any
of the offices of the Peace River District and northward. As has been found
in other cases at the time of a first inspection, a few details of procedure in
handling registrations required correction, and these matters have received
attention. The only offices in the Province which have not yet been inspected
are Stewart, Telegraph Creek, and Atlin.
Inspections have proven to be very valuable from several points of view.
In the first place, records are checked for completeness, and the method of procedure used in securing registrations is reviewed in order to suggest any alterations which may be necessary. In the second place, there are usually various
matters which the District Registrars wish to discuss with the Inspector but
about which they are reluctant to write to the Division. Many helpful suggestions as to amendments in legislation and in procedure have been implemented
as a result of conversations with the District Registrars. Inspections have
likewise served to improve the esprit de corps between the District Registrars
and the central office. Invariably it has been found that where inspections
have been made without an excessive lapse of time between them, the work is
well handled and its importance is realized.
During the year all index registers, covering the period 1872-1899, inclusive, were recalled to the central office for checking in order to assure agreement
between central office records and district office records. Registration of births,
deaths, and marriages commenced on September 1st, 1872, but in hardly any
instances were copies of records kept in district offices until July, 1899. At the
inception of registration a memorandum entry was made by the District Registrar in- an index-book, but as returns were only made to the central office after
lengthy intervals, it was found in checking the old index-books that a number DEPARTMENT OF HEALTH AND WELFARE, 1947. II 39
of original registrations were not on file.    All such registrations have now been
properly recorded.
Following inspections, a considerable amount' of binding of District Registrars' copies of registrations was undertaken, as experience has shown that
where copies are preserved in permanent binding there has been no loss, except
through fire, of any records. Practically all outstanding work in this connection has now been completed, so that future work will consist of binding current
records only. It has been found preferable to have all registrations sent to the
central office for checking prior to binding, rather than have the District Registrar place the records on loose-leaf binders, as many original registrations,
which were not on file in the central office, have been discovered in this manner.
VITAL STATISTICS INFORMATION FOR HEALTH UNITS.
In order to provide more rapid notification of births, deaths, and still-births
to health units, a new system of reporting by the District Registrars has been
evolved. Under this plan a District Registrar will forward to the health unit
director a notification slip giving minimum details of the event as soon as the
information is in his hands. This method ensures that the health unit director
becomes aware of all births, deaths, and still-births in his area within a
few days.
This new service was inaugurated in the Central Vancouver Island Health
Unit this year on an experimental basis and will be expanded where necessary
to include all other health units.
STATISTICAL SERVICES.
One of the major activities of the Division is the compilation of statistical
data which stem from its registration functions, and the provision of statistical services for the other Divisions of the Provincial Department of Health.
Monthly analyses of vital statistics registrations are made according to city and
area of occurrence, and of residence, racial groups, sex, age-group, and according
to other breakdowns. Particular attention is given to those facts which reflect
the health of the people—namely, the causes of death, the infant and maternal
mortality rates, and the incidence of communicable diseases.
The Division carries out the majority of the statistical requirements of the
Divisions of Tuberculosis Control and Venereal Disease Control. Monthly
morbidity analyses are prepared from the diagnostic reports of these two
Divisions, and a continuous up-to-date record is maintained of the current
diagnoses of all known cases of tuberculosis. Special tabulations are prepared
from time to time, as well as the annual statistical reports for these Divisions.
During the year additional requirements for both the Division of Tuberculosis
Control and the Division of Venereal Disease Control have been undertaken.
Service is also provided to other Divisions of the Provincial Department
of Health. The daily reports of the public health nurses are processed by the
punch-card method, the school environment reports of the Division of Environmental Sanitation are summarized and analysed, and a central clearing-house
for public health nurses' family records is maintained. The Division is expected
to function as a statistical workshop for the entire Department, and as such is
prepared to assist the other Divisions whenever required. II 40 BRITISH COLUMBIA.
The Division has an active campaign aimed at complete reporting of cancer
cases and compiles statistics on the incidence of this disease in British Columbia.
Statistical data are provided without charge to both public and private
agencies upon request. Special monthly tabulations of vital statistics information on the municipalities of Greater Vancouver are made for the Metropolitan
Health Committee. Duplicate punch-cards for deaths in Greater Vancouver
are also prepared for this Committee.
MECHANICAL TABULATION.
Continuous use was made of the mechanical equipment of the Division
during the year, both for routine monthly tabulations and indexes and for
special assignments. The work of retabulating all the birth indexes of the
Division by year of occurrence was concluded and the new indexes placed in
service. Revision of the death indexes in a like manner was commenced and
carried back to 1925. Preliminary work on revision of the marriage indexes
was also begun. Considerable use was made of the equipment in connection
with the work done for the National Register of Vital Statistics referred to
above.
Alphabetical and numerical indexes of known cases of tuberculosis and
indexes of tuberculosis dead cases are now revised and retabulated annually for
the central office of the Division of Tuberculosis Control. A special index of
known cases of tuberculosis amongst the Indian population was prepared for
the Department of Indian Affairs, Coqualeetza. Additional requirements of the
Division of Tuberculosis Control were met by virtue of the mechanical processing of records. The punch-card method was instituted during the year for the
follow-up reports of tuberculosis cases discharged from sanatoria, and statistical
analyses will thus be available for this phase of the tuberculosis programme.
VITAL STATISTICS COUNCIL FOR CANADA.
In May the Vital Statistics Council for Canada met in Ottawa for the third
time. British Columbia was not represented because of the sudden illness of
the Director while en route to attend the Council meeting. The Council is
proving to be very worth while, as it permits an opportunity to discuss many
matters and tends to keep its members up to date. Definite advances in all
aspects of registration of vital statistics have resulted since creation of the
Council.
Model Marriage Act.
Considerable discussion followed a report by a committee to study the
Marriage Acts of the various Provinces. As a result the committee was
instructed to continue its. work, with the intention of submitting a proposed
draft model Act to the next meeting of the Council.
The International List of Diseases, Injuries,
and Causes of Death.
The International Committee for the preparation of the sixth decennial
revision of the International List of Diseases, Injuries, and Causes of Death
made very definite progress in its recommendations to the Interim Commission
of the World Health Organization. DEPARTMENT OF HEALTH AND WELFARE, 1947. II 41
It is expected that the sixth decennial conference will be held in Paris in the
spring of 1948. The list, together with an alphabetic index and tabular list
of inclusion terms, will be available shortly thereafter.
An excerpt from the report to the Council indicates what the new International List will mean to the Provincial bureaus of vital statistics: " In the
first place, those engaged in public health statistics programmes will be able to
use one classification list for coding causes of death, causes of illness, causes of
still-birth, hospital admission by cause, orthopaedic impairments, and other
factors such as prophylactic inoculations, blindness, and deafness. Others will
find it possible to obtain mortality statistics of greater public health significance,
which will have greater comparability with morbidity statistics than was
possible in the past. On the other hand, those using the classification for
mortality statistics only will find quite a few categories which are important
as causes of illness but not of death."
Model Vital Statistics Act.
Discussion indicated that the Provinces of Saskatchewan, Ontario, New
Brunswick, Nova Scotia, and Prince Edward Island were contemplating new
legislation with regard to vital statistics. For this reason the Council passed a
resolution requesting that the Minister of Trade and Commerce be requested to
call a joint conference of the Council and the Legislative Counsels of the Provinces in the fall of 1947 for the purpose of studying the provisions of a uniform
Vital Statistics Act for the nine Provinces. On December 1st a conference was
held in Ottawa. A submission was prepared by the Division and forwarded to
be read at the conference. To date the verbatim report has not been received
and hence no comments can be made regarding the principles adopted by the
conference.
National Register of Vital Statistics.
Details of the plan for the establishment of the National Register of Vital
Statistics, and terms of the agreements between this Province and the Dominion
Bureau of Statistics effecting this important undertaking, were outlined in the
report of the Provincial Board of Health for 1945. The passing of Federal
legislation implementing payment of family allowances in Canada from July 1st,
1945, has made the early operation of the proposed National Register of paramount importance. The Register has been functioning during the year for all
current registrations received. It is compiled in Ottawa from microfilm copies
of the registrations, which are forwarded regularly from the Provinces.
For family allowance purposes it was necessary that the Register include
all births and deaths from 1925 onward. One of the major problems that had
to be solved concerned the system of allotting to each vital statistics registration
filed in the Province since that date a standardized ten-digit identity number,
which would be mutually exclusive, yet which would provide an immediate reference to the location of the registration. By the end of 1947 all the difficulties
of the numbering sequence had been satisfactorily dealt with, and the entire
backlog of birth registrations to 1925 had been microfilmed and sent to Ottawa.
The second phase of the National Register project required that the birth
identity number be put on death registrations for all decedents born since 1925. II 42 BRITISH COLUMBIA.
For such persons born in British Columbia this involved searching the birth
records and establishing positive identification of the decedent with the associated birth. For persons born outside the Province it was necessary to request
the birth information from the Province concerned or from Ottawa. When this
searching was completed and the birth identity numbers entered on the death
registrations, it was necessary to punch the required birth information on the
Dominion Bureau of Statistics death index-cards, which had been reproduced
from the existing British Columbia cards. By the end of the year all the searching was completed and the first four years of completed death index-cards forwarded to Ottawa.
The ultimate aim of the National Register is that it should become in effect
the " book of life " for each person enumerated thereon, bringing together the
facts of all the vital events of his life. Such a co-ordinated record will be of
great value in demographic studies and will provide information essential both
to efficient social security measures and to the individual himself.
Plasticized Birth Certificates.
Early in the year laminating equipment was installed and the issuance of
plastic birth certificates was commenced. This new service offers the public a
plastic certificate in a wallet-sized card which is tamper-proof, durable, and, in
particular, very convenient. The new certificates contain a minimum of information sufficient to establish proof of age, which meets all normal requirements
for birth certificates. The old-type certificates, showing details of parentage,
are still available on request.
Plastic birth certificates are issued routinely by the central office of the
Division at Victoria, but due to the equipment required, are not available from
any of the District Registrars' offices. The fee is the same as for the old-type
certificates.
ADMINISTRATION OF THE " MARRIAGE ACT."
One of the primary duties of the Division is the administration of the
" Marriage Act." Responsibilities under this Act include the qualifications of
persons for marriage, caveats, adequate proof of divorce, proof of age and
consent of parents for minors, presumption of death, and orders for remarriage.
The " Marriage Act" further provides that ministers and clergymen must be
duly registered with the Division to be eligible to perform marriages in the
Province. Considerable investigation as to the background of new religious
organizations, their present status and possibility of continued existence, is
made before registration is accepted. All marriage registrations are checked
to ensure that the marriage has been performed by a duly registered clergyman
or a Marriage Commissioner.
GENERAL OFFICE PROCEDURE.
Several improvements in general office routine have been made with a view
to simplifying the increasing volume of work. A major change has been made
in the cash and accounting system by the installation of an electric cash register
which classifies and tabulates each entry and prints receipts. The use of this
equipment has eliminated several procedures which were necessary previously. DEPARTMENT OF HEALTH AND WELFARE, 1947. II 43
A new policy in dealing with delayed registrations of birth has been instituted. In the past it has been the practice to insert as a marginal notation on
the registration the evidence submitted in support of a delayed registration.
