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PROVINCE OF BRITISH COLUMBIA Third Report of the DEPARTMENT OF HEALTH AND WELFARE (HEALTH BRANCH) Fifty-second… British Columbia. Legislative Assembly 1949

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Third Report of the
(Fifty-second Annual Report of Public Health Services)
Printed by Don McDiarmid, Printer to the King's Most Excellent Majesty.
1948.  Office of the Minister of Health and Welfare,
Victoria, B.C., January 24th, 1949.
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, 1948.
Minister of Health and Welfare. Department of Health and Welfare (Health Branch),
Victoria, B.C., January 24th 1949.
The Honourable Geo. S. Pearson,
Minister of Health and Welfare, Victoria, B.C.
Sir,—I have the honour to submit the Third Report of the Department of Health
and Welfare (Health Branch) for the year ended December 31st, 1948.
I have the honour to be,
Your obedient servant,
G. F. AMYOT, M.D., D.P.H.,
Hon. G. S. Pearson   -     -     -     v   -     -     -     Minister of Health and Welfare.
G. F. Amyot, M.D., D.P.H. Deputy Minister of Health and Provincial Health Officer.
J. A. Taylor, M.D., D.P.H. ----- Director, Bureau Local Health Services.
Geo. Elliot, M.D., CM., D.P.H.     -     -     - Assistant Provincial Health Officer.
A. H. Cameron, B.A., M.P.H.        - Administrative Assistant.
R. BOWERING, B.Sc (C.E.), M.A.Sc.       - Public Health Engineer.
Miss M. Frith, R.N., B.A., B.A.Sc, M.P.H.     -     Director, Public Health Nursing.
Mrs. K. Beard, B.Sc, M.S.P.H.      - Consultant, Public Health Education.
Miss E. M. Yvonne Love, B.Sc. (H.Ec), C.P.H.     Consultant in Nutrition.
C. E. Dolman, M.B., B.S., D.P.H., Ph.D.     -     -     Director, Division of Laboratories.
W. H. Hatfield, M.D.       ------     Director, Division of  Tuberculosis
J. D. B. Scott, B.A., B.Com.    -----     Director, Division of Vital Statistics.
C. L. Hunt, M.D., M.R.C.S., L.R.C.P.    - Physician in Charge of Clinics, Divi
sion of Venereal Disease Control.
Mrs. Mary Law, R.N. ------ Superintendent, Provincial Infirmary.  Introduction-
Federal Health Grants  11
Accommodations  19
Thirty-sixth Annual Conference of the Canadian Public Health Association____ 20
Cancer  20
Arthritis  21
Canadian Red Cross Blood Transfusion Service  21
World Health Organization  22
Public Health Services during the Floods  23
Summaries of Activities in the Bureaux, Divisions, and Services of the Provincial Department of Health  32
Longevity and Causes of Death in British Columbia  39
Report of the Bureau of Local Health Services—
Introduction  41
Developments in Local Health Services  41
Health Unit Progress  42
Services of Part-time Medical Health Officers  44
Local Health Services during Flood Conditions  44
School Medical Services  45
Reportable Disease Incidence  46
Table I.—Table showing Return of Cases of Notifiable Disease  49
Report of the Director of Public Health Nursing—
Introduction  53
Development and New Services  53
Personnel Administration  54
Public Health Nursing Educational Programme  55
Tuberculosis  56
Venereal Disease  56
Indian Services  57
Local Public Health Nursing Service  57
Special Activities  58
Report of the Nutrition Service—
Consultant Service to Local Public Health Personnel  59
Consultant Service to Hospitals and other Institutions  61
Co-ordination of Nutrition Activities  62
General Comments and Observations  63
Report of the Division of Vital Statistics—
Introduction  63
Completeness of Registration—
Indians  63
Doukhobors  65
Registration of Births  65
Effect of Family Allowance  66
Registration of Deaths  67
Registration of Marriages  67
District Registrars' Offices, etc  67
Vital Statistics Information for Health Units  68
Statistical Services  69
Manual of Instructions for District Registrars, Marriage Commissioners, and
Issuers of Marriage Licences  70 Z 8 BRITISH COLUMBIA.
Report of the Division of Vital Statistics—Continued. •       pAGE.
Vital Statistics Council for Canada—
International Statistical Classification of Diseases, Injuries, and Causes
of Death   71
Model Vital Statistics Act  72
Model Marriage Act  72
Minimum Standards for Delayed Registration of Birth  72
Administration of the " Marriage Act "  73
Administration of the " Change of Name Act "  73
General Office Procedures  73
Problems outstanding at the End of the Year—
Goal in Registration  74
General Office Manual  75
Certification 1  75
International List of Diseases, Injuries, and Causes of Death  75
Model Vital Statistics Act  76
Public Health Statistics  76
Report of the Division of Laboratories—
Introduction  77
Table II.—Division of Laboratories Statistical Report of Examinations done
during the Year 1948  78
Tests for Diagnosis and Control of Venereal Diseases  78
Tests relating to Tuberculosis Control  79
Gastro-intestinal Infections  79
Bacteriological Analyses of Milk and Water Supplies  81
Other Types of Tests  81
General Comments  82
Table III.—Number of Tests performed by Branch Laboratories in 1948  83
Report of the Division of Venereal Disease Control—
Introduction  85
Treatment -  86
Epidemiology ,  86
Social Service  87
Education  88
General  89
Report of the Division of Tuberculosis Control—
Introduction  90
Clinics  91
Institutions  91
Nursing  92
Social Service  92
Rehabilitation  93
Local Health Services  93
Budget    93
Conclusions  93
Report of the Division of Public Health Engineering—
Introduction  94
Water-supply  94
Sewerage and Sewage-disposal  95
Milk Sanitation  95
Shell-fish Sanitation  96 DEPARTMENT OF HEALTH AND WELFARE, 1948. Z 9
Report of the Division of Public Health Engineering—Continued. Page.
Industrial-camp Sanitation  96
Sanitation of Tourist Resorts  97
Summer Camps  97
Environmental Sanitation of Schools  97
Sanitation of Eating and Drinking Places  98
Frozen-food Locker Plants  98
Increase in Staff of Sanitary Inspectors  99
The Floods  99
General Observations  99
Report of the Division of Public Health Education—
Introduction ■  100
Local Health Services  100
Reference Materials  102
Publicity :  102
Pre-service Training  102
In-service Education  103
School Health Curriculum  103
Canadian Public Health Association  103
General Comments -  104
Report of the Provincial Infirmary  105  Third Report of the Department of Health and Welfare
(Health Branch)
G. F. Amyot, Deputy Minister of Health.
This Third Annual Report of the Health Branch, Department of Health and
Welfare, concerns itself with a year of major activities and changes. Although
these are described in some detail elsewhere in the Report, the events which had
the greatest impact upon the Health Branch during 1948 were the loss of several
officials on the senior administrative level, the annual conference of the Canadian Public Health Association in Vancouver, the floods in the Fraser Valley
and other parts of the Province, and the provision of the public health grants
by the Federal Government.
The body of the Report begins with a general section which describes those
activities and events which affected the Health Branch as a whole. Included in
this section are a description of the Federal health grants and a review of public
health services during the spring floods.
Following the " General " section are accounts prepared by the heads of the
various bureaux, divisions, and services which constitute the Health Branch.
Other departments of Government, members of the many professions,
official lay groups, and voluntary agencies have always given great co-operation
and material assistance to the Provincial Department of Health. During 1948
the demands upon these were increased particularly because of the spring floods
and the inauguration of the Federal health grants.
The Deputy Minister of Health, on behalf of his co-workers, wishes to pay
tribute to all those persons and groups who co-operated in improving and
expanding public health services.
The Deputy Minister also wishes to thank the professional, technical, and
clerical personnel of the Department for their loyal and efficient services
throughout the year.
In May, 1948, the Prime Minister of Canada and the Honourable Paul
Martin, Minister of National Health and Welfare, announced that the Federal
Government would provide the Provinces with moneys to assist in the promotion
of public health services.    These Federal health grants have had, and will con-
tinue to have, such a far-reaching effect that they will be described in some
detail here.    This Report will, of course, confine itself to a description of the
grants as they apply to British Columbia.
There  are  ten  separate grants  totalling  approximately  $2,500,000  per
annum as British Columbia's share.    The following special features should be
(a) All but one of the grants (the health survey grant) recur annually.
That is, the Federal Government will make available annually to
the Province sums of money approximately equal to the amounts
provided in this first year.
(6) The health survey grant is not provided on an annual basis. It is
a single, fixed sum of money which may be spent by the Province
immediately or over a period of months or years. It is designed
to enable the Province to assess its public health services, determine the needs, and formulate a plan to meet these needs.
(c) All but one of the grants (the hospital construction grant) are
non-cumulative. That is, the portions unused in any one fiscal
year do not carry over into the next fiscal year. Instead, the
unused portions revert to the Federal Treasury while entirely new
sums of money are provided to the Province for the following
fiscal year.
(d) The hospital construction grant is the single exception to (c).
Unused portions of this annual grant may accumulate for Provincial use, at least for the first five years.
(e) All but two of the grants (the cancer control grant and the
hospital construction grant are " non-matching." That is, the
the Federal moneys, with the two exceptions noted, are made
available without the requisite that Provincial moneys be spent
on the projects involved.
(/) The cancer control grant is a true " matching " grant. Federal
moneys under this grant are available only if the Provincial Government spends equivalent Provincial moneys on the projects
(gr) The hospital construction grant is based on a more complicated
formula. For projects under this grant, Provincial contributions
must at least match those of the Federal Government.
(h) All but one of the grants (the public health research grant) have
been allocated to the various Provinces according to a formula
which includes the population figure as one of its factors.
(i) The public health research grant has not been divided among the
Provinces. It is held as a central fund, to be allocated when
specific research projects are approved and undertaken.
(j)  The grants are made available only if the projects involved represent new services  or extensions  of present  services.    Federal
moneys may not be used for purposes such as increasing salaries
or replacing equipment.
The following table summarizes this information and provides certain other
Z 13
Provinces  to  match   or  exceed  Dominion   contribution,   which   shall
in no case exceed one-third of total
cost.    Grants = $1,000   per   active
treatment    bed    and    $1,500    per
chronic or convalescent bed.    The
acute shortage of chronic or convalescent beds has  congested hospitals with persons not requiring
active hospital  care but perfectly
capable of being treated in chronic
or   convalescent   beds.     Therefore,
a premium  is  placed on the provision for chronic or convalescent
beds   (which  are  cheaper  to  provide  and   maintain)   in   order   to
reduce   the   congestion   in   active
treatment units.
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Shortly after the announcement concerning the grants was made by the
Prime Minister, the Minister of Health and Welfare for British Columbia
appointed a Central Committee (later renamed the Health Survey Committee)
to make preliminary investigations and to submit recommendations. This Committee originally consisted of three officials of the Provincial Department of
Health. On the basis of its recommendations and in accordance with needs
which later arose, there developed an administrative and advisory organization.
Chronologically, this development took place as follows:—
(1) The Committee, after consultation with the chairman of the Committee on Medical Economics of the British Columbia Medical
Association, invited persons who are authorities in the various
fields for which the grants are provided to serve as chairmen of
sub-committees. These chairmen had power to add, as they saw
fit, to the membership of their committees.
(2) Dr. G. R. F. Elliot, Director, Division of Venereal Disease Control,
was appointed Assistant Provincial Health Officer, with the conduct of the health survey and much of the administration of the
grants as major responsibilities. He was given the title " Director
of Health Studies."
(3) Miss Jean Gilley, formerly branch secretary in the Division of
Venereal Disease Control, was appointed research assistant to
Dr. Elliot.
(4) Assistance on the senior clerical level was provided in the headquarters of the Provincial Department of Health in Victoria.
This was deemed necessary because all communications with the
Department of National Health and Welfare are maintained by
the Deputy Minister's office in Victoria, although Dr. Elliot and
the majority of the sub-committee chairmen and members are
located in Vancouver.
(5) Membership of the Health Survey Committee was increased to
include Dr. J. A. Taylor, a senior official of the Provincial Department of Health, and three members of the British Columbia
Medical Association.
(6) Dr. G. F. Strong, Vancouver, was invited to represent the British
Columbia Medical Association as chairman of a sub-committee on
medical care.
The Minister of Health and Welfare and the Deputy Minister of Health
for British Columbia are the final administrative and approving authorities for
the Province. Their relation to the Director of Health Studies and the various
committees is shown in the following chart:—
(Administrative and Advisory.)
British Columbia.
Minister of Health and Welfare.
Deputy Minister of Health.
Director of Health Studies. Health Survey Committee
(Central Committee).
Sub-committees. DEPARTMENT OF HEALTH AND WELFARE, 1948. Z 17
Persons serving in administrative or advisory capacities under the Minister
and Deputy Minister at the end of the year were as follows:—
Director of Health Studies:   Dr. G. R. F. Elliot, Assistant Provincial
Health Officer, Vancouver.
Research Assistant: Miss Jean Gilley, Vancouver.
Health Survey Committee (Central Committee) :—
Dr. W. H. Hatfield, Director, Division of Tuberculosis Control,
Vancouver (co-chairman).
Dr. J. M. Hershey, Commissioner, Hospital Insurance Service,
Victoria (co-chairman).
A. H. Cameron, Administrative Assistant to the Deputy Minister
of Health, Victoria (member and secretary).
Dr. J. A. Taylor, Provincial Department of Health, Victoria.
Dr. J. H. McDermot, Vancouver.
Dr. F. M. Bryant, Victoria.
Dr. C. J. M. Willoughby, Kamloops.
Sub-committee chairmen:—
Crippled Children's Grant—Dr. Donald Paterson, Director, Health
Centre for Children, Vancouver.
Professional Training Grant—Dr. G. F. Amyot, Deputy Minister
of Health, Victoria.
Hospital Construction Grant—L. N. Hickernell, Director, Vancouver General Hospital.
Venereal Disease Control Grant—Dr. G. R. F. Elliot, Assistant
Provincial Health Officer, Vancouver.
Mental Health Grant—Dr. A. M. Gee, Provincial Mental Hospital,
Tuberculosis Control Grant — Dr.  G.  F.  Kincade,  Division of
Tuberculosis Control, Vancouver.
Public Health Research—Dr. H. K. Fidler, Director, Department
of Pathology, Vancouver General Hospital, Vancouver.
Health Survey Grant—Dr. G. R. F. Elliot, Assistant Provincial
Health Officer, Vancouver.
General Public Health Grant—Dr. G. F. Amyot, Deputy Minister
of Health, Victoria.
Cancer Control Grant—Dr. B. J. Harrison, Department of Radiology, Vancouver General Hospital, Vancouver.
Medical Care—Dr. G. F. Strong, Vancouver.
Any discussion of activities which were conducted during 1948 should begin
by making reference to the fact that the Federal health grants were made available to the Province with little warning and well after the fiscal year had begun.
This had a marked effect on the philosophy and procedures adopted by Provincial authorities who, in their sincere efforts to use the grants wisely and yet
quickly enough to prevent reversion of large unused portions to the Federal
Treasury, were forced to concentrate their attention on activities and projects
seemingly unrelated to one another.   Although a health  survey which will Z 18 BRITISH COLUMBIA.
delineate the public health needs and recommend methods for meeting these
needs is an important part of the Federal health grant programme, it has not
been possible during 1948, for the reasons mentioned above, to postpone other
activities under the grants until the survey has been completed.
Activities to the end of the year have therefore consisted largely of the
preparation and submission of projects—that is, requests for the Federal Government's approval of expenditures under the grants. These projects have been
based upon already known facts concerning public health needs in British
Columbia. Although they have not been based on a master survey, it is felt that
they will fit well into the findings of that survey when it is completed. They
have of necessity been generally of a type upon which relatively immediate
action could be taken. Purchase of materials and equipment, professional
training of personnel, and the appointing of long-needed staff are examples of
projects which have fallen into this class. An effort has been made to avoid, as
far as possible, projects which would encumber the grants in future years.
Administrative Problems.
The Federal health grant programme was an entirely new enterprise for
both Federal and Provincial authorities when it was inaugurated in May, 1948.
It was to be expected, therefore, that many problems would present themselves
to those persons responsible for administration. Because there were few precedents which might serve as guides, many of these problems were concerned
with the establishment of routine administrative procedures. Most of these
had been solved by the year's end. In addition, the following major problems
were encountered:—
(1) The grants were made available after Provincial Government
estimates for the fiscal year had been established. Because all
expenditures must be made from Provincial moneys in the first
instance, with reimbursement from Federal moneys following at
later dates, it has been difficult in some cases to provide for the
initial Provincial expenditures. This problem has been further
complicated in the cases of the cancer control grant and the
hospital construction grant, where Provincial funds must at least
match Federal funds.
(2) The grants were made available with little warning to the Province. Although British Columbia is extremely grateful to have
financial assistance of such proportions, it has been extremely
difficult, in this first year, to plan expenditures wisely and yet use
the annual allotments which, if unused, will revert to the Federal
Government at the end of the fiscal year.
(3) The grants have been provided under the authority of Federal
Orders in Council and have not as yet been placed in Federal Acts
of legislation. This has tended to create a feeling of insecurity in
the minds of certain Provincial authorities, who point out that the
Federal aid can be withdrawn much more easily under these circumstances than it could if the grants were authorized in Federal
Acts. If this unlikely event were to occur, the Provincial Government would have to choose between dispensing with the new ser- DEPARTMENT OF HEALTH AND WELFARE, 1948. Z 19
vices added under the programme and carrying the entire financial
burden with Provincial funds. Where the employment of personnel is concerned, this problem has particularly serious implications. It is sincerely hoped that a solution will be found early in
the new year.
Assistance rendered by other Groups and Agencies.
During the eight months from May to December, 1948, when the programme under the Federal health grants was being launched, several groups and
agencies rendered material administrative assistance and consultative services
to the officials of the Health Branch, Department of Health and Welfare, who
were immediately responsible for the programme.
Officials of the Department of National Health and Welfare have made
every effort to assist Provincial officials. The Honourable Paul Martin, Minister
of National Health and Welfare, and several members of his technical staff have
journeyed westward from Ottawa to provide advice and guidance.
The numerous individuals listed earlier in this Report willingly complied
with the requests that they serve on survey and planning committees. The
unselfish attitude displayed by these persons in giving freely of their time and
effort is a tribute to public health.
The British Columbia Medical, Registered Nurses, Hospitals, and Dental
Associations have all displayed the keenest interest in the new programme and
have expressed a sincere desire to assist in making and implementing plans.
The Provincial Secretary's Department, which administers mental institutions and the " Hospital Act," has continued to work in close co-operation with
the Health Branch, particularly in matters relating to the mental health grant
and the hospital construction grant.
The Hospital Insurance Branch has arranged to make available to the
Director of Health Studies information resulting from the Provincial hospitals
survey which is being made under the auspices of that Branch.
The Department of Finance and the Comptroller-General's Department
have given much-needed guidance and service in matters concerning Provincial
expenditures and Dominion-Provincial financial relations.
The Departmental Comptroller, Department of Health and Welfare,
deserves special mention for his liaison services between the above-mentioned
financial authorities and the Health Branch and for the accurate accounting
procedures which he has inaugurated.
The Civil Service Commission has displayed a sympathetic understanding
of the personnel problems encountered in the new programme and has done
much toward solving these.
During the early part of the year it was hoped that relief from the serious
overcrowding in the central offices of the Health Branch would be forthcoming
when the new temporary building on Superior Street was completed. Plans
had been made to allot space in that building to the Division of Environmental
Sanitation and the Division of Public Health Education. This would have
released much-needed space to the staff remaining in the present quarters in Z 20 BRITISH COLUMBIA.
the west wing of the Parliament Buildings. When allocation of space in the
new building was finally made, however, personnel of the Health Branch were
not provided with accommodations. Thus, the Victoria staff still maintains its
offices and working-quarters in the basement vaults, on the second floor, and in
the attic of the west wing, and in one of the old houses on Government Street.
The Division of Vital Statistics uses a part of the vault on Topaz Avenue. The
overcrowding and the inconvenience resulting from the separation of these, one
from the other, makes it difficult to perform duties efficiently. It is hoped that
the new permanent building to be erected on Government Street will include
accommodations for all central office staff of the Health Branch.
In Vancouver the Division of Laboratories is seriously handicapped by the
inadequate quarters provided in the outmoded buildings—actually old houses—
on Hornby Street. Plans for a modern building which will house all Provincial
public health services in the Vancouver area are still in the formative stage.
Completion of this building will provide long-needed, modern accommodations
for various Provincial Department of Health offices in Vancouver, including the
Division of Venereal Disease Control which now occupies space in old buildings
on the grounds of the Vancouver General Hospital.
By tradition the annual conference of the Canadian Public Health Association is held in the Province in which the president of the Association resides.
With Dr. G. F. Amyot, Deputy Minister of Health for British Columbia, as
president, the 1948 conference was held in Vancouver on May 17th, 18th, 19th,
and 20th.
This event brought together not only public health workers from all parts
of Canada, but also representatives from the United States, especially from the
State of Washington. The Canadian Association was particularly fortunate in
that the Washington State Public Health Association held its annual meeting
at the same time and joined with the Canadian workers in the discussions and
activities. In addition, the Canadian Institute of Sanitary Inspectors was held
in conjunction with the above meetings.
Although much detailed planning on the part of the local committees was
necessary, these efforts were amply repaid. British Columbia public health
personnel and members of many allied professions were able to hear and discuss
papers presented by renowned authorities in nearly all fields of public health
work. British Columbia staff members themselves took an active part in the
scientific programme, presenting papers in section meetings, serving as members
of discussion panels, and participating in a symposium.
The Conference was a noteworthy event in the field of public health in
British Columbia because it stimulated the thinking of professional and technical
personnel toward evolving more effective programmes to meet the health needs
of the people.
Although the Provincial Department of Health does not have a special
division  of its  services  specifically  devoted to cancer-work,   it  maintained DEPARTMENT OF HEALTH AND WELFARE, 1948. Z 21
throughout 1948, as in previous years, close working relationships with those
organizations concerned with this disease. These organizations are the Cancer
Committee of the British Columbia Medical Association, the Provincial Branch
of the Canadian Cancer Society, and the British Columbia Cancer Foundation.
The Cancer Foundation continued to provide the people of British Columbia
with services in the prevention, diagnosis, and treatment of cancer through the
Cancer Institute located in Vancouver and operated by the Foundation. These
services were expanded during the year and the Institute was again provided
with funds by the Provincial Department of Health to assist in this important
Toward the end of the year the Executive Director of the National Institute
for Cancer was invited by the Provincial Department of Health, in co-operation
with the organizations mentioned above, to survey the programme of cancer-
work in this Province. The final report of this survey had not been received
at the year's end. It is felt, however, that any changes which may be forthcoming as a result of the survey will be designed to provide a more formal
and even closer relationship between the Department and the voluntary
As part of its public health duties, the field staff of the Department
performed follow-up work and education of the public in cancer control.
Cancer sufferers throughout the Province received assistance from two
other Government sources. Persons suffering from cancer were among those
who received aid from the Welfare Branch of the Provincial Department of
Health and Welfare. All types of patients, including those suffering from
cancer, benefited by the facilities made available by the Hospital Branch of the
Provincial Secretary's Department through its aid to general hospitals.
Last year's Annual Report made reference to the laying of plans for a
national organization for the study and control of arthritis—plans in which this
Department shared fully. In January, 1948, the final organization meeting
was held and the Canadian Arthritis & Rheumatism Society was formed.
During the year the British Columbia division of this national organization
was the first in Canada to organize and develop a programme for arthritis.
This programme is planned to start functioning early in 1949 in co-operation
with the Provincial Department of Health, certain key hospitals, the British
Columbia Medical Association, other professional associations, and voluntary
British Columbia was the first Province in Canada to have a Red Cross
Blood Transfusion Service. The service was established in this Province in
January, 1947, in co-operation with the Provincial Department of Health, local
health services, the Department of Veterans' Affairs, the hospitals, and the
medical profession.
The British Columbia depot, located in Vancouver, serves the entire
Province, with the exception of the Peace River District and the East Kootenay Z 22 BRITISH COLUMBIA.
District, which are served by the Edmonton depot and the Calgary sub-depot
respectively. Almost all hospitals of the Province have entered into agreements
with the society.
Whole blood and plasma are made available to hospitals. Although there
have been seasonal periods when the response from blood donors has fallen off,
it can be said, in general, that no patient has gone without blood when needed.
When ordinary means of transport were not available or not fast enough
for delivery in cases of emergency, whole blood has been flown to remote centres.
Through the co-operation of the Royal Canadian Air Force, whole blood was
dropped by parachute on three occasions when flood conditions disrupted normal
transport. On another occasion when weather conditions rendered normal
transport impossible, the Air Force dropped whole blood by parachute to
logging-accident victims who were in urgent need.
A mobile team of professional and technical workers was on the road
approximately every other week during the year collecting blood from voluntary-
donors at numerous centres of population throughout the Province.
The Canadian Red Cross Blood Transfusion Service included the following
free services in its activities for 1948:—
(a)  Cross-matching of blood prior to transfusion.
(&) Provision of whole-blood banks to larger hospitals at strategic
points throughout the Province.
(c) Provision of plasma to hospitals.
(d) Testing for the Rh factor associated with pregnancy.
(e) Provision  of equipment to  hospitals  when  replacement transfusions were required for Rh infants.
(/)  Provision of consultative service to physicians and hospitals.
The following table indicates the volume of work performed in British
Columbia during 1948 compared with that for the previous year:—
1947. 1948.
