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 "___. z o u t < £ K u n m c u 2, z 6 > z o > Q Qt o U __ u .2 •e 2 § :i ■ 3{<5 11 _ I _ 0- 6 ™ _ H Z -> 5 o u _i < u 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 z o t-H H U W cc < U h ce h < H CZ_ 12 DEPARTMENT OF HEALTH AND WELFARE. -e o 55 o H ■< ►J (In O CM o o © © o as H w <i Q 55 < tZS o H O H K 55 i—i 3 w 03 W 55 H o _. 55 o H <: o O 55 E-i OJ < K O es 35 K Pa __3 H ^ EH H H ££ £ rap 3 01 -1 Eh ._ 55 * Sri a oj 0)+J+J &< £__ 0) _H o 55* Sri 3 Q. eo t- IC ta 00 oi t- 00 to t~ -rr- eo o. to o 00 o b- o eo c. 00 O. -r» o CO NfflMCOrtOlfflNlO NatSlOtO_.COO)ffl C.a)MO0_.O.CONH : : so eo 00 fc- fr o 00 t- i i rt *-■ H <M ee CO CM «H : : co co Tf to tD ta o r-l ; j io io fc- «i O CM o CD t- COIOt-t_>lOtOt*t- Tf-rftOCNC^OtCt- H H N H : •& Oi IN ■«* tc CO 00 to i : eo OJ t# to 00 OS CD CO : : co t_i Ol 09 rti tD tH o : rn rH r- r- r- OI O) to H i-. CM ■^ CD CO " NQlO-^OOOMN cia__-__ioio<NOtD H N T, tD Tf H tDtO^PO-OOOtOtO (0!D»ffifflMOilKI>0 ir_tco'coc__.coo,-.oo6co t-00Hl>00<DO.tD-OCO HHNNC.MtOI'C.CO r-lWC-C-iOOOT-IOOtDOO C-OT_<0_0_0.-..-._-__© MlOC-flOOOt-tDOW CO eo o o S_ o ID <M on O. r- Tf OS SN CO o» O tO r- r- CO "* to to to to TC CO on in nn r- 10 <-. a_ Tf cn •rf rn to ■*_. t- ■* t- t- OJ t- CS to CM CM CM CO CO c-Oi-fOJcoTfincoc-oo C-O_C>C-C_0^C-CT-ffiOl VENEREAL DISEASE CONTROL REPORT, 1948. 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. T_ 15 Source of Referral. ti a) O EH o H _t ■31 flOJ 055 ti o O 3_ o "3 43 " _ c a fc. > Ch E- C OJ _ P >. U BJ I u u _j t_ c o o 0 -_ ■*- a 0) -fH c. 1-1 t.' s! !_• « is _s * 55 5? u V .-: O B QJ > <__ |1 oo Totals T. 4,534 3,608 1 3,607 896 161 77 464 34 100 | 29 23 8 30 M. 3,147 2,575 1 2,574 547 119 36 256 28 81 | 16 8 3 25 F. 1,387 1,033 1,033 349 42 41 208 6 19 | 13 15 5 5 T. 2,389 2,045 2,045 319 79 30 162 30 1 25 M. 1,570 1,350 1,350 200 59 18 88 9 24 | 2 20 F. 819 695 695 119 20 12 74 2 6 | 5 5 T 2,042 1,783 1,783 M. 1,373 1,214 1,214 140 46 11 58 7 17 | 1 19 F. 669 569 569 95 15 9 62 1 5 3 5 T 146 114 114 11 M. 107 84 84 22 8 3 6 1 3 | 1 1 F. 1 39 30 30 9 3 1 4 1 44 44 M. 28 23 23 5 1 3 1 F. 27 21 21 6 1 1 1 1 1 | 1 Oakalla T. 116 79 79 37 1 4 28 4 [ M. 55 25 25 30 1 4 21 4 i F. 61 | 54 54 7 7 T. 10 | 5 5 5 4 1 M. 6 | 3 3 3 3 F. 4 | 2 2 2 1 1 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. 3' o Eh .c 2 ,c o 055 ti V o 13 o H Acquired. .3 cd fi fH P. qj fi a *H <_ HH ft^ E-iP H cd | U U es 13 B o u <_ M 4H C tu .-I ti u > S ft _. >> ■ H W ti V J3 O Totals T. 4,534 3,608 1 1 |3,607 896 161 1 77 ! 464 i 34 100 . q •>3 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 _ T. 5 1 1 4 4 M. 3 1 1 2 1 2 F. 2 2 .... | 2 T. 12 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. 