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PROVINCE OF BRITISH COLUMBIA Division of Veneral Disease Control Department of Health and Welfare ANNUAL… British Columbia. Legislative Assembly 1950

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Full Text

 PROVINCE OF BRITISH COLUMBIA
Division of
Venereal Disease Control
Department of Health and Welfare
ANNUAL REPORT
For the Year 1948
VICTORIA,  B.C. :
Tiiiitod by Dox McDiarmid, Printer to tbe King's Most Excellent Majesty.
1949.  TABLE OF CONTENTS.
1. List of Tables	
Page.
_ ___        4
2. List of Charts    ~_      	
4
3. Organization Chart	
     5
4. Introduction    '      '      _      _
7
5. Treatment.,                         	
7
6. Epidemiology     ___ _
_    8
7. Social Service     	
_ ____          _        9
8. Educational           	
__ ____     _____      9
9. General  ___
       10
0. Statistical Section	
    11 STATISTICAL SECTION.
LIST OF TABLES.
Table.                                                                                                                                                          Page.
I.—New Notifications of Venereal Infection compared with Reported Cases of
certain  other  Notifiable   Diseases  in   Canada,   British  Columbia,  and
Greater Vancouver, 1948  13
II.—New Notifications of Venereal Infection classified according to Diagnosis,
Sex, and Source of Reporting of Notifications, British Columbia, 1948  14
III.—New Notifications of Venereal Infection classified according to Diagnosis,
Sex, and Age-groups, British Columbia, 1948  16
IV.—Rate per 100,000 Population for Total Venereal Disease by Age-groups,
British Columbia, 1941 to 1948, inclusive  20
V.—New Notifications of Venereal Infection classified according to Diagnosis and
Place of Residence, British Columbia, 1945 to 1948, inclusive  21
VI.—Report of Laboratory-work done by the Division of Laboratories relating to
the Diagnosis and Treatment of Venereal Disease for all Agencies in
British Columbia, 1945 to 1948, inclusive . 27
VII.—Places of Meeting reported as facilitating the Spread of Venereal Disease,
1944 to 1948, inclusive  30
VIII.—Places of Exposure reported as facilitating the Spread of Venereal Disease,
1944 to 1948, inclusive '..  30
LIST OF CHARTS.
Chart.
I.—New Notifications of Venereal Infection and Rate per 100,000 Population by
Diagnosis, reported by all Agencies, British Columbia, 1939 to 1948,
inclusive  11
II.—New Notifications of Syphilis by Age and Sex, British Columbia, 1948  18
III.—New Notifications of Gonorrhoea by Age and Sex, British Columbia, 1948  19
IV.—Patient Visits at all Clinics of the Division of Venereal Disease Control
classified according to Diagnosis, for the Years 1939 to 1948, inclusive .__ 26
V.—Free Medications distributed to Private Physicians by the Provincial
Department of Health and Welfare for the Treatment of Venereal
Disease, British Columbia, 1934 to 1948, inclusive  28 "___.
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o  DIVISION OF VENEREAL DISEASE CONTROL.
ANNUAL REPORT FOR THE YEAR 1948.
G. R. F. Elliot, M.D., D.P.H., Director.
INTRODUCTION.
There would appear to be a 24-per-cent. decrease in the total cases and a decrease
of 27 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 its
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 services of free drugs and specialist consultations 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 services, have
been very much appreciated. Again special mention in this regard should be made of
the Provincial Laboratories, whose efforts for meeting the ever-increasing demands of
this Division have been so successful and so understanding.
TREATMENT.
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 disappear or cease attending before completing their full course of treatment.
7 DEPARTMENT OF HEALTH AND WELFARE.
The routine use of neoarsphenamine has been discontinued by the clinics of this
Division, mapharsen being now almost universally employed 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 surveillance.
Increasing efforts are being made toward establishing the necessity 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 still-births,
infant mortality, and child suffering.
EPIDEMIOLOGY.
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 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 cases and contacts and, where necessary, in bringing these cases in for
investigation and treatment.
