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PROVINCE OF BRITISH COLUMBIA Fourth Report of the DEPARTMENT OF HEALTH AND WELFARE (HEALTH BRANCH) (Fifty-third… British Columbia. Legislative Assembly 1950

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 PROVINCE OF BRITISH COLUMBIA
Fourth Report of the
DEPARTMENT OF HEALTH
AND WELFARE
(HEALTH BRANCH)
(Fifty-third Annual Report of Public Health Services)
YEAR ENDED DECEMBER 31st
1949
VICTORIA,  B.C. :
Printed by Don McDiarmid, Printer to the King's Most Excellent Majesty.
1950.  Office of the Minister of Health and Welfare,
Victoria, B.C., February 28th, 1950.
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, 1949.
GEO. S. PEARSON,
Minister of Health and Welfare. Department of Health and Welfare (Health Branch),
Victoria, B.C., February 28th, 1950.
The Honourable Geo. S. Pearson,
Minister of Health and Welfare, Victoria, B.C.
Sir,—I have the honour to submit the Fourth Report of the Department of Health
and Welfare (Health Branch) for the year ended December 31st, 1949.
I have the honour to be,
Sir,
Your obedient servant,
G. F. AMYOT, M.D., D.P.H.,
Deputy Minister of Health. DEPARTMENT OF HEALTH AND WELFARE
(HEALTH BRANCH).
Hon. G. S. Pearson    - Minister of Health and Welfare.
SENIOR PUBLIC HEALTH TECHNICAL STAFF.
G. F. Amyot, M.D., D.P.H.      -
J. A. Taylor, B.A., M.D., D.P.H.
Geo. Elliot, M.D., CM., D.P.H. -
A. H. Cameron, B.A., M.P.H. - -
R. Bowering, B.Sc. (C.E.), M.A.Sc
F. McCombie, L.D.S.  -     -     -     -
Miss M. Frith, R.N., B.A., B.A.Sc, M.P.H. -
Miss M. Campbell, R.N., B.A.Sc, M.P.H. - -
Mrs. K. Beard, B.Sc, M.S.P.H. - - - -
Miss E. M. Yvonne Love, B.Sc. (H.Ec), C.P.H.
Miss Doris Noble, B.Sc. (H.Ec), C.P.H. - -
C. E. Dolman, M.B., B.S., D.P.H., Ph.D. - -
W. H. Hatfield, M.D.	
J. D. B. Scott, B.A., B.Com.   -
C. L. Hunt, M.D., M.R.C.S., L.R.C.P.
Deputy Minister of Health and Provincial Health Officer.
Deputy Provincial Health Officer and
Director, Bureau Local Health
Services.
Assistant Provincial Health Officer.
Administrative Assistant.
Public Health Engineer.
Acting Director, Division of Preventive Dentistry.
Director, Public Health Nursing.
Consultant, Public Health Nursing.
Consultant, Public Health Education.
Consultant in Nutrition.
Consultant in Nutrition.
Director, Division of Laboratories.
Director, Division of Tuberadosis
Control.
Director, Division of Vital Statistics.
Director, Division of Venereal Disease Control.
_  TABLE OF CONTENTS.
Page.
Introduction  11
General—
Accommodations  12
Arthritis  13
Cancer Control Services  13
Summaries of Activities in the Bureaux, Divisions, and Services of the Provincial Department of Health  14
Longevity and Causes of Death in British Columbia  23
Report of the Health Branch Office, Vancouver Area—
Introduction  26
Bureau of Special Preventive and Treatment Services  26
Federal Health Grants  26
Report of the Bureau of Local Health Services—
Introduction  35
Preventive Dentistry Services  35
Changing Concepts in Community Health Services  35
School Health Services  37
Services of Part-time Medical Health Officers  38
Health Unit Development  38
Interdepartmental Relationships  42
Morbidity Statistics  42
Table I.—Incidence of Notifiable Diseases in British Columbia  45
Table II.—Table showing Return of Notifiable Diseases in the Province of
British Columbia for the Year 1949  46
Report of the Division of Public Health Nursing—
Introduction  49
Personnel  49
Service Analysis  51
Public Health Nursing Supervision  53
Special Services  54
Table III.—Length of Service of Public Health Nurses with Provincial Health
Department as shown in 1949  50
Table IV.—Comparison of Total Time in per Cent, spent on Specified Activities
by Public Health Nurses in Period 1946-49 as indicated by Time Studies 51
Table V.—Per Cent, of Total Time spent by Public Health Nurses in Selected
Activities as indicated by Time Study in 1949  52
Report of the Nutrition Service—
Introduction  57
Consultant Service to Local Public Health Personnel  57
Consultant Service to Institutions  58
Consultant Service to other Departments and Organizations  59
Comments  59
Report of the Division of Preventive Dentistry—
Introduction   60
Establishment of the Division  60
Personnel    61
Dental Health Education  61
Advisory Service to Local Public Health Personnel  62
Dental Programmes  62
Dental Health Committee of the British Columbia Dental Association  63 KK 8 BRITISH COLUMBIA.
Report of the Division of Public Health Engineering— Page.
Introduction  64
Water-supply  64
Sewerage and Sewage-disposal  65
Stream-pollution Control  66
Milk Sanitation  66
Shell-fish Sanitation  66
Industrial-camp Sanitation    67
Sanitation of Tourist Resorts  68
Summer Camps  68
Environmental Sanitation of Schools  69
Sanitation of Eating and Drinking Places  69
Frozen-food Locker Plants  69
Training Programme for Personnel  70
General Observations  70
Report of the Division of Vital Statistics—
Introduction  71
Completeness of Registration  71
District Registrars' Offices, Inspection, etc  76
Vital Statistics Information for Health Units  78
Statistical Services  79
Vital Statistics Council for Canada  81
Administration of the "Marriage Act"  82
Administration of the "Change of Name Act"  83
Administration of Sections 34-40, inclusive, of the " Wills Act "  83
General Office Procedures  84
Problems outstanding at the End of the Year  87
Report of the Division of Public Health Education—
Introduction  91
Local Health Services  91
Visual Aids  92
Materials  93
School Health  93
Pre-service Training  94
In-service Training _:  94
Staff Changes  95
Report of the Division of Laboratories—
Introduction  96
Tests for Diagnosis and Control of Venereal Diseases  96
Tests relating to Tuberculosis Control  97
Food-poisoning and Gastro-intestinal Infections  98
Bacteriological Analyses of Milk and Water Supplies  100
Other Types of Tests  102
Branch Laboratories  104
General Comments  106
Table VI.—Division of Laboratories Statistical Report of Examinations done
during the Year 1949  109
Table VII.—Number of Tests performed by Branch Laboratories in 1949  110 DEPARTMENT OF HEALTH AND WELFARE, 1949. KK 9
Report of the Division of Venereal Disease Control— PAGE.
Introduction  111
Treatment  111
Epidemiology  112
Social Service  113
Education  113
General  115
Report of the Division of Tuberculosis Control—
Introduction  116
Clinics  117
Institutions  118
Nursing Service  119
Social Service  119
Budget  120
Conclusion ,  120  Fourth Report of the Department of Health and Welfare
(Health Branch)
YEAR ENDED DECEMBER 31st, 1949.
G. F. Amyot, Deputy Minister of Health.
INTRODUCTION.
Health has been defined as a state of complete physical, mental, and social
well-being' and not merely the absence of disease or infirmity. In helping the
people of British Columbia to work toward this state, the Health Branch and its
many specialized Divisions and Services on the Provincial level render service
to the citizens of the Province through the public health physicians, public health
nurses, sanitary inspectors, and clerical workers who constitute the staffs of
local health services.
The most efficient administrative organization for providing health services
on the local level is the health unit, which is, in effect, a modern local health
department staffed by full-time public-health-trained personnel serving one or
more population centres and the rural areas adjacent to them.
It has long been a prime objective of public health officials in British
Columbia to provide such full-time" professional service in all parts of the
Province. Although this goal has not yet been reached, the year 1949 was
marked by success in establishing three new health units. This brought to
eleven the number of units in operation. These eleven units, together with the
city health departments serving the Greater Vancouver area and the Victoria-
Esquimalt area, provide complete public health services to 81.3 per cent, of the
population of the Province. When the more limited services provided by those
public health nurses and sanitary inspectors working in non-health unit areas
are included in the calculation, it is revealed that local public health services are
available to 94.9 per cent, of the population.
During the course of the year just ended, the Health Branch also met with
success in the establishment of a Division of Preventive Dentistry. Although it
was not possible to begin actual service to the citizens during the year, a well-
formulated programme and policy were established and accepted, and personnel
to form the nucleus of a trained staff were appointed.
Closely associated with all other advances was the programme of postgraduate training for professional personnel. Made possible largely through
funds from the Federal health grants, this is a continuing programme which
provides not only for complete university courses on the postgraduate level but
also for short-term refresher courses.
An important change in general organization was the transfer of the Provincial Infirmary from the jurisdiction of the Health Branch to the jurisdiction
11 KK  12 BRITISH COLUMBIA.
of the British Columbia Hospital Insurance Service in January, 1949. This
transfer was made because the Infirmary, as an institution providing bed-care,
may be grouped more logically with hospitals than with public health facilities.
Details of these and the many other achievements and changes are presented in this Fourth Annual Report, the body of which is comprised of the
following major sections:—
(a) General: A description of those matters which affected the Health
Branch as a whole.
(b) Summary of activities in the bureaux, divisions, and services of
the Health Branch.
(c) Detailed reports presented by the heads of these bureaux, divisions, and services.
CO-OPERATION WITH OTHER DEPARTMENTS OF GOVERNMENT, PROFESSIONS AND VOLUNTARY AGENCIES.