23 1 6 6 17 M. 21 | 6 6 15 2 7 2 4 F. 2 1 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 i—i w_ O 55 O <! o 55 a_ O 5? O rt o o o <J Q H hH fa HH 02 cfl <! o 55 o I-H Eh w fa 55 <! fa rt rt hw fa « i> ___ ^55 fa fa O P GO OQ 55 fa o rt Eh < CJ HH HH I 1 Eh O % fa 5? fa m Eh VENEREAL DISEASE CONTROL REPORT, 1948. 21 00 ■># ffl O CO o *] 00 N IO ■* IO CO t- H H O IO CM th Tf CD CO : cm 1 Tf CM rH rH rH IO ffl ffl N C- N ; rH ffl : tr- io rH : co : cm o : cm eo .fl n CO CO ta 64 H H H CM OS t-H 00 | CO : cm : co t)h _o ! tr- rH IO : th : co co 2 o EH Tf t- t- IO ® ffl ffl i-H rH co io (M th un io ; io : rH Tf Tf H H H CO M Tf N t- N rH rH CM Tf CD CD ! Tf IO 00 CM CO Tf a. 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'c ri E3 Ih O C ! 4. i rK : o rfi tf oo v j? - 0) (-. 0 tH CD £ Ul o o A u tt X e ri > CQ u ri ft X tt. N c tf bfl Sh O fl P 24 DEPARTMENT OP HEALTH AND WELFARE. to HH o 55 O P -a a § o-l ^ S _. o O O * I P « rt > o u o < p fa 1—I HH 1—I m m < P O 55 O rt I-H Eh <_< CJ i-h fa a a p ■-1 p p ° <v fa a fa r-i Hrt > pq fa o CO 55 O fa o 55 fa P t—t i—i Eh m <! fa o rt HH fa fa SO 2 fa £ a *_. fa Ph *P >< fa P PQ <o: Eh CO ffl _Sq §8 ox Tf Tf Tf Tf CM CO ri CM tr- CO LO tr- tr- CM CM ; Tf CM CM fc- CM : io o t- s. 0_ : cm cm o Tf LO CM CO CO CM CD t- CM : o; o i r-i CM HH O _H Tf Tf CO CO CM t- ri t- ffl to CO tr- tr- CM CM CO CM CM CO ffl : Tf o ! CM ffl t> Tf ffl ^ . _?R o> ri ri | CM o« fi8 0* CM CM LO t- r-i tr- CO rH Tf N N CO CM CM CD ri ri Tf CM CM ri ri Tf al s CO O LO Tf CM LO r-i r-i CM t- LO CD LO "3 -)-_ o EH CM CM CD CO LO O rH rH CO rH ffl CO CO Tf CM CM 00 00 ri ffl O CO ri r-i O CM CD Tf ffl Sh . §8 0J3 t- t- LO 00 LO ffl CO Tf CO CO LO T-i r-i ri ri Tf CM CM r-i CM CO ri ffl CM tr- io CM r-i CM rH ffl CM CM CM LO tr- co tr- o EH tr- tr- cm eo CO r-i CM Tf CO lO LO CD ri ri r-i r-i CD t- CO ri ffl r^ r-l tr- CCl LO Tf ffl ffl ffl ri CO IO O rH CM CM CM r-i r-i Tf ri ri CO o CM r-l co tr- ri CM Tf OQ ft CO O ffl CO CO tH i-H ffl IO LO CM CO ffl CO ffl •g o EH ffl ffl r-i tr- r-i Tf CM rH ri CM ri tr- tr- ri ri CO ri ri LO CO CO r-i CM O CM CM LO < P < < c 1 p J j > j i _> i) j t « o. d fc ri tt f- 0 0 0 p X 0) t. '2 rt bl Sh O c p ffl c fc ri tt. J- < + S P X> a; .-• P tf bl Sh o p t ffl C fc tf a ■5 ■+- a. p fl tf a c. '? tf 1 '5 c Fh C. P tt> HJ CQ tt t ri Sh Jh a H a s- tf p X QJ t. 'p ri bi Jh 0 c p X ffl 0 fc a tti Jh tf t- rt P X a. t. p rt bi Sh O p: P 0 o ri c fc rt 01 u < a H- u rt p X OJ ts p rt bl Sh O fl tf rfi O ri c fc ri tt < H s- a P *9 QJ IS 'p bi Sh O Pi P C o r- C fc a 01 Jh < 1 a j- C P c cc I tf P a 0 1 i tf tf" -H- s- tf p X 01 t "H tf %■ G c X fl H- C t t 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 - •"-i^-- "■"». V --- ILIS ^__ — — ~~~ ^-—- --- SYP. ^,* * \ — ^\G ONORRHO EA y- 0 .-* """"""^-.