During the year there were held three meetings of interested parties concerned
with facilitation and the control of venereal disease in the Province. Attending these
meetings were authorities from the Vancouver City Police Department, the British
Columbia Provincial 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.    Sero- VENEREAL DISEASE  CONTROL REPORT, 1948.
logical 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 Shipowners' Association and on a small scale amongst the Indians at a small reserve.
SOCIAL SERVICE.
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 to give more intensive case-work services to this group of patients during
hospitalization.
EDUCATIONAL.
General public education on venereal disease has now become the responsibility of
the Division of Public Health Education, who are 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 article " Medical Shock and Death following Neoarsphenamine Therapy for
Syphilis," written by Dr. B. Kanee, consultant in syphilology at this Division, and
Dr. Elliot, Director of this Division, was published in the July issue of the Canadian
Medical Association Journal. " Pre-natal (Congenital) Syphilis with Interesting
Diagnostic Findings," an article 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 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 " 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 responsi- 10 DEPARTMENT OP HEALTH AND WELFARE.
bility 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 those 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 that the
above appointment will rectify this condition as it pertains to the nursing and welfare
field in this Province.
GENERAL.
During the year the redecoration of the Vancouver clinic, mentioned in the 1947
Report, was completed, and the resulting improved appearance has been marked.
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 not only exists 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 recent Dominion 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 gratifying 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 occur.
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 recent Dominion 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 is very much appreciated. VENEREAL DISEASE CONTROL REPORT, 1948.
11
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13
This table is of considerable interest, for it shows a very marked reduction in all
forms of venereal disease in British Columbia during 1948, the figures for the incidence
of which are the lowest recorded since 1943. This is in spite of the still greater
efforts being made by the epidemiological staff to track down new cases and contacts
and the excellent co-operation shown by private physicians in notifying cases.
The incidence and rate of gonorrhoea have shown a relatively small but steady
drop since 1946, but the most significant and gratifying figures are those in relation
to syphilis—particularly early cases as represented by primary and secondary infection, the figures for which show a decrease of 60.3 per cent, and 53.9 per cent,
respectively. This is considered to be due in large measure to the intensifying of
the over-all programme of venereal disease control. An important additional factor,
however, is believed to be the more rapid and effective methods of modern treatment,
whereby the patient is more rapidly rendered non-infective.
Other forms of syphilis, which are essentially cases of longer standing, also show
a very marked decrease in incidence. This is more an indication of the success of
past efforts and policy in the Division. It will be observed that the figures are the
lowest recorded in the past ten years.
Other forms of venereal disease also show a marked drop in total incidence and
in rate for the year.
TABLE I.—NEW NOTIFICATIONS OF VENEREAL INFECTION COMPARED
WITH REPORTED CASES OF CERTAIN OTHER NOTIFIABLE DISEASES
IN  CANADA,  BRITISH  COLUMBIA,  AND  GREATER  VANCOUVER,   1948.
Notifiable Disease.
Canada.
British
Columbia.
Greater
Vancouver.
Chicken-pox	
Venereal disease.
Measles	
Tuberculosis	
Mumps	
Scarlet fever	
Whooping-cough
Diphtheria	
41,595
27,358
65,845
12,213
24,574
7,526
7,015
6,087
4,534
4,137
2,178
1,008
383
285
35
2,437
2,682
1,979
653
162
119
26
16 14                                  DEPARTMENT OF HEALTH
AND WELFARE
TABLE IL—NEW NOTIFICATIONS OF VENEREAL INFECTION
CLASSIFIED
ACCORDING  TO  DIAGNOSIS,  SEX,  AND  SOURCE   OF
REPORTING
OF
NOTIFICATIONS, BRITISH COLUMBIA,
1948
Gonorrhoea.
Syphilis.
Acquired.
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Source of Referral.
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Totals	
T.
4,534
3,608
1
3,607
896
161
77
464
34
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29
23
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30
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3,147
2,575
1
2,574
547
119
36
256
28
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16
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1,387
1,033
1,033
349
42
41
208
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15
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2,389
2,045
2,045
319
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30
162
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1,350
1,350
200
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695
695
119
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5
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2,042
1,783
1,783
M.