The responsibilities of the Health Branch are closely related to those of
other departments of Government, and in some measure to almost every other
department. The close co-operation of other departments during this year, as
in other years, has made possible the furthering of plans involving joint responsibilities. Outstanding examples during 1949 included the joint planning between this Department and the Department of Fisheries in the drafting of the
" Regulations for the Sanitary Control of the Shell-fish Industry," joint discussions between the Department of Agriculture and this Department in matters
concerning milk production, and co-operation with the Department of Education in planning the revision of the health section of the curriculum for high
schools.
Similarly, co-operation between this Department and voluntary agencies
interested in public health has furthered projects to improve services to the
public, particularly in the programmes for the control of cancer and arthritis.
Without the interest and support expressed by the public through voluntary
activities, the high standard of public health services of this Province could not
be maintained.
GENERAL.
ACCOMMODATIONS.
There has been no improvement during 1949 in the matter of accommodations. The Provincial Laboratory continues to be housed in totally unsuitable
and inadequate quarters which make the maintenance of their high standard of
achievement extremely difficult. Other divisions in the Vancouver and Victoria
offices are crowded into cramped and inconvenient quarters to such an extent
that efficient conduct of their work is greatly hindered. Every director of a
division in the Victoria offices is forced to share an office with other senior staff
members, who must frequently vacate their space so that meetings or interviews may be conducted. In some offices accommodation for clerical staff is
likewise so inadequate that efficiency is seriously affected.
Storage and filing space is quite inadequate. In many instances files must
be stored in remote corners of the building or in other buildings, with result
that much time is spent travelling between files. DEPARTMENT OF HEALTH AND WELFARE, 1949. KK  13
Washroom facilities are greatly overcrowded and inconveniently located.
Overcrowding in the Health Branch offices for the Parliament Buildings
has become so acute that additional temporary accommodation is urgently
needed to relieve the congestion until the new permanent building, now under
construction, is completed.
ARTHRITIS.
During 1949 the pilot centre for treatment of arthritis was established as a
part of the Vancouver General Hospital's out-patient department. The programme is financed by Federal, Provincial, and voluntary funds. Treatment is
provided to all patients eligible for admission to the out-patients' department.
The British Columbia branch of the Canadian Arthritis and Rheumatism
Society, organized in 1948, has progressed rapidly. The physiotherapy service
established by the Society is now in operation in Vancouver. Four physiotherapists provide treatment and education at the clinic and in the home to
patients referred to them by physicians.
Toward the end of 1949 about 380 patients were receiving instruction and
treatment from the physiotherapists. Many of these patients can, with this
assistance, progress from a completely bed-ridden state to the point where they
can again become wholly or partly self-supporting.
At present this programme is limited to Vancouver, but plans for expansion
are being considered.
Branches of the Society have been organized in eight centres throughout
the Province, and plans are under way in most of these centres for the establishment of similar physiotherapy services.
CANCER CONTROL SERVICES.
The provision of cancer control services for the Province has been maintained within the existing organization of the British Columbia Cancer Foundation, which was incorporated in 1935, and operates the main treatment centre
known as the British Columbia Cancer Institute.
Patients are accepted at the Institute upon referral by a physician, where
they receive diagnostic and treatment services regardless of financial status.
Patients in the lower income group are provided with travel and boarding-home
expenses from the Cancer Aid Fund of the Canadian Cancer Society. In 1949
there were 1,130 new patients examined at the Institute, and 696 of these were
definitely shown to have cancer.
A total of 27,931 treatments and examinations were given at the Institute
during the year. This included 19,611 X-ray treatments for 1,277 patients and
398 radium treatments for 253 patients, in addition to 1,445 X-ray diagnostic
examinations.
During the year expansion of services was made to provide consultative
cancer services in Penticton, Kelowna, Vernon, and Kamloops. At the end of
the year 56 new patients had been examined and 132 follow-up examinations
had been performed. Negotiations are under way to provide similar services in
Nelson, Trail, Prince Rupert, and Cranbrook. A consultant radio-therapist from
the Institute makes regular visits to each centre to examine patients, to consult
with physicians, to advise on treatment, and to check on patients treated or KK  14 BRITISH COLUMBIA.
under treatment. These clinics have been set up in close co-operation with the
local public health services.
In December a building adjacent to the British Columbia Cancer Institute
was opened as a nursing home to care for patients who have come from other
parts of the Province for treatment and require a limited amount of nursing
care. This new service will result in improved management of cancer patients
and their earlier discharge from general hospitals.
In order to improve X-ray facilities available to the cancer consultative
services, X-ray diagnostic equipment at the Vernon Jubilee Hospital, Royal
Inland Hospital, and St. Paul's Hospital was increased as a result of funds
from the Federal health cancer grant.
As the year closed negotiations were under way to provide a free biopsy
service throughout the Province as an auxiliary to improved cancer diagnosis.
This will be developed in co-operation with the Hospital Insurance Service to
permit pathological tissue examination to be conducted in hospitals having
approved pathological facilities in personnel and equipment.
SUMMARIES  OF ACTIVITIES  IN THE  BUREAUX,  DIVISIONS, AND
SERVICES OF THE PROVINCIAL DEPARTMENT OF HEALTH.
Whereas this Annual Report contains detailed reports of the activities of
the various bureaux, divisions, and services of the Provincial Department of
Health, this summary includes only the outstanding features of each report.
Longevity and Causes op Death in British Columbia.
The trend of the death rate in the Province over the last twenty years has
been very gradually upward. This is because of the increasing percentage of
people in the older age-groups.
The age specific death rates based on the mortality experienced during the
first ten months of 1949 show improvement in each category over the preliminary figures for 1948. The infant mortality rate continued to be among the
lowest in Canada, a fact which reflects the comparatively high level of health
in this Province.
The three leading causes of infant mortality—prematurity, congenital malformations, and injury at birth—accounted for over two-thirds of the infant
deaths in the Province.
Preliminary figures for the first ten months of 1949 indicate that the
maternal mortality rate will be 1.3.   The comparative figure for 1929 is 5.5.
During the year a reduction was noted in the mortality rate of the three
leading causes of death, namely, diseases of the heart and arteries, cancer, and
accidents. The year 1949 marked the third successive year in which an improvement in the accident mortality rate has occurred.
Health Branch Office, Vancouver Area.
In January, 1949, the Health Branch office, Vancouver area, was opened at
2670 Laurel Street, Vancouver. Through this office the Assistant Provincial
Health Officer performs the duties of Director of the Bureau of Special Preventive and Treatment Service, of administrator of Federal health grants, and DEPARTMENT OF HEALTH AND WELFARE, 1949. KK  15
of liaison officer between the Divisions of Laboratories, Tuberculosis Control,
and Venereal Disease Control.   These three divisions are located in Vancouver.
During the year the Provincial Government made substantial grants to such
official non-government health agencies as the Western Society for Physical
Rehabilitation, the British Columbia Division of the Canadian Arthritis and
Rheumatism Society, and the British Columbia Cancer Institute. Through the
Health Branch office the Government was kept informed on the administration
of these organizations, and the integration of their services with the general
public health services in the Province.
The Health Survey Committee, as the central advisory committee on the
Federal health grant programme for the Province, met three times during 1949.
The most important development under the crippled children's grant was
the initiation of the survey of crippling diseases in children. This survey is
still being conducted. The survey will provide the basis for the formulation of
a Provincial programme for crippled children.
The professional training grant provided the means whereby personnel
engaged in health work in the Province were given specialized training. As of
September 30th, 1949, a total of seventy-six persons had been approved for
advanced training under one of the Federal health grants.
Projects approved under the venereal disease control grant included provisions for a survey of all phases of venereal disease control in British Columbia,
for expansion of clinic services, for postgraduate studies, and for the visit to
British Columbia of an outstanding authority on venereal disease control.
Mental health diagnostic and treatment services in the Province are under
the jurisdiction of the Provincial Secretary's Department. Through the mental
health grant, diagnostic, treatment, occupational therapy, and teaching equipment was purchased for the Crease Clinic of Psychological Medicine, which was
opened during 1949. Also under this grant, recreational and occupational
therapy facilities at the Provincial Mental Hospital were increased, and psychiatric nurses' training was provided.
X-ray equipment purchased under the tuberculosis control grant during
the fiscal year 1948-49 was placed on loan in nine of the larger hospitals in the
Province and in two strategic health units. The grant also provided the means
whereby it was possible to institute a rehabilitation service and to increase the
occupational therapy service.
The public health grant is allocated by the Federal authorities on a project
basis. During 1948-49 one project from this Province was approved. This
project provided for an evaluation of the Wetzel grid in school health services.
A second research project was approved during 1949-50, namely, evaluation of
the antigenicity of cholera vaccine prepared in fluid media.
The general public health grant made possible the establishment of a Division of Preventive Dentistry during 1949. Further expenditures under this
grant provided other special services directed at improving the public health.
The cancer control grant provided the means for implementing a survey
of the cancer problem in British Columbia. As a result of this survey a programme was drawn up which provides for the extension of existing diagnostic
and treatment services in Vancouver and Victoria, for the organization of
diagnostic centres in other parts of the Province, for organization of a statistical KK  16 BRITISH COLUMBIA.
section, and for continuation of lay and professional education.  At the end of
the year progress had been made on all phases of this programme.
Local Health Services.
Three new health units were established and the satisfactory negotiations
toward the opening of a fourth were completed during 1949. Health unit
directors were appointed to two of three units in operation at the end of the
year; only one of these was without a qualified director. The comparative
figures for 1948 are eight health units in operation, three without qualified
directors.
Another outstanding development during the year was the establishment
of the Division of Preventive Dentistry. It is now possible to evolve a programme of dental education and preservation and restoration of the teeth of
pre-school and school children.