^ __ ^ \ .. / — — \! NOT YET )IACNOSE * V - — — 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 i I i 1 \ \ \ \ \ \ BISMUTH (IN CCS) SULPHONAMIDE (100CRS) PENICILLIN (100,000 UNITS) / / / / / t **** \ \ \ \ / / / / / / / / \ \ \ "". / / / / / / --" _■»"•" t \J // / - f 1 i t a t f # A — - — _■ ,_*J // / ; / . / i -"' .-- / / h •x * _. / \ \ •-- 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. < tf tf tf oo H W EH o tf fc > r-\ H m <; ta H tf HH ( ) tf 1—1 fc o 1—1 < tf ■*e Ci r/. t-H <! o P H w M< H T* tf C5 O Ch r/. W tf tf m o fc 1—( tf < W &Q i—i P W tf S< w tf tf o tf ry. fc H w O r> <! tf 1—1 tf tf tf M <i c_.h h_ s s e _j 2 * I a 1$ (H° Ib ca H c _> m ii H_ T-. O iH 00 O CO ■ \Q _H IC !N CC "* i N W N N -* ' N t- t- _3 ■* t- 00 CC CD N ■*_r ■** \a r-i oo OJ CC CO CO O TH IM r-i CM 00 8S 00 tr- Oi N M f CC ■** cj in ■**" ia (C O f t- t- i-H 00 O O O M M IO CO H oo co eo © tr- lfl © CD i-l CO ■"tf <M CO t-< p H tf tf tf w Eh o fc EH «i EH U <i tf oo o Eh P tf ___ * tf 2 2s CQ <d H H tf tf co O Ph X w tf o tf <l w Ph W 02 fc g£ tf ° 3 w S tf o s M -*J <Ci Eh o 01 a 5 -) G 0} 2 5 Is H_ .Is H_ OJ S Is CJ 0) IS a. S Is O 00 ffl tC O) r-l O OJ t- CC CO CO 00 Cl t- CO N Tf H M OJ © Ci <D IM O CJ CM O. CO CO CM CO CM nil"» <! W (_, g o S ft 0) 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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PROVINCE OF BRITISH COLUMBIA Division of Veneral Disease Control Department of Health and Welfare ANNUAL… British Columbia. Legislative Assembly [1950]
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Title | PROVINCE OF BRITISH COLUMBIA Division of Veneral Disease Control Department of Health and Welfare ANNUAL REPORT For the Year 1948 |
Alternate Title | VENEREAL DISEASE CONTROL REPORT, 1948. |
Creator |
British Columbia. Legislative Assembly |
Publisher | Victoria, BC : Government Printer |
Date Issued | [1950] |
Genre |
Legislative proceedings |
Type |
Text |
FileFormat | application/pdf |
Language | English |
Identifier | J110.L5 S7 1950_V03_15_001_031 |
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Sessional Papers of the Province of British Columbia |
Source | Original Format: Legislative Assembly of British Columbia. Library. Sessional Papers of the Province of British Columbia |
Date Available | 2017 |
Provider | Vancouver : University of British Columbia Library |
Rights | Images provided for research and reference use only. For permission to publish, copy or otherwise distribute these images please contact the Legislative Library of British Columbia |
CatalogueRecord | http://resolve.library.ubc.ca/cgi-bin/catsearch?bid=1198198 |
DOI | 10.14288/1.0340935 |
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https://iiif.library.ubc.ca/presentation/cdm.bcsessional.1-0340935/manifest