In view of the fact that this Province adheres to the accepted standards of
minimum proof for delayed registration of birth, and that no registration is
accepted without conclusive proof of its accuracy, it has been decided that
marginal notations of the evidence submitted will not be made. The fact that a
delayed registration has been accepted is prima facie evidence of the validity
of the facts thereon.
The microfilming of some 175,000 physician's Notice of Birth cards was
undertaken during the year. These physician's notifications, which date back
to 1920, have been filmed chronologically under each physician's name. The
new microfilm record will facilitate reference to these notifications and will
reduce storage-space.
As a service to the Victorian Order of Nurses in Victoria and Esquimalt,
weekly birth lists are now compiled from the physician's notices of birth.
As these notifications of birth must be submitted within forty-eight hours of the
event, the listing provides up-to-date information for use by that organization.
PROBLEMS OUTSTANDING AT THE END OF THE YEAR.
Goal in Registration.
The aim of the Division is to achieve not only the complete registration of
every birth, death, and marriage, but also to improve the quality of the registrations. Improvements in the handling of questions, instructions, and the
further education of District Registrars in vital statistics work is to be
carried on.
Doukhobor registration continues to be a most difficult problem. It is hoped
that the Royal Commission on the activities of this group of people will make
certain recommendations which will stimulate registration.
Instruction Manuals.
Parts I and III of the Manual of Instructions for District Registrars, Marriage Commissioners, and Issuers of Marriage Licences have been completed
relating to the " Vital Statistics Act " and the " Change of Name Act" respectively. Part II regarding the " Marriage Act" is still to be compiled. This
part is the most difficult as so many varied questions arise in connection with
the " Marriage Act."
Material is also being collected on central office procedures and it is hoped
that it will be assembled before the end of the forthcoming year.
Certification,
Considerable thought will have to be given to the development of short-form
certificates of marriage and death in order to simplify the work of the Division
and yet provide all the necessary generally needed information. Refinements
will also have to be developed regarding photographic processes in the Division. II 44 BRITISH COLUMBIA.
Development of Further Services to the Provincial
Department of Health.
The Division has to evaluate constantly its statistical procedures, not only
in connection with vital statistics, but also in connection with the statistical
programmes carried on for the other divisions and the headquarters office.
Further development in statistical services to health units is foreseen. Much
basic work needs to be done in classification of boundaries and the assessment
of forms capable of application to the punch-card method. The Division must
also be able to provide a more useful consultative service to the respective
health units.
REPORT OF THE DIVISION OF LABORATORIES.
C. E. Dolman, Director.
INTRODUCTION.
As forecast in the previous Annual Report, the peak of the Division's
turnover of tests was reached in the first quarter of 1946, since when the
numbers have levelled off at between 20,000 and 22,000 monthly. This year the
total of tests performed in the main laboratories in Vancouver will be approximately 270,000, a decrease of 7.5 per cent, over the previous year's total. This
decrease, although small, was very welcome, since it would have been impossible
to continue coping with the increasing demands which had characterized each
of the preceding twelve years of the present Director's association with the
Division. The turnover is still far too heavy in relation to the staff and quarters
available. It must be emphasized, too, that there is a tendency in well-conducted
public health laboratories for more elaborate and time-consuming types of tests
to be done.    Examples of these will be given in the body of this report.
TESTS RELATING TO VENEREAL DISEASE CONTROL.
In conformity with experience in previous years, roughly three-quarters of
all tests related to the diagnosis and control of syphilis and gonorrhoea. During
the year the policy was adopted of carrying out quantitative estimations of
reagin content on all blood specimens giving a positive Kahn reaction and all
cerebrospinal fluid specimens giving a positive complement-fixation (Kolmer-
Wasserman) reaction. This procedure has meant much additional work to the
section concerned, but has provided physicians with important information
about their patients' infections and responses to treatment. The requisition
and report forms relating to these tests were improved.
There was a decrease of about 20 per cent, in the numbers of dark-field
microscopic examinations for the Treponema pallidum, which is a possible
indication of a lowered incidence of primary syphilis. The physician's growing
awareness of the need for seeking laboratory evidence of an early invasion of
the central nervous system in syphilis was indicated by an increase of over
50 per cent, in the numbers of cerebrospinal fluid specimens received for
complement-fixation tests, colloidal reactions, etc. In accordance with an
agreement reached by the Provincial Laboratory Directors' Conference held in DEPARTMENT OF HEALTH AND WELFARE, 1947. II 45
Ottawa in 1946, the Division ceased to perform the Kahn test on cerebrospinal
fluid specimens.
During the first months of the year the main laboratories participated in
the third serodiagnostic survey arranged by the Laboratory of Hygiene of the
Department of National Health and Welfare. The results of this survey have
recently been made available. They show that our standards of performance,
as in previous years, were very creditable.
Tests relating to gonorrhoea presented many problems, as in previous years.
New methods of treatment have somewhat complicated the classical laboratory
criteria for diagnosis of gonococcal infection. The cultural techniques for
identification of gonococci stand greatly in need of a co-ordinated research
approach by the laboratory worker, the epidemiologist, and the clinician.
A helpful step in this direction would be to place under this Division's supervision the laboratory work now being carried out at the Vancouver clinic of the
Division of Venereal Disease Control. Some consideration has, in fact, been
given to this proposal already. Shortages of trained personnel are at present
a handicap, however.
TESTS RELATING TO TUBERCULOSIS CONTROL.
All types of tests for the laboratory diagnosis of tuberculosis increased.
Requests for cultural examinations were roughly 40 per cent, higher, and a
large proportion of these related to stomach-washings, which entail lengthy
preliminary treatment in the laboratory. Guinea-pig inoculations increased
slightly. The proper care of these animals is quite impossible in the accommodations now available. The Division was again seriously handicapped by
repeated outbreaks of fatal infections, apparently of virus origin, affecting both
the normal stock and animals under test. As soon as circumstances permit, it
is proposed to compare relative susceptibilities to tuberculous and adventitious
infections of the guinea-pig and the hamster. This latter animal is claimed to
offer many advantages over the guinea-pig, and several animal breeders in this
Province are now developing hamster colonies.
TESTS RELATING TO GASTRO-INTESTINAL INFECTIONS.
Although in 1947 the actual numbers of proven cases of Salmonella-Shigella
infection in British Columbia will probably be around 170, as compared with
a total of 289 during 1946, the types of micro-organisms isolated will cover a
broader range than in any previous year. In other words, the variety of strains
causing infections of this type, to which the people of this Province are liable
to be exposed, is still extending. Whereas in 1944 & typhi, S. paratyphi B.,
S. typhimurium and S. neivport were the only Salmonella types isolated in this
Province, in 1947 the laboratories, in co-operation with the Western Division
of the Connaught Medical Research Laboratories, were able to identify no fewer
than fourteen Salmonella types. One of these types, S. litchfield, had not
previously been isolated anywhere in Canada. Of special interest was a milk-
borne outbreak of paratyphoid A fever, in which seven cases were traced to a
healthy carrier operating a dairy farm. S. paratyphi A infection has always
been rare in Canada. S. paratyphi A was also isolated from an Indian of the
North Vancouver Reserve. II 46 BRITISH COLUMBIA.
The reduction in the total numbers of cases and carriers of salmonellosis
identified during the year cannot be interpreted as a cause for complacency.
It so happened that there was no repetition of the series of outbreaks of acute
gastro-enteritis which occurred in the previous year in Vancouver. Several of
these were traced to infected food-handlers in public eating places, and the
efforts launched by the local Health Department to improve restaurant sanitation may be partly responsible for the lower incidence. The arrangements
made with the two main hospitals in Vancouver, whereby stool specimens would
be sent to the laboratories from all new admissions to the infants' wards, and
also from nurses and food-handlers newly joining their staffs, appear likewise
to have been helpful, for there was a marked reduction in the salmonellosis
incidence among hospitalized infants. However, there is need for far greater
reforms in both restaurant and hospital sanitation; and in view of the enlarging
variety of Salmonella types which have been recognized in the Greater Vancouver area, further outbreaks, traceable to healthy carriers and mild cases
serving as food-handlers in restaurants and hospitals, are to be expected. In
1947 the great majority of cases were apparently examples of intro-familial
infection. Sight should not be lost of the possibility that the ultimate source of
certain of these Salmonella strains may be animal reservoirs; for example,
rodents, swine, and fowl.
There is no reason to suppose that the situation respecting salmonellosis is
different in the Province at large from that existing in the Greater Vancouver
area. The thinly scattered population, and the less intensive investigational
work possible outside Vancouver, merely reduces the conclusiveness of the data.
BACTERIOLOGICAL TESTS OF MILK AND WATER SUPPLIES.
Examinations of milk samples showed a further small decline, which
reflected the continuing tendency towards consolidation of dairies in the Greater
Vancouver area. The implementation of a compulsory pasteurization by-law
by the City of Vancouver toward the end of 1946 also had the effect of reducing
the numbers of samples examined from this area. On the other hand, there
was a significant increase in samples examined from dairies outside Vancouver.
The Corporation of Westview continued the custom, established by mutual
agreement with this Division a few years ago, of sending in milk samples
regularly for examination. The findings of this Division underline the urgent
need, repeatedly emphasized in these reports, for more rigid control of the
sanitation of milk and milk products in the Province at large.
Water-sample examinations showed an appreciable increase, amounting to
roughly 40 per cent., over the previous year's totals. The public is undoubtedly
awakening to the basic importance of safe water-supplies.
OTHER TYPES OF TESTS.
Blood agglutination tests for the typhoid-paratyphoid group increased
considerably, while similar tests for brucellosis were double the previous year's
total. This maintenance of interest by physicians in brucellosis is fully justified,
since the disease is still prevalent in various parts of the Province. DEPARTMENT OF HEALTH AND WELFARE, 1947. II 47
Another disease equally difficult to disguise, and of more obscure causation,
is infectious mononucleosis. As judged by the increased demands for agglutination tests bearing upon this infection, its incidence may be rising.
There was a welcome reduction in the numbers of throat swabs examined
for diphtheria bacilli, paralleling an apparent decline in outbreaks of this
disease. A small epidemic occurred in the Interior in December. The Division
regrets the decision of the Laboratory of Hygiene at Ottawa to withdraw, for
the time being at least, the typing service for C. diphtherias which it began two
years ago.
Ringworm has markedly declined in incidence, judging by the single
specimen relating thereto received by the Division. On the other hand, requests
for miscroscopic examinations for intestinal parasites almost doubled. Many
of these specimens came from veterans who had served overseas. On the whole
the incidence of infestation with such parasites has remained surprisingly low
in Canada, despite gloomy predictions during the war years.
GENERAL COMMENTS.
The variety and dollar value of biological products distributed by the Division again increased. Over $30,000 worth of antitoxins, vaccines, toxoids, and
susceptibility-test materials were released free of charge to practising physicians, health officers, and public health nurses for specific immunization against
smallpox, diphtheria, scarlet fever, whooping-cough, typhoid and paratyphoid
fever, and measles. The sustained demand for these biological products is
indicative of successful efforts by the medical and nursing professions and by
health departments to educate the public as to the inestimable value of the protection afforded by specific immunization. The cost entailed is trivial in terms
of illness prevented and lives saved.