Patients transfused  Over 13,000      Almost 18,000
Bottles of blood used  Over 17,000 Over 21,000
Rh investigations (tests made)  Over   6,500 Over 14,000
Dr. G. F. Amyot, Deputy Minister of Health for British Columbia, was
chosen as a member of a delegation of five which represented Canada at the first
meeting of the World Health Organization. The purpose of this meeting was
to implement the recommendations of the interim committee which had been
formulating plans since the end of the war. The discussions were held in
Geneva, Switzerland, over a five-week period during the summer.
Just prior to departure for Switzerland, Dr. Amyot was informed that he
would lead the delegation for the first three weeks until the previously appointed
leader, the Deputy Minister of National Health, arrived at the conference.
In addition to participating actively in the work of many committees, the
Deputy Minister of Health for British Columbia was elected rapporteur of the
Programme Committee. This was the major committee of five committees
whose responsibility it was to plan present and future programmes of the
In order to keep Canadian citizens informed concerning the activities of
their delegation, weekly radio broadcasts were made from Geneva. Dr. Amyot
presented all but one of the English broadcasts which were directed toward
other English-speaking countries as well as Canada.
While in London en route home from Geneva, Dr. Amyot conferred with
Dr. Wilson Jameson, Chief Health Officer, British Ministry of Health, and also
availed himself of the opportunity to visit British Columbia House. The latter
served as his London headquarters and provided him with efficient office
The year 1948 will long be remembered in British Columbia as the year of
the great flood. Not since 1894 had flooding been so severe and so general
in the Province. Commencing late in May and extending through June and
July, and in some cases even longer, all the rivers, streams, and lakes in the
Province were in flood stage. Although this Report will deal with the activities
of the Health Department in the Fraser Valley only, before proceeding to a
discussion of the Fraser Valley flood, some mention should be made of the
flooding in other parts of the Province.
Northern British Columbia.
In Northern British Columbia there was no report of serious damage on
the great rivers such as the Liard and the Peace, simply because there is very
little habitation on these rivers. The Skeena River, which drains an area of
about 20,000 square miles, did cause some flood damage to towns such as
Hazelton, Terrace, and Usk. In each case the local health services took steps
to combat the public health hazard involved.
Columbia Basin.
The first reports of flooding came from the Columbia basin. The Columbia
drains an area of about 40,000 square miles in British Columbia, and includes
the areas drained by the Kootenay, Kettle, Okanagan, and Similkameen drainage
systems. Kimberley, Creston, Trail, Grand Forks, Kelowna, Hedley, Keremeos,
and Princeton were among the communities in the Columbia basin that suffered
damage from the flood. At the year's end there was still very high water in the
Okanagan Valley. In each case the local health services, which had been
supplied with considerable advisory material from the Provincial Health
Department, threw themselves whole-heartedly into the fight against the hazards
of flood-borne disease.
The Fraser.
By far the most important area flooded from the point of view of economic
loss and public health hazard was the Lower Fraser Valley. The Lower Fraser
Valley extends from the Village of Hope down-stream to the Fraser delta, where
the river discharges into the Gulf of Georgia, a distance of about 80 miles. The
width of the agricultural part of the Lower Fraser Valley varies from nil up to
about 15 miles. The agricultural lands are a series of flood-plains broken up by
small ridges and protected from the usual flood stages of the river by some Z 24 BRITISH COLUMBIA.
200 miles of dykes. Some of the area is actually reclaimed land, with an
elevation lower than that of the normal stage of the river.
The river is 785 miles long, rising in a tiny lake in the Rockies, sweeping
by a great bend northward roughly parallel to the Big Bend of the Columbia
River, dropping straight south through the clay canyons of the high Cariboo
plateau, boring its way by a grisly trench through the Coast Mountains, and
flowing calmly through the above-described Lower Fraser Valley. The river
drains a total area of 88,700 square miles of British Columbia. This is nearly
one-quarter of the total area of the Province.
The Lower Fraser Valley has a population of about 100,000 people engaged
in intensive dairying, small-fruit farming, and market-gardening. It is the
richest agricultural area of its size in British Columbia and possibly in Canada.
As the river rose and as dykes broke in various places, about 70,000 acres were
flooded, and all land communication between the Coast and the Interior was
cut off.
Much of this land was flooded in the great flood of 1894, but owing to the
increase in population and owing to the longer period in which the river was in
flood, the flood of 1948 was the worst in the recorded history of British Columbia.
B.C. Flood Control Committee.
On Friday, May 28th, a state of emergency was declared by the Provincial
Government, and, at the request of the Attorney-General, the Area Commander
of the Canadian Army was asked to set up a flood control committee to advise
and assist all phases of the flood-control operations in the Lower Fraser Valley.
The Committee had to do with the securing of voluntary man-power, machinery,
and material to strengthen remaining dykes, evacuate families and live stock
from flooded areas, and arrange for the care of evacuees and for the protection
of the public health. It was also responsible for the co-ordination of the work,
not only in the Lower Fraser Valley, but in the several other areas of the
Province where flood conditions existed. Office space for the Committee was
provided in the Provincial headquarters of the Canadian Red Cross. The
chairman of the Provincial Red Cross Disaster and Relief Committee became
chairman of the B.C. Flood Control Committee, which included representatives
from the Red Cross, the Canadian Army, the Royal Canadian Navy, the Royal
Canadian Air Force, the British Columbia Police, the City of Vancouver, the
Vancouver Board of Trade, and the Provincial Departments of Public Works,
Agriculture, and Public Health. Dr. G. R. F. Elliot was appointed by the
Deputy Minister as representative on the B.C. Flood Control Committee for the
Department of Health. The Committee was very active between May 28th and
July 28th, holding numerous meetings, and while the work was most strenuous,
the importance of such a committee in the time of any emergency was clearly
Available Public Health Personnel.
The District Medical Officer, Canadian Army, and the Senior Medical
Officer, City of Vancouver, worked in close co-operation with the Provincial
representative on the Flood Control Committee. These two doctors also served
as alternates as health representative at the meetings of the B.C. Flood Control
Committee in order to permit more time to be spent in the flooded areas. DEPARTMENT OF HEALTH AND WELFARE, 1948. Z 25
It was indeed fortunate that the Health Branch of the Department of
Health and Welfare had some one hundred public health nurses, ten sanitarians,
two nutritionists and a public health engineer, qualified public health physicians,
and two public health educators who were available in various parts of the
Province and who could be moved at the direction of the Deputy Minister of
Health. In addition, the District Medical Officer, Canadian Army, had his
Command Hygiene Officer flown in from the East to assist, and made available
his staff of sanitarians. The Senior Medical Health Officer, City of Vancouver,
also made available the services of his staff of sanitarians. Two of these
sanitarians served in the flooded area for the entire duration of the flood
emergency. The Department of National Health and Welfare placed three
public health engineers and one epidemiologist at the disposal of the Provincial
Health Department.
The Division of Laboratories, Provincial Department of Health and Welfare, was called upon to extend its services to the utmost, not only in handling
the heavy increase in water-supplies to be examined, but also in assuring that
adequate supplies of typhoid vaccine were received from Eastern Canada, where
it is manufactured, and in arranging for its distribution.
The central office of the Division of Venereal Disease Control, Provincial
Department of Health and Welfare, was used as headquarters for the Health
Section of the B.C. Flood Control Committee, and the staff of this Division
undertook all the necessary clerical work. The work of the public health services
fell into two main sections: (1) The flooding stage (operation overflow), and
(2) the post-flooding stage (operation clean-up). These two sections of the
work rapidly became known as " operation overflow " and " operation clean-up."
In the remaining part of this Report these two sections of the work will
therefore be referred to as operation overflow and operation clean-up.
Operation Overflow.
It was decided from the start that if the work of the Health Department
was to be effective, it must be done through the local part-time Medical Health
Officers in the Fraser Valley, who were thoroughly familiar with the people and
the area. In every instance, therefore, the Local Health Officers continued to
be the local health authorities in their designated areas. Immediately after the
organization of the B.C. Flood Control Committee, in each locality meetings
were held, attended by the Local Medical Health Officer, the local sanitarian, the
Director of Public Health Nurses, the Director of Environmental Sanitation,
and the Health Department representative on the B.C. Flood Control Committee.
At these meetings the local programme was planned for the future in regard to
public health. These meetings also discussed such problems as the need for
additional physicians, public health nurses, sanitarians, public health engineers,
and other public health workers, and the possible isolation of an area due to the
breaking of the dykes, and any other problem that would have an effect on
the public health. It was emphasized that the main purpose of the Provincial
Health Department was to give all the assistance possible, to supply additional
public health personnel, and to give technical advice and direction when indicated
or required. Z 26 BRITISH COLUMBIA.
At the same time that the organizational work was being undertaken in the
field of operation, it was also being undertaken in the central office in Vancouver.
Firms handling chlorine products were contacted, and arrangements were
made to freeze sufficient quantities to ensure an adequate supply at all times.
Inventories were obtained of materials available in the Province which might
be required, such as the amount of D.D.T. and the number of hypodermic
syringes and needles. The Division of Laboratories arranged for an adequate
supply of typhoid vaccine, and the Division of Public Health Education arranged
for press releases regarding public health problems which would arise as a
result of the flood.
In a matter of thirty-six hours from the time of the declaration by the
Attorney-General of the state of emergency and the formation of the B.C.
Flood Control Committee, a total of ten additional public health nurses, seven
additional sanitarians, four additional public health engineers, and four qualified
public health physicians had been placed in the Fraser Valley. These individuals
were located in strategic places, and headquarters similar to the divisional
headquarters in the armed forces were set up in many areas. In the beginning
a few of the public health nurses were not convinced of the necessity for the
importation of nurses from other areas in the Province, largely because the
main work during the period of operation overflow was sand-bagging, evacuation, and feeding of evacuees. These nurses, however, were not long inactive,
and their work in the early days was outstanding. They assisted in the
evacuating of the residents and in the feeding of workers and evacuees; they
supplied transportation, generally doing what all the normal residents were
doing, and, in addition, used their public health training as opportunities arose.
Public health nurses also did yeoman services in setting up first-aid posts at
evacuation camps. The sanitarians supervised the sanitary control of the
evacuee camps and camps that were maintained for dyke-workers during the
period of operation overflow. As evacuees became settled in centres, the public
health nurses commenced organization of immunization clinics.
(a) Water-supply.—Several days before the setting-up of the B.C. Flood
Control Committee, the Director of Public Health Engineering and the Director
of Public Health Nursing met with all the public health nurses in the Fraser
Valley and briefed them on general sanitation in floods, particularly regarding
the treatment of water-supplies. In the flooded areas of the Fraser Valley
there were four municipal water-supplies, which served about 50 per cent, of
all the population. The balance of the residents received their water from wells
which varied in type. The public health nurses were supplied with instructions
for chlorinating the water and with halazone tablets to be given out to those
whose water-supply was likely to be contaminated.
Of the four municipal water-supplies, two were early put in a dangerous
condition as the flood-waters covered part of their mains. In both instances
the systems were old, and the danger of seepage into the mains was great.
Bacteriological examination of samples of water from these distribution systems
did show that the contamination in the mains was increasing, even though the
water-supply was under pressure.
Emergency chlorinating equipment was installed at Mission and in two
places at Matsqui.   The emergency chlorinators consisted of hypochlorinators DEPARTMENT OF HEALTH AND WELFARE, 1948. Z 27
set up, and the chemical used was sodium hypochlorite. These emergency
chlorination plants were very effective in restoring the bacteriological quality
of the water to normal. The other two municipal supplies were never seriously
threatened, so that no treatment of these supplies was necessary. In no case
was a municipal source of water affected by the flood.
A further responsibility in this operation overflow was the assurance of
a safe water-supply for those individuals who were working on the dykes.
Supervision of the quality of water used for this purpose was one of the duties
of the sanitarians.
(b) Typhoid Immunization.—Plans for immunization clinics were made
early in the flood. It was decided that T.A.B. vaccine would be used in preference to T.A.B.T., owing to the fact that immunity could be obtained more
rapidly. It was not recommended that children under the age of 1 year should
be immunized unless there was definite evidence of exposure. All others were
to have a dosage of one-quarter cc, one-half cc, and one cc. at five- to seven-day
intervals, with the exception that those over the age of 60 and under the age
of 3 should receive one-tenth cc, one-quarter cc, and one-half cc at the same
intervals. It was decided at first that only those who were not engaged in
manual labour on the dykes should be immunized, but it was not possible to
carry out this policy as the demand of the public for this protection against
typhoid exceeded the greatest expectations. In all, some 35,000 persons were
immunized in the Lower Fraser Valley. When one considers that many of the
residents of the valley were using safe water and in no way were directly affected
by the flood, it is reasonable to assume that all those requiring protection from
typhoid fever received it. Many interesting incidents occurred during this
immunization campaign. Public health nurses often proceeded in rowboats to
immunize those individuals, who were few in number, who had refused to leave
their homes although surrounded by water.
(c) Milk and Food Supply.—Many cattle were displaced and had to be milked
under unsatisfactory conditions, without the aid of proper facilities for cooling
and handling milk. Most of this milk was processed in Vancouver or in near-by
cities in the Fraser Valley, so that the residents continued to obtain their supply
of pasteurized milk. Most persons handling milk under adverse conditions used
much greater than normal care in handling the milk, with the result that even
though there were changes in the normal manner of handling the milk-supply,
there was no outbreak of milk-borne diseases.
Food continued to be supplied in the normal manner in most instances,
although many individuals were supplied by naval transport or by aircraft. In
addition to consultant service to public health staff in relation to mass-feeding
units, the nutritionists on the staff of the Provincial Health Department were
asked to prepare and obtain emergency rations for a community of some 10,000
people which was in great danger of being completely isolated.
(d) Publicity.—Throughout operation overflow a constant barrage of news
releases and radio flashes was made in order to keep persons affected by the flood
informed of public health problems and to prepare them for problems which
would arise in future, as well as to give the general public an accurate account
of the work being done.    In many instances news releases were prepared by the Z 28 BRITISH COLUMBIA.
Provincial Division of Public Health Education, and in other instances they were
written by the local staff.
In some cases the local sanitarians appeared on programmes on the local
radio-stations in order to advise the people as to the proper method of handling
sanitation. Warning-posters were put up in all strategic places informing the
public as to the proper person to see regarding public health matters.
(e) Mosquito-control.—The Fraser Valley is a natural habitat of mosquitoes,
and although no disease has ever been traced to this insect in this area, it was
realized early that they would become a problem. The responsibility for control
of mosquitoes was accepted by the B.C. Flood Control Committee on humanitarian grounds and placed under the direct supervision of the Health Section.
The actual work was done by a commercial firm, which had on its staff a highly
trained group of recent university graduates, using conventional aircraft, a
helicopter, blowers, and orchard spraying equipment. Much of the spraying-
work was done on the dykes by labourers appointed by the local Flood Control
Committee; 5 and 10 per cent. D.D.T. dust, and 50 per cent, wettable D.D.T. and
oil were used. The spraying and treatment of such a vast area of agricultural
land was undertaken with a good deal of trepidation, as various reports have
been written concerning the harm to beneficial insects that has resulted from
similar undertakings. In this operation, however, praise was received on all
sides.    There have been no adverse reports received to date.
Operation Clean-up.
No definite line of demarcation occurred when operation overflow became
operation clean-up. In the upper regions of the flooded areas, operation clean-up
was under way when operation overflow was still in progress in the lower
regions. This, however, was the period when the sanitarians and public health
engineers lost all track of time, and their duties and responsibilities were heavy.
Comprehensive instructions in regard to cleaning up flooded homes and furniture, dairies, public buildings, milk-houses, pasteurizing plants, cold-storage
plants, and wells were prepared by the Division of Environmental Sanitation.
These were given wide circulation, as well as being posted in all strategic points.
The press and radio were utilized at frequent intervals to give publicity to these
instructions, and many large signs were put up in the flooded areas stating
where information and suupplies for clean-up procedures might be obtained.
(a) Homes.—Early in the flood the B.C. Flood Control Committee announced
that homes would not be reoccupied until they had been approved by the health
authorities as fit for habitation. Since the militia was in control, these instructions were issued in the name of the Army Commander, and they were obeyed
far better than even the most optimistic had dared to hope. In most areas,
centres were set up where information and supplies could be obtained. The
Department of Health supplied chloride of lime and other chlorine products to
householders. These supplies were for the most part donated through the
generosity of firms selling these chemicals in British Columbia. For the most
part the chlorine in solution form was used to treat the sandpoint type of well,
and the powdered form used in a dug type of well. Powdered chloride of lime
was also used extensively in all clean-up procedures, such as for septic tanks, DEPARTMENT OF HEALTH AND WELFARE, 1948. Z 29
privies, and about yards. Great stress was laid on the value of turning over
the soil in yards to the sun and air.
A form, Certificate of Health Inspection, was prepared, and every householder was required to have this signed by the Local Health Officer or sanitarian
before occupancy of the home was allowed. Adults were allowed to return to
their homes during the day to carry out clean-up procedures, but in many
instances this meant that provision had to be made for the care of their young
children. At the suggestion of the Health Department, the Red Cross set up
day-nurseries for this purpose, and they were most worth while. Most of the
work by the residents was hard manual labour, with the aid of liberal quantities
of disinfectants, of which chlorine-bearing compounds were the most extensively
used. In some areas great success was obtained by the use of high-pressure
steam. In giving the final certificate that the house was habitable, care was
taken to point out that this did not cover structural or electrical defects. However, certificates were not given out where the structural defects were quite
obvious. A total of almost 1,500 homes were inspected and certificated by the
staff of sanitarians.
(6) Water-supply.-—The work here continued as in operation overflow.
The municipal water-supply that had ceased to operate when the area was
flooded was closely checked as the water receded, superchlorinated, flushed out,
and put into operation with the use of an emergency chlorinator. In all, three
chlorination plants were put into operation, and these were not taken out of
operation until the bacteriological quality of the water in the mains had returned
to normal.
As mentioned previously,' instructions in regard to the sterilization of wells
were issued and the necessary chemicals applied. To prevent too great a load
on the Provincial Laboratory, frequent sampling was discouraged. In no case
was sampling carried out where there was gross evidence of contamination or
cleansing of the well had not already been carried out. In many instances
it was found that a well showing contamination likely showed contamination
before the flood and would continue to do so owing to improper location or
improper construction. Attempts were always made to have the owner rectify
this condition.
In all, 439 wells were examined by the sanitarians. Of these, 72 per cent,
were the driven sandpoint well. Only 18 per cent, of the sandpoint wells
sampled showed evidence of bacterial contamination. Of the dug wells, only
those that were considered to have a satisfactory sanitary survey were sampled.
Of these, only 50 per cent, showed freedom from contamination on the first
sampling. There were in all a total of 797 samples of water taken by the
sanitarians and public health engineers in the Lower Fraser Valley during the
flood emergency. ■
(c) Merchant Stores.—Grocery-stores in particular presented problems in
many instances. This was due to the fact that although home-owners realized
that compensation would be forthcoming, there was little likelihood of commercial organizations receiving compensation for losses. Food products in all
except water-tight containers were already destroyed by the flood-waters.
Canned foods presented a particular problem. It was considered at first that
canned goods could be used after merely immersing the cans in a chlorine solution, Z 30 BRITISH COLUMBIA.
but the sanitarians soon discovered that cans that had been under water for
several days showed evidence of spoilage. As a result, a good deal of diplomacy
was needed in persuading merchants that goods which in many instances were
the last remnants of his stock, and which to his eye seemed satisfactory, must
be destroyed. However, the policy of destroying canned goods was carried out
in all cases. All bottled goods, such as soft drinks, were destroyed regardless
of the length of time of immersion, as it was considered, and later proved, that
capping methods commonly in use gave little protection against contamination.
Much of the contamination of both cans and metal caps of glass bottles was
caused by corrosion of the metal followed by entry into the contents of bacteria.
(d) Cold-storage Locker Plants.—There are numerous cold-storage locker
plants throughout the valley, but in only two instances was a cold-storage locker
plant affected. In one case the cold-storage locker plant was deprived of electrical energy for two days. However, the plant was closed so that no doors into
the cold-storage section were open, and the plant maintained its refrigeration
temperature for the two days.
In the other case it was impossible to empty the contents of the plant before
the flood-waters became too high. Seven tons of meat remained in the plant.
Water covered about half the lockers in the plant for three or four weeks. It
was then exposed to the heat and flies for some weeks, and as a result the condition of this plant when the waters finally receded was indescribable. The odour
was so intense that it was only with great difficulty that men were able to enter
the plant to commence clean-up operations. Even with the use of gas-masks,
a man could only stay in the plant for a short period of time. Also, the plant
was alive with maggots and flies.
All the lockers were torn out and the lumber destroyed. In addition, the
lining of the plant was taken out and the insulation dried. This plant is now
in operation again.
(e) Pasteurizing Plants.—Several of these plants were affected, but, due
mainly to their normal experiences in sterilizing equipment, no serious difficulties were encountered in cleaning them.
(/) Sewage-disposal.—There were no municipal sewage-disposal works
affected by the flood, as the greater part of the affected area used either septic
tanks or privies. The latter were all problems, as in some instances the septic
tanks were completely destroyed and in other instances privies were carried
away by the flood. The privies were liberally treated with chloride of lime or
covered in, as the individual case warranted.
(g) Dead Animals.—Very few dead animals were found as the water
receded, and these all presented individual problems. In some instances it was
possible to bury the animals on the spot. Early in the flood the use of flamethrowers was suggested, and while the Army was still in the area this method
proved satisfactory.
(h) Garbage-disposal.—The only problem that came to the attention of
the Health Department regarding garbage was during operation overflow when
certain individuals refused to leave their homes. As there were less than twenty
such families in the whole area, this did not present any real difficulty, as in
most cases the swollen waters of the Fraser River quickly carried garbage away.
During operation clean-up, garbage was easily disposed of through normal DEPARTMENT OF HEALTH AND WELFARE, 1948. Z 31
channels and by the use of emergency garbage-disposal dumps which were set
up for this particular operation.
(i) Barns and Milk-houses.—No unusual problem was presented here, as
the usual recommendations of plenty of hard manual labour, followed by the use
of chlorine products, were successful. In the cleaning of barns, the use of a
solution of sodium or calcium hypochlorite by a steam spray was very successful.
(j) Public Buildings and Schools.—No particular problems were encountered regarding public buildings. Some schools were damaged by flooding, but
the same clean-up procedures were used as for homes. Several community halls
and roller-skating rinks were damaged structurally. Some of these have not
been reopened at this writing.
The problems that arise for a Health Department when a flood covers some
70,000 acres of a highly populated area are presented. The importance of the
Provincial Health Department having direct control over public health services
is stressed. It is only in this manner that sufficient numbers of public health
personnel can be obtained in times of emergency. The value of immediately
seeking the assistance of senior government authorities, including the Department of National Health and Welfare and the medical branch of the Department
of National Defence, is evident. Without such aid, much of the success of this
work would not have been possible. It is essential that on the appearance of
a possible flood emergency, the Health Department should prepare plans in
regard to headquarters, personnel, channels of communication, and general
policy. During the emergency, directives should be sent out to all concerned
at frequent intervals, and the senior officials in direct charge of the different
aspects of flood-control should spend much time in the field.
The work of the Health Department in the two main phases of the Lower
Fraser Valley flood emergency is discussed. There is no clear line of demarcation between these two phases. The tempo of the work for the public health
nurses increases early, chiefly due to typhoid immunizations, while that of the
sanitarians and public health engineers increases as the flood-waters recede.
1. The fact that not a single case of typhoid fever or any other type of
flood-borne illness occurred from the aftermath of the flood is to be noted.
2. There was no positive evidence of any salmonella infections, although
a minor outbreak of some form of gastro-intestinal infection did occur among
dyke-workers in one area.
3. Chlorine-bearing compounds are the sterilizing chemicals of choice in
such an emergency.
4. The success of any attempt to control disease in floods depends upon the
hard work and long hours put in by Medical Health Officers, public health engineers, public health nurses, and sanitarians in the field.
5. Any Provincial or State health department should be so flexible that
sufficient trained public health personnel can be placed in the area of emergency
6. During an emergency the public will co-operate very effectively with
the Health Department.
This Annual Report contains complete accounts of the year's activities in
the various bureaux and services which constitute the Provincial Department
of Health. Although the reader is referred to these accounts for specific details,
this summary stresses outstanding features.
Bureau of Local Health Services.
Eighteen health units have been proposed. Eight have already been established. At the year's end, three of these were operating without the direction
of physicians trained in public health.
Plans for the establishment of health units in the Upper Fraser Valley,
the Trail district, the Kamloops district, and the Courtenay district were well
advanced. In each of these, Sanitary Inspectors were appointed, but at the
year's end medical directors were not available to make the health unit " teams "
Ten additional Sanitary Inspectors were appointed to provide services in
existing and potential health unit areas.
Plans were made to provide more uniform supervision of clerical staff in
the field.
A statistician was appointed to supervise the compilation of data available
in health units and public health nursing districts.
A dentist was appointed as the initial step in the formation of a division
of preventive dentistry.
The Cariboo Health Unit, with headquarters at Prince George, began operations in February when a public health physician was appointed Director.
Material assistance was provided to the Greater Vancouver Metropolitan
Health Committee. Additional funds were made available to this Committee,
both from Provincial moneys and from the new Federal health grants.
Councils and School Boards in North and West Vancouver reached agreement concerning the formation of a North Shore Health Unit within the Greater
Vancouver metropolitan health services.
Provincial moneys and funds from the Federal health grants were allotted
to the Victoria-Esquimalt Health Department to make possible increased supervision of the public health nursing programme and to establish programmes of
public health education and mental hygiene.
In co-operation with the flood-emergency authorities, personnel of local
health services served throughout the flood and rehabilitation periods to prevent
the occurrence of epidemics and to assist families during evacuation from, and
return to, their homes.