During the year increased emphasis was placed upon measures designed to
control two of the chronic diseases, namely, cancer and arthritis. In this
respect diagnostic and follow-up services were extended to certain key centres
in the Province.
The possibility of improving the methods of providing school medical
services continued to be investigated during 1949. In this respect the results of
the Wetzel grid survey, conducted during the past two years, are being carefully
examined.
Federal health grants made expansion possible in public health dentistry,
mental hygiene, child welfare, public health education, public health nursing,
sanitation, and nutrition services of the Metropolitan Health Committee. Similar
expansion was also made possible in the Victoria-Esquimalt Health Department
through Federal health grants.
Quarterly meetings of the health unit directors, including the senior medical
officers of the metropolitan areas, were held during the year to discuss changes
in policies and services and to review present programmes and proposals for
new services.
An agreement between this Department and the Department of Agriculture
during the year provided co-operative supervision of milk production. This
agreement co-ordinated these services so that there would be no duplication or
overlapping of services.
There was an upward trend in the morbidity rate in the Province during
the year. This seems to be due mainly to an increase in certain of the communicable diseases of children, and to a significant increase in the number of cancer
cases reported. Very definite increases in rates were recorded for measles,
mumps, poliomyelitis, and cancer.
There were, however, marked decreases in the rates recorded for whooping-
cough and diphtheria.
Public Health Nursing.
The shortage of qualified personnel continued during 1949, necessitating
the appointment of a limited number of registered nurses who lack specialized
training in public health. Eight such nurses, following a period of supervised
field experience, were granted bursaries under the professional training grant
to take a course in public health nursing. DEPARTMENT OP HEALTH AND WELFARE, 1949. KK  17
The public health nursing field staff at the end of 1949 totalled 111 members,
an increase of four over the number at the end of 1948.
The ratio of public health nurses to population in British Columbia is 1 to
4,000.
Three new public health nursing districts were opened during 1949—Gibsons Landing, Howe Sound, and Kettle Valley.
The percentage of the total population covered by public health services
remained at 94.9, only slightly higher than last year. The fact that the increase
in coverage is small is largely due to an increase in the population and to the
small population in the new nursing districts.
In-service educational programmes were effected through regular staff and
regional study group meetings. The field staff continued to provide field training for a large number of undergraduate nursing students, and for thirty-two
graduate nurses taking postgraduate courses in public health nursing.
The senior nurses with supervisory responsibilities met twice during the
year for special conferences. This group also received an advanced course in
public health nursing supervision.
A trial survey of the crippling diseases of children in one of the nursing
districts provided the basis for a similar survey for the entire Province.
As a part of the James A. Hamilton and Associates Report on Hospital
Services in British Columbia, Miss Lucile Petry, Assistant Surgeon-General,
United States Public Health Service, studied the adequacy of the public health
nursing phase of local health services. Miss Petry reported, in part, that " The
Health Branch of the Department of Health and Welfare has an exceedingly
well-conceived plan for public health nursing services in the Province, and has
succeeded in implementing the plan extensively."
Nutrition Service.
The consultants of the Nutrition Service continued to provide consultative
services to local health staffs during 1949. Through the provision of technical
data and direct assistance, the field staff were better able to deal with the
problems of nutrition which were presented to them. Most of these problems
were related to school lunch programmes and to low-cost meal planning.
Public health nurses and teachers in an Okanagan district co-operated on
a study of the school lunches. From information obtained from this study it
was possible to make specific suggestions for improvement. A second study,
several months later, showed that the suggestions were effective. A marked
improvement in the school lunches was noted.
Technical direction was supplied in a project involving the study of the
foods eaten by the school children in another area. As a result of this study, a
programme to improve food habits has been initiated.
Two conferences were held with the senior public health nurses during the
summer. The entire consultant programme was reviewed and certain extension
of services resulted.
Requests and specific problems from public health personnel were dealt with
through correspondence and by articles in the staff bulletin.
Consultant service to institutions continued, with the object of improving
the food habits of the people in such establishments. KK  18 BRITISH COLUMBIA.
A study of the diets, and related factors, was made at the Provincial gaols.
Such a study is completed annually in accordance with recommendations outlined in the revised rules and regulations pertaining to such institutions.
With the provision in 1949 of accommodation for patients at the British
Columbia Cancer Institute, consultant services were provided to the Institute
in the organization and supervision of meal services.
Preventive Dentistry.
The division was established during the year 1949 with the object of improving the dental health of the children of British Columbia. The programme
is directed at prevention of dental ill-health. In this respect plans were formulated with particular emphasis on the care of younger children.
The co-operation of the College of Dental Surgeons of British Columbia and
of the British Columbia Dental Association was obtained.
Dr. F. McCombie was appointed as acting director of the division early in
1949. He left in September for a year's postgraduate study in dental public
health at the School of Hygiene, University of Toronto.
Dr. W. G. Hall joined the division in August from the staff of the Faculty
of Dentistry, University of Alberta. He deputized for the acting director during
the absence of the latter.
The division co-operated with the Division of Health Education in procuring audio-visual aids pertaining to dental health.
Several types of dental programmes were evolved and finalized in consultation with the British Columbia Dental Association. In general these programmes were aimed at incorporating treatment services for pre-school and
Grade I school children.
Plans were formulated for the appointment of full-time dental directors to
local health units, and for the use of the services of private dental practitioners
working in their own offices.
Two further programmes were established to provide dental services to
those areas where there is no resident dentist. The first of these is a system
of grants-in-aid to encourage dentists to locate in such areas. The other is the
establishment of basically equipped dentist offices in these areas, and includes
provision for payment of travel allowance to near-by dentists.
Public Health Engineering and Environmental Sanitation.
An estimated 835,960 people in the Province use water from public water-
supply systems. One of the major responsibilities of the division is to ensure
that these public water-supply systems provide safe water. During 1949 the
division examined all plans for new water-supply systems, and in addition conducted sanitary surveys of a number of plans of new sewerage systems, pending
the approval of such plans by the Deputy Minister of Health. In studying the
plans submitted for approval, the sizes and grades of the sewers were carefully
checked. The methods of sewage treatment and disposal were also carefully
examined.
Almost 500,000 people in the Province use private sewage-disposal systems.
Standard plans were produced showing the proper method of constructing septic
tanks and pit privies. DEPARTMENT OF HEALTH AND WELFARE, 1949. KK  19
There were no major milk-borne epidemics in British Columbia during the
year. The continuous co-operation between the Department of Health and the
Department of Agriculture, in the matter of milk sanitation, is definitely
improving the quality of the milk sold in this Province.
The Division provided consultative services cn milk sanitation to the local
health services. The latter are responsible for the supervision and sampling of
milk supplies. Each of the sanitary inspectors in the Province was provided
with kits which enabled them to carry out resazurin and phosphatase tests.
Many milk samples were sent to the Division of Laboratories for examination.
A new set of regulations governing the sanitary control of the shell-fish
industry was enacted during the year. In this respect the division performed
a considerable number of surveys of oyster-beds. In Boundary Bay and in
Esquimalt Harbour the surveys were especially thorough.
Due to the increased staff of sanitary inspectors in the field during 1949, it
was possible to devote much more time to the inspection of industrial camps.
The sanitary inspection of tourist camps and summer camps was quite comprehensive during 1949. The responsibility for such inspections lies with the
local sanitary inspectors.
Detailed inspections of environmental conditions in and around schools
were made by the local sanitary inspectors. The inspections were reported
upon, and copies of these reports were sent to the appropriate school boards.
The inspection of eating and drinking establishments is an important
feature of the work of the local sanitary inspector. The increased staff in the
field meant that many such establishments were inspected for the first time
during 1949. The division hopes to have each food place inspected at least four
times annually.
In 1949 the biggest single job of the division was in connection with shellfish sanitation. Almost the whole of the time of the Assistant Public Health
Engineer, and of two students during the summer months, was devoted to this
work.
Division of Vital Statistics.
The Division of Vital Statistics is charged with two major responsibilities,
namely, the registration of births, deaths, still-births, marriages, divorces, adoptions, and changes of name, and the provision of all the statistical data, studies,
and analyses required by or stemming from the various services of the Health
Branch. The efficient integration of these two complementary activities, both
directed in the ultimate toward improving the health of the people, is an
accomplishment unique in Canada.
In the registration work of the division, particular emphasis has been
placed during the year upon further improving the quality of the registrations
accepted. Every registration is carefully scrutinized for legibility, clarity of
statement, and accuracy and completeness of all items. During the year a considerable improvement was noted in the quality of the registrations of Indians,
while continued progress was evidenced in the difficult problem of securing
registrations amongst the Doukhobors. This latter gain is felt to be mainly
due to the efforts of the special field representative assigned to Doukhobor work,
and to careful planning of policy concerning the collection of vital statistics. KK 20 BRITISH COLUMBIA.
The Vancouver District Registrar's office was opened in March of this year
in the Provincial Government building at 636 Burrard Street. This was an
important forward step in giving speedy and efficient service to the expanding
population of the Greater Vancouver area, as well as in relieving the overburdened Government agency of a heavy responsibility.
The division undertook to supply the Hospital Insurance Service with a
monthly death index as from January 1st, 1949, and, in addition, a weekly
death index as from May 1st, 1949.
The microfilming of important records was continued during the year, and
15,650 files relating to delayed registration of birth were placed upon microfilm.
Original files were subsequently destroyed and much-needed space was made
available for more urgent requirements.
The system of notification of births, deaths, and still-births to public health
personnel was extended so that the Metropolitan Health Committee in Vancouver is now advised of events which occur to residents of the Metropolitan Health
District who are temporarily in other parts of the Province.