The branch laboratories at Victoria, Nanaimo, Nelson, and Prince Rupert
operated at capacity throughout the year, all showing an increased turnover
over the 1946 totals. At Kamloops the retirement of Dr. A. G. Naismith as
Director of Pathology for the Royal Inland Hospital deprived the Division of
his able supervision of the branch laboratory maintained at that hospital.
Pending the appointment of a successor to Dr. Naismith, the public health work
at Kamloops has been placed in the charge of Miss J. Craig, a qualified nurse
and technician. The Director visited the Kamloops laboratory during the late
summer and made arrangements whereby certain types of specimens from the
Kamloops area should be transferred to the main laboratories. Miss Craig
was also given the opportunity of spending a week with the central laboratory
in Vancouver, so that she might be familiarized with some of the latest procedures. Miss B. M. Forcade resigned her position as Bacteriologist at the
Kelowna General Hospital early in 1947. To date a suitably qualified successor
has not been available. In consequence the work of the branch laboratory at
Kelowna has regrettably been temporarily suspended. Public health specimens
from the Kelowna district are being sent to Vancouver.
Staff changes continued to be very numerous, adding to problems of internal
organization. The most serious loss sustained was the resignation of Miss
E. M. Allan, the Division's Serologist, who left to be married after fifteen years II 48 BRITISH COLUMBIA.
of very efficient service in the Vancouver laboratories. In her place the Division welcomes Miss J. G. McAlpine, who had filled a similar position in the
Ottawa Branch Laboratory of the Ontario Department of Health. It is a
pleasure to refer to the well-deserved promotion of Miss V. G. Hudson to the
rank of Senior Bacteriologist.
During May the Director attended the annual meeting of the Canadian
Public Health Association held at Quebec City. Before the epidemiology section he presented a paper, in conjunction with Miss M. Malcolm, Senior Bacteriologist, and Dr. L. E. Ranta, of the Western Division of Connaught Medical
Research Laboratories, entitled: "Acute Gastro-enteritis in and around Vancouver." This paper will eventually be published. The Director subsequently
attended, also at Quebec City, the annual meeting of the Royal Society of
Canada, to whose Fellowship he had been elected earlier in the year.
Publications by members of the staff included the following:—
" Botulism in Canada: With Report of a Type E Outbreak at Nanaimo,
B.C."    Dolman, C. E., and Kerr, D. E.—Canadian Journal of
Public Health (January), 1947, Vol. 38, p. 48.
" Experience with Salmonella Typing in Canada."    Ranta, L. E., and
Dolman, C. E.—Canadian Journal of Public Health (June), 1947,
Vol. 38, p. 286.
" The Place of the Sanitarian in Public Health."   (Based on an address
to the annual dinner meeting of the Canadian Sanitarians' Institute, British Columbia Branch, held at Vancouver on April 19th,
1947.)      Dolman,  C.  E. — Canadian  Journal  of  Public  Health
(December), 1947, Vol. 38.
Co-operative relations were maintained with the medical profession, with
health units, and with the various Divisions of the National, Provincial, and
city departments of health.    The customary close and fruitful collaboration
continued between the Division, the Department of Bacteriology and Preventive
Medicine at the University, and the Western Division of Connaught Medical
Research Laboratories. DEPARTMENT OF HEALTH AND WELFARE, 1947.
II 49
Table III.—Statistical Report of Examinations done during
the Year 1947.
Examination.
Out of Town.
Metropolitan
Health Area.
Total in 1947.
Total in 1946.
Animal inoculation  	
Blood Agglutination—
Typhoid-paratyphoid group.
Brucellosis	
Infectious mononucleosis	
Miscellaneous  	
Cultures—
M. tuberculosis  	
Typhoid-paratyphoid-dysentery group	
C. diphtherias  .	
Ha_molytic staphylococci and streptococci..
Gonococcus __   	
Miscellaneous    _ __ 	
Direct microscopic examination for—
Gonococcus  	
M. tuberculosis (sputum).. 	
M. tuberculosis (miscellaneous)	
Treponema pallidum     	
Vincent's spirillum   	
Ringworm  —	
Intestinal parasites    ___	
Serological tests for syphilis—
Blood—
Presumptive Kahn ___ _
Standard Kahn  _ 	
Quantitative Kahn  	
Complement fixation 	
Cerebrospinal fluid—
Kahn 	
Complement fixation
Quantitative complement fixation .
Cerebrospinal fluid—
Cell count __ -  _ 	
Protein      	
Colloidal reaction  __   	
Milk-
Bacterial count   — 	
Coli-a_rogenes   .	
Phosphatase test.__ 	
Water—
Total bacterial count___ _  	
Coli-a_rogenes   	
Unclassified tests     —
Totals  	
201
2,224
1,222
137
26
510
978
1,711
607
329
3,261
5,149
510
92
SB
1
112
16,172
5,195
915
3,971
606
38
389
501
580
382
382
210
3,647
76
50,170
608
10,340
3,507
425
4
1,267
4,197
11,127
2,090
11,219
584
31,328
3,735
1,267
762
326
317
89,673
14,105
4,302
14,533
2,703
224
1,443
2,376
2,669
847
847
530
832
1,593
153
219,933
809
12,564
4,729
562
30
1,777
5,175
12,838
2,697
11,219
913
34,589
8,884
1,777
854
362
1
429
105,845
19,300
5,217
18,504
3,309
262
1,832
2,877
3,249
1,229
1,229
740
832
5,240
229
270,103
766
9,980
3,631
337
11
1,317
5,172
15,897
3,652
12,664
1,134
34,743
7,070
1,317
1,093
402
5
292
126,766
23,645
801
21,387
2,300
2,956
53
1,844
2,327
2,948
1,408
1,408
631
3,833
312
292,9 II 50
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EhE-c DEPARTMENT OP HEALTH AND WELFARE, 1947. II 51
REPORT OF THE DIVISION OF VENEREAL
.      DISEASE CONTROL.
G. R. F. Elliot, Director.
INTRODUCTION.
Fewer cases of venereal disease were reported in British Columbia in 1947
than in 1946.    The number of reported cases rose consistently from 1940 to
1946 and it is heartening to note that a reduction occurred this year. The
number of new cases reported in this Province may also be interpreted as a
sign of the excellent co-operation given by the medical profession in reporting
diseases.
It is felt, therefore, that a very high percentage of all individuals suffering
from venereal diseases are reported and are receiving satisfactory treatment.
It would appear that this excellent co-operation by the medical profession is
largely due to the generous policy of the Department of Health in supplying
free drugs, making arrangements for free treatment for the majority of
patients, and, finally, to the high calibre of physicians employed on a part-time
basis at clinics operated by this Division.
TREATMENT.
The year has been marked by an increasing use of penicillin, particularly
in the treatment of syphillis, and the results continue to be most favourable.
The rapid treatment centre being operated by this Division in the Vancouver General Hospital continues in a satisfactory manner. The use of this
centre undoubtedly has assured adequate treatment for a far greater percentage
of individuals than was possible under the former longer type of treatment.
During the poliomyelitis epidemic in July and August, in co-operation with the
Medical Officer of Health, City of Vancouver, several rooms were vacated by
this Division for use in hospitalization of poliomyelitis patients.
Clinics are now being operated in New Westminster, Vancouver, Victoria,
Oakalla Gaol (male and female), Juvenile Detention Home, and Girls' Industrial
School.    An examination Centre at the Vancouver City Gaol was opened in
1947 and found to be most valuable. The clinic formerly operated at Fort St.
John was discontinued as from August 1st, 1947, after which time payment was
made in the usual manner to private physicians for the treatment of indigent
patients.
EPIDEMIOLOGY.
The public health nurses doing epidemiology work continue to show most
encouraging results in case-finding and case-holding. During the year arrangements have been made for the public health nurses in rural areas and public
health nurses in Vancouver and Victoria to assume a greater responsibility in
this work. With this end in view one of the three rural epidemiology workers
of this Division has been withdrawn from the field and greater dependence for
case-finding and case-holding is being placed on the public health nurse in the
field. The third epidemiology worker now acts as liaison between this Division
and the public health nurses on the staff of the Metropolitan Health Committee, II 52 BRITISH COLUMBIA.
in an attempt to have greater responsibility for venereal disease epidemiology
assumed by the local public health authorities.
The presence of a male epidemiology worker on the staff of this Division
has been of great value, particularly in Department of Veterans Affairs work.
This Division assumed full responsibility for follow-up of members discharged
from the armed services who were under surveillance or treatment for venereal
disease.
SOCIAL SERVICE.
With the reorganization of the Vancouver police department, new policies
for co-operation with this Division had to be worked out by the case-work supervisor as liaison between this Division and the police department. By meetings
with the Chief of Police and his senior staff a good working relationship between
the members of the clinic staff and the police officers was established.
As a further aid to case-finding, and in co-operation with the Chief of
Police and the Medical Health Officer of the City of Vancouver, the examination
centre mentioned above was set up at the city gaol. Facilities were provided
by the police department and staff, and equipment provided by this Division, so
that each morning all women prisoners are examined for venereal disease. The
examinations are carried out before Court convenes and, where indicated, the
nurse in charge can request an adjournment on medical grounds by arrangement
with the City Prosecutor.
During the year there has been an increased emphasis on the function of
the case-work supervisor as a consultant in social problems that are found to be
complicating the treatment process of problem patients, and more and more
patients are being referred by medical and epidemiology staff for help on an
individual basis.
The facilitation process as. it indicates trouble spots in the community is
still the job of the case-work supervisor to analyse and report to the local
authorities each month and each quarter. With the exception of reports involving beer-parlours, all types of facilitators have shown a downward trend. The
problem of beer-parlours as facilitators is being studied in close co-operation
with the Liquor Commissioner and British Columbia Hotels Association
executive.
" VENEREAL DISEASES SUPPRESSION ACT."
On April 3rd, 1947, the new " Venereal Diseases Suppression Act" was
passed, and the regulations under this Act came into effect on May 2nd, 1947.
This Act is intended for use primarily in dealing with problem cases endangering the public health. This Act has been most useful, and its existence has had
a most gratifying effect in dealing with many unco-operative individuals.
CO-OPERATION WITH OTHER DEPARTMENTS AND AGENCIES.
This Division has continued to receive excellent co-operation from all other
Divisions of the Department of Health and the central office, Victoria. It is
felt that particular mention should be made of the Division of Laboratories,
which at all times has been most understanding and helpful in the numerous
problems that arise relative to the diagnostic tests concerned with venereal
diseases. Relationship with the city and Provincial police departments is good and
their co-operation is freely given. In only one area in British Columbia have
the authorities failed to take adequate action regarding facilitation or operation
of bawdy-houses.
Several meetings have been held with the chairman of the B.C. Liquor
Control Commission and the executive of the British Columbia Hotels Association, and once again co-operation has always been most freely given.
The Indians of this Province are a problem of this Division. Because of
the migratory habits of many of these people, one cannot be assured that treatment is completed in all instances. Several meetings have been held with the
British Columbia Regional Superintendent, Indian Health Services, and one
meeting with the Superintendent of Indian Health Services, Department of
National Health and Welfare (Federal Government). It appears that a more
satisfactory method of treatment will be adopted. It is hoped the situation will
improve in 1948.
PUBLICATIONS OF THE DIVISION IN 1947.