During the flood period the only disease outbreak was a minor epidemic of
gastro-intestinal infection among the dyke-workers in one section of the Fraser
For the year as a whole, 23,632 cases of disease were reported. This represents the lowest year's incidence of notifiable diseases since 1940. It would
seem to indicate generally a more healthy picture for British Columbia during
Community education and organization concerning X-ray surveys continued to be the responsibility of the public health field staff, while the itineraries of the mobile equipment and the general policies were planned by the
central office staff of the Provincial Department of Health.
This policy, established in 1947, proved satisfactory in most instances.
Further experiences and refinements in general procedure will undoubtedly
result in improvements.
Public Health Nursing.
The following statements are intended to provide a general picture of the
activities of each public health nurse. The figures are average figures. During
1948 a public health nurse in British Columbia:—
Served a population of approximately 5,000 people.
Travelled within a radius of 20 to 50 miles to cover a rural area.
Supervised the health of some 1,000 school-children.
Supervised an average of twenty persons with tuberculosis.
Organized and conducted approximately five child-health conferences
each month, with an average attendance of fifteen to twenty
infants and pre-school children.
Made numerous home-visits for the purpose of infant-health supervision.
Organized immunization clinics which were open to all members of the
Conducted an educational programme on improved sanitation particularly within the home.
Gave practical demonstrations of home nursing to instruct some member of the family in such procedure as patient-care, baby-care,
short-term treatments, and hypodermic injections.
Four new public health nursing districts were opened in 1948—Castlegar,
Invermere, Burns Lake, and the North Thompson District.
Public health nursing services were expanded in many other districts and
health unit areas.
During the year 107 public health nurses were on duty throughout the
Approximately 94 per cent, of the population of British Columbia was
covered by public health nursing services.
The field staff was increased by seven public health nurses. Eight registered nurses were employed on a temporary basis on a nursing " internship "
plan which makes provision for further academic training if the nurses show
their suitability for public health nursing careers.
In-service education of the public health nurses was provided through
frequent staff meetings, study-groups, and formal courses.
Study-group subjects included mental hygiene, infant welfare, the tuberculosis programme, and welfare agencies.
A representative of the Federal Division of Maternal and Child Health
addressed five study-groups on the prenatal and maternal health programme.
A faculty member of the School of Public Health, University of Michigan,
conducted a ten-day course in supervising practices for senior nurses.
The Director and field staff of the Division participated in the training of
student-nurses enrolled at the University of British Columbia and four hospitals
throughout the Province. This included work at both the undergraduate and
graduate levels.    Both lectures and field experience were given.
By arrangement with the Department of National Health and Welfare,
public health nurses continued to give service to Indian reserves.
During the flood emergency the public health nursing staff was concentrated in the affected areas, where the nurses rendered services of major importance in safeguarding the health of the public.
Nutrition Service.
Throughout 1948 nutritionists of the Provincial Department of Health
provided consultative service to local public health personnel through attendance at staff meetings in local areas and conference with individual members
of the field staff; publication of articles on nutrition in the Department's
" Public Health News and Views "; compilation of concise information and data
on special technical subjects; and collection, evaluation, and distribution of
illustrative materials.
Nutrition Service, in co-operation with local public health field staffs and
other departments of Government, provided assistance to hospitals and other
institutions in solving problems of quantity food service. These were concerned
with adequate and varied menus, special diets, selection and arrangement of
equipment, food costs, and organization of the food service.
During the year, staff members of Nutrition Service participated in professional meetings on both the Provincial and National levels, assisted in the
public health education of teachers and student-nurses, provided consultative
service to a committee of the Department of Education in the revision of the
school health curriculum, held joint meetings with members of the Department
of Agriculture to discuss food production and consumption, served in the
devastated areas at the time of the spring floods, and collaborated with the
Division of Health Education in providing material for a radio programme.
Division of Vital Statistics.
The activities of this Division lie in two major fields: (1) Statistical
studies and analyses, and (2) registration of births, deaths, marriages, divorces,
still-births, adoptions, and changes of name.
The Statistical Section served as a workshop for the Health Branch where
statistical problems were concerned. It also provided data to other departments of Government and to the public.
Completeness of registration for the general population had attained such
a high level that efforts were being directed toward improving the quality rather
than the quantity.
Although registration among Indians and Doukhobors still presented problems, much improvement was achieved during 1948.
Inspection of registration offices throughout the Province again proved
its value.
The efficiency of the Division as a whole was increased through the use of
improved methods and forms. DEPARTMENT OF HEALTH AND WELFARE, 1948. Z 35
A campaign to secure adequate verification in eases of delayed registration
resulted in the gathering, microfilming, and indexing of many thousands of
The system whereby verifications of births, deaths, and still-births were
reported to some health units during the previous year was extended to include
all health units and the Greater Vancouver Metropolitan Health Committee.
Parts II, III, and IV of the Manual of Instruction for District Registrars,
Marriage Commissioners, and Issuers of Marriage Licences were distributed
to all district officials. (Part I had been previously distributed in October,
The Director of the Division attended the fifth meeting of the Vital Statistics Council for Canada, in October, in Ottawa. Important topics of discussion
were Regulation No. 1 of the World Health Organization and its implementation, model Vital Statistics Act, and minimum standards for delayed registration.
The adoption of a World Health Organization regulation concerning
diseases, injuries, and causes of death added to the responsibilities of the
Division. Instructions, forms, and information will have to be distributed to
physicians, hospitals, and District Registrars throughout the Province. The
format of many vital statistics tables will have to be changed.
The question of amending the present British Columbia " Vital Statistics
Act " or replacing it by the model Act arose. This will bear close consideration
by the Attorney-General's Department and staff of the Division.
The minimum standards for delayed registration of birth were reaffirmed
and endorsed by the Vital Statistics Council for Canada. It is understood that
each Province has agreed to these recommendations. (British Columbia has
been adhering to them since February, 1945.)
Division of Laboratories.
Almost 365,000 laboratory examinations were made by this Division in
1948. Almost 300,000 of these were performed in the central laboratory in
There was a slight decline in the number of tests performed by the branch
laboratories throughout the Province, but the tests performed in the central
laboratory showed an increase of approximately 10 per cent.
The tests continued to become more exacting, and there is a tendency for
the more complicated tests to be referred to the central laboratory.
Tests relating to venereal disease control represented almost three-quarters
of all tests.
Tests relating to the laboratory diagnosis of tuberculosis again increased.
In work concerned with gastro-intestinal infections, the laboratory dealt
with several outbreaks of staphylococcal food poisoning and one outbreak of
botulism. There were, however, no major Salmonella-Shigella epidemics
(typhoid-dysentery infections).
The number of milk and water samples examined increased. This was
encouraging evidence of the competent attention being given to this important
phase of public health work.
Tests relating to diphtheria increased approximately 15 per cent., indicating
that the importance of diphtheria toxoid as a preventive measure should be
stressed. Z 36 BRITISH COLUMBIA.
During the flood emergency the central laboratory was much involved in
the distribution of biological products. The laboratory subsequently undertook
the testing of water from flooded wells in the amended area. During the course
of a few weeks, T.A.B. vaccine sufficient for the immunization of some 60,000
persons was distributed.
The laboratory assisted in intensive immunization campaigns against
typhoid and paratyphoid T.A.B. in the Peace River, Cariboo, and East Kootenay
Health Units.
The distribution of biological products for the prevention and control of
communicable diseases reached new records in 1948. More than 50,000 packages of various products were released for distribution. Sufficient vaccine
virus was distributed to vaccinate almost 50,000 persons against smallpox.
Diphtheria toxoid for the immunization of approximately 40,000 children, pertussis (whooping-cough) vaccine for 30,000 children, and T.A.B. vaccine for
approximately 80,000 persons were also released free of charge to practising
physicians and health officials throughout the Province.
Division of Venereal Disease Control.
For the second consecutive year there was a substantial decrease in venereal disease rates. This was a reflection of the increased efforts in case-finding
and the earlier and more rapid treatment.
The provision of free drugs and free consultative services continued
throughout the year.
Changes were effected in treatment methods to conform with the findings
of recent research throughout the world.
As a result of the success of the female clinic in the Vancouver City Gaol,
a diagnostic clinic was established in the male section of the gaol. Serological
tests are now performed on 25 per cent, of all male prisoners.
Increased efforts were made toward the establishment of the routine blood-
testing of all women in pregnancy, with full anti-syphilitic treatment for those
cases found to be positive.
The programme for control of premises facilitating spread of venereal
diseases was taken over by the Epidemiology Section of the Division. This
programme was formerly conducted by the Social Service Section. The change
now leaves the latter free to deal with social problems of individuals.
The Director of the Division was appointed Assistant Provincial Health
Officer, to act as the Deputy Minister of Health's representative in the Vancouver area and to assume major responsibilities concerning the Federal health
Division of Tuberculosis Control.
A shortage of approximately 500 beds for the treatment of tuberculosis
existed during 1948. Plans for a new 500-bed unit in Vancouver were completed, and it is hoped that construction will begin early in 1949. This should
provide 250 of the proposed 500 beds. Construction on the addition to the
Vancouver unit neared completion at the year's end. This building, provided by
the British Columbia Tuberculosis Society, will house new surgical and teaching
facilities and an auditorium. It will allow this institution to carry out every
form of active treatment for tuberculosis patients and will make this one of the
best-equipped and best all-round treatment units of its kind in North America. DEPARTMENT OF HEALTH AND WELFARE, 1948. Z 37
Many of the changes that have been recommended for the improvement of
facilities at the Tranquille unit were accomplished during the year. These
included new housing facilities for the staff and a change in the electrical power
from direct to alternating current.
There was a greater drop in the death-rates of tuberculosis this year than
in any previous year in the history of the Province.
The Vancouver unit of the Division of Tuberculosis Control was certified
by the Royal College of Physicians and Surgeons of Canada as a post-graduate
training centre in chest diseases.
The clinics operated by the Division during 1948 continued as in the previous years. It was impossible to have physicians attached to the travelling
diagnostic clinics, except in one instance. Consulting services had to be limited
to the taking of X-ray films in the rural areas and forwarding these to the main
units of the Division for interpretations. The number of examinations performed by the stationary survey clinics continued to increase. This in turn
placed an additional load on the stationary diagnostic clinics. The mobile units
performed approximately the same volume of work as in 1947.
The expensive equipment used in these surveys was provided several years
ago by the British Columbia Tuberculosis Society. It has served the communities of the Province well. Although plans are in only the preliminary
stage, it is hoped that the service of these " buses " will be supplemented by
making use of new X-ray equipment in strategically located larger hospitals and
health units throughout the Province.
In the tuberculosis nursing programme, much time and effort was devoted
to projects dealing with the standardization of policies and routines. Programmes for staff orientation and patient education were outlined and adopted
to local circumstances in various units. Although there was still a shortage of
nurses, recruitment improved during the last few months. The educational programme for undergraduate and postgraduate students progressed favourably.
In the social service field, it was found necessary to close the boarding-
home for women. This had not been replaced by the end of the year. Placement problems concerning women patients and those long-term chronic patients
who have intermittent positive sputums have become critical.
Division of Public Health Engineering.
This Division reviewed and approved approximately $2,000,000 worth of
waterworks construction during the year. In addition, sanitary surveys of
a number of existing water-supplies were carried out.
Approximately $2,000,000 worth of sewerage works were revised and
For the first time in many years there was no major milk-borne epidemic
in British Columbia. The Division feels that this may be attributed to the
increase of the use of pasteurized milk.
The sanitary inspection of tourist resorts was made the responsibility of
the Local Sanitary Inspectors. The Division now has reports on 656 tourist
During 1948 the Division received detailed reports concerning the environmental sanitation of the 342 schools. It was noted that many improvements
have been made following reports of inspections made in 1945, 1946, and 1947.
Early in the year a survey of glass-washing facilities in beer-parlours was
made in co-operation with the Liquor Control Board. This survey revealed
tremendous improvements in glass-washing methods.
Restaurant inspection continued, and with the increased staff of Sanitary
Inspectors it is expected that by the end of 1949 all the restaurants in the Province will have been inspected three or four times during the year.
Ten new Sanitary Inspectors were added to the staff, which was thus
increased to nineteen in number.
Emergency conditions relating to the flood occupied the full attention of
the Division from May to August. During the height of this emergency ten
extra Sanitary Inspectors were placed on duty in the Lower Fraser Valley.
Eight of these were Provincial Sanitary Inspectors from other parts of the
Province and two were members of the staff of the Greater Vancouver Metropolitan Health Committee. Four public health engineers were made available
to the Provincial Department by the Department of National Health and Welfare. The work included the sanitation of work camps and evacuee camps, the
inspection of all homes that had been damaged, and sanitary surveys of 439
wells. Emergency chlorinating apparatus was installed in two public water-
supplies. Several tons of chloride of lime and other chlorine products were
distributed for clean-up purposes.
Division of Public Health Education.
The film library was increased, but at the year's end was again found to
be too small to meet the demands in some fields. The staff of the Division conducted frequent previews and studies of health films in order that they might
provide sound consultative service to potential users.
In co-operation with the Division of Public Health Nursing, the Division
of Tuberculosis Control, and the British Columbia Tuberculosis Society, the
Division assisted in the revision of materials for mass X-ray surveys.
Much time was devoted to the necessary work of classifying filing materials useful in public health education. These included books, periodicals, and
pamphlets.   This work again revealed the need of a trained librarian.
In spite of the loss of the editor, the " Health Bulletin " was published and
distributed with only slight departures from the normal publication dates.
The orientation programme for new staff members was improved and
formed the basis of in-service training for newly appointed Health Unit Directors, Sanitary Inspectors, statisticians, and health educators. A similar course
was planned for a new field-worker on the staff of the Junior Red Cross to
acquaint her with Provincial public health services.
The Division took a part in the in-service education of Departmental personnel by assisting in planning and collecting materials for courses for study-
groups. The Consultant in Health Education gave lectures at the Victoria Summer School for teachers, the public health nursing class at the University of
British Columbia, and the senior nursing classes at the Royal Jubilee and St.
Joseph's Hospitals. DEPARTMENT OF HEALTH AND WELFARE, 1948. Z 39
Consultative service was provided on request to the Department of Education in planning the revised school health curriculum. Work was also done on
a handbook of communicable diseases which is being prepared as a teacher's
The staff of the Division assisted in the preparation and implementation
of plans for the Canadian Public Health Association meeting held in Vancouver
in May.
During the flood emergency the Division complied with requests to compile
information and prepare material for distribution. News releases and instructions to householders in clean-up procedures were included.
The Director of the Division was appointed Administrative Assistant to
the Deputy Minister of Health, and the editor of the " Health Bulletin " resigned
during the course of the year.
Provincial Infirmary.
The Provincial Infirmary continued to maintain patients in three separate
units as follows: Marpole, 124 beds; Allco, 100 beds; and Mount St. Mary,
Victoria, 105 beds under contract.
All patients admitted were first screened through either the Vancouver
General Hospital or St. Joseph's Hospital, Victoria, where each patient was
given a thorough examination.
A physician is in charge of all patients. The services of an eye specialist
and dentist are provided.
Surgery and other forms of treatment were provided to Infirmary patients
at the Vancouver General Hospital, St. Paul's Hospital, the Western School for
Rehabilitation, and the Cancer Clinic.
The services of a part-time physiotherapist and a full-time occupational
therapist were maintained.
The Women's Auxiliary of the Marpole unit continued their untiring and
active interest in the welfare of the patients.
The Superintendent of the Provincial Infirmary welcomed the appointment
of an Advisory Committee to assist her. This Committee consisted of two
officials of the British Columbia Hospital Insurance Service and a personnel
officer of the Civil Service Commission.
An analysis of deaths in the Province is valuable in measuring the general
well-being of the people. However, statistics on deaths must also be considered
with the incidence of sickness and disease in order to obtain an accurate picture
of the health of the people.
It is of interest to note that the death-rate in British Columbia has
remained fairly constant during the last two decades. Preliminary figures,
excluding Indians, based on the first ten months of 1948, indicate that the crude
death-rate increased slightly from 9.8 per 1,000 population in 1947 to 10.2 in
A consideration of age specific mortality experience in the Province shows
a reduction of deaths in the earlier age-groups and the lengthening life-span of Z 40 BRITISH COLUMBIA.
the population. The provisional death-rates for 1,000 population in specific
age-groups, based on the first ten months of 1948, were 3.2 in the group 0-19
years, 1.9 in the group 20-39 years, 7.6 in the group 40-59 years, and 47.8 in
the group 60 years and over.
A comparison of the 1948 figures with those of two decades ago further
reveals gains in longevity in the Province. The age specific death-rate in 1948
in the group 0-19 was only 58 per cent, of the corresponding rate in 1928 and
the 1948 rate in the group 20-39 was only 44.2 per cent, of the same rate in
1928. A less significant decrease was also noted in the 1948 rate in the age-
group 40-59, as compared with the 1928 rate. In the age-group 60 and over
the 1948 rate was 28.9 per cent, higher than the comparable rate in 1928.
Progress has been made in gaining control of conditions and influences affecting
life to the extent that people are now attaining the older age-groups.
A study of each age-group from 1 to 39 shows that more deaths occurred
from accidents than any one other cause. Congenital malformations and infectious diseases ranked equally as the second leading cause of death in the group
1-9 years, while tuberculosis ranked second in the group 10-39. Pneumonia
was the third leading cause of death in the group 1-9, and diseases of the heart
was third in order of importance in the group 10-39.
The three leading causes of death in the age-group over 60 years were
diseases of the heart and arteries, cancer, and intracranial lesions.
Infant mortality has declined both in number and in rate. The rate of
22.8 per 1,000 live births is 22.7 per cent, lower than the rate of 29.5 recorded
last year. Premature births, congenital malformations, and injury at birth
were the three chief causes of death among infants. This year's rate is one of
the lowest rates in the history of the Province.
Deaths from maternal causes were also at a minimum in 1948. The preliminary maternal mortality rate was 0.9 per 1,000 live births, compared with
1.2 for 1947.
The two leading causes of death, diseases of the heart and arteries and
cancer, each showed increased rates when compared with 1947 figures. The
provisional death-rate for diseases of the heart and arteries per 100,000 population, excluding Indians, was 401.9. This was 7.4 per cent, higher than the
rate of 373.9 recorded in 1947. The preliminary cancer death-rate for 1948 was
149.1 per 100,000 population. This figure represents an increase of 3.3 per cent,
over last year's rate.
Accidents, the third leading cause of death, had a rate of 76.3 in 1948,
compared with 78.8 per 100,000 population in 1947. In the distribution according to type, deaths from automobile fatalities held first place among accidents,
accounting for 20.7 per cent. Deaths from accidental falls or crushing were
responsible for 14.7 per cent., and drowning accounting for 11.6 per cent.
Nephritis and pneumonia were the fourth and fifth leading causes of death
respectively, according to preliminary figures for 1948. Both of these causes
showed an increase in rate over the 1947 figures. The nephritis death-rate in
1948 was 40.7, compared with 35.3 in 1947. In 1948 the pneumonia death-rate
was 39.2, compared with 33.1 in 1947.
Diseases of early infancy, the sixth main cause of death, was followed by
intracranial lesions, tuberculosis, diabetes, and congenital malformations. DEPARTMENT OF HEALTH AND WELFARE, 1948. Z 41
J. A. Taylor, Director.
The term " local health services " denotes public health services at the local
or municipal level, embracing public health nursing and environmental sanitation, and is closely allied with the services in tuberculosis control, venereal
disease, laboratories, nutrition, and public health education, which, although
administered by separate divisions, are interpreted to the community by the
field staff in local health services.
The original establishment and continuity of planning for local health
services have been, in the main, the task of Dr. J. S. Cull, Deputy Provincial
Health Officer, who for eleven years was Director of Local Health Services for
the Province. Although the demands on his time and energy were multitudinous, he was able to formulate and, as personnel became available, to expand
gradually local health services to the point that there was an unprecedented
demand from all areas of the Province for inauguration of full-time health
services. His resignation early in 1948, to become Provincial Medical Director
of the Red Cross Blood Transfusion Service, created a loss to the Department
which was particularly regrettable, since it coincided with the provision of
additional finances by the Department of National Health and Welfare to
augment public health services throughout the Province. The introduction of
the Federal grants provided an opportunity for development of local health
services on the basis of the formative planning of Dr. Cull, to whom belongs
considerable credit for the progress which was possible during the year.
Planning for local health services in British Columbia has evolved around
the formation of health units to provide full-time local health services. Eighteen
health units have been proposed to provide entire Provincial coverage; eight
have already been established, of which three are operating without the direction
of public-health-trained physicians. It is the lack of these latter personnel that
has continued to hamper the development of complete health unit services
throughout the Province.
Although it has been found impossible to establish complete health units as
desired, the impetus given by the Federal health grants toward augmentation of
public health services has permitted additional progressive steps toward that
goal.    These developments can be briefly listed as follows:—
(1) To augment the programme of environmental sanitation, ten
additional Sanitary Inspectors have been appointed to provide
inspection services in existing and potential health unit areas.
This fulfils the requests of numerous communities for this type of
(2) To expand nursing services as needed; extra public health nurses
where required and the employment of registered nurses for bedside nursing care in certain areas. This expansion is only feasible
as nursing personnel become available; the demand still exceeds
the supply. Z 42 BRITISH COLUMBIA.
(3) To appoint a clerical supervisor and additional clerical staff to
assist in the maintenance of records and preparation of reports.
(4) To provide special types of equipment to existing and potential
health unit centres to permit a more effective provision of service
to the public.
(5) To provide increased laboratory services, consideration is directed
toward assisting local hospitals in strategic locations to provide
laboratory facilities for both clinico-pathological and public health
tests, which will become branch laboratories under the Division of
(6) To expand the programme of environmental sanitation, necessitating a degree of supervision, in particular where Sanitary
Inspectors are operating without Health Unit Directors. To provide for this, another engineer has been appointed to the Division
of Public Health Engineering.
(7) To provide further development of statistical services within
health units, a statistician has been engaged to devote his major
attention to the compilation of statistical data in the field. This
has been a long-expressed desire of the Health Unit Directors.
(8) To appoint a dentist as the initial step toward the formation of a
Division of Preventive Dentistry. He will devote his complete
interest to the organization of dental clinics to deal with the
increasing problem of dental caries among children.
At the close of last year it was intimated that the Cariboo Health Unit, with
headquarters at Prince George, was expected to commence operation early in
1948. This prediction became an actuality in February when a public health
physician was appointed as Director of the new unit, which serves Prince
George, Vanderhoof, Quesnel, Wells, Williams Lake, Lac la Hache, and the intermediate unorganized territory. By June a Sanitary Inspector was added to
the staff to provide the complete health unit team. However, the distances
between population centres are so lengthy that it is difficult to plan a regularly
organized periodic inspection service. Thus, this is one of the areas to benefit
from the augmented environmental sanitation programme through the addition
of another Sanitary Inspector, who will be centred at Quesnel.
The Cariboo Health Unit was the only one it was possible to open in 1948.
Plans had provided for the establishment of a health unit in the Upper Fraser
Valley, to be centred at Chilliwack, but this was thwarted by the shortage of
medical personnel. In addition, Trail and district are well advanced in health
unit planning, even to the point of provision of a commodious well-planned office,
while Kamloops district and Courtenay district have also requested inauguration
of complete health unit services. In each of these, sanitary inspection services
have been added this year to provide almost a complete health unit team, only
the Medical Director being necessary to complete the staff.
Resignations of the Directors of the Saanich and South Vancouver Island
Health Unit, the Prince Rupert Health Unit, and the East Kootenay Health Unit
occurred during the year.    These, together with the resignation of the Deputy DEPARTMENT OF HEALTH AND WELFARE, 1948. Z 43
Provincial Health Officer, occasioned a set-back to developmental progress in
health units.
To fill the vacancy in the central office, the Director of the Central Vancouver Island Health Unit accepted an appointment as Director of Local Health
Services, while the Director of the South Okanagan Health Unit (formerly the
Okanagan Valley Health Unit) transferred to the Central Vancouver Island
Health Unit. The employment of two recently graduated public health physicians permitted the filling of the vacancies in the South Okanagan Health Unit
and the Saanich and South Vancouver Island Health Unit.
The former Director of the East Kootenay Health Unit is continuing on a
part-time basis as Acting Director of that unit. Prince Rupert Health Unit,
minus a public health physician for the second time in its six-year history, is
carrying on under the direction of Dr. A. W. Large, while the Peace River Health
Unit functions without a qualified Director, as it has for the past five years.
The health services in the Greater Vancouver Metropolitan Health Department continued to show material progress during the year. Conferences were
held with the Senior Medical Health Officer to discuss recommendations for
expansion of public health services within each of the participating municipalities, toward which this Department offered materially increased grants.
Further additional funds were made available to the Metropolitan Health Service as a result of this Department assuming the entire cost of public health
laboratory tests and the purchase of all biological products. Finally, opportunities for further expansion were provided through the Federal health grants
on the basis of the several approved projects submitted by the Senior Medical
Health Officer.
A definite forward step, within the Metropolitan Health Service, was taken
when final agreement was reached by the Municipality of West Vancouver, the
Municipality of North Vancouver, the Corporation of the City of North Vancouver, and the School Boards of Districts No. 44 (North Vancouver) and
No. 45 (West Vancouver) toward the formation of a North Shore Health Unit.
This will provide for more effective operation of health services, while providing for more efficient administration and financing of the service. The
North Shore Unit will continue to maintain representation on the Metropolitan
Health Committee as an integral component of that original body.
The Department acknowledges with gratitude the excellent co-operation of
the Senior Medical Health Officer and staff of the Metropolitan Health Department. During the floods, several staff personnel were loaned to the Provincial
Department, and on several occasions individual senior officials departed from
their own tasks to investigate reported communicable disease incidence outside
their own areas. Such co-operation serves to emphasize co-ordination and
unity of purpose among local health services toward maintenance of health
throughout the Province.