The division continued its important statistical obligations to all divisions
of the Health Branch, particularly to the Division of Tuberculosis Control and
the Division of Venereal Disease Control, in the processing and tabulation of
service and treatment statistics, in the presentation of monthly, quarterly, and
annual reports, and in the maintenance of Provincial case registers.
Advice and assistance were given in the planning of the Province-wide
survey of crippling diseases of children, in drawing up the associated questionnaire, and in setting up the recording and statistical procedures for summarizing and analysing the results. Consultative and statistical help was provided
in a special study carried out jointly by the Provincial and Federal Health
Departments on the use of the Wetzel grid in school health services. Assistance
was also provided to the British Columbia Cancer Institute, to the British
Columbia Division of the Canadian Arthritis and Rheumatism Society, and to
other non-official health agencies. Considerable effort was expended in complying with statistical inquiries from Government, commercial, and private sources.
Public Health Education.
The efforts of the division were mainly devoted to providing consultative
services and educational materials to local public health personnel. Through
funds available from Federal health grants, a basic library of seven public
health reference books was supplied to each public health office. Additional
books were sent to each proposed or established health unit centre.
Audio-visual equipment, including a film projector, a film-strip projector
and a record-player, was supplied to each of the eighteen health unit centres.
The central film library was increased to include eighty-five films and forty-nine
film-strips.
A series of demonstrations on the use of the above visual aids was presented at the annual Public Health Institute and classes were given to local
staffs at some health unit centres.
In 1949, as in other years, a large number of films was previewed. Those
of value in the public health programme were purchased and added to the film .
DEPARTMENT OF HEALTH AND WELFARE, 1949. KK 21
library.   The film catalogue was revised and brought up to date.   It contains
more complete descriptions of films than is usually found in such catalogues.
As the result of an increased demand, more books and other reference
materials were purchased. The increased demand was particularly noticeable
in the fields of mental hygiene and child-development. All the books in the
library were classified and catalogued during the year.
The division co-operated with the Department of Education in planning
the health phases of the revised curriculum in " Effective Living," which will
include health, guidance, and family relations in one course.
Articles on school health were prepared and distributed to schools in the
Province. Kits of reference materials were assembled and provided to school
health teachers through the local public health nurses.
The division planned and conducted orientation courses for new appointees
in the Department.
Laboratories.
Almost 380,000 examinations were made by the laboratories of the division
during 1949. This represents an increase of about t per cent, over the number
for the previous year. Roughly 80 per cent, of these examinations were made
in the central laboratories in Vancouver.
As in previous years, tests relating to venereal diseases accounted for about
75 per cent, of the total tests done. Most of the tests on blood specimens were
submitted by practising physicians.
There was an increase of over 1,100 in the number of cultures examined for
M. tuberculosis. This substantial increase is largely attributed to a growing
tendency to request repeat examinations at short intervals from the same
patient.
During the summer months a number of outbreaks of staphylococcal food
poisoning were identified. There was another botulism episode—the third in
British Columbia within the past five years.
The number of acute gastro-enteritis infections, due to micro-organisms of
the salmonella-shigella groups, increased by about 75 over 1948. There were
no extensive epidemics. The infections were confined to individuals or to small
familial groups.
The upward trend in the number of bacteriological tests of milk- and water-
supplies was maintained during the year. The number of milk samples examined
increased by more than 50 per cent. The number of phosphatase tests for
efficient pasteurization doubled.
Tests of water samples for the presence of the coli-aerogenes group of
micro-organisms increased from 6,930 in 1948 to 7,942 in 1949.
Tests relating to diphtheria totalled nearly 20,000 for 1949, an increase of
about 30 per cent, over the 1948 figure.
The number of Paul-Bunnell tests for infectious mononucleosis increased
from 739 in 1948 to 1,028 in 1949. Although requisitions for these tests are
steadily increasing, there is no convincing evidence that the disease is prevalent
in British Columbia.
Cultures of throat-swabs for hemolytic staphylococci and streptococci continued to mount, 3,819 of these being reported on in 1949, as compared to 3,092
in 1948. KK 22 BRITISH COLUMBIA.
Microscopic examinations for intestinal parasites also increased by over
25 per cent, over 1948.
Venereal Disease Control.
The incidence of venereal diseases in general showed a slight decrease during 1949. The greatest improvement appeared in relation to syphilis, where
early infections showed a decline of over 50 per cent, over 1948. The figures
for gonorrhoea remained fairly constant.
Free diagnostic and treatment services continued to be given at all clinics
of the division. The free consultative service to private physicians continued
to be used to an ever-increasing extent. Free drugs for treatment of venereal
diseases were again made available to all persons, through their private
physicians.
A new treatment schedule for syphilis was drawn up in 1949 and distributed to every physician and hospital in the Province. Penicillin became the
drug of choice in the treatment of all stages of syphilitic infections. In most
instances the penicillin treatment was followed by a short course of arsenic
and bismuth.
The shortage of hospital beds necessitated an increased use of the ambulatory form of treatment with " delayed absorption " types of penicillin. The
results from this method appeared to have been as effective as the more inconvenient three-hourly injections of aqueous penicillin.
Health unit directors and public health nurses in the field continued to carry
an ever-increasing share of the epidemiological work for the division.
Meetings were again held at intervals of three to four months for discussion
of problems relating to the spread of venereal diseases. These meetings were
well attended and included representatives from all interested groups.
Two blood-testing surveys were conducted during the year. Out of 680
persons examined a total of sixty new syphilis cases were discovered.
Social factors related to venereal diseases assumed an increasingly important part of the programme. Every new patient who reported to the Vancouver
Clinic was granted an interview with a social service worker. This worker
attempted to detect and assess any underlying social or psychological problems.
The " Reference Manual for Clinic Physicians " was revised to include
recent developments in treatment and diagnosis. The booklet " Procedures and
Services in Venereal Disease Control " was also revised. Copies of the latter
publication were sent to every practising physician in the Province.
Tuberculosis Control.
The programme of the division continued to be hampered by the inadequate number of beds available for treatment of tuberculosis patients. Despite
this handicap, there was some improvement in the over-all tuberculosis picture
in the Province.
The greatest improvement in the division during the year was the opening
of the new surgical and teaching facilities at the Vancouver unit.
The problem of obtaining qualified medical personnel persisted in 1949, as
in previous years.
Plans were completed for a major change in the tuberculosis survey programme, whereby mass X-ray surveys will be reduced.   Instead, X-ray equip-
I DEPARTMENT OF HEALTH AND WELFARE, 1949. KK  23
ment will be installed in general hospitals and local health units in most areas
of the Province, where the service will be readily available to the people at all
times.
The rehabilitation programme which was initiated by the British Columbia
Tuberculosis Society was transferred during the year to the division, using
funds from the Federal health grant.
No new clinics were opened but the volume of work performed in each
clinic continued to grow.
The new home for nurses at Tranquille was opened during the year. It
proved a valuable addition. Also at Tranquille an alternating-current system
was made available and a new telephone system installed.
The epidemic of poliomyelitis during the summer months necessitated the
removal of the division's patients from the Vancouver Isolation Hospital for a
period of fourteen weeks.
The Federal health grants made possible three major developments in the
social service work of the division. A full-time rehabilitation officer and a full-
time occupational therapist were appointed. A home-making service for tuberculosis patients was established, and at the end of the year there were seven
full-time home-makers and four part-time home-makers in patients' homes.
As in previous years, there was, during 1949, complete co-operation between
the division and the British Columbia Tuberculosis Society.
LONGEVITY AND CAUSES OF DEATH IN
BRITISH COLUMBIA.
As the establishment of health units throughout the Province progresses,
there is a growing recognition of the value of quantitative data on morbidity
and mortality. It is only by a consideration of this data that a comprehensive
public health programme can be properly established and maintained. The
statistics which are developed in this way will, over a period of years, help to
indicate the strength and the weakness of the services provided and will also
indicate where further activity may be best expended.
Much has been done to increase the life-span of the people in the Province,
but the mitigation of some of the more urgent health problems will also serve
to emphasize those which remain. While progress in public health matters may
appear slow when viewed from year to year, a comparison of the position to-day
with that of twenty, or even ten, years ago brings out the advances very clearly.
In some fields, such as cancer and heart-disease, the mere holding of the line
indicates progress when the ageing of the population is considered.
The mortality rate in the Province has shown very little fluctuation over
the last twenty years. It has varied within a small range, with a low of 8.7
deaths per 1,000 population in 1933 and a high of 11.1 in 1943. The trend of
the death rate has been very gradually upward because of the increasing percentage of people in the older age-groups. The crude mortality rate, based on
preliminary figures for the first ten months of the year (excluding Indians),
declined from last year's rate of 10.2 deaths per 1,000 population to 9.6 deaths
in 1949.
When the age specific death rates based on the mortality experienced
during the first ten months of the year are considered, improvement is shown KK 24 BRITISH COLUMBIA.
in each category over the preliminary figures for 1948. The provisional death
rate last year in the 0-19 age-group was 3.2 deaths per 1,000 population while
in 1949 it declined to 2.8. For the group 20-39 years of age, last year's figure
was 1.9, this year's 1.7, and for the 40-59 group, the comparable figures were
7.6 in 1948 and 7.1 in 1949. A more substantial improvement occurred in the
death rate of the group 60 years of age and over. The rate, based on the first
ten months of 1948, was 47.8, while this year the rate has declined to 41.4.
As an indication of the progress being made in public health a comparison
between the infant mortality rate this year and that for 1929 is interesting.
Twenty years ago the rate was 45.7 infant deaths per 1,000 live births; in 1949
it has decreased by more than 43 per cent, to 25.8 deaths per 1,000 live births.
British Columbia's infant mortality rate has for some time had the distinction
of being among the lowest in Canada, a fact which reflects the comparatively
high level of health of the community.