" Procedures and Services in Venereal Disease Control "—a manual for
physicians—was distributed to all physicians in British Columbia during the
year. This booklet was prepared in order to provide the physician with a
readily available source of information on policies and procedures in control of
venereal disease. The reception by the physicians in the Province has been
most satisfactory.
In June at the Vancouver Medical Association summer school a symposium
entitled " Gonorrhoea, Syphilis, and Other Venereal Diseases, Highlights of
Diagnosis and Treatment" was presented by consultants of this Division.
This also was distributed to all physicians in the Province and had an equally
gratifying acceptance.
At the fourth Western Venereal Disease Conference held in Winnipeg on
May 16th and 17th, Miss Beattie, the senior epidemiology worker of this Division, and Miss E. Wyness, case-work supervisor of the Vancouver clinic, presented two papers, " Tracing Contacts and Defaulters " and " Interprovincial
Co-operation " respectively. These were well received and will be published
at a later date.
Dr. G. R. F. Elliot, Director of the Division, presented a paper, " Syphilis
in  Pregnancy,"  to the  Vancouver  Medical  Association,  which  also  will  be
PUbKshed- EDUCATION.
This most important work is now carried out in conjunction with the
Division of Public Health Education of the Department of Health and Welfare.
During the year no concentrated, short-term educational campaign was
carried out as has been customary in the past. Rather the programme can be
said to be one of continued education, with numerous talks being given and films
shown by members of this Division and public health workers in the field.
GENERAL.
The central office of this Division received extensive alterations and repairs
this year.    This has improved these offices markedly, not only in appearance but also through the addition of space which has made for greater efficiency.
The Vancouver clinic is in need of similar improvements.
An investigation is being made to determine what number of newly reported
cases of venereal disease are transient persons, or persons who have been
diagnosed elsewhere prior to taking up residence in British Columbia. These
figures should be most interesting and should be available early in 1948.
This Division is still suffering from shortage of full-time medical personnel.
An additional full-time physician would be of great value. The number of part-
time clinical physicians available has improved markedly, and this situation at
the clinics is very satisfactory.
Dr. G. R. F. Elliot assumed the position of Director of this Division in July
of this year. Prior to this date Dr. J. M. Hershey, Assistant Provincial Health
Officer, was responsible for this work, as well as his own work in the office of
the Deputy Minister of Health, Victoria. To Dr. Hershey; all members of this
Division and in particular, Miss Jean Gilley, branch secretary; Mrs. A. Grant,
nurse in charge, Vancouver clinic; Miss Beattie, senior epidemiology worker;
and Miss E. Wyness, case-work supervisor, the present Director is most grateful
and feels any progress made during the year is due to their unselfish and
untiring efforts.
REPORT OF THE DIVISION OF TUBERCULOSIS
CONTROL.
W. H. Hatfield, Director.
INTRODUCTION.
The Division of Tuberculosis Control, which has been developing its organization over the last number of years, has reached the point where it is well
rounded out in all its facilities except one phase—namely, the number of beds
and the necessary facilities to go with these.
In a tuberculosis control programme the first step is the location of cases
within the community. To this end the case-finding programme of the Division
has expanded to a point where almost one-third of the population over 15 years
of age is being X-rayed annually.
During the year new X-ray equipment was added, with a machine for the
mobile unit work taking 70-millimetre films, and other equipment for survey
and diagnostic work at the stationary clinic in Victoria. There are now three
pieces of mobile equipment with which it is possible to give the Province fairly
adequate coverage. The present equipment is being used to capacity and to be
ideal further mobile equipment would be necessary. As in previous years a
large number of new cases was found by this service. The majority of cases
diagnosed continue to be in the earlier stages. The volume of work in the
stationary survey clinics is tending to increase as community consciousness of
the value of routine X-ray examinations increases.
During the year Jericho Beach Hospital was opened, providing ninety additional beds. These beds, which have been sorely needed, do not numerically
meet the need but materially help the situation.
It is disappointing that plans for the proposed new sanatorium at Vancouver have not progressed any further.    Plans for modernizing existing insti- tutions, particularly Tranquille, have also been at a standstill. It is hoped that
circumstances conducive to building will appear soon, as the facilities as planned
are badly needed. One ray of hope in this regard was the gift of an addition to
the Vancouver unit by the British Columbia Tuberculosis Society. This new
unit will house a fully modern auditorium and completely up-to-date surgical
facilities and also provide some space for research. This will make the Vancouver unit a chest institute of a type that will have facilities equal to any such
institute on this continent. The end of the year saw construction of this addition under way.
Staff problems in general have been less difficult during the year. An
improved scale of wages, with more specific schedules for staff, has greatly aided
in improving the general staff situation except in the case of physicians. It has
been impossible to get the trained medical staff that the Division requires.
During the year the appointment of a general superintendent of nurses
materially improved the correlation of nursing-work among the many units of
the Division, both institutions and clinics.
Some change has been made in the liaison work between the Division and
the field services. A public health nurse doing this phase of the work has been
appointed as a member of the staff of the central office of the Department of
Health and allocated to work with this Division. Further, the central office of
the Department has taken the responsibility of preparing the itinerary for the
mobile survey clinics, the Division taking the responsibility for supplying equipment and staff to take the X-ray films and make the necessary interpretations,
and forwarding such reports to local health services who are responsible for
developing the survey, giving out the reports, and doing necessary follow-up
work.
The regulations applying to tuberculosis under the " Health Act," by which
an infectious case may be forcibly isolated, have not been used due to the fact
that there is a lack of bed facilities. With the long waiting-list it is impossible
to admit even those patients who are willing to accept treatment without
having to take on the problem of the recalcitrant case. Further, there are no
adequate facilities within the Division to handle such a type of person, special
accommodation being required to care for them adequately.
During the year streptomycin has come to play a definite part in the
treatment of tuberculosis. A special streptomycin fund was provided by the
Government, and in order to assess carefully the results of this new antibiotic
a streptomycin committee has been set up within the Division through which all
cases are carefully analysed before this new form of treatment is instituted.
Careful correlation in studying this therapy has been worked out by the Division
with other centres throughout North America. It is recognized that this
antibiotic does not replace the fundamental treatment of tuberculosis—-namely,
rest—but does in certain specific types of case aid in suppressing the disease.
During the year a start was made in the use of B.C.G. vaccine to aid in the
control of tuberculosis. This vaccine is being used among student nurses and
in addition is advocated wherever there is a group in which tuberculosis rates
tend to be higher than average. It will be advocated for use in tuberculosis
contacts where there is an open case in the home. II 56 BRITISH COLUMBIA.
CLINICS.
Clinics operated by the Division during 1947 were as follows:—
Stationary diagnostic clinics:  Four—Vancouver, Victoria, New Westminster, and Tranquille.
Stationary  survey  clinics:    Three—Vancouver,  Victoria,  and  New
Westminster.
Mobile survey clinics: Three.
Travelling diagnostic clinics:  Five.
In addition, the consultation service continues to be used more extensively
from year to year. There has been an increase in referred films over the
previous year of 40 per cent.
The mobile unit work has been increased by the addition in February of
a third unit using 70-millimetre film. During the year all units were equipped
with Moran timers which has greatly simplified the taking of films.
In addition to the mobile unit examinations of 155,674 persons, the stationary survey clinics examined 44,196, giving a grand total of 199,870. Of that
total 2.15 per cent, were referred to diagnostic clinics. Of the group referred
for further study, 692 or 16 per cent, were diagnosed as tuberculous. These
tuberculous diagnoses were as follows: Primary, 2.2 per cent.; minimal, 68.1
per cent.; moderately advanced, 24.4 per cent.; far advanced, 5.3 per cent.
Thus 0.35 per cent of the total examined were found to be tuberculous. Of those
diagnosed 189 required active treatment and of those at the end of the year
91 had been admitted to hospital.
As the work of the survey units increases it automatically increases the
work of the diagnostic clinics. The total number of people examined in the
diagnostic clinics during the year was 34,188, an increase of 20.62 per cent, over
the previous year and an increase of 28.07 per cent over 1945.
The stationary clinics also carry on out-patient treatments and the volume
of out-patient pneumothorax treatment was 8,868. This amount of work
remains relatively unchanged from the previous year.
The total number of examinations, including all clinics, both survey and
diagnostic, was 235,121. This is an increase over the previous year of 34.68
per cent. Including out-patient treatment-work, the total number of patient-
visits to all clinics and survey units was 243,579.
The travelling diagnostic clinics continue to operate as previously and are
not entirely satisfactory, due to lack of trained physicians to carry out the
consulting-work with these clinics. During the year only one such clinic—
namely, the Kootenay travelling clinic—was under the direction of a full-time
tuberculosis officer. The work of the Island, Coast, Interior, and Fraser Valley
was handled in so far as possible by senior physicians from the Victoria,
Vancouver, New Westminster, and Tranquille units. In many instances the
nurse-technician has made trips single-handed, referring all films to stationary
units for diagnosis.
During the year the Victoria clinic was completely reorganized and the
building previously used for occupational therapy was taken over, thus making
a much more modern clinic. The previous clinic building was converted into
quarters for occupational therapy, social service, and the Island travelling clinic.
This arrangement made available three extra beds in the pavilion. DEPARTMENT OF HEALTH AND WELFARE, 1947. II 57
INSTITUTIONS.
The limited number of beds available within the Division of Tuberculosis
Control still creates an acute situation. As has been mentioned, ninety beds
were opened at Jericho Beach Hospital. This provides a temporary alleviation
of the situation, reducing the long waiting-list which, however, is not reduced
to a point where patients can be readily admitted to hospital. The Division is
still forced, because of lack of beds, to carry on a policy of discharging patients
from hospital after a relatively short period of treatment. It also continues to
admit no cases other than pulmonary tuberculosis. A number of applications
was received during the year for admission of suspect cases of tuberculosis.
It has been necessary to place the responsibility for diagnosis of certain of these
cases on facilities outside the Division of Tuberculosis Control. Such cases
requiring hospitalization are admitted to a general hospital until the diagnosis
has been definitely established.
There has been some reduction in the number of applications from the
Department of Veterans Affairs, and the new policy of that Department of
discharging its cases from its own institution has made an earlier discharge
from the institutions of the Division of Tuberculosis Control possible. The
policy is now to transfer all Department of Veterans Affairs cases after treatment by the Division of Tuberculosis Control to the chest unit at Shaughnessy
Hospital.   At the end of the year this unit is working at full capacity.
At Tranquille no improvement in buildings has been possible. The much-
needed nurses' home and the homes for doctors are still in the blueprint stage.
It is also recommended that improved accommodation be provided for visitors
to Tranquille. It is hoped that an early start will be made in the long-
recommended change from direct to alternating current at that institution.
In the Vancouver unit the top floor of the isolation hospital continues to be
used for surgery. As this arrangement is wholly inadequate to meet the
demands, those cases requiring surgery are having rather a long wait before the
treatment is instituted. The new surgical facilities under construction, provided
by the British Columbia Tuberculosis Society, will by the end of 1948 rectify
this situation.
St. Joseph's Oriental Hospital is used as previously, and once more the
Division must reiterate that the accommodation at that hospital is not considered satisfactory for the treatment of tuberculosis.
The Japanese continue to be treated in the New Denver Sanatorium, which
is still operated by the Dominion Government.
NURSING.
The activities of the past year have been diversified. The results of this
diversification are becoming increasingly apparent, and the most outstanding
is the improvement in the recruitment of nurses for the institutional staffs.