Changes in the senior staff of the Victoria-Esquimalt health service were
occasioned during the year. The resignation of the senior Medical Health
Officer occurred early in the year, and the position was assumed by the Director
of the Saanich and South Vancouver Island Health Unit. Later in the year the
Assistant Medical Health Officer resigned to accept a commission in the Royal Z 44 BRITISH COLUMBIA.
Canadian Air Force, his position being assumed by a former practitioner in
Increased financial grants by this Department permitted a certain degree of
expansion within the Victoria-Esquimalt Health Department. As a result, a
public health nursing supervisor was appointed to supervise and correlate the
public health nursing programme in these metropolitan areas, while provision
was made for office expansion and additional clerical help. The beginning of
public health education and mental hygiene programmes within the Victoria-
Esquimalt area is possible as a result of approved projects submitted under the
Federal health grants.
The scheduled quarterly meetings of the Health Unit Directors, inaugurated last year, were continued, being held in January, May, and September for
two- or three-day periods. At these meetings, discussions centred around topics
which were submitted in advance by the field staff, resulting in clarification of
numerous problems, while explanations of policies and programme ensued.
These meetings are felt to be of distinct value in permitting the various Health
Unit Directors to meet together to thresh out common problems and develop a
united programme.
Throughout the Province there are sixty-nine medical practitioners serving
as Medical Health Officers for their communities, acting under the " Health
Act " as the responsible health authority in the district under their supervision.
These physicians have co-operated with the public health nursing field staff,
in the areas outside of health units, to promote a degree of public health progress which would never have been possible without their assistance. Programmes of sanitation, communicable disease control, immunization, and infant
clinics have all evidenced their support and active participation. Assistance
has been available to these health officers, and consultative aid has been provided in numerous instances to deal with problems arising from incidence of
communicable disease or inadequate sanitation. Considerable credit is due
these men for the time, effort, and interest they have provided toward improvement of public health conditions for their own communities.
All parts of this Province were ravaged by floods during the late spring and
early summer. The dissemination of garbage and sewage by flood-waters, the
contamination of water-supplies, and the evacuation and congregation of communities within evacuation centres created facilities for rapid spread of infection and potential hazards to the health of the public, which were of major
concern to the various local health services. In co-operation with the flood-
emergency authorities, local health services served throughout the flood and
rehabilitation periods to prevent the occurrence of any epidemics, while assisting the families during evacuation from and return to their homes. Immunization centres were organized on short notice all over the Province, while special
instructions and advice for treatment of water-supplies and reconditioning of
homes were prepared and disseminated by radio, newspaper, and poster. Sanitary Inspectors and public health nurses were borrowed from local health services in non-flooded areas in Vancouver and Vancouver Island for service in
flooded areas, while those remaining carried extra duties.
Floods occurred in the East Kootenay, West Kootenay, Okanagan Valley,
Bulkley Valley, Cariboo, and Fraser Valley areas. The only disease-outbreak
was a minor epidemic of gastro-intestinal infection among the dyke-workers in
one section of the Fraser Valley, a record which speaks well for the effectiveness
of local health services during the flood conditions. This record was only
established as a result of the closely concentrated effort of Medical Health
Officers (part time and full time), public health nurses, Sanitary Inspectors,
and various senior officials who worked long hours, at a personal sacrifice of
time, doing their best to ensure maintenance of health to the degree that those
who had suffered the loss of their homes would not be exposed to the added
calamity of sickness.
One major task of local health services is to provide school medical services
to the various schools throughout the Province. This entails physical examination of the school-children, detection of communicable disease amongst pupils
and personnel, control of spread of infection, organization and conduction of
immunization clinics, and inspection of the school plant and environment,
including the sanitary facilities.
The details concerning school medical services are provided in the Medical
Inspection of Schools Report. The policy concerning examination of the pupils
by the School Health Inspector in Grades I, IV, VII, and X routinely each year
has been continued, as being the most practical use of the physician's time.
The pupils in the intervening grades are screened by the public health nurse,
who refers pupils to the School Medical Inspector for a more detailed examination where necessary.
The Department acknowledges with gratitude the interest, aid, and
co-operation of the seventy-four part-time School Health Inspectors throughout
the Province, who, at no small sacrifice of time, have carried on school medical
services in their area. Their co-operation with the local public health staff is
much appreciated, both by the local staff and the senior officials of this Department.
Three years ago a new report form covering environmental sanitation of
schools was introduced, which provided in detail a fairly complete analysis of
the physical features of the school buildings and grounds. This report form has
proved most valuable in providing such information as lighting, heating, ventilation, water-supply, sewage-disposal, and food-handling facilities in cafeterias
and lunch-rooms. However, it is now felt advisable to revise this form to
provide a more concise follow-up record, since so few of the school buildings
change from year to year. It is felt that the original complete report form,
with a short concise follow-up report, will provide all the information in detail
required by this Department or the local School Board. A committee has been
appointed to study this matter and recommend a practical substitute for the
present form.
In the last Report, mention was made of a special study being conducted in
the Central Vancouver Island Health Unit by this Department and the Child and
Maternal Health Division of the Department of National Health and Welfare.
This had reference to the use and application of the Wetzel Grid in assessing
the physical status of the school-child. A preliminary report on this study was
presented at the Canadian Public Health Association meeting in May, in which
certain evidence was shown to prove that the Wetzel Grid did present some
advantages over the clinical assessment of the physical condition of the pupil.
However, it was pointedly mentioned that further study was indicated before
conclusive evidence could be presented. For this reason, a study is being continued on the same co-operative basis for another eight months' period, to be
completed in June, 1949. More detailed investigation into emotional tension
and nutritional factors as they affect growth and development are being
assessed in this further study, and it is expected more worth-while evidence
will be garnered as to the practicability of the Grid in comparison with the
present school medical examinations.
A complete list of the diseases reported from the various Medical Health
Officers throughout the Province during the year is shown in Table I (page 49).
From this it will be noted that the total number reported—namely, 23,632—
represents a material decrease over the number reported during the previous
year. As a matter of fact, it is the lowest year's incidence of notifiable diseases
since 1940, and would seem to indicate generally a more healthy picture for
British Columbia during last year. Actually the decrease is substantially due
to the very low incidence of minor communicable infections of childhood, such as
measles, mumps, and whooping-cough. It must, however, be acknowledged that
the communicable disease situation in general was a favourable one for British
Columbia, as even those diseases common to the population as a whole showed
material decrease.
Last year the Province experienced an epidemic year in so far as poliomyelitis was concerned, there being 312 individuals reported. This year there
were only 118 cases reported, which is a curious circumstance, in view of the
fact that there were epidemics to the east and south where more cases than ever
were reported. It is of further major interest that the earliest cases reported
occurred in the Peace River District, which had a local epidemic of poliomyelitis
for the first time in its history, where 26 cases were reported for the entire year.
The onset in the British Columbia portion of the Peace River Block was followed
by the occurrence of cases in the Alberta section of the block, and finally by considerable incidence of cases in the Province of Alberta. When it was realized
that a minor local epidemic was likely to occur in the Peace River Block, special
consultative physicians from other local health services visited the Peace River
Health Unit to discuss with the Acting Medical Health Officer and the medical
practitioners latest treatment of the infection. This resulted in organized community effort toward provision of physio-hydrotherapy facilities at the Providence Hospital in Fort St. John, so that the area was fairly well able to care
for the patients locally without transportation to the larger outside centres.
Reference has been made in previous reports to the fact that measles frequently occurs in epidemic cycles of four to five years, and this would seem to
be one of the years between peaks, as only 4,137 cases of measles have been DEPARTMENT OF HEALTH AND WELFARE, 1948. Z 47
reported, which is just about one-half of last year's total. Incidentally, the
picture of this communicable infection for British Columbia showed definite
peaks for 1937, 1941, and 1945, and if the cycle is to remain true, it might be
expected that there would be another peak during 1949.
Emphasis can again be directed toward the fact that the number of
whooping-cough cases registered at 285, which is a considerable decrease from
the 1,500 of last year, but is nevertheless still an unfortunate happening when
immunization in the infant and preschool period is known to prevent this
Only one-quarter as many cases of mumps occurred this year as during
1947—namely, 1,008—as compared with 4,789 for the previous year. This
again is a communicable infection of childhood which seems to run in cycles
with definite peaks, while the intervening years show a considerably varying
incidence. This past year would seem to have been one of the low-incidence
years, for which credit cannot be given for any particular public health measures, but rather that the disease experience of the population has built up an
immune group.
There was a minor decrease in the number of reported cancer cases at 2,492
for this year, as compared with 2,620 for 1947 and 2,521 for 1946. This is an
encouraging trend, but it is only of minor note, as it is definitely known that the
number of reported cases does not give a real indication of the actual incidence
of the disease. The reported cases are only those cases that have been sufficiently disturbed to seek medical attention, and there are still a large proportion
of early cases requiring medical treatment that remain unknown and unreported.
Educational campaigns are continually being pressed to encourage the public
in the early signs and symptoms of cancer and the need for early diagnosis and
An encouraging trend was shown in the fact that the number of individuals
who developed diphtheria this year coincided with the number reported last
year, there being 35 reported for 1948 and 34 for 1947. Minor epidemics
occurred in Kamloops, Surrey, and one or two other locations in the Province,
invariably traceable to carriers. Such epidemics occasion a considerable amount
of work for local health services and for the Division of Laboratories. While it
is probably gratifying that the incidence has been maintained at such a low level
and that these epidemics have been curtailed in their infancy, yet it points to
the need for immunization, with reinforcing doses at regular intervals throughout life.
The venereal disease record for the past year also showed decreased incidence, there being only 3,615 cases of gonorrhoea against 4,005 for the previous
year and 1,018 cases of syphilis against 1,540 for the previous year. This is
gratifying to the Division of Venereal Disease Control, which has been waging
an intensive campaign for a number of years and has evolved a very efficient
venereal disease control system, in which local health services co-operate
through location of contacts and follow-up of the patients. The co-ordinated
scheme results in a Province-wide coverage, in which nearly all contacts are
investigated and brought to treatment when indicated. Only a programme of
continuous personal investigation of cases and contacts, coupled with adequate
treatment, will result in defeating these two diseases. One other large operation in communicable disease is in the Division of
Tuberculosis Control, in which case-finding, adequate treatment of patient, and
follow-up pay dividends in the recovery of the patients and decrease of the
disease. In this a gratifying trend was indicated in the lowering of the incidence of tuberculosis from 2,544 for 1947 to 2,178 for 1948. It is recognized,
however, that this infection still constitutes a major public health problem which
will require continuous investigation to bring it under control.
Detailed reports of the venereal disease situation and the tuberculosis situation are contained in the reports of the Division of Venereal Disease Control
and the Division of Tuberculosis Control which are presented later in this
Annual Report.
During the year four cases of tick paralysis were reported, the first reporting of this condition for three years, the last-reported case occurring in 1945
when one patient developed the condition. It is found to be due to a toxin
resulting from wood-ticks which have become implanted in the skin, usually
following travel in the woods. The cases have all been children and have all
responded to medical treatment for removal of the tick, when within eight to
twelve hours the symptoms begin to abate and the child displays evidence toward
recovery, which becomes complete. It is a condition which parents would be
well advised to watch for during the early spring months when the woods of this
Province are heavily infested with ticks, which drop onto any passing animal or
human who brushes against them.
From time to time instructions have been issued concerning the need to
exercise care in the home canning of vegetables and other commodities, pointing
out the dangers that can occur if these home-canned products harbour disease
organisms, especially of the spore-forming group. This fact was further accentuated this year when two cases of botulism were reported occurring in Central
British Columbia, which resulted fatally and which were traceable to spore-
formers in home-canned asparagus. This is the second occasion when such
fatal incidents have occurred within the last five years. Such deaths are entirely
preventable, when canning is properly done and unwholesome food products are
destroyed rather than consumed. DEPARTMENT OF HEALTH AND WELFARE, 1948.
Z 49
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Z 51
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Mayne Island	
Mesachie Lake	
Mission City	
New Denver	
New Westminster	
North Okanagan Health Unit	
Oak Bay	
Ocean Falls.".	
Okanagan Falls	
Peace River Health Unit	
Pine View	
Pitt Meadows	
Port Alberni	
Port Coquitlam	
Port Moody	
Powell River 	
Prince Rupert Health Unit	
Qualicum Beach	
Queen Charlotte City	
Rose Prairie	
Saanich and South Vancouver Island
Health Unit...	
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South Okanagan Health Unit	
South Shalalth	
Telegraph Creek	
Tupper Creek	
Greater Vancouver Metropolitan
Health Committee	
Williams Lake	
William Head	
Whole Province—
Monica M. Frith, Director.
Public health nursing continued to forge ahead during 1948, bringing
improved health facilities to the residents of the Provincial areas of British
Columbia. The public health nurse continued to be the essential link in the
utilization of those services made available from the various divisions of the
Provincial Department of Health and Welfare, from community groups, and
from voluntary organizations.
Changes in personnel of both the central office and field staff created many
difficulties, which have been met. In June Mrs. Dorothy Tate Slaughter, the
capable Director of Public Health Nursing since 1944, left to join her husband
in Saudi Arabia. The unprecedented demand for public health nursing service
by the general public, coupled with the lack of qualified public health nursing
staff, has required many adjustments, which the staff has accepted with willingness and co-operation.
Four new districts were opened in the following communities: Castlegar;
Invermere, the centre of the Golden-Windermere district; Burns Lake; and
the North Thompson, which includes the Birch Island and Barriere School
Districts. In addition, the Surrey public health nursing service, which had
formerly carried a partial programme, took over the generalized public health
nursing service in the Surrey Municipality. The Mission public health nursing
service was expanded to a two-nurse district; the South Okanagan Valley
Health Unit added an additional nurse in the Oliver-Osoyoos area and the services of a part-time nurse in Kelowna. An additional public health nurse was
assigned to the rural section of the Kamloops public health nursing service.
In all, 107 public health nurses provide nursing service in the Provincial areas
of British Columbia, which now includes eight health unit areas, twelve single-
nurse districts, and twelve centres which serve as headquarters for more than
one public health nurse. Two public health nursing supervisors continue to
give generalized public health nursing supervision in their district, while the
Director and Assistant Director supervise the rest of the Province, as well as
administer the service from Victoria. Two public health nurses are centred at
the Division of Tuberculosis Control in Vancouver. Assistance has been given
to providing some nursing care to small isolated communities, which, because of
a small population, would not warrant a resident public health nurse—for
example, Beaton, Francois Lake region.
The people of British Columbia have a public health nursing service which
is to be envied by other Provinces in Canada and many American States, as
approximately 94 per cent, of the population of British Columbia is now covered
by the public health nursing service. This is an enviable record, especially
when the geography of the Province, travel distances, and rigours of travel and Z 54 BRITISH COLUMBIA.
isolation have to be considered in relation to an organization staffed by women
with natural physical limitations and who, of necessity, must meet high academic standards.
It is interesting to note that the staff has increased in numbers from 47
public health nurses in 1942 to 107 at the present time, yet it has not been possible to provide a continuity of service in all districts at all times because of
lack of field staff. However, due to improved administrative practices, it is
possible, with more flexible utilization of staff from adjoining districts, to
render service for short periods of time to the areas without a resident nurse.
During 1948 twenty-four nurses were added to the staff; fourteen transferred within the service, while one transferred to the Division of Venereal
Disease Control and another to the Division of Tuberculosis Control. Transfer
of staff, after a satisfactory period of service in an area, usually two or three
years, is an excellent method of improving the quality of service throughout
the Province and at the same time stimulating the interest and ability of the
public health nurse by offering new situations that require greater skills, which
come with graduated levels of experience in public health nursing practices.
Fourteen nurses resigned from the field staff, five to obtain additional
university training, one to take a post-graduate nursing course, one retired,
four married nurses left the staff for family reasons, one left for another
Province, while three crossed the border to be employed in the United States.
Three positions had not been filled by the end of this year.
The majority of nurses added to the staff were recruited from other
Provinces and nursing organizations, as the University of British Columbia has
not been giving postgraduate training to a sufficient number of nurses to meet
current staff changes and expansion demands. The public health nursing service has maintained its strength, largely because married public health nurses
have continued to work and because of a new plan of public health nurse
" internship " now under way.
At the present time eight registered nurses are on the temporary public
health nursing staff on the nursing " internship " plan. These nurses do not
meet the requirements of having completed a course in public health nursing,
accredited by the National Organization Public Health Nursing, but are giving
a limited type of service under close supervision, with a view to determining
their suitability for a public health nursing career, and also preparing themselves for academic training, which becomes more meaningful following actual
district experience. Following a satisfactory period of time on the staff, this
year one registered nurse qualified for a scholarship under Federal health
grants to help her to attend the University of British Columbia. Nurses
accepting scholarships return to the Provincial service for a minimum of two
years. It is hoped that a similar opportunity may become available to the
presently employed registered nurses doing public health work, in order to
provide an adequate supply of public health nurses to meet the demands for
service being made by the people of British Columbia. DEPARTMENT OF HEALTH AND WELFARE, 1948. Z 55
Because of rapid development in science in relation to health and preventive medicine, continuous education of the staff in new developments and health
programmes becomes increasingly important.
Staff meetings have continued as an excellent method of co-ordination of
the activities of health-workers—clerical, sanitarian, medical, and nursing—
so that a united front in matters of policy becomes apparent to the public.
At nursing study-groups, public health nurses have been able to build up their
knowledge and background on specific subjects. The following topics were
included among study-group subjects last year: Mental hygiene, infant welfare,
the tuberculosis programme, study of welfare agencies, etc. Miss Ruby Tinkiss,
from the Federal Division of Maternal and Child Health, addressed five study-
groups on the prenatal and maternal health programme.
Study-group and staff meetings serve an important function in bringing the
nurse who works alone in an isolated district into contact with other professional
workers meeting similar problems. Study-groups, too, serve as democratic
bodies to suggest and test new policies or materials, so that final decisions
become the joint decision of the central administration and the field staff.
Study-groups have been formed in the north and south of Vancouver Island,
North and South Fraser Valley, North and South Okanagan, Kamloops area,
Prince Rupert area, Cariboo area, the East and West Kootenays, and the Peace
During the year the Director of Public Health Nursing represented the
Public Health Nursing Division on a number of committees, among them the
Committee on Educational Policy and the Public Health Nursing Committees of
the B.C.R.N.A., the Junior Red Cross, as well as Committee on the Co-ordination of Field Experience and Theory offered,to the Public Health Nursing
Students of the University of British Columbia.
To meet the ever-increasing responsibilities being carried by senior nurses
who had been placed in senior positions, with no special training in supervisory
practices, Miss Marion Murphy, associate professor in public health, from the
School of Public Health, Ann Arbor, Michigan, conducted a ten-day course in
supervisory practices. Seventeen nurses attended the course, which was given
in Victoria in September, and returned to their districts much more able to cope
with the administration, organization, and staff problems of their districts.
Tangible results of this course were evident almost immediately in raising the
level of performance, as well as morale, of the seniors and supervisors.
Through assistance from the Federal health grants (professional training
grant), two experienced public health nurses are obtaining postgraduate courses
in supervision and administration at eastern universities. Miss Barbara Smith,
who was senior nurse in Prince Rupert, is now attending the School of Nursing
at the University of Toronto. Miss Margaret Campbell, who has been supervisor of Kamloops and district, is attending the University of Michigan School
of Public Health at Ann Arbor, Michigan. The return of these members of
the staff will help to bring the number of supervisors somewhat closer to the
desired number. Z 56 BRITISH COLUMBIA.
Student Programme.
The nursing-student programme, which includes both undergraduate and
graduate nurses, has continued to be a heavy programme. Thirty-two students
from the University of British Columbia course in public health nursing
received rural field experience of either a month or two weeks. The Director
of Public Health Nursing participated in the lecture programme to the public
health nursing students at the University and was chairman of the Committee
on Co-ordination of Field Experience and Theory offered to Public Health
Nursing Students of the University of British Columbia. Greater co-ordination
between the University teaching programme and the student field experience
was made possible by more frequent contacts with University teaching personnel, and through revision of the Guides to Student Field Experience for student
field-work advisors. It is expected that the new revised Cumulative Record
will assist in planning better field experience.
The public health nurses participated in lecture programmes, and short
periods of field experience were provided for the nurses-in-training at the
Royal Inland Hospital, Kamloops; the St. Eugene Hospital, Cranbrook; the
Royal Columbia Hospital, New Westminster; and St. Joseph's Hospital, Victoria. Although the field experience on the undergraduate level has been short,
it is helping student-nurses to realize that there is a field of nursing apart from
institution work, in which they may wish to specialize.
The orientation programme of the registered nurse on the " internship "
plan has required careful planning and attention by public health nursing
seniors and supervisors. Public health nurses, too, have assisted with the
orientation of other new members of the staff—for example, sanitarians, statisticians, and clerks.
Closer integration with the nursing services of the Division of Tuberculosis
Control has been made by the transfer of Miss Doris Bullock, formerly public
health nurse on the district nursing staff of the Division of Tuberculosis Control
in Vancouver, to the Provincial public health nursing staff, with headquarters
remaining at the Vancouver unit.
An additional public health nurse was centred in this office to assist with
the case-finding programme of the mobile chest X-ray survey unit, which travels
throughout the Province. Included in this was planning of itineraries to suit
local health services, organization and field visits to areas where no public health
nursing service is available, as well as preparation of educational and organizational material and the general co-ordination of activities in relation to the
best utilization of the facilities of the Division of Tuberculosis Control by the
local community.
A close working relationship has continued with the staff of the Division of
Venereal Disease Control. Field epidemiology consultant services have been
available to the districts and have assisted the public health nurses to continue
to become more competent in field epidemiology in venereal disease control.
Greater standardization of procedure and records has continued, and has been DEPARTMENT OF HEALTH AND WELFARE, 1948. Z 57
assisted by a new venereal disease procedure manual and also by a recently
revised book, Venereal Disease Information for Nurses.
Public health nurses continue to give services to Indian reserves by arrangement with the Department of National Health and Welfare. This service has
been given this year in the Alberni Canal and Nanaimo districts of the Central
Vancouver Island Health Unit, in the Oliver and Penticton areas of the South
Okanagan Valley Health Unit, in the East Kootenay Health Unit at Cranbrook,
Creston, and Tobacco Plains, at Keremeos, Lillooet, and in the Fraser Canyon.
In all areas the public health nurse works with the Indian Agent in matters of
communicable disease.
Because the scope of the public health nurses is not always understood, the
following highlights may give some appreciation of the public health nurses'
work in the district.
An average public health nurse on the Provincial field staff in British
Columbia serves a population of about 5,000 people. Generally she lives in a
scattered rural area, in the largest population centre, and may travel within a
radius of 20 to 50 miles to cover the surrounding area.
She supervises the health of about 1,000 school-children, who usually attend
two large schools and eight smaller one- or two-room schools, which she visits
on a regular schedule. In the schools she organizes and assists with the school
medical examinations. She inspects those children not seen by the doctor and
visits in the children's homes to explain physical or behaviour difficulties to the
parents. At the school she advises on the lunch programme, helps the teacher
with class-room instruction by providing the latest information, and watches
over the environment and sanitation of the school. She is for ever watchful of
the development of communicable diseases and skin infections. During the
year 25,190 school-home visits were made within the Provincial area to interpret to the parents health matters pertaining to the school-child.
The public health nurse supervises about twenty persons with tuberculosis,
their families and contacts, and regularly arranges for chest X-rays for them
with the travelling chest clinic. A total of 20,450 visits for home supervision
were made.
The public health nurse organizes and holds about five child health conferences per month, each having an average attendance of fifteen to twenty
infants and pre-school children. In addition, home-visits for infant health
supervision is an extensive part of the programme, particularly in those areas
where a scattered population makes clinics impractical. During the year
35,672 infant welfare visits and 23,308 pre-school visits were made for general
health supervision.
The public health nurse assists in the communicable disease control programme by organizing and operating immunization clinics at strategic areas
throughout her district. These may be attended by any members of the community.   There were 7,041 persons completing the series of injections for pro- Z 58 BRITISH COLUMBIA.
tection against whooping-cough, 15,721 against diphtheria, 4,244 against scarlet
fever, 22,485 against typhoid fever, and 11,568 against smallpox.
Sanitation, particularly in the home, diet, and general health practices are
stressed by the public health nurse in her personal contacts.
As the public health nursing service is the community nursing service in
the rural parts of British Columbia, more time is being spent on nursing care in
the home, primarily for the purpose of teaching some member of the family to
carry on under the nurse's supervision. Demonstrations of nursing-care procedure, bathing the baby, and preparation of formula are part of the programme, as well as short-term treatments and hypodermic injections.
Kelowna, in the South Okanagan Valley Health Unit, continues to carry the
full bedside-nursing programme, while the community sponsors the housekeeping service known as the " Kelowna Home Service." As most patients at
home primarily require housekeeping care, the residents of this community have
a well-rounded programme, offering the necessary nursing and housekeeping
care in the home.
The public health nurses had the privilege of attending the Canadian Public
Health Association Conference, which was held in Vancouver in May. It was
a rare opportunity to mingle with other Canadian and American public health
workers, and to become imbued with new enthusiasm. The public health nurses
appeared in uniform in a pageant which paid tribute to the work of the public
health nurse in British Columbia.
Following upon the Conference, the floods in early June created an emergency health situation, which sent the public health nursing staff into immediate
action to meet the changed conditions. Emergency headquarters were set up in
Vancouver, with the Assistant Director of Public Health Nursing in charge of
the immediate nursing problems in the Fraser Valley. Additional public health
nursing staff were sent into the flooded areas to assist the resident nurses, who
were on voluntary twenty-four-hour duty during the crisis. As Vancouver
Island was the only part of British Columbia untouched by the floods, public
health nursing teams were borrowed for emergency service in the Fraser Valley
and the Okanagan.