1,373
1,214
1,214
140
46
11
58
7
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1
19
F.
669
569
569
95
15
9
62
1
5
3
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146
114
114
11
M.
107
84
84
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21
21
6
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1
1  |
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Oakalla	
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116
79
79
37
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28
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55
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25
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2
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Girls' Industrial School
and Juvenile Deten-
T.
20
20
20
M.
1
1
1
F.
19
19
19
Private physicians	
T.
1,992
1,480
1
1,479
507
78
47
262
21
52
23
18
6
5
M.
1,458
1,155
1
1,154
298
57
18
141
17
43
12
8
2
5
-
F.
534
325
325
209
21
29
121
4
9
11
10
4
Institutions and hospitals-
T.
55
6
6
49
26
2
17
2
2
M.
44
5
5
39
22
2
13
1
1
F.   |        11
1
1
10
4
4
1
1
Other	
T.
M.
98
75
77
65
77
65
21
10
4
3
14
5
1
1
2
1
F.
23
12
12
11
1
9
1
Source: Notifications
of Ve
nereal I
lfection
For
•n N. 1.
• VENEREAL DISEASE CONTROL REPORT, 1948. 15
The drop in the number of reported cases of venereal disease appears to be shared
equally by clinics and by private physicians, their percentage of notifications being
52.7 per cent, and 44 per cent, respectively, practically the same figures as those
reported in 1947.
One case only of ophthalmia neonatorum was notified during the year.
There has been a very marked decrease in all forms of syphilitic infection. Total
syphilis has shown a decrease of almost 50 per cent., cardiovascular syphilis 48 per
cent., and neurosyphilis 34 per cent. These latter conditions, being the later manifestations of syphilitic infection, are an indication to some extent of the success of
past efforts on the part of the Division and also on the part of the private physicians
of the Province. It is to be hoped, furthermore, that the reservoir of such late cases
among the general population is gradually running dry.
The number of cases of prenatal syphilis reported in 1948, as compared with 1947,
is almost halved. It still shows twenty-three cases in excess of the ideal, however,
and strenuous efforts will continue to be made to reduce this figure still further.
In view of the great effectiveness of modern preventive treatment, it is felt that, with
adequate co-operation from the private physician, prenatal syphilis should ultimately
become almost unknown in this Province or in any civilized community.
It will be noted that cardiovascular syphilis in females is 1.7 per cent, of total
female syphilis, while in males it is 5.1 per cent, of the total. Neurosyphilis in females
is 5.4 per cent, of total female syphilis, while in males it is 14.8 per cent, of the total.
This brings out the fact that syphilis runs a more severe course in men than in women. 16                                  DEPARTMENT OF HEALTH AND WELFARE.
TABLE   IIL—NEW   NOTIFICATIONS   OF   VENEREAL   INFECTION
CLASSI-
FIED  ACCORDING  TO   DIAGNOSIS,   SEX,  AND   AGE-GROUPS,
BRITISH
COLUMBIA, 1948.
Age-groups.
_>
__
'rt
H_
O
E-i
Gonorrhoea.
Syphilis.
Other
Venereal Disease.
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T.
4,534
3,608
1
1    |3,607
896
161   1  77
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464   i   34
100
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8
30
M.
3,147
2,575
1    12,574
547
119
36
256
28
81
16
8
3
25
F.
1,387
1,033
1,033
349
42
41
208
6
19
13
15
5
_
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5
1
1
4
4
M.
3
1
1
2
1
2
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2
2
.... |
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6
1
5
6
1
.
M.
3
2
1
1
1
1
F.
9
4
4
5
1
4
5-9 years	
T.
M.
8
1
7
1
7
1
1
1
F.
7
6
6  1        1
1
T
8
5
2
1
M.
3
2
2
1
1
F.
5
3
3
2
1
1
15-19 years	
T.
386
329
329
55
15
9
26
5
2
M.
145
133
.    |   133
11
6
1
3
1
1
F.