The improvement may be attributed largely to the effect of the educational
programme for undergraduate students, postgraduate students, and in-service
training as carried out by the Division of Tuberculosis Control.
The situation at Tranquille unit, where the problem of nurse shortage was
the most acute, has improved to the extent that major surgery, discontinued II 58 BRITISH COLUMBIA.
due to lack of nursing staff for post-operative cases, can now be resumed on a
limited scale. An adequate nursing staff was obtained to open the Jericho Beach
unit in June of this year. When one considers that in most centres tuberculosis
beds have been closed due to shortage of general staff nurses, it is encouraging
to know that the bed capacity of the Division has been utilized to the full extent.
The instruction and supervised experience given to student nurses and
graduates is far-reaching in developing a new concept of tuberculosis nursing—
a fundamental factor in obtaining well-prepared and interested nurses for all
branches of the service. Nurses are becoming increasingly aware of the scope
and. opportunities in tuberculosis nursing. However, the major problem, as
pointed out in the previous report, is the need for reorganization of the nursing
service routine in the institutions in order to attract and retain nurses for
general staff duty and to enable the professional nursing staffs to participate
effectively in the active therapy programme.
Experimentation along these lines has been carried out in the Vancouver
unit, whereby many of the routine nursing procedures are assigned to nurse
aides under supervision of the professional nurses who function on a modified
group nursing plan. The physical set-up of the institution presents some
difficulties in the complete implementation of group nursing. Another problem
is the instability of the nurse aide group and the wide variation in the experience
and preparation of the applicants. Provision for basic training, to be made
available through the proposed vocational course in practical nursing recently
approved by the Department of Education, should help materially in providing
the hospital with prepared personnel.
Another experimental project is centred on the stabilization of the orientation programme for all new personnel in the nursing service, both professional
and auxiliary workers. The rapid turnover and instability of the auxiliary
workers, such as nurse aides, already referred to in this report, creates a
problem in so far as group classes are concerned. A plan for instruction
applicable on an individual or group basis has been worked out in the Vancouver unit, with the object of reducing the staff time spent in on-the-job training yet safeguarding the worker with sufficient information and instruction
before assignment to ward duties. A simple form is used on which to record
instruction and demonstration—also response and ability. This method may
be introduced, with minor adaptations, to other institutions in the Division.
The correlation of the various services within the Division and with allied
services throughout the Province makes this comprehensive plan of orientation
possible for all workers associated with the tuberculosis programme, including
those in institutions, clinics, and districts. Individual interest and scope are
increased through an appreciation of all aspects of the service.
The nursing service occupies a key position among the major services.
Therefore, it is extremely gratifying that provision has been made for a centralized administration to function on a Provincial basis for all branches of the
nursing service within the Division.
Most of the activities this past year have centred on evaluation and reorganization of the institutional procedures, with a view to achieving uniformity
in the various units. While much remains to be done in this field, it should be
possible this coming year to direct our efforts toward further improvement and DEPARTMENT OF HEALTH AND WELFARE, 1947. II 59
correlation of the tuberculosis programme with allied services in the districts.
The central nursing administration should facilitate greatly any efforts in this
regard.
SOCIAL SERVICE.
The work of the social service section has been lightened during the past
year by the achievement of a new basis of understanding and co-operative work
with the Metropolitan Health Committee and the Vancouver City social service
department. For example, many of the routine inquiries formerly made for the
public health nurses are now made directly by the nurses, saving the social
workers hours of time.
Previously the social workers in the Vancouver unit found new cases in a
variety of ways—through the nurses, through the doctors, through the patients
themselves, or through relatives. Now the doctors refer all cases they consider
are in need of case-work help to the social worker. This has strengthened the
understanding and support of the medical staff and has given the social workers
more security in their work.
Because of the changes in policy just mentioned, the quality of the work
done has improved. In order to further the improvement, a programme of
staff development, consisting of case discussions, lectures by medical men, and
discussion of professional techniques was started late in the year and will be
carried over into 1948.
At the present time the staff consists of one worker at Tranquille, four
workers and a supervisor in the Vancouver unit, one worker at Jericho Beach
unit, and one worker at Victoria.
STATISTICS.
As heretofore, the Division of Vital Statistics has given close co-operation
and continues to aid the Division in the handling of its statistical analysis.
The records and statistical system of the Division have become more stabilized
and it is now possible to make better comparative analyses from year to year.
The preliminary death-rate for the year was 53 per 100,000 for the total population ;  34 for whites, 633 for Indians, 250 for Orientals.
LOCAL HEALTH SERVICES.
There has been a further co-ordination of the relation of the Division to
local health services. The responsibility of health remains that of the local
health services, with the Division acting in a consulting capacity to these
services and providing facilities that it would be illogical to expect local services
to duplicate. The Division also takes the responsibility for hospitalizing cases
of tuberculosis within the limits of its facilities.
BUDGET.
There will be an increase in the budget of the Division in the forthcoming
year due to three factors: The opening of the new Jericho Beach Hospital,
increase in wages and adjustment of hours of work, and increased commodity
prices. Except for the new hospital beds the increases in costs are largely
beyond the control of the Division. II 60 BRITISH COLUMBIA.
Revisions of salaries through the Civil Service Commission have tended
to improve the general services throughout the Division.
The creation of the position of business manager of the Division of Tuberculosis Control during the past year has aided greatly in the organization and
supervision of costs throughout the many hospitals and clinics of the Division.
CONCLUSION.
In general, all facilities of the Division are taxed to the limit. With the
great advance in chest surgery, the addition to the Vancouver unit will materially implement the armamentarium of the Division in its treatment programme.
It is felt that the survey and diagnostic work is at a high level, and further
progress in the treatment of this disease is dependent upon the provision of
further bed facilities and modernization of the present institutions.
REPORT OF THE DIVISION OF PUBLIC HEALTH
ENGINEERING.
R. Bowering, Director.
INTRODUCTION.
Public health services are concerned with the adjustment of the relationship
between man and his environment for the protection of man against diseases
and for the betterment of the general well-being of man. The attainment of
this state may be sought through the adjustment of man himself to his environment, or through the adjustment of the environment to better man, or through
a combination of both. Public health engineering service is concerned with the
adjustment of the environment to man for the betterment of the public well-
being and the protection of man from disease organisms which enter his body
from without. For this reason the Division of Public Health Engineering is
sometimes referred to as the Division of Environmental Sanitation. Included
within the scope of the Division of Public Health Engineering are water-supply
sanitation, sewage-disposal, milk-plant sanitation, industrial-camp sanitation,
shell-fish sanitation, sanitation of eating and drinking places, sanitation of
housing and tourist resorts, and the many miscellaneous items which are
included in the term environmental sanitation. This report will deal with these
various features under specific headings.
WATER-SUPPLY.
One of the oldest and most important responsibilities of the Division of
Public Health Engineering lies in the field of water-supply sanitation. There
are two sections into which water-supply sanitation may be divided. The first
has to do with municipal or public water-supplies, and the second has to do with
private water-supplies.
It is estimated that 75 per cent, of the population of British Columbia
receive drinking and domestic water through public water-supply systems.
The " Health Act " requires that whenever a public water-supply system is
constructed, extended, or altered, the plans and specifications governing the work must be approved by the Minister of Health and Welfare before work may
commence. During the year 1947 the Division of Public Health Engineering
studied plans and specifications of waterworks construction costing between
two and a half and three million dollars. In checking these plans, the source of
supply and the layout of the distribution system are carefully checked to see
that no public health hazards exist. Where treatment of the water is indicated,
the type of treatment is usually discussed with the engineer preparing the plans.
British Columbia is unique among the Provinces of Canada in that most of the
water used comes from surface sources. Canadian experience with water-
borne diseases show that 49 per cent, of water-borne outbreaks occur due to
contamination of a surface water-supply source, 7 per cent, result from the
contamination of an underground water source, 4 per cent, occur from contamination entering reservoirs, 12 per cent, occur from breakdown of water-
purification equipment, 15 per cent, occur as a result of contamination entering
the distribution system, 9 per cent, occur from contamination entering the
collection or conduit system, and 7 per cent, occur from miscellaneous causes.
In addition to checking the plans of new waterworks construction, sanitary
surveys of existing water-supplies are made throughout the year.
In the 1946 Annual Report it was mentioned that a new standard of quality
for water-supplies was introduced in the United States by the United States
Public Health Service and officially approved by the American Waterworks
Association. These standards have not yet been officially adopted in Canada.
If they are adopted, however, it will require that a larger number of samples
will have to be taken from the various water-supply systems, which will
necessitate increases in the staff of the Division of Public Health Engineering
and in the capacity of the Division of Laboratories for handling water samples.
The second section dealing with water-supply has to do with private water-
supplies, such as wells and springs. The Sanitary Inspectors working in the
health units make sanitary surveys and take samples from a large number of
private water-supply sources during the course of the year. In this way the
sanitary quality of the water used by the rural population is gradually being
improved.
In 1947 the facilities of the laboratory of the Division of Public Health
Engineering of the Department of National Health and Welfare was made
available to the British Columbia Department of Health and Welfare for the
making of chemical analyses of water.   This has filled a long-felt need.
SEWAGE-DISPOSAL.
The supervision of sewerage and sewage-disposal is another important
feature of the work of the Division of Public Health Engineering. As in the
case of water-supply systems, sewerage and sewage-disposal falls naturally
into two classes—the public sewerage system and the private sewage-disposal
system.
Since 1896 it has been a requirement in British Columbia that plans of all
new sewerage-works be approved by the Provincial Board of Health of British
Columbia (now the Provincial Department of Health). The result of this
requirement is that the general quality of sewerage-works in the Province is II 62 BRITISH COLUMBIA.
good. Also, except for a very few instances, the waters of the Province have
been maintained in a reasonably good state as far as public health is concerned.
The larger cities of the Province have sewerage systems, although in many
cases these systems do not serve all the residents of the cities in question.
Because the larger cities are located on the sea-coast, the most common method
of sewage-disposal in British Columbia is by dilution in salt water. This method
is generally satisfactory for the prevention of gross nuisances, although in some
localities the bathing-beaches have been seriously menaced by contamination
from the discharge of raw sewage.
During the year plans and specifications governing the proposed construction of nearly three million dollars worth of sewerage and sewage-disposal
works were checked by the Division of Public Health Engineering. Of these,
the largest single plan concerned a sewerage system for the Municipality of
Saanich.
Standard plans have now been prepared for the construction of septic tanks
and private sewage-disposal systems. These have been very widely distributed,
principally through local health units and part-time Medical Health Officers.
They have been adopted as standard plans by several municipalities, and have
been endorsed by the Plumbers' Association. This has resulted in improvements
in new installations and has lessened the number of complaints regarding
insanitary disposal of sewage in rural areas. Unfortunately, however, there
are still a large number of nuisances existing through unsatisfactory disposal
of sewage in areas that have become too heavily populated for the satisfactory
use of the septic-tank method of sewage-disposal. Where these cases occur in
municipalities, the municipality can take action to build proper sewerage
systems, provided that it can afford the cost. In unorganized areas there is
still no satisfactory solution to the problem of having public sewerage systems
constructed. In some parts of the United States this problem has been attacked
by the making of State grants-in-aid to municipalities and sewerage districts.