The public health nurses assisted with the organization of health facilities
for flooded-out victims, including safety, first-aid, and sanitation measures,
prior to the immunization campaign, when 35,000 individuals received protection from typhoid fever in the flooded areas. Many thousands more received
reinforcing doses and an incomplete series. As a complete series consists of
three doses of vaccine given at regular intervals, the organization required to
carry out this tremendous undertaking is difficult to realize.
As the result of time studies of the various activities being carried on by
public health nurses, it was evident that more clerical assistance would give the
public health nurses more time for professional services, and accordingly more
clerical assistance has been made available to public health nursing staff this
year, with the result that more nursing time is now being spent on activities
best done by a public health nurse.
The public health nursing uniform continues to be an important symbol of
the British Columbia public health nursing service.    This year, because an DEPARTMENT OF HEALTH AND WELFARE, 1948. Z 59
annual uniform allowance was granted, the regulation uniform coat was added
to complete the public health nurse uniform. As the value of the uniform has
been demonstrated, it is now significant that the adoption of a complete uniform
will bring increased recognition of the service by the residents of British
Voluntary organizations and community clubs have assisted local health
services with educational programmes, with volunteer assistance, and financially by contributing special equipment. Local community clubs, too, have
been instrumental in sponsoring, along with the Provincial Health Department,
a number of successful dental clinics. Special tribute should be given the Kinsmen Club for the two fine community health centres built by the local Kinsmen
Clubs at Langley Prairie and at Cloverdale, which have been made available as
headquarters for the public health staff. This is indeed tangible evidence of
support of the public health service.
The continued high quality of public health nursing service rendered to
the people of British Columbia has been accomplished in spite of difficulties
which have seemed out of proportion at times, and is a tribute to the untiring
efforts of every public health nurse.
E. M. Yvonne Love, Consultant in Nutrition.
Nutrition education assumes a place of importance in the Health Department programme, which covers every aspect of public health. Nutritionists
have a clear responsibility to make known to the people through the public
health staff the vital role which nutrition plays in building and maintaining
vigorous health.
The objective of the Nutrition Service is to improve the health of the people
by stressing the proper attitude toward food and promoting good food habits.
The service is directed (a) toward the individual in the home, through the local
public health field staff, and (6) toward the individual institutions, through
assistance in improving the institutional food service. The actual nutrition
tors of Public Health Nursing, Public Health Education, Environmental Sanita-
service is developed through co-ordination with the programmes of the Direction, and other divisions.
Local public health personnel, in their daily generalized health programme,
meet many problems on which nutrition has an important bearing. Technical
assistance is provided to public health staff, in order that this vital information
may become an integrated part of all health service. Consultants in nutrition
have continued to provide local public health personnel with the following
1. Staff Education.
Attendance at staff meetings of local health units and public health nursing
districts during field-trips has enabled the nutritionists to give reviews of the Z 60 BRITISH COLUMBIA.
pertinent points in nutrition education, to report on recent developments in the
field of nutrition, and to discuss the application of this information in the community health programme. A questionnaire, consisting of twenty-five nutrition questions commonly asked, was found to be a most satisfactory means of
reviewing nutrition, while at the same time supplying simple, direct statements
which might be utilized by the staff in their daily programme. Visits have been
made to staff meetings of Prince Rupert, Cariboo, North and South Okanagan,
and Central Vancouver Island Health Units, and public health nursing study-
groups of Vancouver Island and the East Kootenays. At the time of visits to
the various areas, nutritionists have had the opportunity of meeting all of the
personnel individually in their own areas, as well as in staff meetings. More
time and emphasis on this phase of staff education has proven to be most effective in co-ordinating nutrition in the generalized public health programme.
Through the articles in the Provincial Department of Health's publication,
Public Health News and Views, local public health staff have been informed of
current items of special interest. Orientation of new staff members, prior to
their appointment to field positions, has been found to be most effective, in that
the general outline and objectives of the Nutrition Service have been reviewed.
2. Provision of Technical Information, Guidance,
and Assistance.
Certain activities of the health unit director and public health nurse require
more specialized information than the general interpretation of the daily diet..
Technical assistance has been provided in the following projects :—
(a)  High-calorie diets and reducing diets for use in connection with
a special study.
(&)  Outline of subject-matter, reference material, and suitable projects for a community study-group on nutrition.
(c) Assistance in organization and planning of equipment for school-
lunch projects.
(d) Results of the questionnaire prepared for the Parent-Teacher
Federation. This summary has been very useful in relation to
the follow-up, in many districts, of a programme of education
designed to improve the packed lunch.
The importance of the school-lunch projects as a means of evaluating the
nutritional status of the child's meals, and a project through which nutrition
education may be directed simultaneously to the school-child and to the parents
in the home, has been stressed in all staff meetings. Encouragement has been
given whereby public health staff may supply illustrative material and guidance
to the teachers utilizing the school-lunch project in the class-room. In addition
to a health study, the school-lunch may be considered with other subjects, including geography, science, and art. By correlating these subjects, the school-lunch
programme takes on added interest for all concerned.
During the emergency at the time of the spring floods, the nutritionists of
the Provincial Department of Health were called upon to provide consultative
service to the public health field staff and committees in charge of flood-control.
The nutritionists compiled data on adequate emergency rations and gave
guidance in food service in evacuee camps. department of health and welfare, 1948. z 61
3. Provision of Nutrition Materials for Distribution by the
Local Health Services.
Nutrition films, posters, pamphlets, and exhibits have been collected by the
Nutrition Service in collaboration with the Division of Health Education. Illustrative material has been evaluated and constantly rechecked to ensure adequate
and up-to-date information on a variety of subjects. When new materials have
been received and evaluated, samples have been distributed with Public Health
News and Views to each member of the local field staff. During local staff
meetings the needs of the local health personnel have been discussed with a view
to procuring illustrative material suitable for use in the communities.
A continuous programme of staff education has been directed toward evaluation of nutritional status of school-children and families in the community as
a part of the daily generalized health service. Through a consistent flow of
practical information, Nutrition Service has endeavoured to promote a healthful
attitude and to develop food habits which will ensure adequate meals for everyone every day.
This service, which is administered through the Director of Local Health
Services, has been directed toward those persons living in institutions. Services
have been made available through public health staff in local areas, as well as
through other departments of Government. The objective—improvement in
attitude to food, resulting in more healthful food habits—has been approached
through assistance to administrators and food-service personnel in increasing
the efficiency of the food service in institutions.
The service given has included all phases of information, analysis of food
value, economy of food service, organization of staff, selection and arrangement
of equipment, and the development of a healthful attitude toward the food service. In assisting food-service personnel, the general approach has been to
survey existing conditions, suggest recommendations, conduct discussions with
all persons concerned, and assist in implementing changes.
In the past year, progress has been made in many of the projects already
under way. The analysis of the food consumed in Provincial gaols brought
about a change in the gaol rules and regulations, and resulted in rations conforming to recommended allowances for an adequate diet. A periodic check
of the food consumption has been made, and related factors, such as necessary
equipment, storage, and staff supervision, have been taken into consideration
in regular reports. Assistance to Oakalla Prison Farm and the Women's Gaol
at Prince George has brought forth encouraging developments. In the project
undertaken in the Vancouver unit of the Division of Tuberculosis Control,
co-operation of staff has been successful in implementing all of the recommendations to improve the food service and to develop a healthful attitude of staff and
patients toward food service. Many changes in the organization of the food
service, with the addition of selective menu, have combined to produce a most
satisfactory food service. Continued assistance has been requested by Fair-
bridge Farm School.    In this project, attention has been directed toward pro- Z 62 BRITISH COLUMBIA.
duction and consumption of food, based on an adequate diet for the schoolchildren. Although the various studies were similar in many respects, the
circumstances required adaptation of available information to existing conditions. Many of the improvements involve considerable time, and thus projects
are of a long-term nature.
Considerable time was spent in giving advice to small hospitals. Visits to
many of these were made in order to ascertain their needs. Assistance was
given in relation to adequate menus, with variations, special diets, selection and
arrangement of equipment, food costs, and general organization of the food
service. These activities were co-ordinated with the work of the office of the
Provincial Hospital Inspector, as well as with local health services.
Meetings of nutritionists, representing the Greater Vancouver Metropolitan Health Services, dietary departments of hospitals, and the Extension Service
and the Department of Home Economics of the University of British Columbia,
have been held at regular intervals.
Discussion of programmes, common problems, and special projects were
most beneficial. A major project was to provide community workers with
pertinent information concerning the serving of adequate family meals.
During the year, nutritionists of the Provincial Department of Health
assisted in the training of several groups of students. These groups included
classes of the Junior Red Cross summer school for teachers, student-nurses and
student-dietitians in hospital training-schools, and the public health nursing
class at the University of British Columbia. Services available through the
Provincial Department of Health were outlined, and nutrition objectives were
In collaboration with the Division of Public Health Education, assistance
has been given to the Department of Education in the revision of the health
curriculum for schools. Mutual problems have been discussed with members
of the Department of Agriculture, and joint meetings were held whereby the
subject of food and health was considered from the standpoint of food production and consumption.
A nutritionist of this Department again represented British Columbia at
the Dominion-Provincial Nutrition Committee meeting held in Ottawa in March.
The exchange of information and discussion of mutual problems has been found
to be most beneficial in evaluating programmes and developing nutrition education material.
In collaboration with the Division of Health Education, nutrition information has been supplied to radio personnel for use on a well-established programme. This programme stimulated many members of the listening public
to submit questions. In accordance with the policy of the Provincial Department of Health, each question was referred for answer to local public health
personnel in the listener's area.
At a meeting of the Canadian Home Economics Association, a nutritionist
from this Department was given the opportunity of presenting the subject of
nutrition education from the Provincial aspect.   Discussion of this subject with DEPARTMENT OF HEALTH AND WELFARE, 1948. Z 63
home ecomonists from many parts of Canada gave a valuable insight into the
mutual problems encountered, and the means by which the needs of each
Province are being met.
There has been a temporary reduction of staff, since Miss Doris Noble was
given an opportunity to take postgraduate study in public health at the School
of Hygiene in Toronto. The purpose of the course is to provide a general
knowledge of public health with special advanced training in nutrition. The
latter studies are under the direction of Dr. E. W. McHenry, professor in public
health nutrition, who is one of the outstanding authorities in this field. Much
of the nutrition reference material used by this Department is based on the
reference manual written by Dr. McHenry.
Attendance at meetings in local areas has continued in accordance with
plans to stress staff education in all areas of the Province. New approaches to
the serving of adequate meals must be utilized, and the most effective methods
incorporated in a continued programme of nutrition education, with attainment
of adequate meals for all the people of the Province as the goal.
J. D. B. Scott, Director.
The activity of the Division increased over the previous year. Among the
most difficult problems to be met by the Division were Indian and Doukhobor
registration, although definite progress has been made in the last year.
The value of inspection was again proved worth while.
The Vital Statistics Council for Canada, of which the Director was a member, was most active during the year, and the most important items reported
Procedures in an office such as the Division of Vital Statistics can become
stereotyped. Efforts were made to stream-line many of the forms and methods
carried out in the central office. It was felt that the efficiency of the Division
was brought up to a higher level than before.
The Statistical Section acted as a workshop for the whole Health Branch
of the Department in regard to statistical problems. In addition, it supplied
a great deal of data to other departments of Government as well as to the public.
Current Registrations.
The year 1948 brought a considerable improvement over previous years in
the completeness and quality of registration of Indian births, still-births, marriages, and deaths. Among the factors contributing to this condition are the
payment of family allowance to Indians, the realization by the Indian Superintendent of the importance of accurate vital statistics, and a close liaison between Z 64 BRITISH COLUMBIA.
the Division, the Indian Commissioner for British Columbia, and the Superintendents in charge of the various Agencies.
As in many years past, the Division has enjoyed the whole-hearted
co-operation of the office of the Indian Commissioner for British Columbia.
Results of inspections by officials of both departments are compared, and in
this manner many mutual problems can be overcome. Periodic visits were made
to the Indian Commissioner's office during the year, resulting in revision and
expansion of certain routines which were designed as a check of the progress
of registration. One of the most valuable methods of checking the more recent
registrations was the inauguration, in the fall of 1948, of a report from the
Indian schools covering pupils enrolled for the first time.
Inspections were made by the Division in seven of the Indian Agencies
during the year, while periodic visits which did not entail complete inspection
were made in five other agencies.
The main causes of difficulty confronting the Indian Superintendent appear
to be the result of poor transportation, poor educational facilities in the more
remote areas, and the nomadic nature of many of the Indians. An improvement
in transportation facilities, combined with a more frequent contact with whites,
is bound to cause an improvement in the registration of this minority group.
In certain instances where Indian Agencies are near the International
Border, it has been found that families move seasonally back and forth across
the Boundary-line. During absences from British Columbia, births, still-births,
deaths, and marriages occur, and most cases these events are within the State
of Washington. Owing to a different method of gathering vital statistics
records in the United States, the Indians, upon returning to their respective
Agencies, are generally unaware as to whether or not proper registrations have
been made covering events during their absence. The Indian Superintendents
find it quite impossible to check directly as to whether or not registrations have
been made but, through the courtesy of Irvin Vaughn, State Registrar of Vital
Statistics, Seattle, Wash., an agreement was reached whereby the State office
will clear any verifications requested by this Division. In practice this means
that the Indian Superintendents will notify this Division of any events which
have occurred in the State of Washington, and a check will be made with the
State Registrar, who, if necessary, has agreed to take steps to obtain satisfactory registration. Gratitude is hereby expressed to the State Registrar for his
co-operation in this regard.
Documentary Revision.
The project of checking, typing, reindexing, and correcting the registrations during the period 1917 to 1946, inclusive, was carried on throughout the
year. As a result of this work, the quality of the registrations for the earlier
years is being considerably improved, and steps are being taken to obtain
delayed registrations when proper records are found to be lacking.
Among the factors contributing to the difficulties in this particular project
has been the practice of Indians to change their names at will, thus making it an
exceedingly arduous task in many instances to trace identity. Often it has been
found that an Indian child has taken as his surname the given name of his
father, so that by the third generation all means of tracing identity through
names has been lost.    In other instances, changes have been made for no
apparent reason.
In order, therefore, to obtain satisfactory results, it has been necessary in
several cases for the Superintendent of the Agency concerned to work in close
conjunction with the staff of this Division, in order that explanations as to variations in names may be had with the least possible delay.
Current Registrations.
At the commencement of 1948 the attitude of Doukhobors toward registration was almost entirely negative. However, as a result of a carefully planned
programme, tactfully and diplomatically carried out by a special field representative of the Division, it was found by the spring that the situation was
already showing signs of improvement. As the months passed, the results of
the work indicated that the policies were meeting with a considerable measure
of success.
By the end of the year it was found that most of the Doukhobor factions
were willing to supply information for the registration of vital statistics.
Although the Doukhobor problem appears to be the most serious with
which the Division must contend in accomplishing completeness of registration,
it is quite certain that progress has been made during 1948. There are indications that this progress will continue in 1949. In any case, the Division believes
that a long-term view of this problem must be taken.
Registration of Births.
Current Registrations.
There is no lack of proper birth registration, except in a small number of
the most isolated areas of the Province and among Doukhobors and Indians, as
already noted. Particularly since the advent of family allowances, very few
people, even in the most remote areas, are not aware of the requirements of
On the other hand, with the stimulus of family allowance payments, steps
must be taken to ensure that there is not overregistration—that is, the registration of one child's birth under several sets of names, such as might permit the
payment of several allowances to be made without detection.
In previous years it has been noted that the basis for most fraudulent
registrations was a desire on the part of the mother of a child to conceal the fact
of illegitimacy. However, during the past year a new situation has been
observed—namely, that of false registrations being filed in the belief that a
mother was protecting her rights to custody of the child. In practically every
case it has been found that false registrations were made through ignorance
and a desire to protect the child more than as downright intent to defraud. The
Division is nevertheless cognizant of its responsibilities of ensuring as far as
possible that only correct registrations are received.
Appreciation is extended to the medical practitioners for the services they
have rendered  in forwarding notifications  of births  and  still-births to the 1
appropriate District Registrars, thus assisting all concerned to file registrations
with a minimum of delay. The hospitals of the Province have likewise
performed a very valuable service to the Division in the submission of the
monthly returns of births, and in many instances have assisted the District
Registrars in obtaining registrations promptly. Gratitude is therefore
expressed to the hospital officials for this assistance.
A new type of birth registration form was prepared during the year and
will be put into use commencing January 1st, 1949. Certain details have been
rearranged in the hope of having the questions made clearer to the general
public. The birth form has been enlarged to cap size in order to give more
space for questions and marginal notations, and to standardize the size for
microfilm purposes, binders, etc.
Delayed Registration of Birth.
A survey of the delayed registrations of births filed in the last several years
reveals that the largest number of registrants were born either immediately
prior to the turn of the century or up to approximately 1920. For many such
applicants the matter of securing adequate verification to meet the minimum
standards adopted by all Canadian Provinces was most onerous. Over a period
of many years, records of baptisms have been gathered from numerous churches
of the Province, and these have been found very useful in completing delayed
registration files. In order to assist the public, steps were taken to secure the
loan of many more such records, by such means as writing to the clergymen in
charge of churches, by requests to District Registrars, and by personal contact
during inspection trips. The result of this campaign was that during the year
many thousands of records were gathered, placed on microfilm, and indexed in
such a way that they can be of great assistance in supporting applications for
delayed registrations.
In addition to the above records, many thousands of old Notices of Birth
made by physicians were consolidated, institutional records were obtained, the
whole being indexed in such a manner that ready reference may be made for the
desired information. Efforts will be continued during the next year to make
this library of verification as complete and useful as possible.
Effect of Family Allowance.
It has been the experience of the Division since the inception of family
allowances that numerous inaccuracies in registration, such as fraudulent
records, misspelling of names, and incorrect dates of events have been brought
to light.    In many cases it has thus been possible to have the records amended.
Payment of the allowance constitutes a valuable stimulus for prompt
registration, particularly with regard to many Indians who have not shown any
great desire to file birth registrations except for the remuneration involved.
An excellent liaison exists between the Family Allowance Branch and the
Division, and gratitude is hereby expressed for the spirit of co-operation shown
at all times by the Family Allowance Branch. department of health and welfare, 1948. z 67
Registration of Deaths.
No difficulty is encountered in obtaining completeness of death registration,
except in the most remote areas of the Province and among Doukhobors and
Indians. There has, however, been an improvement in both these minority
groups during the year, and steps have been taken through the field representatives to ensure that registration is kept at a high standard. With the expansion in the Indian medical services, there has been a marked improvement in
the quality of registration, including the certification of cause of death.
Several minor changes were made in the death registration form, preparatory to putting them into operation on January 1st, 1949. Certain details
have been rearranged on the form in the hope of having the questions made
clearer to the general public. However, in 1949 a further revision will be
necessary in the form concerning the statement of cause of death as recommended by the World Health Organization, effective January 1st, 1950.
Registration of Marriages.
Generally speaking, the Division believes that virtually all legal marriages
are registered. However, among two groups—namely, Indians and Doukhobors—there is a problem created by these people being married by their own
customs rather than those prescribed by the " Marriage Act."
Steady progress is being made with respect to the former through the
influence of the clergy. It is felt that the situation will continue to improve as
the contact between Indians and whites becomes more frequent. On the other
hand, the Doukhobors, owing to their religious beliefs, are not served by the
clergy of any denomination and thus have little means of gaining a new point
of view beyond their own natural desire to break away from the old sectarian
beliefs. Although most Doukhobors persist in marrying according to their own
customs and without the solemnization of the ceremony by a clergyman as such,
an increasing number of young persons were married by civil ceremony during
the past year. This is an indication that the customs which were so rigidly
followed by the older people are losing their significance to the younger
Completed marriage registers are checked routinely at the time of issuance
of each new register. In addition, many registers which have been issued
over a period of years and which are not completely filled in have been recalled
so that the entries therein could be checked. In this manner many delayed
registrations of marriages were effected. Also, all Certificate of Publication
of Banns forms, when received, are checked with the incoming registrations in
order to locate any unregistered marriages.
Twenty-six district offices and sub-offices in the Province were inspected.
Also, the offices of seven Indian Agencies were visited. In addition, frequent
visits were made to the offices at Vancouver, North Vancouver, and New Westminster, and one visit was made to the Kootenay area to check on the progress
of registration of vital statistics of Doukhobors.    A larger number of inspec-
tions had been planned for the year, but owing to the disastrous flood conditions
prevailing in the late spring, all such arrangements had to be cancelled.
During the last few years a growing need has been felt for larger space for
the office of the District Registrar of Births, Deaths, and Marriages at Vancouver. This has been partly occasioned by a great increase in population in
that area, as well as a growing number of civil marriages.
As the Provincial Government purchased during the year a building on
Burrard Street, near the Court-house, arrangements were made for the transfer
of the District Registrar's office in the spring of 1949 to space allocated in this
building. In the years gone by, no suitable space has been available for interview-work and only one office has been available for civil marriages. However,
with the new location it will be possible to conduct interviews with a great deal
of privacy. In addition, provision has been made for private offices for two
Marriage Commissioners.
Once again it was found that many District Registrars were new appointees
since the previous inspection, and it was thus possible to render assistance and
given instructions, particularly to those who had had no former experience in
this type of work. Through inspections made and personal contacts, it has been
proved that a very good spirit exists between the District Registrars and the
central office. Apart from instructing District Registrars in their duties and
discussing various problems with them, including the methods of gathering
registrations and advising the District Registrar of progress in various types
of certification and record-keeping, inspections have been used as a means of
checking the growth and shift of population. Information so gained is passed
along to the senior statistician in order to verify estimates of population within
certain areas in the Province.
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-four sub-offices within these districts. Thirty-eight of the District
Registrars were Government Agents and Sub-Agents, forty District Registrars
and Deputy District Registrars were members of the British Columbia Police,
six were other Government employees, and the remaining thirteen were not
Government employees. In addition, the eighteen Indian Superintendents of
the Province acted as ex officio District Registrars of vital statistics for Indians.
The system by which verifications of births, deaths, and still-births were
reported to health units during the previous year was extended to include all
the health units and the Metropolitan Health Committee in Vancouver. In all
instances except the latter, a small card is prepared by the District Registrar
upon receipt of each registration of birth, death, or still-birth. These cards
are then forwarded currently to the health unit director. However, in Vancouver, such a system would be exceedingly onerous, so a variation of the
system was put into operation. The District Registrar in this instance prepares
a carbon copy of each registration at the time his own office copies are being
prepared, and these duplicates are forwarded daily to the Metropolitan Health
Vital statistics have been called the book-keeping of health. Within this
function lies the duty of the Division to compile and analyse figures arising from
vital statistics registrations. Various types of statistical services are also made
available to all divisions within the Provincial Department of Health.
Monthly summaries of registrations are completed by this Division showing breakdown by age, sex, racial groups, place of residence, place of occurrence,
and others. Under this category the infant and maternal mortality, deaths by
causes and age-groups are of particular value, since they are an important
measure of the state of health in the Province.
Assistance in the preparation, tabulation, and presentation of monthly and
annual reports is rendered to the Divisions of Tuberculosis and Venereal Disease
Control. Current diagnoses of tuberculosis cases are recorded in this office in
order to keep all records as up to date as possible. Periodically the Division
is called upon to assist with special requests and assignments with regard to
tuberculosis and venereal disease.
The information given on public health nurses' records is transferred to
punch-cards and tabulated. Each month a summary is completed showing the
amount and type of work done by the nurses. In addition, the Division maintains a central clearing office for the public health nurses' school and family
Among other services rendered for different divisions are the reports of
School Environmental Sanitation and Medical Inspection of Schools.
The Division has aided in a programme aiming to develop complete reporting of cancer cases within the Province. Information given on the cancer
report forms is punched on statistical cards. Each year all the information
given on the punch-cards is tabulated and compiled in table form for further
Requests for statistical information received from business firms, other
Government departments, or individuals are handled free of charge. Special
tabulations of vital statistics in Greater Vancouver are run for the Metropolitan
Health Committee. In addition, duplicate punch-cards relating to deaths in
Greater Vancouver are made for this Committee. Monthly tables giving vital
statistics information for Greater Victoria are also compiled for the City
Medical Health Officer of Victoria.
Special assistance was given by the Statistical Section to the British
Columbia Hospital Insurance Service with regard to detailed figures on population, births, and deaths in the Province over a period of years. Statistical work
was also done for the Wetzel Grid study in the Central Vancouver Island Health
Unit area.
Boundaries of school areas have been gazetted and are likely to remain
fixed, apart from subdividing them. They provide an excellent basis for outlining health unit boundaries, several school areas often making up one health
unit area. Commencing the first of the year, all relevant punch-card statistical
applications were coded according to school boundaries. This will provide
information for health unit directors and other personnel of the Branch.   Health Z 70 BRITISH COLUMBIA.
unit boundaries cannot yet be considered as finalized, and perhaps may never be.
However, just so long as they attempt to follow combinations of school areas, if
at all possible, it should be possible for the Division to compile adequate health
unit area statistics from the data on its files.
Mechanical Tabulation.
Continuous use was made of the mechanical equipment of the Division
during the year both for routine monthly tabulation and indexes and for special
assignments. At the end of the year virtually all of the marriage index punch-
cards from 1872 to date had been punched. During the forthcoming year the
indexes will be sorted and listed on the tabulator. At the same time the death
index punch-cards for the period 1872 to 1925 will be commenced.