241
196
.    |   196
44
9
8
23
4
1
20-24 years...	
T.
1,272
1,143
.    11,143
124
38
15
64
2
3
2
5
M.
841
777
.    |   777
60
27
8
21
1
2
1
4
F.
431
366
.    I   366
64
11
7
43
1
1
1
1
25-29 years	
T.
953
841
841
105
28
11
62
1
3
7
M.
697
642
642
51
22
4
23
1
1
4
F.
256
199
199
54
6
7
39
2
3
M.
375
333
333
40
20
4
11
3
1
1
2
F.
119
91
91
28
4
4
19
1
35-39 years	
T.
373
284
284
87
15
8
46
12
2
2
?,
2
M.
284
227
227
55
12
5
30
7
1
2
F.
89
57
57
32
3
3
16
5
1
2
2
40—44 years	
T.
247
171  [
.    1   171  1     73
9
6
40
1
15
2
3
M.
186
138  |
138
45
8
2
23
11
1
3
F.
61
33  [
33
28
1
4
17
1
4
1
45-49 years	
T.
183
113  1
113
66
6
3
36
1
12
8
4
M.
147
95
95
48
6
2
25
1
10
4
4
F.
36
18
18
18
1
11
2
4
50-54 years	
T.
136
58
58
74
6
4
38
5
16
5
4
M.
108
50
50
54
5
2
26
3
13  1    5
4
F.
28
8
8
20
1
2
12
2
3
T.
84
29
29
54
4
32
5
12
1
1
M.
72   j      25
25
46
4
27
5
10
1
F.
12
4
4
8
5
2
1
60-64 years	
T.
67
17
17
50
3
2
24
9
8
4
M.
60
17
17
43
3
2
21
8
7
2
F.
7
7
3
1
1
2
T.
45
14
14
31
6
2
M.
40
14
14
26
1
11
6
6
2
F.
5
5
4
1
T.
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6
17
M.
21  |        6
6
15
2
7
2
4
F.
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    I        2
2
75-79 years :.	
T.
12  1        1
1
11
9
1
1
M.
9
1
1
8
8
F.
3
3
1
1
1
80 and over	
T.
M.
F.
3
3
3
3
2
2
1
1
T
223
159
159
64
9
3
9
5
32
18
M.
149
111
111
38
3
8
1
F.
74
48
48   |      26
6
4
14
1
1
Source: Notifications of Venereal Infection, Form N. 1. VENEREAL DISEASE CONTROL REPORT, 1948. 17
The chief age incidence of venereal infection appears to remain much the same
as in previous years, with a steady rise from the post-school age—the highest incidence
still remaining in the age-group 20-29.
While admitting that this is the age of greatest sexual activity, it might be questioned whether something more might be done during the early maturing years to
improve the educational programme, not only in sexual and venereal-disease problems,
but also in improving the mental resources within the individual, as well as the responsibilities of the individual toward the community.
Prenatal syphilis still shows a proportionately high notification rate in the period
following the first year of life, though there is an improvement over the previous year.
It is to be hoped that, with adequate treatment of infected mothers and early blood-
testing of the new-born, no cases will remain undiscovered after the first year of life. 18
DEPARTMENT OF HEALTH AND WELFARE.
CHART IL—NEW NOTIFICATIONS OF SYPHILIS BY AGE AND SEX,
BRITISH COLUMBIA, 1948.
30-34      35-39
AGE    GROUPS
Age-group.
Male.
Female.
Age-group.
Male.
Female.
Totals..
Under 1 year..
1- 4 years	
5- 9 years	
10-14 years	
15-19 years	
20-24 years	
25-29 years	
30-34 years	
1
11
60
51
40
349
2
5
1
2
44
64
54
28
35-39 years..
40-44 years..
45-49 years..
50—54 years..
55-59 years..
60-64 years..
65-69 years..
70 and over..
Not stated....