GARBAGE-DISPOSAL.
During the year a number of inspections of garbage-disposal sites was made
by officials of the Division of Public Health Engineering. Greater interest is
being shown by communities in providing improved arrangements for garbage-
disposal for the improvement of community sanitation. Reports from the
rodent-plague survey on rat conditions in various municipalities have been
forwarded to a number of our municipalities with offers of assistance in
providing technical information on rat-control.
MILK SANITATION.
In 1947 the advance in the number of pasteurization plants in the Province
continued. It is now possible to buy pasteurized milk in all of the major cities
and towns of British Columbia. Milk sanitation in British Columbia is under
the jurisdiction of the Department of Agriculture as far as the grading of
dairy-farms is concerned. The quality of the milk itself is a responsibility of
local health authorities. The work of the Division of Public Health Engineering
is mainly a consultant service to the local health services.    The day-to-day DEPARTMENT OF HEALTH AND WELFARE, 1947. II 63
sampling and supervision of the milk-supplies is the responsibility of the local
Sanitary Inspectors.
Beginning in 1947 the pasteurization of all milk offered for sale was
required by by-law in the City of Vancouver. The City of Cranbrook also pa'ssed
a by-law requiring pasteurization of all milk sold or offered for sale in the city.
There was one milk-borne epidemic investigated in 1947 by the Division of
Public Health Engineering. This epidemic, involving nine cases of paratyphoid
A, occurred in an Interior city in March.
SHELL-FISH SANITATION.
The Division continued its work on the sanitary surveys of oyster leases.
The largest sanitary survey made in 1947 was at Ladysmith Harbour. As a
result of this survey, it is now possible to* delineate those areas of Ladysmith
Harbour that are safe for the taking of market shell-fish. A considerable
amount of sanitary survey-work remains to be done in other parts of the
Province. It is hoped that with the aid of engineering students this work will
be intensified in the summer of 1948. Another feature of shell-fish sanitation
which requires more attention is the sanitation of the shucking and marketing
of shell-fish.
The collection of samples of clams for testing for toxicity continued
throughout 1947. An analysis of the results of this work appears to indicate
that the waters on the west coast of Vancouver Island are unsafe for the taking
of clams at any time of the year. There is not sufficient information available
on the open coast north of Vancouver Island. It is planned that in 1948 the
sampling be extended to obtain information on the northern coast-line. The
programme for the control of clam and mussel poisoning is a combined effort
by the Federal and Provincial Departments of Fisheries and the Federal and
Provincial Departments of Health. No deaths from shell-fish poisoning have
occurred in British Columbia since 1942.
INDUSTRIAL-CAMP SANITATION.
A new set of regulations dealing with sanitation of industrial camps came
into effect on January 1st, 1947. These regulations were widely distributed,
and it is believed that the operators of all camps in the Province coming under
the regulations have received copies. Along with the new regulations, a new
set of inspection forms was issued to the Sanitary Inspectors and local health
services. With this new set of forms, the reporting on inspections of industrial
camps became more efficient and more uniform. In the health-unit areas,
inspection of industrial camps is made by the local Sanitary Inspector. In
non-health-unit areas, it has been more difficult to see that all camps were
inspected, although the British Columbia Police have rendered valuable
assistance in this regard. The effect of the new regulations has been very
good, resulting in a general improvement of industrial-camp sanitation in the
Province.
The number of fish-canneries at present in operation is considerably less
than was the case a few years ago. With the reduction in number of canneries,
the sanitary and housing facilities are improving.    A considerable amount of II 64 BRITISH COLUMBIA.
money was spent in  1947 by the cannery operators  in  improving housing
accommodations and other environmental conditions in cannery camps.
A considerable amount of work was done on farm-labour service camps.
This work was done in co-operation with the Department of Agriculture.
Inspections of a number of farm-labour camps were made and discussions with
operators were held. It is believed that this work will result in a better type
of housing for seasonal farm-labour.
SANITATION OF TOURIST RESORTS.
Detailed tourist-camp inspections have been carried out during the past
two years. The total individual camp inspection reports amount to 503. During
the year 1947 many of these were reinspected. The periods between the original
inspection and the reinspection varied greatly, from a few months to well over
one year. It was most encouraging to note that reinspection showed the
majority of operators as being anxious to comply with the suggestions made at
the time of the original inspection, consequently improvement over conditions
found on earlier inspections was most evident.
There are twenty-two camps, or 4.4 per cent., of the total inspected which
this Department has declined to approve. Some of these places have never
operated as tourist accommodation, but intend to as soon as approval is received.
There are 8.2 per cent, of the camps inspected (in addition to the previously
mentioned 4.4 per cent.) in need of a reinspection before the next licensing
period. These forty-one camps (8.2 per cent.) were found to have conditions
contrary to the " Regulations governing Tourist Camps and Trailers," but it
was felt that these faults were not of a nature serious enough to affect their
licences if remedied within a reasonable time. Most of these.camps will be
reinspected before the 1948-49 licensing-year starts on June 1st, 1948. If a
reinspection shows that this Department's recommendations have not been
followed or that the operator has made no reasonable effort to remedy the
particular situation, it may be found advisable to refuse permission for the
operation of the camp as tourist accommodation.
Following the two-year period in which this Department has provided a
tourist-camp inspection service, it has been found that certain amendments and
additions to the regulations should be given consideration. This office supplied
the British Columbia Government Travel Bureau with a list of suggested
changes in the portion of the regulations enforced by this Department.
The improved transportation facilities made available during the year
permitted a better coverage of the camps. It is quite apparent that the
operators appreciate the service given, and the many expressions of opinion
heard would indicate that they would welcome more frequent inspections. It is
felt that with the continued expansion of health unit services the demands for
inspections and supervision from Sanitary Inspectors will be met more easily
and the standard of the tourist accommodation throughout the Province will
be improved accordingly.
SUMMER CAMPS.
Summer camps for children are exempted from the regulations governing
tourist camps.     They  do,  however,  come  under  the  " Welfare  Institutions DEPARTMENT OF HEALTH AND WELFARE, 1947. II 65
Licensing Act." This Act is administered by the Inspector of Hospitals and
Institutions. The Division inspected a number of summer camps on behalf of
the above agency, and made recommendations regarding the approval of environmental features in connection with the licensing of the camps. In addition
to this, a number of consultations was held with the Camping Association in
order to better acquaint the operators of these camps with the essential features
of good camp sanitation.
ENVIRONMENTAL SANITATION OF SCHOOLS.
The inspection of environmental conditions in and around schools is a
responsibility of local health services under the " Public Schools Act." In 1945
the Division prepared a report form for the making of detailed inspections of
the structural and sanitary conditions in and around the schools by the local
health services. In the first full year of operation of this new service (1945-46)
complete reports were obtained on 371 schools. In the 1946-47 school-year
complete reports were obtained on 411 schools. Copies of the reports were
made available to the School Boards. Using these forms, the School Boards
effected a number of improvements and repairs of the schools reported on. The
continuance of this service should result in better environmental conditions of
the schools of the Province.
SANITATION OF EATING AND DRINKING PLACES.
A new set of regulations governing eating and drinking places was passed
in the latter part of 1946. These regulations were widely distributed, and 1947
marked the first full year of their enforcement. One of the main results of the
enforcement of these regulations is the improvement in the methods of washing
and sterilizing of dishes and utensils.
In addition to the enforcement of the regulations, which were prepared as
a guide to operators of eating and drinking places, it is felt that more education
of food-handlers is necessary. To this end, in 1947, in co-operation with the
Division of Public Health Education, United States Public Health Service, a
pamphlet entitled " From Hand to Mouth " was adapted, with permission, for
local use and published. In addition to this, a number of the local health units
conducted classes for the training of food-handling personnel.
FROZEN FOOD LOCKER PLANTS.
In February, 1947, a set of regulations governing the construction and
operation of frozen food locker plants was prepared by the Division of Public
Health Engineering and passed by Order in Council on February 21st, 1947.
This was the first time in British Columbia that frozen food locker plants as
such came under regulation pursuant to the " Health Act." These regulations
require that plans and specifications governing the construction of all new
frozen food locker plants be approved by the Deputy Minister of Health. In
addition, the regulations require that existing locker plants be brought up to
the standards within a year after the coming into force of the regulations.
Although no new locker-plant construction was approved in 1947, by the end of
the year there were some applications pending and it is believed that a number
of approvals will be made early in 1948. II 66 BRITISH COLUMBIA.
GENERAL OBSERVATIONS.
In 1947 the Division of Public Health Engineering had the heaviest year
on record as far as approval of water- and sewage-work plans is concerned.
During this year it also took more responsibility in the supervision of the
technical side of the work of the Sanitary Inspectors in the health units. It
prepared a number of new record forms for the use of Sanitary Inspectors in
their work. This establishment of a uniform record system will make it possible to transfer Sanitary Inspectors from one district to another with a
minimum loss of continuity in the work. In addition, it provides the Division
of Public Health Engineering with an improved method of evaluating the programme of the field sanitarians throughout the Province. As the number of
health units increases, the supervision of the technical work of Sanitary Inspectors will become a more important part of the work of the Division. With this
increase in administrative work, more and more of the Director's time will be
required for administrative purposes. For this reason it is recommended that
an Assistant Public Health Engineer be appointed in the near future to assist
in the public health engineering work. It is also recommended that a Chief
Sanitary Inspector be appointed for the better supervision of the work of the
Division as it applies to local Sanitary Inspectors.
The Division again wishes to express thanks to the Division of Laboratories
for its co-operation in the examination of samples of water, sewage, and milk.
The Provincial Police Department deserves mention for its valuable work in
the inspection of sanitary complaints and industrial camps in outlying districts.
The Division would also like to record its thanks to the officials of the Division
of Public Health Engineering of the Department of National Health and Welfare for their whole-hearted co-operation on many public health engineering
problems. Other members of the staff of the Provincial Department of Health
and Welfare have given invaluable assistance, for which the Division of Public
Health Engineering is deeply grateful.
REPORT OF THE DIVISION OF PUBLIC HEALTH
EDUCATION.
A. H. Cameron, Director.
INTRODUCTION.
Public health education as a specialized branch, with personnel specifically
trained for the activities involved, is perhaps the most recent major development in the broad field of public health work on this continent. Although this
is the second annual report of the Division, the field is so new that it is felt that
a summary of the development on the continent as a whole, as well as in British
Columbia, should be given here.
DEVELOPMENT OF THE FIELD IN NORTH AMERICA.
In recent years public health officials in the United States, recognizing
always that education of the public in health matters is a prime function of all
public health personnel, saw that there was a need for persons qualified in both DEPARTMENT OF HEALTH AND WELFARE, 1947. II 67
the broad principles of public health and in educational methods. They envisioned that one such person should be added to the staff of each local health
department, not to relieve the health officer, the public health nurses, and the
sanitary inspectors of their responsibilities in education, but to assist them in
this phase of their work, to co-ordinate the educational activities and to make
use of modern educational methods.
As these specially qualified persons were gradually added to health department staffs, they came to be known as " health educators." This term is,
perhaps, unfortunate. It implies that health education is a definite responsibility of only the " health educator." As stressed in the previous paragraph,
this has never been the intention nor practice since the beginning of the movement. The task is one of consultation, guidance, and co-ordination. More
appropriate names would, therefore, be " health education consultant" or
" health education co-ordinator."