The Division gave considerable assistance to the Divisions of Tuberculosis
Control and Venereal Disease Control, environmental sanitation and public
health nursing services, the compilation of the Annual Report of Medical Inspection of Schools, and cancer reporting.
Due to the creation of new services in the Government, both equipment and
personnel were loaned to the Social Security and Municipal Aid Tax, the Bureau
of Economics and Statistics for the hospital insurance plan, and also the Taxation Branch of the Department of Finance. It was felt that this co-operation
should be extended to these services because of their urgent need, even although
it was at some sacrifice to the schedules of this Division.
Parts II, III, and IV of the Manual of Instruction for District Registrars,
Marriage Commissioners, and issuers of Marriage Licences were distributed to
all district officials. Part I had been previously distributed in October, 1946.
The complete manual is comprised as follows:—
Part I—" Vital Statistics Act."
Part II—" Marriage Act."
Part III—" Change of Name Act."
Part IV—Alphabetical List of Places in British Columbia.
The first three parts contain comprehensive instructions for the Acts concerned, together with rulings which have been received from higher authorities
from time to time and miscellaneous instructions. This is the first such detailed
instruction manual to be put into use by any of the Canadian Provinces, and
only a few of the States of the United States have prepared such consolidated
instructions. Copies were therefore distributed to the Provincial vital statistics
offices, as well as the Dominion Bureau of Statistics, each of the State Registrars
and the National Office of Vital Statistics in the United States. The publication
was very well received, and experience has shown that it has filled a real need in
supplying to the District Registrars instructions covering numerous situations
with which they have not heretofore been confronted. In passing it should be
noted that through transfers of members of the British Columbia Police, who
also are District Registrars, many new appointees have had no experience whatsoever in this type of work, and a comprehensive guide of some sort is essential
if the work of the Division is to be carried out satisfactorily. DEPARTMENT OF HEALTH AND WELFARE, 1948. Z 71
The fourth part shows the vital statistics registration district in which the
place is included, whether in organized or unorganized territory, the statistical
area, and school district number. This publication has been very useful, not only
to health personnel of the Branch, but also to a number of other departments.
In October the Vital Statistics Council for Canada met in Ottawa for the
fifth meeting. The agenda was very full, the most important items being the
Report on the International Statistical Classification of Diseases, Injuries, and
Causes of Death and matters relative to the recommendations of the World
Health Organization, the consideration of the model Vital Statistics Act, the
minimum standards required for delayed registration of birth, and many other
items of a technical nature.
International Statistical Classification of Diseases, Injuries,
and Causes of Death.
The World Health Organization adopted on July 24th, 1948, Regulation No.
1, regarding nomenclature and the compilation and classification of statistics
with respect to diseases and causes of death.
Article 1 requires that members of the World Health Organization shall
compile and publish annually statistics of causes of death in accordance with the
said regulations on a calendar-year basis and in accordance with the classification, nomenclature, and numbering as set out in the list given in the manual
under International Statistical Classification of Diseases, Injuries, and Causes
of Death annexed to the regulation.
Article 2 requires that the coding of mortality statistics shall be in accordance with the regulation.
Articles 3 and 4 require that each member shall publish the above statistics
of diseases on (a) territory as a whole, (6) principal towns, (c) national aggregates of urban areas, and (d) national aggregates of rural areas, and they shall
be published in accordance with the detailed lists for group (a) above and, if
this is not possible, in accordance with the Intermediate List of 150 Causes.
Article 5 requires that groups (o), (c), and (d) should be published according
to either the Intermediate List or, if this is not possible, of the Abbreviated List
of 50 Causes.
Articles 6, 7, and 8 prescribe the breakdowns of sex and age grouping.
Article 9 adopts a form of medical certificate of the cause of death almost
similar to the one now in use. Article 10 requires that medical certification of
the cause of death shall be the responsibility of the physician as far as possible.
This means that the present method of following the rules of joint causes of
death will be discontinued. Consequently, it may be expected that there will be
a very considerable change in the statistics of certain causes of death.
Articles 13 to 17 deal with morbidity in a somewhat similar manner to those
outlined in the above mortality statistics. It may be noted that the list is a
combined mortality and morbidity code and will undoubtedly be of the utmost
value for comparative purposes. The need for an up-to-date morbidity code has
been felt for a long time.
The effective date for these regulations will be January 1st, 1950. Z 72 BRITISH COLUMBIA.
There is a tremendous amount of work to be done, both by the Dominion
Bureau of Statistics and the respective Provinces, in connection with the preparation and the adoption of these regulations.
Model Vital Statistics Act.
The Model Vital Statistics Act was drafted by the Vital Statistics Conference in December, 1947; it was revised by the committee of the Conference of
Commissioners of Uniformity of Legislation in Canada and presented to the
Vital Statistics Council. Very full discussions were held on controversial sections, and the matter was again referred by the Council to the sub-committee of
the Conference of Commissioners of Uniformity of Legislation which, in turn,
reported this matter to the committee of the parent committee in December,
1948. At the end of the year the matter had not been reported to the respective
Attorneys-General. It is expected that during the forthcoming year the draft
model Act will be thoroughly discussed by interested organizations in British
Columbia and certain recommendations may be made to the 1950 Legislature.
Model Marriage Act.
At the time of writing the last Annual Report the verbatim report of the
fourth Council meeting, which took place on December 5th, 1947, had not been
received, the Division being unrepresented. Hence it was unaware that the
Council had decided to take no further action toward the making of a draft
Model Marriage Act, except to suggest that each Provincial representative refer
the matter back to his Deputy Minister. The reason lay in the fact that not all
members were responsible for the administration of the respective Provincial
Marriage Acts.
There was a question whether the Federal Department of Trade and Commerce, of which the Dominion Bureau of Statistics is a part, had any legal
responsibility in the solemnization of marriages, in view of the provisions of the
"British North America Act," which specifically states that this subject is a
Provincial matter.
The Council felt that while a model Marriage Act is necessary, yet, because
of the question of jurisdiction, a conference would have to be held under other
auspices. The work which a committee of the Council had already done will be
a most valuable document to any interested body, such as the committee of the
Conference of Commissioners of Uniformity of Legislation in Canada.
Minimum Standards for Delayed Registration of Birth.
In 1944 the Dominion and Provincial Conference of Vital Statistics passed
Resolution No. 10, recommending that minimum standards of evidence required
to effect birth registrations be accepted by each Province. Subsequently, it was
found that some of the Provinces had not adhered to this resolution, and the
standards for delayed registration were being questioned by certain agencies,
including the Canadian National and the Canadian Pacific Railway pensions
schemes, the Old-age Pensions Board, life insurance companies, etc. It was
decided to reconstitute the committee on this matter. The standards were
reaffirmed and endorsed by the Council.    Since that time it is understood that DEPARTMENT OF HEALTH AND WELFARE, 1948. Z 73
each Province has agreed to these recommendations.    British Columbia has
been adhering to them since February 22nd, 1945.
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. Such investigations include personal
visits by the Inspector of Vital Statistics so that he may assess the statements
made regarding application for registration, in so far as they pertain to the
number of adherents, possible growth, and continuity of existence.
A consolidation of the Forms C.N. 2 and 3, covering an application for
change of name, were made. Additional instructions were outlined on these
forms and on Form CN. 1, as well as in the covering letter. This had the effect
of stream-lining the work of this part of the Change of Name Section.
Following the installation of an electrical cash register in November, 1947,
several improvements have been made in the general office routine dealing with
searches and certificates, etc. A new Application for Cash Mail was drafted
during the year and is to be put into effect on January 1st, 1949, with the idea
of giving greater direction and control and speeding up the large volume of
Similarly our Application for Interdepartmental Free Searches and Certificates was revised and is proving to be both workable and labour-saving, not only
to this Division, but also to the receivers.
The filing system of the Division was completely revised and enlarged, with
new equipment adding greatly to its efficiency.
The Microfilm Section was very busy during the year microfilming all the
hospital reports received since 1917, in addition to virtually all the information
useful for producing evidence for delayed registrations. This included old
Doctors' Notices of Birth, church records, registers of institutions, etc.
New equipment has been installed for printing of positives, to be issued
instead of certified true copies, presently typed. This will mean exact reproduction of the documents and will reduce the chances of error to nil.
During the year a short form of paper birth certificate was introduced
instead of the long-form certificate. These certificates contain the same content
as the plastic birth certificates. Certified true copies were issued where full
data were needed. Z 74 BRITISH COLUMBIA.
Short-form paper marriage certificates were introduced. However, it was
found that these were not acceptable in divorce proceedings in the Supreme
Court, and it was necessary to issue certified true copies in lieu of them.
No change has been made in the certificates of death, although the provisions of the draft Model Vital Statistics Act requires that short-form death
certificates should be issued routinely.
All current marriage registrations are checked to ensure that the marriage
has been performed by a duly registered clergyman or a Marriage Commissioner.
As experience of previous years has shown that there was practically no
uniformity in applications for remarriage submitted to the Director in accordance with section 45 of the " Marriage Act," specific forms were drafted and
put into use. It has been found that this system has enabled the Division to
deal much more rapidly with such applications.
The Forms M.2—Statutory Declaration, M.3—Notice of Marriage, and
M.4—Marriage Commissioner's Certificate of Compliance contained many
details which were duplicated. A consolidation was therefore made, eliminating
the unnecessary information and placing the three forms on one sheet. Likewise Forms M.8—Application for Permit for an Immediate Marriage and
M.10—Permit for an Immediate Marriage contained duplications and were
revised so that all details now appear on one form, although the headings have
been retained in order to refer to the respective sections of the " Marriage Act."
These changes have materially reduced the time taken both by the applicants for
marriage licences or civil marriages and by the clerks assisting them.
Goal in Registration.
The ultimate aim of the Division is not only to obtain registration of every
birth, death, marriage, and still-birth, but to have each registration of the
highest possible quality. As previously noted, there is practically no lack of
registration, except among Indians and Doukhobors, and both of these situations are receiving very careful attention. Transportation and educational
facilities are continually improving. This has a definite bearing on completeness of registration in the remote areas. It is believed that the time is very
near when non-registration will be more a matter of wilful neglect than of
ignorance, for in reviewing the few cases where births are known to have
occurred, but registrations have not been made, it is almost invariably found
that the child was illegitimate and the mother had left the hospital, etc., without
leaving any trace of her whereabouts. Upon analysing the returns from cemeteries, it has been found that there is no lack in registration of deaths, and
ample means of maintaining a continuous check of this situation are available.
There is likewise every reason to believe that the checks on completeness of
marriage registrations are very effective. Therefore, in the future more and
more emphasis will have to be placed on quality of registration.
Since the introduction of short-form birth and marriage certificates,
experience has shown that there are cases where individuals still require more
details than are shown on the abbreviated certifications.    Rather than revert to DEPARTMENT OF HEALTH AND WELFARE, 1948. Z 75
the old style of long certificates, it is intended to use photographic prints as
widely as possible. Such copies can be produced for a reasonably low unit cost
and eliminate any possibility of error. As the ultimate success of such a system
depends very largely on the quality of registration, a great deal of attention
must in future be paid to ensuring that all copies are neat and contain every
detail required on the registration form. It naturally follows that any correction which is made, or any variation used in the colour of the ink on the
original record, will adversely affect the appearance of photographic prints.
Measures have been taken to advise the District Registrars of this situation,
and request their co-operation in accepting only the highest quality of records.
At the time of investigation of each fraudulent or improper registration,
the reasons for the record being so filed are carefully noted so as to be aware
of any overregistration. With the stimulus of family allowance payments, this
sidelight on incorrect registration cannot be overlooked. There is, therefore,
little doubt that there will be more cases where investigations are necessary
than heretofore.
General Office Manual.
Several sections of a manual of general office procedures have been prepared, but owing to the magnitude of this undertaking it will be some time yet
before it can be completed, assembled, and printed. Like the Manual of Instructions for District Registrars, it will be prepared on a loose-leaf system so that
amendments may be made from time to time. Once this manual is in use, it is
hoped that it will be of great value, as there are so many details in connection
with an office of this type that it is easy for slip-ups to occur when personnel
In view of the introduction to the Division of short form certificates as a
general policy and the use of positive prints in lieu of the cap size certificates,
a certain amount of educational work will have to be done amongst lawyers,
District Registrars, and the public generally regarding the types of certification
International List of Diseases, Injuries, and Causes of Death.
The adoption of World Health Organization Regulation No. 1 means
definite responsibilities to the Division.
In the first place, death and still-birth registration forms and instructions
thereto, the Physicians' Pocket Reference to the List, and Vital Statistics Handbook will have to be distributed to physicians, hospitals, District Registrars, etc.
Information will have to be given to all practising physicians emphasizing
the importance of certifying the proper order of events on the statement of
cause of death on the death registration in view of Article 10 of the above
The use of the new medical certification form places the responsibility for
indicating the train of responsibility on the signing physician. It is assumed,
and rightly so, that the certifying medical practitioner is in a better position
than any other individual to decide which of the morbid conditions led directly
to death and to state the antecedent conditions, if any, which gave rise to this
cause. Z 76
Hence, except in the case of certain basic rules governing a relatively small
number of cases, causes of death will be coded according to the physician's
statement. Undoubtedly, health unit directors will be asked to give information on this subject to the local medical associations.
The format of many of the vital statistics tables will be changed, including
the Annual Report of the Division. It will be necessary for the Division to
begin to capitalize on the advantage created by the establishment of this combined mortality and morbidity code.
Model Vital Statistics Act.
A great deal of effort and cost has gone into the draft of the Model Vital
Statistics Act. Although a final draft has not been submitted to the Division,
it is understood the best items in all the Vital Statistics Acts of the various
Provinces have been incorporated. It is not known whether the present British
Columbia " Vital Statistics Act" should be amended to include the most important items or rather to have the Act repealed and the new Act to come in force.
In any case there will have to be a very close consideration on these matters by
the Attorney-General's Department and members of the Division before the
matter is finally referred to the Legislature.
Public Health Statistics.
During the coming year the Division will have to give a great deal of study
to its policy in regard to the devolpment of local health statistics. With the
establishment of more and more health units and an enlarging public health
personnel, a challenge has to be met. The Division of Vital Statistics has the
responsibility to give advice and direction on statistics to health unit directors
and others in the field. Data cannot just be collected for the sake of compiling
tables, but rather the Division must interpret and advise. During the current
year, personnel has been added to the Division through the means of the Federal
grants, but so far only the fringes of the problem have been touched. Adoption
of the evaluation schedules recommended by the American Public Health Association, application of survey methods to the various public health problems,
and the building-up of health unit statistics are only a small part of the picture.
This is one of the major problems of the Division which will have to be tackled
C. E. Dolman, Director.
During 1948 the Division of Laboratories performed a total of nearly
365,000 examinations, of which almost 300,000 were carried out in the central
laboratories in Vancouver. Although there was a slight decline in the demands
upon each of the branch laboratories, tests done in the central laboratories
increased by approximately 10 per cent. Thus the small decrease in turnover
which occurred last year probably represented, as foretold, only a brief interruption of the upward trend in public health laboratory-work. This trend,
manifest in British Columbia for the past fifteen years, was greatly accellerated
during and shortly after the war, for reasons fully explained in previous
Reports. Resumption of a reduced rate of increase is expected, which will
reflect both the expanding population of the Province and the Division's programme enlarged to whatever extent the available staff and accommodation
The actual amount of services rendered during the year increased considerably more than the 10 per cent, shown for total tests done. The types of
tests continually become more exacting, and much investigational work bearing
on the performance of improved tests cannot be listed in the statistical tables.
Again, there has been a tendency, fostered by the central laboratories as a
deliberate policy, for the more complicated tests to be referred by branch
laboratories to Vancouver. This tendency is apparent in the fact that some
20 per cent, of all tests made in the central laboratories related to specimens
from sources outside the Greater Vancouver area. Until the last few years,
this figure averaged only 10 per cent. Total examinations made in the central
laboratories are listed, under appropriate headings, for the years 1948 and
1947 respectively in Table II. Z 78
Table II.—Division of Laboratories Statistical Report
of Examinations done during the Year 1948.
British Columbia (excluding
in 1948.
in 1947.
Animal inoculation	
Blood agglutination—
Typhoid-paratyphoid group
Infectious mononucleosis	
M. tuberculosis
Typhoid-Salmonella-dysentery group	
C. diph theriss    —
Hemolytic staphylococci and streptococci..
Direct microscopic examination for—
M. tuberculosis (sputum)	
M. tuberculosis (miscellaneous) _
Treponema pallidum	
Vincent's spirillum	
Intestinal parasites _
Serological tests for syphilis—
Presumptive Kahn	
Standard Kahn 	
Quantitative Kahn 	
Complement fixation .	
Cerebrospinal fluid—
Complement fixation  	
Quantitative complement fixation..
Cerebrospinal fluid—
Cell count 	
Colloidal reaction.....  	
Bacterial count. 	
Total bacterial count. 	
Unclassified tests  	
As in previous years, tests relating to the diagnosis and control of syphilis
and gonorrhoea accounted for almost three-quarters of all tests performed by
the Division. It does not follow that these tests represented an equally high
proportion of the total work done, since many other types of tests are more
complex and time-consuming.
The policy was continued of estimating quantitatively the reagin content of
all blood specimens giving a positive Kahn reaction, and of all cerebrospinal
fluid specimens giving a positive Kolmer-Wasserman reaction. The system
was adopted of reporting results in terms of the final dilution of serum giving DEPARTMENT OF HEALTH AND WELFARE, 1948. Z 79
complete precipitation and of spinal fluid giving complete complement fixation
respectively. This is not so arbitrary as the former system of units, and in the
long run should prove less confusing for the physicians. The Divisions of
Laboratories and of Venereal Disease Control issued a joint statement to all
physicians in the Province explaining the reasons for the change. These two
Divisions made good use of numerous opportunities for close co-operation during
the year. Although most of the sero-diagnostic tests showed slight increases
over last year's figures, these may be accounted for mainly in terms of enlarging
public interest in routine blood tests. A continued decline in darkfield examinations for Treponema pallidum suggests that the downward trend in the incidence
of primary syphilis, noted in last year's Report, was maintained during 1948.
During the summer, United States consular offices suddenly announced a
Federal Government regulation requiring all persons entering the United States
for periods exceeding six months to present evidence that a blood test for
syphilis had been performed by an authorized laboratory. This enactment has
caused considerable inconvenience in the central laboratories from travellers
bringing in specimens for immediate examination. Earlier in the year, arrangements were made with a neighbouring State to accept reports, for pre-marital
purposes, on tests done in our central laboratories.
In late September, the Laboratory of Hygiene, National Department of
Health and Welfare, Ottawa, organized a three weeks' refresher course in
syphilis serology for the benefit of senior serologists in the various Provincial
laboratories. Miss Mabel Malcolm attended this course as representative of
this Division and found it most helpful. The course was organized by Dr. R. H.
Allen, of the Laboratory of Hygiene staff, who is to be congratulated on the
excellent arrangements. Upon her return from Ottawa, Miss Malcolm assumed
charge of our sero-diagnostic department. The central laboratories participated
in the fourth survey launched in November by the Laboratory of Hygiene, as a
means of verifying the sensitivity and specificity of the various serological tests
performed in the Provincial laboratories throughout Canada. The results of
the survey will not be known for several months.
All types of tests involved in the laboratory diagnosis of tuberculosis again
increased. Requests for animal inoculations were more numerous than ever.
Some of these had to be rejected, and cultural examinations made instead, owing
to lack of guinea-pigs. The main reason for this lies in the completely inadequate and unsuitable quarters available for laboratory animals, to which reference has been made in previous Annual Reports. These critical accommodation
difficulties have entailed postponement of the projected comparison between
guinea-pigs and hamsters as test-animals for tuberculosis work! However,
opinion elsewhere has not shown overmuch enthusiasm for the hamster in this
particular field.
Although there were several outbreaks of staphylococcal food poisoning
and one of botulism during the year, no major Salmonella-Shigella epidemics
(typhoid-paratyphoid-dysentery infections) were identified. A wide variety of
Salmonella strains were nevertheless isolated, mostly from sporadic cases or
familial outbreaks.    A disturbing number of these came from food-handlers.
In all, 75 Salmonella strains and 20 Shigella strains were isolated from different individuals during the first eleven months of 1948. These came from all
parts of the Province, but the great majority were from patients domiciled or
hospitalized in Vancouver. The distribution of these strains according to types
was as follows: S. newport, 23; S. typhi, 20; S. typhi murium, 13; S. paratyphi
B., 10; S. bareilly, 5; S. oranienburg, 4; and S. derby, 4. Of the 20 Shigella
strains, 19 were Sh. flexneri and 1 Sh. sonnei.
The rather meagre epidemiological information usually available indicates
that these infections were of man-to-man conveyance. The laboratories obtained
no evidence of animal-to-man transmission.
As in previous years, branch laboratories were encouraged to send on to
Vancouver all specimens of excreta for cultural examinations. The Victoria
laboratory was the only one to examine any significant number of such specimens. The primary isolation and subsequent identification of members of the
Salmonella-Shigella groups now entails keeping on hand too great a variety of
media, and requires a degree of experience too specialized, for branch laboratory
resources. Indeed, the central laboratory was pleased to refer all Salmonella
cultures isolated therein to Dr. L. E. Ranta, of the Western Division of Con-
naught Medical Research Laboratories, by whom their identification was finally
made. The physician thus received an early notification from us that a Salmonella culture had been isolated from his patient. On receipt of Dr. Ranta's
report, a second notice was sent to the physician, indicating the particular type
of Salmonella identified. This system has now been followed for several years.
It is proposed in the near future to publish a summary of the findings over the
past five years. Briefly, these suggest that a widening variety of Salmonella
strains are endemic in British Columbia.
Botulism Outbreak.
Two years ago three fatalities at Nanaimo due to botulism, type E, were
reported. Early in 1948 two deaths occurred at Grand Forks which were identified in the central laboratories at Vancouver as due to type A botulism. The
former outbreak was traced to home-canned salmon. The recent episode was
due to home-bottled asparagus. In both instances the preserving methods used
were extremely primitive and careless, suggesting that still more health education is necessary in this field. The fact that the diagnosis was apparently not
suspected by the attending physicians in either outbreak also suggests that the
profession should bear in mind the characteristic symptomatology of this rare,
but extremely dangerous, form of food intoxication. The Nanaimo and Grand
Forks outbreaks are incidentally the only known examples of botulism in Canada
in which the casual micro-organism was actually isolated from the incriminated
foodstuff. Further, the corresponding organisms were in each instance isolated
from near-by garden soil. Both outbreaks have been recorded in appropriate
journals (vide infra). DEPARTMENT OF HEALTH AND WELFARE, 1948. Z 81
An encouraging indication of efforts to improve the basic sanitation of the
Province was the increased number of milk and water samples examined. Use
of air mail facilities, or of specially constructed ice-containing boxes, permitted
shipment of specimens to the central laboratories from greater distances than
heretofore. A better distribution of Sanitary Inspectors in some areas of the
Province also promoted this service. There is room for more effective follow-up
of the laboratory findings.
The Bang's disease incidence among dairy cattle apparently remains high.
Although the milk-supply of the City of Vancouver has been pasteurized for two
years, human brucellosis still occurs in other parts of the Province, and some
Vancouver physicians suspect sub-acute and chronic cases of the disease are
fairly common still in this city. The majority of such infections, if correctly
diagnosed, are presumably contracted from milk or milk products, or from some
other source of Brucella organisms, encountered outside the city limits. But
there have been occasional examples of faulty pasteurization, as shown by
the results of phosphatase tests. Moreover, cream has apparently been sold
unpasteurized in city markets. Cheese is also a potential source of brucellosis,
although probably less dangerous than cream in this respect. It should be
emphasized that Brucella abortus is the only member of the Brucella group so
far identified in human or bovine infections in this Province.
There was further evidence from several quarters during the year of the
public's anxiety for safe water-supplies, as was indicated by the increased
number of samples submitted to the laboratory for analysis. This service was
particularly valuable to the Fraser Valley area during the period of the recession
of the flood-waters.
Blood agglutination tests for the typhoid-paratyphoid group of infections
again increased slightly, while similar tests for brucellosis underwent an
increase of nearly 30 per cent.
In the diagnosis of brucellosis, the findings of the public health laboratory
may be of crucial importance. But this does not mean that laboratory tests
alone may be expected to give a conclusive answer to a queried diagnosis of
brucellosis. The results of blood agglutinations and opsone-cytophagic tests
may be confusing and even contradictory. In view of this, the laboratories
discourage any practice suggesting routine requisitions for these tests.
Cultures for C. diphtherias showed an increase of approximately 15 per
cent. Diphtheria remains far more prevalent in the Province than it should be.
Bearing in mind the proven efficacy of diphtheria toxoid, when properly administered in the pre-school years, with reinforcing doses given at appropriate
intervals thereafter, every case of diphtheria should be viewed as a challenge to
the self-esteem of public health workers. Small outbreaks occurred in various
parts of the Province, but were quickly brought under control. One outbreak
in Vancouver was of larger dimensions, and involved in all some eleven persons,
with two fatalities. This episode and one at Kamloops were traced to convalescent carriers prematurely released from isolation on the basis of three
negative nose and throat swabs taken on successive days.   There is good evi- Z 82 BRITISH COLUMBIA.
dence that these criteria for the release of convalescents are inadequate. This
question was made the subject of a paper published in the Canadian Journal of
Public Health (vide infra).
On two or three occasions during the year the central laboratories isolated
strains which gave pseudo-positive virulence tests upon inoculation into guinea-
pigs, but were not C. diphtherias, as judged by cultural or biochemical reactions
or by the patient's response to treatment. In one instance an organism having
characteristics intermediate between those of C. pyogenes and C. hsemolyticum
was isolated from a tonsillar membrane of a person complaining of a sore throat,
with slight fever. Such findings raise problems in connection with quarantine.