55
32
45
28
48
18
54
20
46
8
43
7
26
5
26
5
38
26
It will be noted that the ratio of male to female syphilis has dropped from its
previous level of 2.4:1 to 1.57:1, showing a marked levelling-off of the sexes. There
is still a preponderance of women diagnosed in the 15-19 age-group, though the total
number notified in this age-group has diminished slightly compared with the figures
reported in 1947. Indeed the number of females notified exceeds males throughout the
early age-group 15-29. VENEREAL DISEASE  CONTROL REPORT, 1948.
19
CHART IIL—NEW NOTIFICATIONS OF GONORRHOEA BY AGE AND SEX,
BRITISH COLUMBIA, 1948.
20-24     25-29
30-34      35-39      40-44
AGE      GROUPS
Age-group.
Male.
Female.
Age-group.
Totals..
Under 1 year..
1- 4 years	
5- 9 years	
10-14 years	
15-19 years	
20-24 years	
25-29 years	
30-34 years	
2,575
1
2
1
2
133
777
642
333
4
6
3
196
366
199
91
35-39 years..
40-44 years..
45-49 years..
50-54 years..
55-59 years..
60-64 years..
65-69 years..
70 and over..
Not stated—.
227
138
95
50
25
17
14
7
111
57
33
18
8
4
There is still a preponderance of male cases of gonorrhoea over females notified
during 1948, the ratio being 2.5:1 as against 2.6:1 for the previous years.
As in syphilis, there appears to be a greater number of women than men notified
in the age-group 15-19. The reason for this is largely open to surmise, though the
possibility that development, social and educational factors may be responsible raises
the question of the need for greater efforts along social and educational lines during
the terminal years of school-life. 20
DEPARTMENT OF HEALTH AND WELFARE.
TABLE IV.—RATE PER 100,000 POPULATION FOR TOTAL VENEREAL DISEASE BY AGE-GROUPS, BRITISH COLUMBIA, 1941 TO 1948, INCLUSIVE.
Age-group.
1941.
1942.
1943.
1944.
1945.
1946.
1947.
1948.
25
24
35
231
821
690
552
499
412
271
246
184
149
166
73
24
19
23
326
1,046
770
619
518
375
249
265
133
188
113
83
21
26
24
385
1,133
843
598
543
474
272
218
193
141
80
74
23
17
43
616
1,383
953
619
534
573
337
309
196
183
106
61
29
23
19
637
1,525
1,039
751
699
586
446
307
211
188
169
53
35
24
33
709
2,069
1,547
986
737
565
457
292
232
215
157
83
25
20
9
697
1,921
1,306
689
607
474
438
325
234
208
172
81
16
10
12
523
20-24 years	
1,413
25-29 years	
1,036
30-34 years	
555
35-39 years	
495
361
308
238
141
60-64 years	
119
65-69 years	
100
70 and over	
62
All ages	
336
392
415
508
553
677
575
419
This table shows a substantial decrease in the rate of venereal disease in the
Province, amounting to about 27 per cent, for all ages.
The highest incidence still remains in the 20-29 age-group, but the rate per 100,000
population, even in this field, has decreased by 24 per cent, over the previous year.
Attention was drawn in the previous Annual Report to the great and continued
influx of population to British Columbia. This influx continues in ever-increasing
numbers, and the decrease in the total incidence of cases reported in the Province is
therefore especially gratifying, as is also the decrease in the venereal-disease rate per
100,000 population. m
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fc VENEREAL DISEASE CONTROL REPORT, 1948. 25
This table gives an indication of the areas in which most of the cases of venereal
disease are notified. It will be observed that 67 per cent, of all cases notified occur in
Area 4, which represents the Greater Vancouver area and contains about 40 per cent,
of the total population of the Province.
This may be due to two factors: Vancouver is a port of call for ocean-going ships
and is also a vacation centre for loggers and others who spend much of their time in
isolated places away from normal human society. Perhaps if more could be done to
provide for their care and healthy entertainment within the confines of the city, more
might be accomplished in reducing vice in its various forms.
There has been a fairly uniform decrease in the number of reported cases in most
areas of the Province, with the exception of Areas 9c and 10c. This slight local
increase may be due to greater efforts at case-finding among the Indian population in
these two areas. 26
DEPARTMENT OP HEALTH AND WELFARE.