Post graduate training courses have been established in several universities
in the United States for the purpose of giving professional training to " health
educators." In general, admission to these courses is dependent upon the applicant having studied a certain minimum of sciences in his undergraduate work.
Leading to a master's degree in public health, the training is usually of twelve
months' duration and includes the following:—-
(a) Basic public health sciences (epidemiology, bacteriology, parasitology, sanitation, public health problems in industry, venereal
disease control, tuberculosis control, nutrition, mental health).
(b) Community organization for health education.
(c) School health education.
(d) Special problems in public health education. (Use of materials
like films, posters, and displays; preparation of news releases
and radio scripts; preparation of reports; conduct of surveys;
planning of workshops; working conferences and staff meetings;
and similar tasks.)
(e) Field training. (A period of approximately three months, during
which the student is attached to a local health department for
actual participation in public health work.)
FUNCTIONS IN HEALTH EDUCATION.
The American Public Health Association, which has given great impetus
to the movement, has done much to clarify the duties of the health educator.
In 1943 the association's Committee on Professional Education prepared a
report entitled " The Educational Qualifications of Health Educators." The
section of this which refers to the functions in health education is quoted
below:—
" The following functions are believed to be essential for carrying out
complete community-wide programmes in health education. Such programmes
include health education in the schools and health education with the general
public. It is recognized that there is an increasingly close relationship between
these two phases of health education. Health educators in various positions
will be expected to undertake some or all of the following functions or activities
which involve the formulation of plans and methods, the application of specific II 68 BRITISH COLUMBIA.
techniques and skills, the supervision of the work of others, and the maintenance
of group relations. A job analysis of existing positions reveals wide variations
in their scope.
" The functions of health educators in community-wide programmes of
health education are:—
" In accordance with the administrative policy of the health department or
other employing agency:—
"(1) To be responsible for assistance in planning and organizing a
programme of health education of suitable scope and activities
to meet adequately the needs of the community, state, or area to
be served. This includes at the outset a study or survey of the
needs, the determination of health problems which may be solved,
at least in part, by the educational process, and an appraisal of
resources.
"(2)  To assist the community in organizing itself to find and solve its
health problems.
"(3) To assist in establishing and maintaining close co-operative working relationships between all agencies (official and non-official)
which may contribute to health education.
"(4) To aid in the planning, development, and conduct of training programmes for employed personnel, in accordance with the policy
of the agency involved, for (a) health agency personnel, (b) school
personnel, and (c) personnel of other agencies.
" Nearly all public health personnel have important educational opportunities.    To increase the effective use of these opportunities is an important function of health education leadership.
"(5)   To  give  aid   in   accordance   with  the   policy   of   the   institution
concerned,   in  planning the  health  education  aspects   of  pre-
service training programmes for professional personnel, including
(a) public health personnel, (6) school personnel, and (c) others.
"(6)  To provide consultation and guidance to various individuals and
groups (such as Parent-Teacher Associations, service clubs, and
others)   in   developing   and   improving  their   health   education
activities.
"(7) To assist in promoting, organizing, and guiding study programmes
in the field of health for adult and group-work agencies such as
divisions of adult education, Young Men's Christian Associations,
and similar groups.
"(8) To contribute to the improvement of the quality of the health
education of the school child in accordance with the standards and
policies of the school system:—
"(a)   Through  aid  in  planning school  health  programmes
and curricula of health instruction.
"(b)  Through conferences with teachers, supervisors, and
school administrators.
"(c)  Through such other activities as the school may desire. DEPARTMENT OF HEALTH AND WELFARE, 1947. II 69
"(9) To organize and operate an informational service to provide
answers to inquiries and to supply source materials and source
references in answer to requests.
"(10) To be responsible for the preparation, selection, assembly, and
distribution of health education materials, using the services of
special technicians and health experts as necessary. Such
materials include:—
"(a)  Reports and other printed materials.
"(b)  Visual  aids,   such  as  motion  pictures,   photographs,
graphic materials, exhibits, and posters.
"(c)  News releases.
"(11) To organize and assist in conducting a speakers' bureau, conferences, meetings, and radio programmes.
"(12) To see that there is established  a, programme of continuing
appraisal of health education methods and materials in order to
evaluate the effectiveness of health education procedures."
It should be noted that the American Public Health Association, in preparing this statement of functions, was probably thinking of the health educator
attached to the staff of the local health department or health unit.   As will be
shown later, health educators have not yet been added to local staffs in British
Columbia.    The functions must, therefore, be adapted for application on a
Provincial level by the limited staff of the Division working in the central office
in Victoria.
DEVELOPMENT OF THE FIELD IN BRITISH COLUMBIA.
So long as there have been public health workers in British Columbia, there
has been a process of public health education. Before 1946, however, there was
no one person whose prime responsibility lay in this field. A " health library "
had gradually been built up and, for a time, was supervised by a trained
librarian. A pamphlet service had been established, but the variety of material
was limited.
In 1945 Miss Kathleen McNevin, a graduate in home economics and a high
school teacher of that subject, was granted a fellowship by the W. K. Kellogg
Foundation to study public health education. Miss McNevin undertook a full
year's study in the University of North Carolina's Graduate School of Public
Health. After she received the degree of Master of Science in Public Health,
she returned to British Columbia in January, 1946, to take up duties as
Consultant in Health Education. For more than a year and a half following
this time Miss McNiven was the only professionally trained health educator
in the Province. The demands upon her time and energy were very great.
Working always with a very limited staff and in crowded office accommodations,
she was able to establish the Division of Public Health Education on a sound'
basis and to inaugurate a service which included the central office staff, the
public health workers in the field, and, through the latter, schools and voluntary
agencies throughout the Province. Among the many tasks she performed
should be mentioned the reorganization of the library, the establishment of a
health film service, the publication of the monthly Health Bulletin, and the
evaluation, ordering, and distribution of health education pamphlets.   Although II 70 BRITISH COLUMBIA.
these by no means represent the full scope of her activities, they serve to show
the great variety of tasks performed.
In August, 1946, the Provincial Health Officer, through the W. K. Kellogg
Foundation, made available a second fellowship for advanced studies in public
health education. This fellowship was granted to A. H. Cameron, a former
teacher of science and mathematics in the high schools of British Columbia.
Mr. Cameron, like Miss McNiven, chose the University of North Carolina for
his postgraduate training and received his master's degree from that institution
in August, 1947. When Mr. Cameron returned to the Department on completion
of his postgraduate training, he was appointed Director of the Division of
Public Health Education.
Two other changes in staff took place during the year. In April, 1947, the
Division was fortunate in securing the services of Miss Marion Dundas, a
University of British Columbia graduate with much experience in newspaper
writing. Since her appointment Miss Dundas has taken a major part in the
publication of the Department of Health's widely read monthly Health Bulletin
and has given efficient supervision to the Department's news releases.
For the five months from May to September the Division received the
temporary services of Miss Joan List, a former teacher who has special
qualifications in health and physical education and who is now completing
studies for her bachelor's degree at the University of British Columbia. When
Miss List has graduated, it is hoped that she will undertake postgraduate
training in public health education with a view to joining the staff of the
Division on a permanent basis.
ACTIVITIES OF THE DIVISION OF PUBLIC HEALTH
EDUCATION DURING 1947.
It is difficult to set down in writing a statement which will give a clear
picture of the volume of work undertaken by the Division of Public Health
Education. A written statement can provide only by implication an indication
of the time and thought required in partaking in the numerous conferences and
discussions which are necessary to co-ordinate the educational activities of the
public health personnel both in the central office and in the field. It cannot
include all the smaller tasks in which members of the Division have been
involved.
The remainder of this section will, however, be devoted to the major
activities of the Division of Public Health Education during 1947 grouped
under suitable headings.
Pre-service Training.
There were three major parts to this phase of the health education
"programme. During the year five new Medical Health Officers were appointed
to the Provincial Department of Health. Before assuming control of their
respective health units, each underwent a period of orientation with the
Department. It was the task of the Division of Public Health Education to
organize and supervise this training. The assembling of study material, the
arrangements of interviews, and the preparation of discussion outlines for use
during the interviews were part of the work involved.    Constructive criticism DEPARTMENT OF HEALTH AND WELFARE, 1947. II 71
was welcomed from each person undergoing orientation, and each successive
programme was altered with a view to constant improvement. As a result, it is
now felt that a sound programme of orientation has been established.
The senior public health nurse in Kamloops was invited by the officials of
the Royal Inland Hospital to present a course of ten lectures on community
health and social needs to the student-nurses in training there. At her request
the Division of Public Health Education prepared an outline and assembled
specific reference materials for use in the lectures. It is felt that the approach
to this problem illustrates well one policy of the Division. Consultative service
and guidance in educational methods were given, and the material was prepared
only after discussions had been held with the Director of the Division of Public
Health Nursing and other senior officials in the central office. Again, constructive criticism was invited and received from the user of the outline in Kamloops.
This proved valuable when the material was adopted for use by the Director
of the East Kootenay Health Unit in a similar lecture series presented to
student-nurses in Cranbrook.
Members of the Division of Public Health Education presented three
lectures to nursing classes. Two of these were given to the nurses in training
at St. Joseph's Hospital in Victoria. The third was given to the senior class in
public health nursing at the University of British Columbia. Each was part
of a series presented by members of the staff of the Provincial Department
of Health to acquaint the nurses with the public health services in British
Columbia.
In-service Training.
In this phase of its work the Division is responsible for assisting professional personnel to keep abreast of the latest developments in public health.
During 1947 both public health workers and members of the teaching profession received service of this type. Although many activities described later in
this report aided in this important matter, four will be mentioned here as being
of special interest.
At the request of the Deputy Minister of Health, the Division presented to
the senior officials of the central office staff suggestions for the conduct of staff
meetings. When these had been discussed and altered for final adoption, the
Division assumed its rightful responsibility of organizing and supervising a
continuing programme of staff meetings.
The senior public health nurse in Saanich and South Vancouver Island
Health Unit requested an outline on the subject of mental health for use by
members of her staff in two discussion-group meetings which she planned to
conduct on the topic. As in the case of the lecture outline mentioned in the
previous section, the Division of Public Health Education consulted with senior
officials in the central office in preparing the material. It was the Division's
special responsibility to assemble the technical facts, to provide reference
material, and to offer suggestions concerning the method of presentation at the
meeting.
The Division assisted in the in-service training of the staff of the Victoria
City health department. At the request of the Medical Health Officer there, a
lecture on the functions in public health education and the work of the Division
was presented at a staff meeting of that department. II 72 BRITISH COLUMBIA.
At the invitation of the Junior Red Cross Society, a member of the Division
spoke to teachers who were attending the Summer Teachers' Workshop conducted by the society. Entitled " Community Health Resources," these talks
stressed the importance of local public health services and dealt also with the
splendid assistance available from voluntary agencies.
School Health.