Premature birth was the leading cause of infant mortality, accounting for
almost 40 per cent, of the deaths of children under one year. Next was congenital malformations, which caused 16 per cent, of the infant deaths. This
was followed by injury at birth, responsible for 12 per cent, of the deaths.
These three causes together accounted for over two-thirds of the infant deaths
in the Province.
A very marked improvement has occurred in maternal mortality in 1949 as
compared with the period twenty years ago. Then, the number of deaths of
mothers per 1,000 live births was 5.5. Preliminary figures for the first ten
months of this year indicate that the rate will be 1.3, a reduction of over three-
quarters from the 1929 figure.
This year a reduction is noted in the mortality rate of all the leading causes
of death. Preliminary figures show that diseases of the heart and arteries this
year caused 386 deaths per 100,000 population, an improvement of 4 per cent,
over the first ten months of 1948, when the rate was 401.9. Cancer, the second
leading cause of death, shows a preliminary rate of 144.8 deaths this year as
compared to 149.1 last year, a gain of nearly 3 per cent. Accidents maintained
their position as third leading cause of death this year with a rate of 75.7 deaths
per 100,000 people, which is slightly less than last year's figure of 76.3. This
marks the third year an improvement has occurred in the accident mortality
rate and it is hoped that this downward trend can be continued, for accidents
represent the most easily preventable form of wastage of human life.
Several changes have occurred in the order of importance of the various
specific types of accidents. Deaths from falls or crushing last year were in
second place, accounting for 14.7 per cent, of the deaths from all accidents.
This cause has moved into first place in 1949, figures based on the first ten
months of the year indicating that 26.6 per cent, of accidental deaths will arise
from this cause. Motor-vehicle accidents, which were the leading cause of
accidental death last year, accounting for 20.7 per cent, of such fatalities, this
yea_r dropped to second place with 17 per cent. Drowning maintained its
third place as a cause of death by accident, preliminary figures showing it to
have claimed 13.3 per cent, of the lives lost accidentally in 1949, compared to
11.6 per cent, last year.
The three leading causes of death accounted for over 60 per cent, of the
deaths from all causes. DEPARTMENT OF HEALTH AND WELFARE, 1949. KK  25
Intra-cranial lesions of vascular origin (without mention of arteriosclerosis) ranked fourth as a cause of death, with a rate of 38.3 deaths per 100,000
people, an improvement over last year's rate of 45.7.
The death rate from pneumonia, the fifth leading cause of death, was 36.5
per 100,000 population this year, while last year it was 40.7.
Diseases of early infancy has moved up into sixth place as a cause of death
this year, and nephritis has fallen back to seventh place. Tuberculosis, diabetes,
and premature birth, in that order, fill the last three places among the first ten
major causes of death.
A study of the comparative effect of the leading causes of death within
each age-group is interesting as it reveals the changing importance of the
various causes as age progresses. In the first year of life, as noted before,
prematurity caused the greatest number of deaths, followed by congenital malformations, and injury at birth.
Accidents caused the greatest number of fatalities at all ages between 1
and 39 years, but as the age progresses their importance as the leading cause
decreased. They were responsible for 44.2 per cent, of the deaths in the 1-9-
year age-group, 42.5 per cent, in the 10-19 group, 38.6 per cent, in the 20-29
group, and 25.4 per cent, in the 30-39 group. Drowning caused the greatest
percentage of accidental deaths in the 1-19 age-group, and this was followed by
motor-vehicle accidents. In the two groups 20-39 years, motor-vehicle accidents
moved up to first place, forestry accidents occupying second place in the 20-29
group, and drowning in the 30-39 group.
Leukemia and pneumonia followed accidents as causes of death in the 1-9
age-group. In the next two age-groups, tuberculosis held second place. Cancer
and tuberculosis were second and third in importance as fatal diseases in the
30-39 age-group.
From 40 years of age onward, heart-disease accounted for an increasing
percentage of deaths in each age-group up to 90 years, when it declined in effect
slightly, but retained its position as the leading cause of mortality. In the
40-49 age-group, heart-disease caused 24.1 per cent, of the deaths; this increased to 31.9 per cent, in the next age-group, and to slightly over 41 per cent,
in the following two age-groups. It took the greatest toll in the 80-89 age-
group, where nearly one-half of the deaths which occurred were charged to this
cause. In the last age-group, the proportion declined to 41 per cent. Cancer
followed heart-disease as a cause of death in the age-groups 40-79, taking
a toll of close to 20 per cent, of the total deaths in each of these groups. Accidents were the third leading cause of death in the 40-49-year group with 15.2
per cent, of the deaths being attributed to this cause. In the 50-79-year groups,
intra-cranial lesions of vascular origin took third place, causing about 9 per
cent, of the deaths in the first two groups, and 12.6 per cent, in the last group.
Intra-cranial lesions were responsible for 12.3 per cent, of the deaths in the
80-89-year group, and thus occupied second place after heart-disease as a death
cause. Cancer followed in third place, contributing 9 per cent, of the deaths.
Accidental falls, always dangerous as age progresses, came after heart-disease
in second place as a killer of people in the 90-99-year group, and this cause was
followed by intra-cranial lesions, responsible for 8.7 per cent, of fatalities. KK 26 BRITISH COLUMBIA.
REPORT OF THE HEALTH BRANCH OFFICE,
VANCOUVER AREA.
G. R. F. Elliot, Assistant Provincial Health Officer.
INTRODUCTION.
In the fall of 1948 Dr. G. R. F. Elliot, formerly Director of Division of
Venereal Disease Control, was appointed Assistant Provincial Health Officer in
charge of the Vancouver area. He was given dual responsibilities, namely, the
direction of the Bureau of Special Preventive and Treatment Service and the
administration of the Federal health grants, including conduct of the survey
required by the health survey grant. In January, 1949, a separate office was
set up, known as the Health Branch Office, Vancouver, located at 2670 Laurel
Street.
BUREAU OF SPECIAL PREVENTIVE AND TREATMENT
SERVICE.
The Assistant Provincial Health Officer acts as a liaison officer between the
Divisions of Laboratories, Tuberculosis Control, and Venereal Disease Control,
all of which are located in Vancouver, in regard to matters of policy or particular problems. In general administration, these three divisions continue to
deal directly with the Deputy Minister of Health, Victoria.
The Provincial Government is now making substantial grants to certain
official non-government health agencies, such as the Western Society for Physical Rehabilitation, the British Columbia Division of the Canadian Arthritis
and Rheumatism Society, and the British Columbia Cancer Institute. It was
considered advisable, therefore, that the Government should be kept informed
on the administration of these organizations and should be assured that these
services are integrated with the general public health services in the Province.
Responsibility in this regard was delegated to the Assistant Provincial Health
Officer.
Close co-operation is maintained with the Bureau of Local Health Services
in giving advice and assistance to the local public health personnel in the Lower
Mainland and Fraser Valley area. Attention has also been given to the formation of health units in this area, in co-operation with the Director of Local
Health Services.
FEDERAL HEALTH GRANTS.
General.
Federal health grants to the Provinces were continued in 1949, having been
authorized again this year by Order in Council. The total amount available to
British Columbia for the year 1949-50 is $2,617,726, an increase of $81,073 over
the year 1948-49. This increase was due primarily to an increase in the basis
of distribution of the general public health grant from 35 cents -per capita to
40 cents per capita. Other grants increased slightly, as population is one of the
factors governing the distribution of the total amount. The Advisory Committee on Research, Ottawa, continued to allocate the public health research grant,
the total amount of which increased from $100,000 to $205,148. DEPARTMENT OF HEALTH AND WELFARE, 1949. KK  27
The Federal health grants were made available to the Province in 1948
with little warning and well after the fiscal year had begun. As a result, in
order to prevent reversion of large unused portions of the grants to the Federal
Treasury, attention was given during the remainder of the fiscal year 1948-49
to the preparation and submission of projects based on already known facts concerning public health needs in British Columbia and upon which relatively
immediate action could be taken.
At the same time, however, the importance of a long-range programme was
recognized, and definite steps have been taken this year toward this end.
Several surveys concerned with individual phases of health have been completed.
In any plans ensuing therefrom, emphasis has been placed on the integration of
such services with generalized public health services. In addition, these plans
will be integrated with the survey of all Provincial health facilities and needs
which is being undertaken by the Assistant Provincial Health Officer under the
provisions of the health survey grant.
Administration.
The organization which was established by the Minister of Health and
Welfare when the Federal health grants were inaugurated has remained essentially the same as that outlined in the 1948 Annual Report of the Health Branch.
The Health Survey Committee, as the central advisory committee is known,
met three times during 1949 to receive progress reports and to advise on particular problems referred to it by the subcommittee chairmen of the individual
grants. The attendance of Dr. F. W. Jackson, Director, Health Insurance
Studies, Ottawa, at the meeting of July 6th, provided an excellent opportunity
for the clarification of various questions. Thus, through this Committee, co-ordination between the various plans for expenditure of the grants is assured and
duplication is avoided.
Two changes have taken place in the composition of the Health Survey
Committee. Miss Alice Wright was appointed as representative of the Registered Nurses' Association of British Columbia, and Dr. Charles Hunt replaced
Dr. G. R. F. Elliot as chairman of the Sub-committee on Venereal Disease
Control Grant. In addition, Dr. Myron Weaver, Dean, Faculty of Medicine,
University of British Columbia, has been asked to attend the meetings.
General administration and over-all control of the grants is the responsibility of the Assistant Provincial Health Officer. Where Provincial programmes
are established, such as hospital construction, mental hygiene, venereal disease
control, tuberculosis control, and general public health services, planning for
expenditure of the funds available through the grants is undertaken largely by
each of these Government services. The expenditure of the remaining grants,
as well as any expenditure of grants by non-government agencies, is under the
immediate jurisdiction of the Assistant Provincial Health Officer.