They also emphasize the necessity of requiring all branch laboratories to submit all doubtful cultures for C. diphtherias to the central laboratories for confirmatory tests. The central laboratory was pleased to avail itself of the
restored verification and typing service offered by Dr. E. T. Bynoe, of the
Laboratory of Hygiene at Ottawa. The findings on numerous strains sent him
during the year coincided with ours in every instance. His typing of gravis
strains furnished epidemiological information of considerable value.
There has been a noteworthy tendency for an increasing percentage of
specimens to reach the central laboratories from sources outside Vancouver.
This has been deliberately fostered, in the belief that comparatively few types
of public health laboratory tests now require a report so urgently that hasty
judgments based on provisional tests are warranted. Many new refinements
have been introduced in recent years, and at the same time micro-organisms
have themselves shown striking capacities to deviate from classical, text-book
descriptions. Only those laboratory-workers confronted regularly with fairly
large numbers of the various tests in question can keep familiar with their
commoner idiosyncrasies. Hence, branch laboratories were urged to take every
advantage of air mail facilities and other methods of improved communication,
and to refer difficult and unusual types of tests to the central laboratories in
Z 83
Table III.—Number of Tests performed by Branch
Laboratories in 1948.
Blood agglutination—
Typhoid-paratyphoid group   	
Typhoid-paratyphoid-dysentery group..
Hsemolytic staphylococci and streptococci    	
Direct microscopic examination for—
Serological tests for syphilis—
Presumptive Kahn 	
Standard Kahn    	
Cerebrospinal fluid—
Cerebrospinal fluid—
Cell count  _
Miscellaneous (phosphatase and reduc-
Totals, 1948
Totals, 1947	
Flood Emergency.
The floods in the Fraser Valley and elsewhere in the Province brought
special problems to the Division, as they did to other divisions of the Department of Health. The central laboratories in Vancouver were very much
involved in mobilizing and facilitating the distribution of biological products
for use in the affected areas, and subsequently undertook the task of testing
water samples from flooded wells. These two emergency services were carried
out in a spirit of cordial co-operation with Dr. G. R. F. Elliott and R. Bowering,
who were in charge of the Provincial Department of Health's programme in Z 84 BRITISH COLUMBIA.
the Fraser Valley. Miss D. E. Kerr, Assistant Director of the Laboratories,
and Mrs. M. Allen, in charge of the office staff, deserve special mention for their
efficient and selfless efforts throughout the emergency. To the Fraser Valley
communities in the flooded areas, sufficient T.A.B. vaccine was distributed,
during a period of a few weeks only, for the immunization of some 60,000
Biological Products.
Apart from the Fraser Valley communities, intensive immunization campaigns against typhoid and paratyphoid A and B fevers were launched in territories covered by the Peace River, Cariboo, and East Kootenay Health Units.
In many parts of the Province a very satisfactory proportion of the population
has now received prophylactic T.A.B. vaccine. It should be emphasized that the
specific protection afforded by this product wanes fairly rapidly, and should be
renewed by "booster" or reinforcing doses at regular intervals. Moreover,
T.A.B. vaccine confers no protection against other members of the Salmonella
group, or against the Shigella (bacterial dysentery) group.
The distribution of biological products for the prevention and control of
communicable disease reached new records for 1948. Over 50,000 packages of
various products were released for distribution by the Division. This activity
represents one of the least spectacular, but most important, services of the
central laboratory. Only a few examples can be given to suggest what this
work may mean in lives, health, and money saved. Sufficient vaccine virus was
distributed to vaccinate nearly 50,000 persons against smallpox. Diphtheria
toxoid for the immunization of roughly 40,000 children, pertussis (whooping-
cough) vaccine for 30,000 children, and T.A.B. vaccine for roughly 80,000
persons were also released free of charge to practising physicians and health
officials throughout the Province. The resulting benefits to the people of British
Columbia are inestimable.
Scientific Meetings attended.
The Director attended the annual meeting of the Western Regional Group,
Associate Committee on Medical Research, National Research Council of
Canada, held in Edmonton in mid-February. He read a paper on " Separation
and Purification of Staphylococcus Enterotoxin."
The Director also acted as chairman of the Epidemiology Section, Canadian
Public Health Association, which held its annual meeting in Vancouver in May.
Apart from organizing the scientific programme for this Section, two papers
were presented by the Director and associates, and these have since been
Again the Director attended a meeting, held under the auspices of the
Laboratory of Hygiene in Ottawa early in December, of the Technical Advisory
Committee on Public Health Laboratory Services. While there, he read a paper
on " Influenza to the Ottawa Bacteriology Society." Afterwards he went to
London, Ont., for the annual meeting of the Laboratory Section, Canadian Public
Health Association, where he presented two scientific papers. These meetings
were all very worthwhile. department of health and welfare, 1948. z 85
Scientific Publications.
The following papers by members of the Division of Laboratories were
published during 1948:—
Dolman, C. E.:  "The Sanitarian's Place in Public Health," Canadian
Public Health Journal (January), 1948, 39, 41.
Dolman, C. E.: "Oral Immunization," American Journal of the Medical Sciences (March), 1948, 215, 327.
Dolman, C. E.; Hudson, Vivienne G.; and Kerr, Donna E.:  " Diphtheria Outbreaks due to Premature Release of Convalescent Carriers," Canadian Public Health Journal (August), 1948, 39, 305.
Dolman, C. E., and Kerr, Donna E.:  "Two Fatal Cases of Botulism
from Home-bottled Asparagus," Canadian Medical Association
Journal (October), 1948, 59, 412.
In closing, appreciation is expressed of the excellent spirit shown by the
staff in the continual struggle to maintain high standards in the face of difficult
and discouraging circumstances.    The Assistant Director, Miss Donna Kerr,
must be credited with a large share of credit for this accomplishment.
G. R. F. Elliott, Director.
There would appear to be a 22.5-per-cent. decrease in the total cases and a
decrease of 25.2 per cent, in the rate of venereal disease reported in British
Columbia during the year 1948 as compared to 1947. This is the second consecutive year a substantial decrease has been noted in this Province, following
a consistent rise since 1940. It is felt this decrease is noteworthy since the
vigorous efforts on the part of the epidemiological staff to trace contacts, the
new diagnostic clinic formed at the Vancouver City Police station, and sundry
other small blood-testing surveys carried out amongst mariners and other groups
have done much to find previously unreported cases.
The drop in incidence, though due in part to the receding war years with
the abnormal living conditions, is believed to be largely accounted for by the
increased efforts made in case-finding and the earlier and more rapid treatment
of cases and of contacts. Other factors concerned are the excellent co-operation
of private physicians in reporting and following up cases, the assistance of
health units and nurses, the ready help given by various public groups in helping
to combat facilitation, and the gradual dissemination of knowledge of venereal
disease among the general population.
The provision of free drugs and specialist consultative services to private
physicians continue to be offered by this Division. These services are freely
used and go far toward ensuring adequate treatment according to the most
modern standards, as well as adequate after-care and supervision, and help to
maintain a friendly relationship and co-operation with the private physician.
The ready and generous help and co-operation given to this Division by
other Provincial divisions, as well as by the local authorities and other public Z 86 BRITISH COLUMBIA.
services, have been very much appreciated.    Again special mention in this
regard should be made of the Division of Laboratories, whose efforts for meeting
the ever-increasing demands of this Division have been so successful and so
In view of the great amount of venereal disease research being carried on
throughout the world at the present time, it becomes necessary from time to time
to make changes or modifications in treatment to conform with the latest views.
Such changes have been evident in this Division during the past year, though
there has been some reluctance to abandon completely the older and well-tried
methods of treatment which have shown such a high degree of success in
the past.
Penicillin has been used to an ever-increasing extent, and appears to be
slowly and steadily replacing the older and more-prolonged methods of treatment
in many stages of venereal infection. This has been a time-saving factor and
has led to a marked shortening of the period of treatment. It is hoped also
that it will lead ultimately to a diminution in the number of persons who cease
attending before completing their full course of treatment.
The routine use of neoarsphenamine has been discontinued by the clinics of
this Division. Mapharsen is now used in almost all cases where arsenicals are
indicated. This change, besides being in accordance with modern trends, is
considered to offer a wider margin of safety for the patient.
The Division has continued its policy of admitting selected cases of syphilis
to the Infectious Diseases Hospital, Vancouver, for intensive penicillin treatment. The number of beds available was reduced to six during the latter half
of the year, owing to the extra bed requirements of the Vancouver General
Hospital during rebuilding operations. In spite of this, however, there has
been very little decrease in the number of patients admitted for treatment during
the year.
Streptomycin has been made available for the treatment of resistant cases
of gonorrhoea where treatment by ordinary methods has failed. The impression
has been gained in this Division, however, that true failures are rare in the
treatment of gonorrhoea with penicillin, apparent relapses being due in most
instances to reinfection.
Clinics continue to be operated as before, with the one addition of a daily
male diagnostic clinic at the Vancouver City Gaol. This clinic has already
proved itself most useful in the detection of new cases of venereal infection, as
well as in renewing contact with patients who have lapsed from treatment or
Increasing efforts are being made to provide for the routine blood-testing
of all women in pregnancy and, where these are found to be positive, of carrying
out full anti-syphilitic treatment. It is only by this means that prenatal
(congenital) syphilis can be eradicated, with a corresponding reduction in stillbirths, infant mortality, and child suffering.
The workers in the field of epidemiology continue to show most gratifying
results in case-finding and case-holding.    This is due in a large measure to a DEPARTMENT OF HEALTH AND WELFARE, 1948. Z 87
high standard of persistence, resourcefulness, and tact on the part of the
workers. A close liaison has been maintained by the workers in this Division
with the public health nurses in the field, as well as with the nurses on the staff
of the Vancouver Metropolitan Health Committee and the various health units
throughout the Province.
Valuable assistance has been given throughout the year by the Medical
Health Officer of the City of Vancouver and by the Vancouver Police Department. Their help has been readily and freely given and has been especially
valuable in locating suspected venereal disease cases and contacts and, where
necessary, in bringing these cases in for investigation and treatment.
During the year there were three meetings held of interested parties concerned with facilitation and the control of venereal disease in this Province.
Attending these meetings were authorities from the Vancouver City Police
Department, the British Columbia Police, British Columbia Hotels Association,
Liquor Control Board, Vancouver City Licence Inspector, representatives of the
United States Armed Services, as well as the Senior Medical Health Officers of
the Cities of Vancouver and Victoria.
These meetings have had as their main purpose the discussion of the various
aspects of facilitation and the methods to be adopted for dealing with this
problem. The friendly nature of the discussions and the very willing and active
co-operation of the participants have been most helpful in developing this aspect
of venereal disease control. As a result of suggestions put forward at these
meetings, many of the trouble spots in facilitation in the City of Vancouver have
been markedly improved.
As already mentioned, as a result of the success of the female clinic at the
Vancouver City Gaol, a diagnostic clinic has been set up in the male section of
the Vancouver City Gaol. The clinic is conducted by a member of the nursing
staff of this Division and is concerned primarily with the detection of syphilitic
infection. Serological tests are carried out on 95 per cent, of all male prisoners.
The investigation has been on a voluntary basis, but in only a few instances has
the blood-testing been refused. The results obtained from these examinations
have well repaid the time and energies involved.
Blood-testing surveys have been carried out at the medical centre of the
ship-owners' association and on a small scale amongst the Indians at a small
In September of this year there was clarification of the place of the social
worker in venereal disease control, and a change in the programme of the
Vancouver clinic medical case-worker. The Social Service Section formerly
conducted the programme aimed at the control of premises which facilitate the
spread of venereal disease. This programme has now been taken over by the
Epidemiology Section, leaving the social worker free to make her specific contribution to combating venereal disease. An increasing number of persons is
being referred to her with social problems, such as severe emotional stress,
domestic difficulties, illegitimate pregnancy, and the need of financial assistance.
Juveniles who are developing behaviour problems are also referred for guidance.
Daily ward rounds are made at the rapid-treatment centre in an endeavour Z 88 BRITISH COLUMBIA.
to give more intensive case-work service to this group of patients during
General public education on venereal disease has now become the responsibility of the Division of Public Health Education, which is working in close
conjunction with the Division of Venereal Disease Control.
Lectures on various aspects of venereal disease and its control have been
given throughout the year to student-nurses, lay-student organizations, and to
social workers.
During the year the following articles were published by members of this
Division: The paper " Medical Shock and Death following Neoarsphenamine
Therapy for Syphilis," written by Dr. B. Kanee, Consultant in Syphilology at
this Division, and Dr. G. R. F. Elliott, Director of this Division, was published
in the July issue of The Canadian Medical Association Journal; "Pre-natal
(Congenital) Syphilis with Interesting Diagnostic Findings," written by Dr.
Kanee, was published in the November issue of The Canadian Medical Association Journal; the paper " Some Recent Developments in Venereal Disease
Epidemiology in British Columbia " was read by the Director at the Canadian
Public Health Association Conference held in Vancouver in May of this year.
Reprints of all these articles have been obtained and distributed to the medical
profession and other interested parties in this Province.
During the year an excellent booklet entitled "Venereal Disease Information
for Nurses," prepared by this Division, was published, and is being circulated
for professional educational purposes.
Agreement has been reached by the Vancouver General Hospital and the
Divisions of Tuberculosis Control and Venereal Disease Control for the establishment of a library for use particularly by interns, nurses, and other staff
members. The contribution of this Division will ensure the inclusion of a
section on venereology and the various phases of venereal disease control,
thereby making available and readily accessible adequate and up-to-date reference material on this subject.
A valuable addition in the field of professional education has been made
in the decision of this Division to appoint a public health nurse as Nursing
Educator. This individual will have as her responsibility the co-ordination of
educational work related to the nursing and welfare personnel taking training
in this Province. Groups of public health nurses, social welfare workers, and
undergraduate nurses visit this Division during their training period, and it
will be the Nursing Educator's responsibility to assure that their education in
regard to venereal disease is complete. In addition, the Nursing Educator will
establish a working relationship with those nurses' training-schools throughout
the Province where the students do not have the opportunity of spending time
with this Division in an attempt to carry out a similar educational programme
amongst these nurses. Much time and effort has been expended in recent years
on lay education regarding venereal disease; it is felt that the education of
professional personnel has been neglected to some extent, and it is hoped the
above appointment will rectify this condition as it pertains to the nursing and
welfare field in this Province. DEPARTMENT OF HEALTH AND WELFARE, 1948. Z 89
During the year the redecoration of the Vancouver clinic, mentioned in the
1947 Report, was completed, and the resulting improved appearance has been
At the present time the study mentioned in the 1947 Report regarding the
number of newly reported cases of venereal disease who are transient persons,
or persons who have been diagnosed elsewhere prior to taking up residence in
British Columbia, has progressed on the Dominion level, and it is hoped figures
will be available for the annual report of this Division.
The Director attended the conference of Venereal Disease Control Directors
of the Provinces held at Ottawa in March. Much valuable information and
exchange of ideas were obtained at this meeting, and a further meeting is being
planned for February, 1949, in Ottawa.
The shortage of full-time medical personnel remains exceedingly acute.
This situation exists not only in this Division, but is also found throughout the
Department of Health in this Province.
Late in the year the Director of this Division was given additional responsibilities in regard to the Federal health grants, and, as a result, it has not been
possible to spend the time required in this Division. The Division, however,
was most fortunate in obtaining a well-qualified physician with wide clinical
experience, who has been placed in charge of all clinics, with headquarters at
the Vancouver clinic. In addition to this, a highly qualified physician has been
appointed on a part-time basis as physician in charge of the Victoria clinic.
These two appointments, and particularly the former, are extremely fortunate
and will do much to improve treatment procedures and establish and improve
liaison with other medical authorities in this Province.
The part-time clinic physicians continue to be rotated. The calibre of these
men remains high, and there is no dearth of applicants.
During the year, as is normal in all such divisions to-day, staff changes
occurred. It is felt that the loss of Mrs. Lorna Marshall should be mentioned.
Mrs. Marshall was one of the senior clinic nurses at this Division, and when she
decided to leave for Eastern Canada, it was a definite loss to this Division, since
her work and contributions had always been of the highest calibre.
Late in 1948 Miss Jean Gilley, branch secretary of this Division, received a
well-earned promotion to the position of research assistant. The work in this
new position will be primarily concerned with the Federal health grants at first.
Miss Gilley has made an outstanding contribution to the success of this Division,
and although the loss of her direct services to this Division is regretted, it is felt
she has much to contribute to the general health administration problems of this
Province, and the opportunity to use this talent is present in the new position.
The addition of the increased Federal grant has done much to add to the
control of venereal disease in this Province, and this assistance has been very
much appreciated.
Finally, the co-operation and understanding of the Deputy Minister of
Health and all members of his staff in the central office has been most helpful. Z 90 BRITISH COLUMBIA.
W. H. Hatfield, Director.
The Division of Tuberculosis Control is pleased to report considerable
improvement in its programme during the year 1948. The most urgent problem
has been that of insufficient bed facilities. In order to handle the tuberculosis
problem in British Columbia adequately, it will be necessary to have approximately 500 more beds than are available at the present time. It is hoped that
the money that has now been allotted will complete 250 beds of the proposed
500-bed unit. Plans for this new institution in Vancouver have been completed,
and it is hoped that construction will be started early in 1949.
The addition to the Vancouver unit, which will house new surgical and
teaching facilities and an auditorium, is nearing completion, and it is hoped to
have this unit in full operation by March, 1949.
A number of additions and changes that have been previously recommended
for the Tranquille unit have been started during the year. New homes have
been provided for the medical staff, and an addition to the nurses' home is under
way. Further internal improvements have been carried out in the existing
The announcement from Ottawa that grants are to be made to the Provinces
for expansion of services has allowed for certain new developments. A programme to cover a number of years has been planned and submitted to Ottawa
in connection with these new grants, and at the end of the year certain projects
have been planned to expand the work of the Division in the year 1949. Projects
that have been approved are:—
(1) Survey X-ray equipment to be loaned to local hospitals and health
(2) Occupational therapy for patients in their homes.
(3) Equipment for the Tranquille unit.
(4) Equipment for the surgical unit in Vancouver.
(5) Postgraduate training.
(6) Medical library.
From time to time other projects will be submitted up to the amount of the
annual tuberculosis grant. All these new developments fit into a definite pattern
that has been planned over a period of time, and with the provision of adequate
beds in the Province the tuberculosis control programme will be completely
rounded out. One of the most difficult situations with which the Division has
been confronted, however, is the problem of getting properly trained medical
staff to carry out the work of the institutions and clinics, and, to this end, reports
have been submitted indicating the necessity for a complete revision of medical
In the over-all picture of tuberculosis control in the Province it is encouraging to note that there has been a greater drop in the death-rate this year than
in any previous year in the history of the Province. The 1948 preliminary
tuberculosis mortality rate for the total population was 40.7 per 100,000 in 1948
as compared with 50.3 in 1947; for the other-than-Indian population, 28.3 in DEPARTMENT OF HEALTH AND WELFARE, 1948. Z 91
1948 and 36.2 in 1947; for the Indian population, 507.1 in 1948 and 581.5 in
1947. Also, despite approximately the same number of people being X-rayed in
the survey-work, there is a decrease in the number of new cases being found and
a shift in these new cases from the younger to the older age-groups.
We are pleased to report at the end of the year that the Vancouver unit has
been certified by the Royal College of Physicians and Surgeons of Canada as a
postgraduate training centre in chest disease.
The clinics operated by the Division during 1948 remained the same as
in the previous year. It is unfortunate that it has been impossible to have
physicians attached to the travelling diagnostic clinics, except in one instance.
The employment of specialist physicians is necessary in order to carry out this
work, and with the salary rates that are presently paid, it has been impossible
to obtain such physicians for the service. It has been necessary for consulting
services to be confined to the taking of X-ray films in the rural areas and forwarding these to the main units of the Division for interpretation.
The stationary survey clinics continue to increase in the number of examinations, which in turn throws an increasing load on the stationary diagnostic
clinics.    This is particularly apparent in the Vancouver area.
The mobile units have carried on in the same pattern as previously, doing
almost the same volume of work as in 1947. The preliminary total examined
by all survey clinics during the year was 184,600. Of that total, 1.7 per cent,
were referred to diagnostic clinics, which is slightly lower than the rate in
previous years. Of the group referred for further study, 429 or 14.1 per cent,
were diagnosed as tuberculous. These tuberculous diagnoses were as follows:
Primary, 1.6 per cent.; minimal, 65 per cent.; moderately advanced, 28.7 per
cent.; far advanced, 4.7 per cent. Thus 0.2 per cent, of the total examined
were found to be tuberculous. Of those diagnosed, 139 required active treatment, and of those at the end of the year, 78 had been admitted to hospital.
In the diagnostic clinics 37,718 examinations were made, which is an
increase of 10.3 per cent, over the previous year and 24.9 per cent, over 1946.
The out-patient pneumothorax work remains at a fairly constant level of 8,074
treatments during the year. The total number of examinations, including all
clinics, both survey and diagnostic, was 222,318. Including out-patient treatment work, the total number of patient-visits to all clinics and survey units
was 231,121, which is a decrease from the previous year of 12,458.
The acute situation in regard to the number of beds still remains the same,
although, as mentioned, plans have now been completed for the start of a new
institution in the City of Vancouver. There has continued to be a long waiting
list for institutional care. Even when the cases on the waiting list are limited
to acute, active pulmonary tuberculosis, there is still an interval of some months
between date of application and date of admission to institution. As new
institutions take time to build, it will probably be another eighteen months at a
minimum before any relief in the bed situation can be foreseen. In the meantime, improvements have been made in the existing institutions so as to be able Z 92 BRITISH COLUMBIA.
to render more advanced forms of treatment and better service in general. The
most notable improvement is at the Vancouver unit, where the building provided by the British Columbia Tuberculosis Society will allow this institution
to carry out every form of active treatment for the tuberculous patient and will
make this one of the best-equipped and best all-round treatment units of its
kind in North America.
Many of the changes that have been recommended for the improvement of
the facilities at Tranquille have been accomplished during the year. New
homes for the doctors have been completed. The much-needed addition to the
nurses' home is well on its way to completion. The electric current has been
changed from direct to alternating. With further training of medical staff it
has been possible to do chest surgery again at Tranquille.
There have been no new developments at the Victoria unit.
It is necessary to report again that St. Joseph's Oriental Hospital, which is
considered by the Division as unsatisfactory for the care of tuberculous
patients, is still in operation.
Correlation of the various branches of the nursing service was effected on
a full-time basis approximately one year ago. It was necessary during the year
to devote much time and effort to projects dealing with standardization of
policies and routines on a Provincial level.
Programmes for staff orientation and patient education were outlined and
have been adapted to local circumstances in the various units. Further
improvement and expansion of the nursing service to meet present-day standards and progress in other phases of the tuberculosis programme will be possible through central planning based on helpful suggestions from the nurses
in institutional, clinic, and district services.
Recruitment of professional nurses has improved during the past few
months. A total of 102 nurses are employed in the various branches of the
Division. The shortage of nurses at the Tranquille unit is less acute, as shown
by the following comparative figures. In the Reports for 1946 and 1947 the
number of professional nurses ranged from twenty-five to thirty-two, while at
the present time there are thirty-eight full-time and four half-time nurses.
The educational programme for undergraduate and postgraduate students
is progressing favourably. Satisfactory progress is being made in reorganization of the course at the Victoria unit in accordance with recommendations
for uniformity of policies and opportunities for students in both centres.
The Division, through the Vancouver and Jericho Beach units, is co-operating in providing clinical experience for the practical-nurse students enrolled in
the one-year course at the Technical School in Vancouver. Participation in
this project will benefit the various units of the Division by providing a source
of supply of auxiliary nursing personnel with uniform basic preparation.
During 1948 the situation with regard to social service staff at the
Tranquille unit did not improve, but it was possible to maintain staff in the
A short staff-training course was given with the assistance of a member
of the medical staff, who gave a series of talks on psychosomatic aspects of other
diagnostic groups than tuberculosis. It was also possible during the year to
have a psychiatrist as consultant for some problem cases in Vancouver.
In November, 1947, the Provincial Supervisor of Social Service was
appointed to the Assessment Committee on Institutional Revenue. This contact
has proved very valuable in giving the Supervisor an opportunity to interpret
to the members of the Committee some of the problems facing patients in tuberculosis institutions.
During the year the boarding-home for women was closed, and so far has
not been replaced. Placement problems, not only with regard to women
patients, but for long-term chronic patients who have intermittent positive
sputum, have reached the point where there does not seem to be any possible
place for many of these patients to go.
It is planned during the forthcoming year for the Division to take over the
rehabilitation-work initiated by the British Columbia Tuberculosis Society.
Further improvement in the local health service makes it possible to
operate the field-work of the Division more smoothly, and every co-operation
has existed between the Division and local services.
There will be an increase in the Provincial expenditure for tuberculosis
during the forthcoming year due to factors beyond the control of the Division—
namely, increased commodity prices and increased wages. Further increases
due to the expansion of facilities of the Division, such as routine X-ray examination of patients admitted to general hospitals, rehabilitation services, postgraduate courses, etc., will be provided under the new Federal health grants.
The only new facility to be opened during the forthcoming year which will be
a part of Provincial expenditure is the addition to the Vancouver unit, the
operating costs of which will be part of the Provincial budget.
As reported in the previous year, all facilities of the Division are still taxed
to the limit. Clinics are becoming overcrowded. In Vancouver this will be
largely rectified with the opening of the new addition, but the New Westminster
clinic has reached a stage where additional space is essential.
In order to bring about further advances in the control of tuberculosis in
the Province, it is necessary to have a considerable number of additional beds.