The school is recognized as being one of the most important media for disseminating public health information. The inculcation of correct living habits
and ideals in the school population is a responsibility of all individuals and
agencies. It was for this reason that the Division of Public Health Education
welcomed the invitation of the Department of Education's School Health Curriculum Revision Committee to assist in the preparation of new curricula for
elementary, junior, and senior high schools. Although this project had not been
completed by the end of 1947, members of the Division of Public Health Education attended two joint committee meetings in Vancouver. As a result of
arrangements made at these meetings, personnel of the Division have spent
much time reviewing and constructively criticizing the first draft of the new
curricula. The suggestions offered have, of course, been limited to the technical
aspects of the materials involved. In addition, the Division has prepared an
outline of Provincial public health services and suggestions concerning school
health councils. The revision committee proposes to include these in the new
curriculum.
A second activity which should affect schools throughout the Province was
concerned with first-aid equipment and procedure. At the request of the
Department of Education, the Division prepared recommendations for first-aid
equipment to be provided to small, medium, and large schools. In addition, it
prepared an outline of policies and procedures to be followed in the case of accident or sickness in schools. In this important matter the Division received the
assistance of H. G. Henderson-Watts of the public health field staff. Mr.
Henderson-Watts' experience and advanced qualifications in first aid made his
advice invaluable.
Materials.
The Division of Public Health Education maintains and supervises the
Department of Health's library, film service, and supply of health pamphlets
and posters. This is far from routine work in that a sound knowledge of
public health and educational methods is necessary in order to advise potential
users of the materials of their suitability for any particular purpose. This
service is made available to all public health workers and, through them, to
teachers and other interested groups throughout the Province.
Two monthly publications are released by the Provincial Department of
Health. The Division of Public Health Education has the major responsibility
in writing and editing the widely read Health Bulletin. This publication has
a circulation of almost 2,500. It is distributed to all public health field personnel, private physicians, high schools, and newspapers throughout the Province. The monthly " News and Views " is prepared by the Division of Public
Health Nursing for distribution to the field staff.    The Division of Public DEPARTMENT OF HEALTH AND WELFARE, 1947. II 73
Health Education has given assistance in the editing of this publication which
is so valuable a means of in-service training.
Early in the year the Division of Public Health Education published a new
film catalogue. This catalogue lists and describes not only those films available
from the Division itself, but also those available from the University of British
Columbia, the Department of Education, and the British Columbia Tuberculosis
Society.
At the request of the Senior Sanitarian the Division adapted a publication
of the United States Public Health Service for distribution to workers in
restaurants and other food-handling establishments throughout the Province.
Editing of materials prepared by other staff members is also a responsibility of the Division. A major task of this nature was concerned with the
publishing of the Provincial Department of Health's annual report.
Work with Voluntary Agencies.
Voluntary agencies are in such a favourable position to aid in the advancement of public health that every effort is made to maintain co-ordinated working
relationships with them. During the year valuable contacts were made, especially with the British Columbia Parent-Teacher Association. The Consultant in
Health Education was invited to address the annual convention of the association. The Director of the Division met in conference with the association's
Committee of Health Conveners. It is hoped that the coming year will see the
further development of such co-operative relationships with this and other
voluntary agencies. Mention should also be made of some assistance given to
lecturers and discussion leaders appearing before the Y.M.C.A. So-Ed classes.
This was of less importance than the work with the Parent-Teacher Association
only because it was limited to the Victoria area rather than being Province-wide
in scope.
Informational Service.
The ultimate objective of this service is, of course, to provide public health
information to the people at large throughout the Province. The Division of
Public Health Education makes little, if any, attempt to do this directly.
Instead, it provides information and advice only through the public health field
staff. Throughout the year the Division has received many requests for
information in the form of letters from private individuals. It has been an
established policy to refer these persons to their local public health workers. In
this way an increasing number of people have been made aware of the services
available to them in their own districts. In providing this service, the Division
has been rightfully required to maintain a supply of resources material and to
perform some research-work for the public health workers themselves. This
is obviously related to the in-service training programme previously mentioned.
Press Releases and Radio Programmes.
An important duty of the Division of Public Health Education is to maintain liaison between the Department of Health as a whole and the newspapers.
The work of preparing news releases assumed large proportions during the 1947
poliomyelitis epidemic, and in order to keep the public fully and accurately II 74 BRITISH COLUMBIA.
informed concerning the situation, the Division's specialist in newspaper reporting gave much of her time to this phase of the work when the epidemic was
at its height.
In the field of radio-broadcasting the Division has never felt that it was in
a position to produce a programme of its own. Such a project would require
the full-time services of at least one member of the staff to prepare, rehearse,
and finally produce the programme over the air. The Director of one health
unit has, however, presented a series of programmes from the station in his
district, and the Division has provided him with certain resource material and
advice to aid him in the heavy task of programme production. Toward the end
of the year definite plans were made with the Canadian Broadcasting Corporation in Vancouver to incorporate a " question and answer " series on prenatal,
infant, and child care as part of an already established programme presented
by a women's commentator. There is every indication that this programme
will serve well as another channel for disseminating public health information.
OBJECTIVES AND PLANS.
The single over-all objective of the Division is to search out and make the
most efficient use of means of promoting positive health among the people of
British Columbia. Any activity which furthers the attainment of this objective
is a legitimate task of the Division.
The foregoing section indicates that a sound foundation in public health
education has been laid. It is worthy of note that the activities described
follow closely the functions in health education advanced by the American
Public Health Association. But it is not sufficient to evaluate a programme
merely by comparing the activities undertaken with those in a list prepared
by acknowledged leaders in the field.
At the close of the year it was evident that there were opportunities both
for establishing new methods of health education and for expanding those which
were already in use. In broad terms, plans for 1948 include, in first place,
increased consultative service to personnel of the Provincial Department of
Health. The provision, especially to the field staff, of carefully chosen materials,
together with advice in their use, constitutes a continuing phase of the work to
which the greatest attention should be given.
It is hoped that the excellent relations established with the Department of
Education may be continued and developed to include projects in addition to
those previously mentioned.
More than one voluntary agency has shown a desire to co-operate with the
Provincial Department of Health in activities related to public health. The
Division plans to give every aid possible to these organizations.
When the most efficient methods for using the radio have been found
through experiment, it is hoped that personnel of local health units may be given
sound advice which will encourage them to use the stations in their areas without being overburdened with programme production.
CONCLUSION.
The Division of Public Health Education has taken part in many projects
of many different types.    In almost all of these the work has been conducted jointly with other persons or groups. Included have been members of the public
health field staff, other departments of Government, voluntary agencies, and
other officials of the Provincial Department of Health. The Division expresses
its sincere thanks to these for the splendid co-operation they have given.
REPORT OF THE PROVINCIAL INFIRMARY.
Mrs. Mary Law, Superintendent.
INTRODUCTION.
There are three branches of the Provincial Infirmary: (1) At Marpole,
Vancouver, bed capacity 124; (2) at Allco, Haney, 100 beds; and (3) at Mount
St. Mary, Victoria, 100 beds under contract. Ambulatory men only are sent to
the Allco branch, but a number become bed cases after admission.
During the year there has been an average of approximately 100 persons on
the waiting list for admission either to the Marpole or Mount St. Mary branches.
The Allco branch has averaged 74 patients per day, varying from a low of 60
to high of 80. The principal demand for care is for bed or potential bed cases
which cannot be satisfactorily cared for in the Allco branch.
During the year it has been possible to inaugurate improvements as
follows:—
Patients.
1. All patients admitted are first sent to either the Vancouver General
Hospital or St. Joseph's Hospital in Victoria, as the case may be, and each
patient is given a thorough examination. The organized medical staff of these
two hospitals diagnose each case, advise on treatments, set out prognoses, and
generally assist the attending physician of each branch. The thanks of the
Department is due to these organized medical staffs for this valuable assistance.
2. The capacity of the Marpole branch has been reduced from 144 to 124
patients.
3. Physiotherapy and occupational therapy have been provided or expanded.
4. Chest X-rays have been taken on all patients by the mobile clinic under
the Division of Tuberculosis Control.
Employees.
A straight shift and a forty-four-hour week were inaugurated on June 1st.
Salaries have been adjusted, each employee's work has been analysed and many
have been reclassified by the Civil Service Commission.
Continuing Problems.
The most pressing is the need for more infirmary beds. As is well known,
with the exception of the Mount St. Mary building, the infirmary branches are
all housed in buildings designed for other purposes, and it is difficult to adapt
them.
The " Civil Service Act " and the regulations and orders under the Act have
resulted in a large turnover of staff, due to difficulties in finding suitable infirmary employees who are under 45 years of age. II 76 BRITISH COLUMBIA.
Despite these difficulties, there have been practically no complaints from
the patients themselves. On the contrary, patients have on more than one
occasion expressed their disagreement with and their concern regarding complaints emanating from outside the institution.
INFIRMARY INSTITUTIONS.
Marpole.
A physician is in charge of all patients. He visits regularly and is on call
at all times.
Vancouver General Hospital out-patient department has assisted by giving
examinations of infirmary patients in dermatology, urology, neurology, radiology, etc.
Surgery has been performed in Vancouver General Hospital for five
patients.
St. Paul's Hospital has received, and surgery has been performed on,
patients.
An eye specialist pays regular visits, and patients are fitted with glasses
and given treatment as required.
A dentist visits regularly, and dentures are supplied as needed.
The work of the part-time physiotherapist has proved satisfactory to the
institution and to the patients.
The work of the occupational therapist is of increasing value as time passes.
The annual display of handicraft this year showed a greater variety and an
improved quality in the work of patients. More patients are interesting themselves in this work. Arousing the patients' interest in something creative
brings many benefits, including a more cheerful outlook on life on the part of
the patient.
This branch enjoys a very active women's auxiliary who are untiring in
their interest in the welfare of the patients. A bus has been engaged to take
patients for drives each week during the summer and on suitable days in winter.
An electric iron, an electric kettle, and a fan have been purchased for use in
the occupational therapy room. Books have been added to the library; all
patients' requests for books have been met. A new projector has been donated.
A pipe band was engaged to entertain at the annual garden party held at the
home of Mrs. Clarence Wallace. Special treats and entertainment have been
provided on different occasions, and especially at Christmas.
Mount St. Mary.
Specialist services are available in this branch as at the Marpole branch.
The occupational therapist from the Marpole branch spends three days a month
at Mount St. Mary branch, and this work has increased and improved.
A group of volunteer women have continued visiting the patients throughout the year, and they cater to the patients' special needs in diversions and treats.
The Sisters of St. Ann have provided a station-wagon, and the infirmary
patients have been taken for drives. department of health and welfare, 1947. ii 77
Allco.
In addition to regular medical services, a dental service is given weekly
and an eye service is available.
An occupational therapist has been appointed, and his work has helped the
patients' morale. A greater variety and a better quality of work has been done.
The occupational therapist from the Marpole branch visits once a week.
An infra-red lamp and other treatment and diagnostic aids, including a
chiropody set, have been supplied.
There is a fund consisting of voluntary gifts with which special treats,
Christmas entertainment, and birthday cards are provided.
CONCLUSION.
The present facilities of the infirmaries are used to provide custodial sympathetic care for persons with incapacitating disabilities. Every care is taken
to see that all applicants are thoroughly examined by the best specialist medical
skill available. Where there is hope for the saving of lives, or rehabilitation or
partial rehabilitation, our larger general hospitals are used, while the infirmary
itself does everything to alleviate suffering and to make the lives of the inmates
brighter than they otherwise would be.
VICTORIA,  B.C. :
Printed by Don McDiabmid, Printer to the King's Most Excellent Majesty.
1948.
715-448-2028   

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