Requests for approval by the Federal Government of expenditures under
the grants are made in the forjn of projects. The Department of National
Health and Welfare, Ottawa, has shown a keen desire to co-operate with this
Province. Concrete suggestions have been made in regard to our submissions
and administrative problems. At all times there has been a willingness to
accede to requests that further consideration be given to rejected projects. KK 28 BRITISH COLUMBIA.
All submissions are reviewed by the Assistant Provincial Health Officer
to ensure that they conform to the provisions of the grant; that they do not
conflict with present or future health programmes in the Province; and that
the total amount allocated does not exceed the amount available in each grant.
They are then referred for approval to the Deputy Minister of Health as well
as to the Minister of Health and Welfare for the Province. The fact that
mental health and hospital construction in British Columbia do not come within
the jurisdiction of the Deputy Minister of Health has not created any major
problems; an excellent working relationship and understanding exists between
all members of the Provincial Secretary's Department, the Department of
Health and Welfare, and the Hospital Insurance Commission in the management
of the Federal health grants.
Close co-operation is maintained with the Departmental Comptroller, who
is responsible for payment of accounts, submission of all claims to the Federal
Government, and maintenance of an inventory of all equipment purchased with
the Federal grants. Where such equipment is placed in a non-government
institution or agency, it is considered to be the property of the Provincial
Government on loan to that agency. The efficient manner in which this work
has been handled has contributed greatly to the reasonably easy operation of
the programme in British Columbia and to the good relationship with Federal
officials.
Grants received Year ended March 31st, 1949.
Due to the foresight and preparedness of health authorities in this Province,
British Columbia was able to take immediate advantage of the health grants.
Although the fiscal year 1948-49 was well advanced when these grants were
announced, projects approved by the Federal authorities resulted in the allocation of 80 per cent, of the amount of money available. British Columbia ranked
second in this regard, being surpassed only by Prince Edward Island. For
various reasons it was not possible to implement all approved projects, but
health services actually received $1,094,151 up to March 31st, 1949. Of the
seven grants where there was no matching principle or the balance could not
be carried over to the next fiscal year, expenditures in the amount of $705,768
were completed by March 31st, 1949, that is 63 per cent, of the total amount
available was expended. In addition, the hospital construction grant, $1,080,745,
and the health survey grant, $52,744, may both be carried over to the next fiscal
year so that there is no loss to the Province from these two grants. Expenditures were made from the cancer control grant to the extent that matching
Provincial funds were available.
The amount available under each grant for the year ended March 31st,
1949, is given in the following table, together with the amount allocated for
approved projects and actual expenditures. DEPARTMENT OF HEALTH AND WELFARE, 1949. KK 29
Comparison of Amounts approved and Actual Expenditures with
Total Grants for the Year ended March 31st, 194-9.
Total
Grant.
Approved.
Actual Expenditure.
Grant.
Amount.
Total
Grant.
Amount.
Amount
Approved.
Total
Grant.
$42,574
42,574
1,080,745
42,574
338,832
272,740
7,500
52,744
365,400
290,970
$32,635
28,394
1,034,631
39,953
189,011
254,424
7,500
17,667
359,864
48,534
Per Cent.
77
67
96
94
56
93
33
98
17
$29,863
24,600
337,004
37,279
134,785
209,369
4,894
3,024
264,978
48,355
Per Cent.
91
87
33
93
71
82
65
17
74
99
Per Cent.
70
58
31
87
40
77
65
6
General public health	
Cancer control	
72
17
Total	
$2,536,653
$2,012,613
79
$1,094,151
54
43
* Total grant held by Federal authorities.   These figures represent amount allocated to British Columbia.
Present Status.
Every endeavour has been made this year to utilize to the fullest extent the
money available, but there are various factors which influence the allocation
of these funds. The amount of possible expenditure may be limited until a
Provincial programme is finalized, as in the crippled children's and hospital
construction grants. On the other hand, where the Provincial programme is
well developed, such as in tuberculosis control and mental health, difficulty may
be experienced in meeting the requirement that expenditures must be for new
and extended services. Over one-half of the grant for venereal disease control
is allocated for projects approved under the Federal grant originally made in
1943 and continued in succeeding years. In addition, as pointed out above,
there are reasons why certain grants are lagging in their spending programme.
Accomplishments.
The Federal health grants have not only made possible new developments
in health in British Columbia but have also accelerated expansion of present
policies. Although the grants have been in operation for less than two years,
that progress has been achieved under each grant is evident from the following
record.
Crippled Children's Grant.
For purposes of this grant, " a crippled child is one under the age of 21
years who, because of disease, accident, or defect, is restricted in his normal
muscular movements." This definition restricts planning and makes it necessary to separate this phase of child health from the remaining phases, such as
blindness, deafness, rheumatic heart-disease, and mental defectiveness, which
must, therefore, be included in the planning under other grants. Representations have been made to the Department of National Health and Welfare,
but it has not been possible to broaden the definition due to the limitations of
the grant. KK  30 BRITISH COLUMBIA.
The most important development under this grant is the survey of crippling
diseases in children which is being carried out at present, and which is to
include all the phases of child health in accordance with the decision of the
Health Survey Committee. A questionnaire was drafted in consultation with
representatives from the various medical specialities concerned. Pilot studies
completed in a rural and an urban area indicated that 95 per cent, of the
questionnaires would be completed from school medical health records through
the co-operation of the public health staff. The survey has now been extended
to the Province as a whole, and it is expected that a partial analysis of the
results will be ready early in 1950.
This survey will provide the basic information necessary for the formulation of a Provincial programme for crippled children in this Province. It has
already aroused keen interest among the public health staff and brought to
light many points on which there was no previous knowledge.
Expenditures under this grant have been almost entirely for orthopaedic
and other equipment for hospitals and institutions in order not to encumber
this grant for future years until the Provincial programme for crippled children
is finalized. A new development, which is being financed this year but which
will easily become an integral part of any Provincial programme, is the provision of staff and facilities whereby patients under the age of twenty-one will
receive the necessary investigation, retraining, and rehabilitation following an
attack of poliomyelitis. The management of this project is under the Western
Society for Physical Rehabilitation, Vancouver, in co-operation with the Poliomyelitis Advisory Committee of the Vancouver General Hospital and the private
physician. The opportunity thus provided for these patients with residual
paralysis to have retraining will enable them, as far as possible, to return to
normal living.
Professional Training Grant.
During the year 1948-49, priority was given to applications for training
of general public health personnel, although there were also sufficient funds to
provide training for some specialized services. In 1949-50 the total amount
required for professional training was in excess of the amount of the grant,
and projects for training have therefore also been submitted under the crippled
children's, venereal disease control, tuberculosis control, mental health, general
public health, and cancer control grants.
This opportunity for postgraduate study has encouraged personnel presently
engaged in health work to improve their qualifications, and it has also made it
possible to attract untrained personnel on the understanding that training will
be provided. All recipients of benefits under the professional training grant
are required to sign an agreement to return to suitable employment in British
Columbia for a specified period of time depending on the length of the training
provided.
As at September 30th, 1949, a total of twenty-five persons had completed
their training, including seven physicians and six public health nurses; forty-
five persons, including nine physicians and fourteen public health nurses, had
commenced training; and approval had been given for an additional six persons
whose training had not yet commenced.   A total of seventy-six persons to date, DEPARTMENT OF HEALTH AND WELFARE, 1949. KK  31
therefore, has received, or will receive, postgraduate training under one of the
Federal health grants.
General public health training for additional physicians, nurses, and
sanitary inspectors has made it possible to open new health units and fill
positions which have been vacant for some time due to lack of personnel.
Postgraduate work for those in public health nursing and sanitary inspection
supervisory positions, as well as in-service training courses for these two groups,
has undoubtedly raised the standard of the service given.
Specialized services have also benefited considerably. Physicians on the
Provincial Mental Hospitals staff have taken courses in electroencephalography,
hospital administration, pathology, and psychiatry; nurses in neuro-surgical
technique and nursing supervision; other members of the staff in clinical
psychology and psychiatric social work; and, in addition, two school teachers
are taking special courses in mental hygiene. Similar training, related specifically to tuberculosis, venereal disease, cancer, and crippled children, has been
taken by personnel employed in these services.
Hospital Construction Grant.
This grant differs from the others in that any amount not expended during
the current fiscal year may be carried over to the succeeding year. Administration of this grant is thereby made considerably easier, as it would be very
difficult to have plans approved for a hospital of any size and the building
completed within the fiscal year. Approval has recently been granted whereby
the cost of construction of special services, such as staff quarters, heating
plants, etc., may be included in the total cost of construction, even though they
are separate from the main hospital buildings, but this still applies only when
such facilities are constructed at the same time as additional hospital beds.
Representations have been made to the Federal authorities to make it possible
for hospitals to receive assistance in constructing these additional facilities
required as a result of additional beds constructed prior to April 1st, 1948.
The majority of the projects approved to date have been for building under
way at the time the Federal health grant programme was announced. The
projects which had received Federal approval by December 31st, 1949, made
provision for an increase of 1,439 hospital beds in British Columbia (689 in
general hospitals, 652 in mental hospitals, and 98 in chronic hospitals). By the
end of the year, these projects had been implemented to such an extent by
actual construction that 531 additional general hospital beds and 351 additional
mental hospital beds were in use or ready for occupancy. It is expected that
future construction of general hospitals will be based on the recommendations
contained in the report of the hospital survey completed by Messrs. J. A.
Hamilton and Associates in October, 1949.
Venereal Disease Control Grant.
The grant, which became available in 1948, was in effect an addition to
existing Federal grants, since the Federal Government has contributed toward
the cost of venereal disease control in this Province since 1943. At the beginning
of the fiscal year 1949-50, the provisions of both grants were consolidated. KK 32 BRITISH COLUMBIA.