CHART IV.—PATIENT VISITS AT ALL CLINICS OF THE DIVISION OF VENEREAL DISEASE CONTROL CLASSIFIED ACCORDING TO DIAGNOSIS, FOR
THE YEARS 1939 TO 1948, INCLUSIVE.
PATIENT  VISITS
100,000
80,000
60,000
40,000
20,000
10,000
8,000
6,000
4,000
2,000
-
-
—
—
—
TOTAL
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1939
40
41
42
43
44
45
46
47
1948
Total.
Syphilis.
Gonorrhoea.
Not yet diagnosed.
Year.
All            Vancouver
Clinics.            Clinic.
All
Clinics,
Vancouver
Clinic.
All
Clinics.
Vancouver
Clinic.
All
Clinics.
Vancouver
Clinic.
1939	
59,588
55,678
42,863
36,410
36,170
46,961
46,898
56,385
51,129
43,871
47,964
43,294
32,357
28,046
28,929
36,069
35,657
41,856
38,180
32,480
41,948
38,346
28,712
24,173
22,389
24,766
26,297
30,047
28,291
24,894
34,379
30,288
21,636
18,686
18,573
19,468
20,084
23,158
21,986
19,166
10,577
10,088
8,107
7,584
9,331
13,021
9,692
11,382
9,799
8,480
8,993
8,315
6,406
5,927
7,366
10,580
8,065
9,297
8,051
7,014
7,063
7,294
6,044
4,653
4,450
9,174
10,909
14,956
13,039
10,517
4,592
4,691
4,315
3,433
2,990
6,021
7,508
9,401
8,143
6,292
1940         	
1941    	
1942    	
1943        	
1944	
1945	
1946	
1947	
1948    	 VENEREAL DISEASE CONTROL REPORT, 1948.
27
This chart shows an over-all decrease in patient attendances at the clinics of this.
Division. Two factors are responsible here: (1) The decrease in venereal disease,
and (2) the gradual shortening of the treatment courses following the greater use of
penicillin. There is a possibility that this second factor will be responsible for a
steadily increasing drop in patient visits in the future, as penicillin preparations are
improved and treatment becomes more effective.
Syphilis:—
In 1939 there were 549 reported cases and 41,948 visits;   that is, 76 visits
per case.
In 1948 there were 319 cases and 24,894 visits;   that is, 78 visits per case.
Gonorrhoea:—
In 1939 there were 871 reported cases and 10,577 visits;   that is, 12 visits
per case.
In 1948 there were 2,045 cases and 8,480 visits; that is, 4 visits per case.
This shows that the newer forms of treatment have reduced to one-third the
number of visits per case of gonorrhoea. The number of visits per case of syphilis,
however, has increased slightly, in spite of shorter periods of treatment. This would
indicate an increase in the number of visits made for purposes of observation following
the completion of treatment.
TABLE VL—REPORT OF LABORATORY-WORK DONE BY THE DIVISION OF
LABORATORIES RELATING TO THE DIAGNOSIS AND TREATMENT OF
VENEREAL DISEASE FOR ALL AGENCIES IN BRITISH COLUMBIA, 1945
TO 1948, INCLUSIVE.
Examination.
Gonococcus cultures _ _ „._.._
Gonococcus microscopic examinations	
Treponema pallidum microscopic examinations
Serological tests for syphilis	
10,619
12,664
11,219
10,322
31,275
34,743
34,589
33,990
666
1,093
854
605
155,053
177,908
152,437
167,816
It will be observed that the number of blood tests and other examinations carried
out by the Division of Laboratories on behalf of this Division shows a slight increase
in 1948 over the previous year. Perhaps a greater appreciation of the magnitude of
assistance given to this Division by the Division of Laboratories can be obtained
by a realization that the figure for blood-testing alone represents an average number
of 460 tests daily throughout the year. 28
DEPARTMENT OF HEALTH AND WELFARE.