It is sincerely hoped that by the end of another year it will be possible to report
that bed facilities are becoming more adequate to meet the need. Z 94 BRITISH COLUMBIA.
R. Bowering, Director.
The Division of Public Health Engineering is primarily concerned with
environmental factors that affect health. Engineering public health service is
concerned with the adjustment of the environment so that man may enjoy better
health.    The Division is often called the Division of Environmental Sanitation.
The technical staff of the Division includes engineers and Sanitary
Inspectors. All members of the technical staff must have either a degree in
engineering or a certificate in sanitary inspection.
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, sanitation of cold-storage locker
plants, and the many miscellaneous items which are included in the term
" environmental sanitation." This report will deal with these various features
under specific headings.
There are over 150 separate water-supply systems in British Columbia. It
is estimated that these water-supply systems serve 75 per cent, of the population of the Province with drinking-water. One of the most important responsibilities of the Division of Public Health Engineering is to be sure that these
public water-supply systems provide a safe water.
The " Health Act " requires that plans of all new waterworks construction
be approved by the Deputy Minister of Health. Approximately $2,000,000
worth of waterworks construction was approved in 1948. In studying the
plans for approval, the source of supply and the distribution is gone over very
carefully in order to see that no public health hazards exist. In many instances
the Division is able to suggest alterations in the plans that are of benefit to the
local water authorities.
In addition to approval of plans, sanitary surveys of a number of existing
water-supplies were carried out. In several instances treatment of the water
was recommended. In this regard it is interesting to note that in two widely
separated cities of the Province, Cranbrook and Prince Rupert, plebiscites were
held on the question of chlorinating the local water-supply. In both cases the
people supported this public health measure by a very good majority.
In addition to public water-supplies, the Division is interested in the private water-supply used on farms and in certain small villages. It has been the
policy of the Division to have all water samples taken by qualified personnel
after having made a sanitary survey of the water-supply source in question.
With the increase in the staff of Sanitary Inspectors that was made in 1948,
it will soon be possible to provide this type of service throughout the entire
Province. In this way the sanitary quality of the water used by the rural
population is being improved year by year. DEPARTMENT OF HEALTH AND WELFARE, 1948. Z 95
In 1948 a considerable number of chemical analyses of water-supplies
through public water systems was made by the laboratory of the Division of
Public Health Engineering of the Department of National Health and Welfare.
This made it possible for the Department to give advice on improving the
potability of certain waters.
It is hoped that in 1949, with the appointment of an Assistant Public
Health Engineer, that adequate inspection of the water-treatment plants which
are now established in the Province can be made, to see that all these plants are
operating at maximum efficiency.
Sewerage and sewage-disposal is an important feature of the work of the
Division of Public Health Engineering. Sewerage and sewage-disposal falls
naturally into two classes—the private sewage-disposal system and the public
sewerage system. British Columbia was one of the earliest authorities (on the
State or Provincial level) in North America to require approval of plans of
sewerage and sewage-disposal systems by the Department of Health. For this
reason, the sewerage systems in British Columbia, on the whole, are built to a
good standard. Another important result is that pollution of streams and tidal
bodies of water has not become as serious a problem in British Columbia as it
has in some of the other Provinces and States of North America.
In 1948 plans and specifications covering the proposed construction of
approximately $2,000,000 worth of sewerage-works were approved by the
Health Department after checking by the Division of Public Health Engineering.
The year 1948 also saw the coming into operation of the new modern sewage-
treatment plant at Penticton.
It was mentioned in the 1947 Report that a large sewerage system had been
planned for the Municipality of Saanich. Unfortunately the people of the
municipality turned this plan down, and, as a result, this important municipality
is without a sewerage system. It is felt that one of the biggest problems of the
Division is the lack of sewerage construction in certain urban areas. This is
particularly true in the case of unorganized areas. It is hoped that some
concrete suggestions can be made in 1949 for a renewed approach to this
The standard plans that have been prepared for the construction of septic
tanks and private sewage-disposal systems have been very widely distributed
and very widely used. This has resulted in improvements in new installations,
and it is already beginning to lessen the number of complaints regarding
insanitary sewage-disposal in certain rural areas.
The Province still has not a Provincial plumbing code. An important task
which should be performed in 1949 is the establishment of such a code.
For the first time in many years there was no major milk-borne epidemic
in British Columbia. This is probably a result of the increase in the use of
pasteurized milk. While there is still a considerable amount of raw milk sold
in the Province, it is now possible to buy pasteurized milk in all of the major
cities and towns in British Columbia. Z 96 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 and as
far as the licensing of pasteurizing plants 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 consultative service to local health
services. The day to day sampling and supervision of the milk-supplies is a
responsibility of the local Sanitary Inspectors. With the increase in the number
of Sanitary Inspectors, the problem of having milk samples examined in the
Provincial laboratory is becoming more and more acute. It is hoped that steps
can be taken to increase the capacity of the Division of Laboratories within
the next year.
The work of the Division on sanitary surveys of oyster leases was greatly
hampered this year because of the floods. The staff that was gathered for the
sanitary survey of oyster-beds had to be used for flood-control work, and, as a
result, the shellfish-bed work had to suffer.
The largest single sanitary survey of an oyster-bed that was done in 1948
was the sanitary survey of Esquimalt Harbour.
The Division also drafted a proposed set of shell-fish regulations which
have been mimeographed and sent to the various oyster-growers for comments.
It is expected that these regulations will be made effective in 1949. A visit
was made to the shellfish-growing areas and shucking and packing plants in
Washington State by the Director in order to compare shellfish-control measures
in Washington State with those in British Columbia.
The collection of samples of clams for testing for toxicity continued
throughout 1948. The sampling-work was extended in 1948 to areas on the
northern coast which had not been adequately tested before. It is the opinion
of the writer that sufficient samples to determine adequately the extent of
shell-fish toxicity in British Columbia waters are not being taken.
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.
As reported in the 1947 Annual Report, a new set of regulations dealing
with sanitation of industrial camps came into effect on January 1, 1947. The
year 1948 was, therefore, the second year in which these regulations were in
effect. One of the gratifying results was that the number of complaints
regarding industrial camps was the least received by the Department in many
Regular inspections of industrial camps has now become a routine part of
the work of local Sanitary Inspectors. This means that the health unit areas
were very well covered in 1948. With the expansion of the sanitary inspection
staff into non-health unit areas, it is expected that in 1949 there will be very few
industrial camps in the Province that will not be inspected by a qualified
Sanitary Inspector. DEPARTMENT OF HEALTH AND WELFARE, 1948. Z 97
The number of inspections of fish-cannery camps was down in 1948 as these
inspections are usually made in June and July, and at that time the staff were
all engaged in flood-control work.
Detailed inspections of tourist camps have now been carried out for a period
of three years. During 1946 and 1947 a special inspector was appointed for
tourist camp work. In 1948 it was felt that the work had got a reasonably good
start, and the responsibility of tourist camp inspections was placed on the local
Sanitary Inspectors. Although in some areas where there is a large number
of tourist camps this threw a heavy additional load on the Sanitary Inspectors,
it is felt that a very good coverage of the tourist camp facilities was made in
1948.   The Division now has reports on 565 tourist camps.
It was very encouraging to note that most tourist camp operators were
anxious to comply with the regulations and with the suggestions of the Sanitary
Whenever a new tourist camp applies for registration with the Travel
Bureau of the Department of Trade and Industry, a request for an inspection
by the Sanitary Inspector is made to the Division of Public Health Engineering.
The original inspection by the local Sanitary Inspector is then made the basis
for recommending to the licensing authority as to whether or not registration
should be accepted.
The application of the regulations this year has shown several weaknesses
in the presently established regulations, and it is proposed that certain amendments and additions to the regulations should be given consideration. It is
hoped that the regulations will be strengthened and improved in the year 1949.
Summer camps for children are exempted from the Regulations governing
Tourist Camps. They do, however, come under the " Welfare Institutions
Licensing Act." This Act is administered by the Inspector of Hospitals and
Institutions. As mentioned in the 1947 Report, the Division inspected a large
number of summer camps on behalf of the above agency. In 1948, owing to the
fact that the flood emergency was on during the time when summer camps
normally would be inspected, the number of summer-camp inspections was
reduced. However, a number of reinspections of camps was carried out at the
request of various camping officials, and it was found that in general the
camping operators had made many of the improvements suggested in the report
following the 1947 inspection. It is felt that, with a continuation of this policy,
summer camps will be greatly improved in the next few years.
Under the " Public Schools Act " the inspection of environmental conditions
in and around schools is a responsibility of the local School Boards, but is
usually administered by local health services. Since 1945 the Division has been
receiving reports of detailed inspections of schools covering structural and
sanitary conditions.    Detailed reports on 342 schools were received in 1948. Z 98 BRITISH COLUMBIA.
It was noted that many improvements had been made following reports of
inpections made in 1945, 1946, and 1947. With the expansion of the sanitary
inspection staff of the Division, it is expected that a fairly large number of
schools will be reported on for the first time in 1949.
The year 1948 was the second year of enforcement of the Regulations governing Eating and Drinking Places, which were passed late in 1946. Early in
the year 1948 a survey of glass-washing facilities in beer-parlours was made in
co-operation with the Liquor Control Board. A total of 196 beer-parlours were
covered by this survey. Of these 196 beer-parlours, 41 had in operation
mechanical dish-washers of an approved type. These mechanical dish-washers
were made in British Columbia. Before the coming into force of the regulations, only 3 of the beer-parlours covered by the survey had installed mechanical
dish-washers. Of the rest, 64 had installed three-compartment sinks and 63
had installed two-compartment sinks. This represents a tremendous improvement over the method of glass-washing in use in beer-parlours in British
Columbia prior to the passing of the regulations. The inspection of beer-
parlours is now a routine part of the work of Sanitary Inspectors throughout
the Province. In most districts where full-time Sanitary Inspectors are
employed, beer-parlours are inspected three or four times a year.
Inspections of restaurants are made by Sanitary Inspectors in health units
and in other areas where Sanitary Inspectors are appointed. Forms are used
which list the various items of restaurant sanitation. From these forms it is
possible for both the local health authorities and the restaurant operators to tell
whether the sanitation of each restaurant is satisfactory, improving, or not.
With the appointment of the new Sanitary Inspectors to cover areas not included
in health units, it is expected that by the end of 1949 almost all of the restaurants
in the Province will have been inspected three or four times during the year.
The year 1948 was the first complete year in which the Regulations governing the Construction and Operation of Cold Storage Locker Plants were in
operation. 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. The regulations do not require the licensing of existing
plants on an annual basis. There were seventeen approvals of plans of either
new locker plants or extensions to existing plants in 1948. At the end of the
year the Division had knowledge of seventy-six plants either in operation or
under construction. A fairly detailed inspection report was made on forty-eight
of the seventy-six plants. This survey showed that the forty-eight plants had
a total of 29,072 lockers, or an average of about 600 lockers per plant. It is
expected that complete reports will be made on the remaining twenty-eight
plants early in 1949. These reports will be followed by routine inspections
by local Sanitary Inspectors throughout the year. DEPARTMENT OF HEALTH AND WELFARE, 1948. Z 99
There was a large increase in the number of Sanitary Inspectors employed
by the Provincial Department of Health during 1948. At the end of 1947 there
were nine Sanitary Inspectors employed, and these men were attached to
various health units in the Province. During 1948 it was decided to appoint
Sanitary Inspectors in areas where health units had not yet been established.
Money obtained through the Federal health grants was used for this expansion.
At the end of 1948 ten new Sanitary Inspectors had been appointed, increasing
the staff to nineteen. In addition, C. R. Stonehouse was appointed as Chief
It is expected that in 1949 the sanitary inspection staff will be further
increased to cover the entire Province. It is also expected that at least two
new engineers will be appointed to the staff of the Public Health Engineering
No report of the Division of Public Health Engineering for 1948 can be
complete without some mention of the floods. A more complete report of the
activities of the Department in this emergency appears elsewhere in this book.
However, the floods occupied the full attention of the Division from late in May
until early in August. Most of the work of the Public Health Engineering
Division was done in the Lower Fraser Valley. During the flood emergency
ten extra Sanitary Inspectors were placed in the Fraser Valley. Two of these
Sanitary Inspectors were from the City of Vancouver and eight were from other
parts of the Province. In addition, the services of four public health engineers
were made available to the Provincial Department by the Department of
National Health and Welfare.
During the early stages of the floods, the main sanitation effort was directed
toward the sanitation of work camps and evacuee camps. As the flood-waters
began to subside, the work of the Division of Public Health Engineering included
the inspection of all homes that had been damaged by the flood and the sanitary
surveys of all wells. Sanitary surveys were made of a total of 439 wells. There
were only two public water-supplies seriously affected by the flood. Emergency
chlorinating apparatus was installed and used on these supplies until the
emergency was over. Also several tons of chloride of lime and other chlorine
products were distributed for the cleaning-up of homes, dairies, barns, etc.,
that were contaminated by the flood-waters. During the flood emergency, good
liaison was maintained between the Division of Public Health Engineering and
the other divisions of the Health Department, and the result was a freedom from
overlapping of work by various members of the public health service.
In 1948 the biggest single piece of work of the Division of Public Health
Engineering was in connection with the floods. The flood-work occupied almost
three months of the Director's time and a similar portion of the time of most of
the Sanitary Inspectors. The work of approval of plans was not quite as heavy
in 1948 as it was in 1947. As a result of the Federal health grants, the staff of
Sanitary Inspectors was more than doubled, and this threw a tremendous Z 100 BRITISH COLUMBIA.
amount of administrative work on the Chief Inspector. The continued use of
more uniform record systems in the local areas made it much easier for the
Division to evaluate the work of the Sanitary Inspectors in the field. This
increase in administrative work has made it more and more essential that at
least two new engineers be appointed.
The Division 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.
In this connection it is hoped that the calls on the Police Department will be less
frequent in the future, as there are now Sanitary Inspectors located in practically all parts of the Province. 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 very grateful.
Kay Beard, Consultant.
The year 1948 has been marked by a decided increase in the amount and
variety of the work carried out by this Division. The increasingly wide scope
of the work is evidence that public health education as a special field is a vital
part of a modern public health programme. British Columbia is among the
leaders in Canadian public health, in that it is the third Province in Canada to
realize the value of a health education programme developed by persons with
specialized training in public health education. Because the staff has been
limited, progress has been slow in some fields, but the accomplishments during
the three years since the inception of this Division have resulted in marked
improvements in many phases of health education. One of the most noticeable
improvements has been that other divisions have been able to pass on to the
Health Education Division many of the educational matters for which they were
formerly responsible, with the result that more time could be devoted to the
development of their own programme. At the same time, health education
matters could also receive more concentrated attention than was possible before
the existence of this Division.
During the past year, particular attention has again been given to meeting
the requests of the field staff. Because the local public health service is the
basic service, it is most important that as much assistance as possible be given
to the field staff in planning and conducting local health education programmes.
Assistance was provided through a number of channels. department of health and welfare, 1948. z 101
Printed Materials.
Supplies of posters and pamphlets for general distribution through local
health services have been greatly increased during this year. Much of the
increase has resulted from the production of new materials by the Department
of National Health and Welfare. Further expansion will have to be seriously
curtailed, however, until more storage-space is available. The present overcrowding of supply-rooms presents many difficulties in developing an efficient
system of distributing supplies. The policy of making available all public
health literature produced by the Department of National Health and Welfare
through local health services is being continued. All requests made by the
public in British Columbia to the Department of National Health and Welfare
are referred back to the local public health personnel throughout the Province.
This policy is another step in developing the local programme in public health
education, since it provides the local personnel with new opportunities to interpret their service.
All new public health films about which information was available were
previewed during the year, and, from these, suitable films were selected for
addition to the film library. Films of interest to the Department of Education
were referred to that Department for preview, and on several occasions joint
previews were held.
The use of films by the field staff has increased noticeably. This development has reached such proportions that at times the present supply of films on
some subjects is insufficient. Plans are in progress for expanding the film
library to meet these demands.
Increased assistance to the field staff and to interested organizations in the
selection of films to serve a definite purpose has been provided by this Division.
Such assistance necessitates a fairly complete knowledge of all the films
available, and of the purpose for which each film can be used.
With the anticipated increase in health education staff during the next year,
it should be possible to prepare lecture notes to accompany all films. Such
material has been requested on numerous occasions, but lack of staff and lack
of a suitable projection-room prevented the completion of this material.
The regional office of the National Film Board has provided valuable service
in supplying films for preview and in loaning films not included in the public
health library.
A complete revision of the film catalogue is necessary and should be
completed early in the new year.
The proposed purchase of 16-millimetre sound-film projectors and film-strip
projectors for all existing and planned health units, from funds available under
the recently established Federal health grant, will make possible a much wider
use of these visual materials and greatly increase the opportunities of the field
staff for effective public health education.
Assistance was provided to the Divisions of Public Health Nursing and
Tuberculosis Control in the revision of materials for use in organizing mass
X-ray surveys. In co-operation with the British Columbia Tuberculosis Society,
materials and procedures for the use of public health personnel in organizing
surveys were planned.   These are now in use.   This information is contained
in two manuals. One provides advice concerning the organization and conduct
of surveys; the other includes suggestions and sample materials for education
and publicity. The bringing of this material together into two manuals has
helped to reduce some of the difficulties previously encountered in preparing
for such large-scale surveys.
Another phase of the work of the Health Education Division has been the
collection and filing of reference materials in the form of library books,
periodicals, and pamphlets on a wide field of subjects related to public health.
This reference material is used to supply information requested on special
subjects by both the central office and the field staff. The value of this service
increases substantially each year as new material is added. The task of
classifying and indexing now requires the full-time services of a trained
librarian. It is hoped that a suitable person may be available early in the
new year.
A project for the provision of basic public health reference books to all
local public health offices has been submitted under Federal health grants. The
acceptance of this project will make possible the provision of a few of the most
widely used reference books for all field staff.
Throughout the year the health education staff prepared news releases on
request for other divisions, but there is still much to be done in developing this
phase of the programme.
The Health Bulletin, issued monthly by this Division, continues to be the
chief means of supplying information on public health to the press, as well as
to doctors, high schools, and other interested groups throughout the Province.
If the anticipated increase in staff is realized during 1949, it should be possible
to produce a printed bulletin with a much larger circulation. Such a publication
would be a valuable means of providing sound public health information to the
public of this Province and would assist tremendously in the task of informing
the public about the public health services available throughout British
The programme for the orientation of new staff members, which proved its
value during 1947, has been expanded during this year. Courses to acquaint
new staff members with the policies and procedures of this Department have
been planned for health unit directors, sanitarians, statisticians, and one health
educator. In addition, through arrangement with the Junior Red Cross, a
similar course was planned for a new field-worker on their staff. This worker
is now engaged in organizing Junior Red Cross branches in schools throughout
the Interior of the Province, and the knowledge of the services provided by the
Provincial Health Department is proving to be a valuable background for the
enrichment of local Junior Red Cross programmes.
As the planning of pre-service training courses progresses, it becomes
increasingly evident that such courses more than pay for the time and effort DEPARTMENT OF HEALTH AND WELFARE, 1948. Z 103
expended. New staff members begin their duties with a background of
information regarding policies and programmes which can save costly mistakes
and delays, and which greatly increases the satisfaction the new worker derives
from his part in the public health programme.
The proposed enlargement of the health education staff should make possible
the preparation of orientation manuals, which are becoming more and more
necessary as this phase of the programme expands. The planned increases
in all professional staff, made possible through Federal health grants, should
result in much greater demands for orientation courses.
Assistance was provided to the Division of Public Health Nursing in collecting materials for the course for senior public health nurses held in September
of this year.
Throughout the year public health nursing study-groups have been provided on request with references and outlines for use in the planning of study
programmes, which constitute an important phase of in-service education for
public health nurses.
A series of lectures on public health was given by the Health Education
Consultant as part of the Junior Red Cross course at the Summer School for
Teachers held in Victoria. Lectures on public health education were also given
to the public health nursing class at the University of British Columbia and the
senior nursing classes at the Royal Jubilee and St. Joseph's Hopsitals as part
of a series on public health services.
Throughout the year the staff of this Division has provided advice on
request to the Department of Education in the planning of the revised school
health curriculum. A representative of this Division attended several conferences throughout the year and took part in a curriculum workshop held
during the Summer School. A handbook on communicable diseases is being
prepared as a teacher reference, and should be completed soon.
A staff of trained health educators could provide valuable assistance to the
school health programme throughout the Province. It is to be hoped that this
most important phase of the programme can be expanded within the next few
For the first time in ten years the Canadian Public Health Association met
in British Columbia. The meeting was held in Vancouver in May of this year
in conjunction with the annual meeting of the Washington State Public Health
Association and Sanitary Inspectors' Institute. Responsibility of planning for
the meeting was vested in the Health Department of this Province. Public
health workers in both Victoria and Vancouver devoted much time and effort
to ensuring the success of this conference. The Division of Health Education
was represented on the planning committees by A. H. Cameron, at that time
Director of the Division, and Mrs. Marion Gait, health educator. These persons
were responsible for details concerned with publicity and organization of the Z 104 BRITISH COLUMBIA.
meetings and for the preparation of material for the printed programme.
Several months of concentrated planning resulted in a conference which was
outstanding in its educational value as well as its efficient organization.
A paper on " Evaluation of Materials in Health Education " was presented
by the consultant to the Health Education Section and was later published in
the official journal of the association.
The emergency resulting from the Fraser Valley flood resulted in requests
to the Division of Health Education for assistance in finding information and
in preparing materials for distribution. The Division assisted in the preparation of news releases and instructions to householders in clean-up procedures.
A detailed description of the work of the Health Department in this disaster is
contained elsewhere in this report.
The improved accommodation planned for this Division in the new temporary building on Superior Street was needed for other purposes, but some
additional office space fairly close to the present basement office became available in August. This has done much to lessen the former congestion and
improve working conditions for the senior staff. Storage-space for supplies
and working conditions for office staff in charge of supplies are still unsatisfactory, however. Increases in staff which are being planned will again make
the present office space inadequate.
Staff Changes.
During this year, staff changes have been numerous. A. H. Cameron, who
was appointed Director of the Division of Health Education in 1947, was promoted to the position of Administrative Assistant to the Deputy Minister in
April of 1948, a change which, although it benefited the Department as a whole,
was a distinct loss to this Division.
Miss Marion Dundas, who became Mrs. Gait in June of this year, resigned
her position in October. Miss Hope Spencer, a graduate in arts and sociology,
accepted a position with this Division in the same month.
Miss Joan List, a graduate in arts and physical education, was again
employed on a temporary basis during the summer months and has accepted a
permanent position with this Division at the beginning of the new year.
Through a project submitted under the Federal health grants, it will be
possible to add two health educators to the staff and to provide them with postgraduate training in public health when suitable persons can be found. The
present salary schedule presents great difficulties in obtaining qualified persons,
however. Salaries and annual increases are lower and requirements more
rigorous in this Division than in those allied fields from which most applicants
should be chosen.
The demand for health education services from the field staff, from other
divisions, and from related services has increased tremendously during the past DEPARTMENT OF HEALTH AND WELFARE, 1948. Z 105
year. With the development in the whole public health service made possible
through Federal assistance, a rapid expansion of this Division will be necessary
to meet the additional requests for assistance in health education. The recruiting of additional staff thus becomes a major project for the new year.
Mrs. Mary Law, R.N., Superintendent.
The Provincial Infirmary continued to provide custodial care for incapacitated patients at the Marpole and Allco units and at Mount St. Mary in Victoria.
Special and acute treatment was provided at the larger general hospitals in
Vancouver and Victoria.
Bed capacities were as follows: Marpole, 124 beds; Allco, 100 beds; Mount
St. Mary, 105 beds (under contract).
The waiting list remained at approximately 100. The principal demand
was for care of bed patients or potential bed patients. (Care of these can be
provided only at Marpole or Mount St. Mary because only ambulatory men are
sent to Allco.)
The plan inaugurated in 1947, by which all new patients are given a
thorough physical examination at either the Vancouver General Hospital or
St. Joseph's Hospital, Victoria, has been continued. The assistance of the
medical staffs of these hospitals was much appreciated.
Physiotherapy and occupational therapy services were expanded during
the year.
Chest X-rays were taken on all patients by the mobile clinic under the
direction of the Division of Tuberculosis Control.
Staff changes decreased during 1948, and a greater stability seemed evident.
A system involving the use of meal tickets by employees became effective
November 1st. Each employee's work was evaluated, some employees were
reclassified, and salaries were adjusted.
Although the pressing need for beds and improved accommodations continued to present difficulties, practically no major complaints were received from
the patients themselves.
The Superintendent welcomed the appointment early in the year of an
Advisory Committee, which met regularly to discuss problems and suggest
solutions. This Committee consisted of two members of the Provincial Hospital
Insurance Service and a personnel officer of the Civil Service Commission.
A physician was in charge of all patients. He visited on a regular schedule
and was on call at all times.
The services of the Vancouver General Hospital were used for examinations
and surgery, and surgical treatment of patients with eye conditions was also
performed at St. Paul's Hospital.
An oculist and a dentist paid regular visits to the infirmary.
Two patients attended the Western School for Rehabilitation to assist them
in learning to walk.
Several patients were referred to the cancer clinic.
The Women's Auxiliary to the Marpole unit, the Sisters of St. Anne in
Victoria, and several other voluntary groups again displayed a keen and untiring Z 106
interest in the welfare of the patients. These workers made possible weekly
drives during the summer and on suitable days in the winter, and provided
motion pictures, an electric motor for the occupational therapy section, cupboards, display-racks, small tools, and books. The annual garden party and
other entertainment for the patients were again included in the year's
Printed by Bon McDiarmid, Printer to the King's Most Excelleut Majesty.


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