A project was approved during the year 1948-49 for a survey of all phases
of venereal disease control in British Columbia by Dr. D. H. Williams, of
Vancouver. The report of this survey was presented to the Deputy Minister
of Health in December, 1949.
Other approved projects provided for expansion of clinic services through
the provision of additional personnel and equipment, postgraduate studies, and
for the visit to British Columbia of an outstanding authority on venereal disease
control. More detailed information in regard to this grant is given in the
Annual Report of the Division of Venereal Disease Control.
Mental Health Grant.
As previously stated, most mental health services are under the jurisdiction
of the Provincial Secretary, and reference to this grant is made in this report
only in order to complete the report regarding Federal health grants.
The Crease Clinic of Psychological Medicine was completed in 1948, and
as this was a new development it was possible to purchase diagnostic, treatment,
occupational therapy, and teaching equipment for this institution worth
approximately $150,000.
Under this grant, facilities at the Provincial Mental Hospital have also
been increased for recreational and occupational therapy and psychiatric
nurses' training. A mental hygiene programme has been instituted by the
Victoria-Esquimalt Board of Health, and expansion of the programme of the
Metropolitan Health Committee of Greater Vancouver has also been approved.
The University of British Columbia has been assisted in enlarging their clinical
psychology department in order that postgraduate studies may be available.
Tuberculosis Control Grant.
Expansion of the case-finding programme has taken place through the
provision under this grant of X-ray equipment, which was purchased in 1948-49
and has since been placed on loan in nine of the larger hospitals in order to
make possible routine X-ray of all admissions. Equipment has also been placed
in two strategic health units. Plans are being made for the purchase of
additional X-ray units for a number of the smaller hospitals. Approximately
$70,000 has been expended in providing equipment for the new Surgical and
Educational Unit of the Division of Tuberculosis Control, Vancouver. It has
also been possible to institute a rehabilitation service and to provide increased
occupational therapy service, a wider use of free streptomycin, and professional
staff education. Further information regarding the utilization of this grant
will be found in the Annual Report of the Division of Tuberculosis Control.
Public Health Research Grant.
This grant is allocated by Federal authorities in order to ensure that there
is no duplication, to permit of research being directed particularly toward
public health problems, and to facilitate reference to the National Research
Council and the Defence Research Board of those applications which are not
considered to come within the scope of the public health research grant.
One application from this Province was approved in 1948-49. This project
provided for an evaluation of the Wetzel grid in school health services.   The DEPARTMENT OF HEALTH AND WELFARE, 1949. KK  33
study, which has been carried out in the Central Vancouver Island Health Unit
area, is a continuation of a preliminary one begun in 1946 by the Department
of National Health and Welfare in order to offer guidance in the practical
application of the Wetzel grid in public health and welfare services providing
it meets Canadian requirements. The project was completed in the fall of 1949
and the report is being prepared.
A second research project was approved in 1949-50, namely, evaluation
of the antigenicity of cholera vaccine prepared in fluid media. It will enable
cholera vaccine prepared in synthetic fluid media, which was suggested during
the war period, to be compared antigenically with the commonly used cholera
vaccine produced from solid media. This work is being carried out under the
direction of Dr. L. E. Ranta, Department of Bacteriology and Preventive
Medicine, University of British Columbia, and an application has been made
for it to continue in the year 1950-51.
Health Survey Grant.
The purpose of this grant is to assist the Provinces in setting up machinery
to ensure the most effective use of the other health grants and planning a long-
range health programme for each Province. Reference has been made in other
sections of this Report to individual surveys which have already been completed. Action in regard to the survey of all health facilities in the Province
was delayed pending completion of the hospital survey by Messrs. J. A. Hamilton and Associates. This survey will include all phases of hospital administration and personnel. Because of the necessity of considering hospitals in relation to other factors, such as area, population, and existing health services,
including physicians and nurses, a large amount of valuable data is being
collected through this survey.
The Hospital Survey Report was presented in October, 1949, to the Minister of Health and Welfare, and preliminary plans have now been drafted for
the Provincial survey of health services and facilities.
General Public Health Grant.
Expenditures under this grant have been directed primarily toward the
expansion and improvement of public health services in local areas through
provision of staff and equipment. Since plans have been on hand for some
years, comparatively little delay occurred in taking advantage of this grant,
72 per cent, of the total amount available being expended during the year
1948-49. In particular, this grant has made it possible to establish a Division
of Preventive Dentistry, to formulate plans for a Provincial dental programme,
and to expand and integrate the present dental health services.
In addition to the expansion of general public health services, a full description of which is given in the section of this Report entitled Bureau of Local
Health Services, expenditures have been made under this grant to other special
services directed at improving the public health. A programme for the investigation and treatment of persons suffering from arthritis was inaugurated in
1948, with Federal and Provincial funds, and is being continued. Facilities for
the care of premature infants have been improved through the purchase of
incubators and resuscitators for the hospitals on the Lower Mainland.    Finan- KK  34 BRITISH COLUMBIA.
cial help has been given to the University of British Columbia for the provision
of equipment to assist in extending training to an increased number of bacteriologists, public health nurses, and other public health personnel.
Cancer Control Grant.
A cancer control programme had been under discussion and consideration
for several years, but no final plans had been drafted at the time the Federal
grant was announced. On the recommendation of the Sub-committee on Cancer
Control Grant, and with the concurrence of the British Columbia Medical
Association, Dr. 0. H. Warwick, Executive Director, National Cancer Institute
of Canada, made a survey of the problem in British Columbia in December,
1948. The British Columbia Cancer Foundation drew up a plan, at the request
of the Sub-committee on Cancer Control Grant, for the implementation of the
recommendations made by Dr. Warwick. This plan provides for the extension
of existing diagnostic and treatment services in Vancouver and Victoria,
organization of diagnostic centres in other parts of the Province in conjunction
with local public health services, organization of a statistical section in co-operation with the Provincial Division of Vital Statistics, provision by the Foundation of a sixteen-bed nursing home in Vancouver, and continuation of lay and
professional education by the British Columbia Division of the Canadian Cancer
Society and appropriate professional groups. It is gratifying to note that by
the end of December, 1949, progress had been made on all phases of this
programme with considerable assistance being given through this grant.
The question as to whether or not biopsy, radiodiagnostic, consultative,
and radiotherapy services should be free was referred to the Health Survey
Committee. It was agreed that the biopsy service should be free to the patient
and available to everyone in the Province and this has been approved by the
Department of National Health and Welfare. With regard to the remaining
services, however, no final action has been possible, and patients who are able
to pay for treatment are therefore still being asked to do so.
Acknowledgments.
The progress achieved through the Federal health grants is due to the
whole-hearted co-operation of all public health personnel. The staff of the
central office of the Health Branch, Victoria, has been ready to assist at all
times.
The co-operation of officials of the Department of the Provincial Secretary
and, in particular, the Civil Service Commission has facilitated the administration of this programme.
The members of the Health Survey Committee and the chairmen and members of the sub-committees under the individual grants have given valuable
advice and assistance, and their willingness to do this on a voluntary basis is
very much appreciated. DEPARTMENT OF HEALTH AND WELFARE, 1949. . KK  35
REPORT OF THE BUREAU OF LOCAL HEALTH
SERVICES.
J. A. Taylor, Director.
INTRODUCTION.
Health services on the local or municipal level have long been in the transition stage, emerging from the part-time basis to the full-time service in more
and more areas of the Province. Those municipalities and school districts
which have united their community and school health services under a Union
Board of Health have had a uniform basic community health programme considered to be the most efficient method of public health administration. In
recent years, more and more municipalities and school districts have turned
to the Health Branch, Department of Health and Welfare, with requests for
the introduction of health unit services in their areas. For five years the
provision of these services was not possible because of the shortage of qualified
personnel. If, for no other reasons, then, the year just passed must be recognized as a notable one from the community health service view-point, because
of the establishment of three new health units under Union Boards of Health
and satisfactory negotiations toward the opening of a fourth. This constitutes
a most significant advance in local health services for any one single year.
PREVENTIVE DENTISTRY SERVICES.
A major community health problem universal to the entire Province has
long been that of the dental health of pre-school and school children. Year
after year in annual reports hope has been engendered that a programme of
preventive dentistry could be evolved, principally to preserve and, in part, to
restore the teeth of these children. It is regrettable that something could not
have been done earlier; certainly in no other crippling condition affecting 97
per cent, of the children would such a period of delay have been so long
tolerated.
The outstanding advance in public health services for this year is, therefore, the establishment of a Division of Preventive Dentistry, for which a report
of the first year's activity is included under a separate heading. This represents the culmination of years of planning, and portends a forward advance in
local health services as the programme becomes more definitely established on
the community level. In no small part, the programme to date has been contingent upon the very definite contribution of the dental profession of the
Province through their dental health committee, whose members have given
unreservedly of their-time to assist the Department of Health in formulating
the four-point programme.
CHANGING CONCEPTS IN COMMUNITY HEALTH
SERVICES.
The scope and pattern of public health services show a progressive change
from year to year to fit the altered needs and conditions revealed by mortality,
morbidity, and population statistics. Significant decreases in infant and
maternal mortality,  in communicable-disease incidence,  and other changing KK 36 BRITISH COLUMBIA.
factors would tend to indicate that the attention devoted to these conditions,
concomitant with an improvement in environmental sanitation, is beginning
to yield results. These results, however, present new features as the changes
in gross mortality rates are examined. The diseases which threatened during
infancy, childhood, and the most productive periods of life have, to a considerable extent, been conquered. The leading causes of death to-day are mainly
those of the older ages—degenerative diseases.