CHART V.—FREE MEDICATIONS DISTRIBUTED TO PRIVATE PHYSICIANS
BY THE PROVINCIAL DEPARTMENT OF HEALTH AND WELFARE FOR
THE TREATMENT OF VENEREAL DISEASE, BRITISH COLUMBIA, 1934
TO 1948, INCLUSIVE.
37,500
30,000
22,500
15,000
7,500
LEGEND
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SULPHONAMIDE   (100CRS)	
PENICILLIN   (100,000 UNITS)	
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1934       35
38
41 42 43 44 45 46
1948
Year.
Arsenicals
(Ampoules).
Bismuth
(CC).
Sulphonamide
(Grains).
Penicillin
(100,000 Units).
Penicillin
O. & W.
(100,000 Units).
1939.
1940.
1941.
1942.
1943.
1944.
1945.
1946.
1947.
1948.
10,933
10,212
10,955
12,636
11,162
12,005
17,147
20,586
18,328
15,601
I
21,270
22,029
22,566
27,024
26,300
23,350
27,580
33,375
35,325
26,625
252,930
336,825
469,998
772,301
583,786
883,986
950,719
308,565
213,829
165,195
6,777
14,983
14,149
15,803
7,059
It will be noted that the quantity of bismuth and arsenic distributed to private
physicians has shown a marked decrease in 1948. At the same time penicillin distribution has increased very markedly. This is a reflection of modern trends in treatment, in which penicillin is gradually replacing arsenic and bismuth in the treatment VENEREAL DISEASE CONTROL REPORT, 1948. 29
of syphilis. It is anticipated that this trend will be still more marked in the course
of time.
It will be further noticed that sulphonamide distribution has decreased. This
again reflects the greater use and effectiveness of penicillin in the treatment of
gonorrhoea.
In addition to the drugs shown in this table, considerable quantities of other
materials have been distributed to private physicians, including potassium iodide,
silver nitrate, BAL, streptomycin, distilled water, etc.
This policy has done much to retain the co-operation of the private physician in
the treatment of venereal disease, while at the same time it has enabled this Division
to keep the physicians informed on latest trends in diagnosis and treatment. 30
DEPARTMENT OF HEALTH AND WELFARE.
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CQ VENEREAL DISEASE CONTROL REPORT, 1948. 31
These tables give an indication of the places where meetings take place and contacts occur.
It will be observed that dance-halls, beer-parlours, and cafes are most frequently
named as places of meeting, and therefore as places for facilitating the spread of
venereal disease. It is obviously not feasible to close these institutions, but with the
assistance of the various authorities concerned every effort is being made to exert
greater control in those premises which are most frequently named as places of meeting.
Hotels and rooming-houses remain a problem as places of exposure. Their number
has increased since 1947 and, in this respect, far exceeds all other places combined.
It is questionable whether any effective measure of control will be possible until adequate legislation is available to deal with the problem.
A certain measure of control is possible with the co-operation of the hotel-keepers
and their employees, for where complaints have been lodged, there has occasionally
followed a marked diminution in the frequency with which those premises have been
named. Furthermore, some hotels have maintained a persistently good reputation,
while others in the same neighbourhood have held a bad one.
EPIDEMIOLOGICAL INVESTIGATION OF PERSONS LIVING IN BRITISH
COLUMBIA NAMED AS CONTACTS TO VENEREAL INFECTION IN 1948.
Since it sometimes takes several months to confirm the final disposition of these
cases, the figures for 1948 are not available at the time of compiling this Report. The
tables showing these figures will be included with the 1949 Annual Report.
In comparing the figures for the first nine months of 1948 with the figures for
1947, certain general observations may be made. It appears that there has been an
increase of about one-third in the total number of persons reported as contacts, in
spite of the decrease in reported cases. This is most gratifying, as it suggests a
marked improvement in interviewing patients about their contacts. The adequacy of
this contact information has improved from 74 per cent, to about 80 per cent. It is
also encouraging to note a slight increase in the percentage of contacts investigated
by local public-health personnel.
VICTORIA, B.C.:
Printed by Don McDiabmid, Printer to the King's Most Excellent Majesty.
1949.
995-649-2320
_   

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