The two leading causes of death for the past several years have been diseases of the heart and arteries and cancer, both considered to be chronic
degenerative diseases. The third leading cause of death has repeatedly been
accidents, in which slightly more than 20 per cent, were automobile fatalities
during 1948, 14.7 per cent were accidental falls or crushing, and 11.6 per cent,
were due to drowning. This third cause of death indicates a public health
need requiring some concerted action toward development of a programme
to curtail its annual toll.
Such diseases as typhoid fever and diphtheria have disappeared from the
ten leading causes of death. At present, only two of the ten, namely, diseases
of early infancy and congenital malformations, in sixth and tenth place in
1948, are associated with early life. In contrast, the chronic illnesses, such
as heart-disease, cancer, nephritis, and diabetes, account for an increasing
amount of the total mortality each year.
In addition to the emphasis placed on control of infectious diseases, it is
becoming apparent there is a need for some measure, or measures, designed to
control the chronic diseases, to extend the period of active life, and to provide
adequate public health protection for the ageing segment of the population.
During the year, with the extension of services provided, some attempt was
made to deal with two of the chronic diseases, namely, cancer and arthritis.
The British Columbia Cancer Foundation has for some time provided
service in diagnosis, treatment, and prevention through the Cancer Institute, located in Vancouver and operated by the Foundation. It was considered
advisable to inaugurate diagnostic and follow-up services in key centres of the
Province to provide the local physicians with auxiliary consultative service,
and to save the patient expensive trips to and from the existing single centre.
Under the plan, qualified specialists in cancer will visit each centre on a planned
schedule, depending upon the volume of the work. The local health unit is
charged with the organization and administration of these centres and the
subsequent follow-up of patients, ensuring the community facilities for cancer
sufferers are provided as efficiently as possible.
During 1948 the British Columbia Branch, Canadian Arthritis and Rheumatism Society was organized to carry on an extensive educational campaign
on this crippling disease and to provide certain treatment facilities. These
are mainly physiotherapy and massage services, designed to be administered in
the home by qualified personnel, who could demonstrate and instruct others
in the procedures. Extension of these services from the Metropolitan areas
to the smaller cities of the Province is under way to provide patients with
ready access to these remedial measures. Local health services have a part
to play in the referral, supervision, and follow-up of these patients in the
intervening periods. DEPARTMENT OF HEALTH AND WELFARE, 1949. .    KK 37
Finally, to gauge the magnitude of the public health and medical needs of
the Province, contemplation is being given to a morbidity study of a selected
sample or samples of the population. It is felt that such a study can best be
organized and conducted by the local health services staff, who are already
acquainted with the medical histories of the individuals in the survey group.
It is likely that this morbidity study will be commenced during the forthcoming
year in co-operation with the Division of Vital Statistics.
SCHOOL HEALTH SERVICES.
School medical services are more directly concerned with the medical and
preventive health aspects of the school health programme, including the mental,
emotional, physical, nutritional, and immunization status of the school child.
In this, the classroom teacher and the public health nurse serve as the spearheads of the service, in which close collaboration is necessary. The effectiveness and success of the programme depends, in no small part, upon co-operation
between teachers, parents, children, family physician, public health nurse, and
school medical inspector. Each has a responsibility to assume in ensuring
the development and maintenance of optimum health by school children, in
which health is defined as a " state of complete physical, mental, and social
well-being and not merely the absence of disease or infirmity."
Each year, children in Grades I, IV, VII, and X have been examined, constituting in the neighbourhood of 45 per cent, of the pupils enrolled. Figures
for 1948-49 are not yet available, but during the academic year 1947-48, 43,662
children were examined, over 90 per cent, of them being found physically fit.
The details concerning these school medical services are provided in a separate
report entitled " Medical Inspection of Schools Report."
A considerable number of examinations could never have been accomplished without the assistance of the seventy physicians in their capacity as
part-time School Health Inspectors. Their contribution toward the improvement in health of the school children is doubly appreciated, in view of the fact
that the time devoted to this work must be sandwiched into a personal private
practice.
Investigation of the results obtained through the routine medical examinations has been continued. This has been prompted mainly by a desire for a
reorganization of the school medical inspection to provide an opportunity to
deal with the nutritional, mental, and emotional, as well as the physical, aspects
of the pupil's health. There is continued questioning and searching for the
most efficient methods of providing the greatest service to the maximum number of pupils, while giving more individual attention to those needing it most.
Early in 1947, consideration was given to a new method of examining the
physical status of children on the basis of height and weight measurements,
related to chronological age plotted on a special chart known as the Wetzel
grid. It would appear from a study of the grid that it would be possible to
divide children into two main groups: Satisfactory, those who maintained
their individual normal growth and development, and unsatisfactory, those
who deviated from their anticipated growth and developmental patterns. In
other words, the grid might serve as a screening tool to select the children
requiring special attention by the school health personnel. KK  38 BRITISH  COLUMBIA.
On the basis of the preliminary study conducted in the academic year
1947-48, it was felt advisable to carry on a more intensive study during
1948-49. In this, the Department of National Health and Welfare participated with the Provincial Department and the Central Vancouver Island Health
Unit, providing financial assistance, the requisite number of grids, and sending
their pediatric specialist from their Division of Child and Maternal Health as
director of the study. As the year closed, the study became completed, but
the findings must be examined critically prior to public release of the report.
Because of the interest in the possibilities of the technique, the methods
are being continued as an integral part of the school health service in one local
health area in the Central Vancouver Island Health Unit. Frequent assessments of the values to be obtained through its use will be made to ascertain if
the school health inspection benefits to the degree expected. Further information on the Wetzel grid study will be found in the Medical Inspection of Schools
Report, and in the Report of the Study of the Wetzel Grid in B.C. School Health
Services.    These reports are published separately.
SERVICES OF PART-TIME MEDICAL HEALTH OFFICERS.
It is with considerable gratitude that the Department acknowledges the
services provided by the sixty-nine medical practitioners throughout the Province who have served as medical health officers for their communities. In
large part, the interest and effort of these physicians has prompted an improvement in health measures for their community. No request for their services
has gone unheeded, while the degree of assistance and co-operation provided
to the local public health nurses and sanitary inspectors has been exemplary.
Under their direction and supervision there has been a continued steady growth
in public health services throughout the Province, and, in part, the present
public demand for development of health units stems from their counsel and
advice.
HEALTH UNIT DEVELOPMENT.
Attention has already been directed to the significant advances in local
health services through the establishment of three new health units and satisfactory progress toward the development of a fourth. The development of
complete health units has been materially assisted by the introduction of the
Federal health grants, which have permitted the organization of planned health
units in advance of the time possible under normal circumstances.
Progressive planning toward the development of complete health units
has been based upon the introduction into the community of an initial public
health nursing service. This is considered advisable, since public health nursing is the channel through which1 the majority of the specialized consultative
public health services flow to the individual families in the community. During
this period of health unit development the public health nurse, in addition to
her nursing duties, provides a minimum sanitation service. However, as the
public health nursing service develops sanitation becomes increasingly emphasized, so that the next logical step is the introduction of sanitary inspectors to
deal more specifically with all the ramifications of that public health field.
This was accomplished a year ago through the assistance of Federal health
grants, when ten new sanitary inspectors were appointed in local health dis- DEPARTMENT OF HEALTH AND WELFARE, 1949. KK  39
tricts to comply with numerous requests from municipalities for that service.
The duties performed by these inspectors, now in the field one year, have again
proven the effectiveness of their work in promoting improvements in water-
supplies, milk-supplies, sewage-disposal methods, and the many other features
of the field of environmental sanitation. During that period, they have served
under the direction of the various part-time health officers in their areas, with
whom they have manifested the same degree of co-operation that was presented
by the public health nurse with those same physicians.
The last progressive step in the building up of the health unit is the decision
by two or more neighbouring municipalities and school boards to unite their
individual health services under a Union Board of Health, and to appoint a
health unit director to administer all community and school health services
through a health unit. The unit director becomes the medical health officer
for all the participating municipalities, and the school medical inspector for
all the school districts. This final step in the development of a health unit
results from the very efficient groundwork of the public health nurse and sanitary inspector, which has led to a desire on the part of so many municipalities
and school boards for a complete full-time service in all respects.
In the last Annual Report, the hope for early establishment of health units
at Chilliwack, Trail, Courtenay, and Kamloops was presented. Toward midyear it was possible to recommend a qualified public health physician to the
local advisory board in Chilliwack, which led to the establishment of the Upper
Fraser Valley Health Unit, with headquarters at Chilliwack. This health unit
is organized under the Upper Fraser Valley Union Board of Health, made up of
representatives from the City of Chilliwack, Municipality of Chilliwhack,
Municipality of Kent, and School Districts Nos. 33 and 76. As the unit
develops, it is hoped the Municipality of Sumas, Municipality of Matsqui, Village of Abbotsford, Village of Hope, and School Districts Nos. 32 and 34 will
enter the Union Board of Health. This unit is at present serving a population
of 20,900, but, when fully developed, will meet the public health needs of 35,350
persons.
The second health unit to be established was the Upper Island Health Unit
in the north portion of Vancouver Island, with headquarters at Courtenay.
Negotiations on the formation of a unit in this area have been under way for
the past five or six years; only the shortage of qualified personnel prevented
earlier progress. The Upper Island Union Board of Health results from the
consolidation of the local health services of the Cities of Courtenay, Cumberland, Comox, Village of Campbell River, and School Districts Nos. 71 and 72,
providing a total population of 15,550 with the unit services. The complete
unit is planned to include School District No. 47 on the Mainland, in which is
included the Village of Cranberry Lake, Village of Westview, and the unorganized company town of Powell River. When this population of about 7,550 is
added the services will be provided to a total population of 23,100.
The third health unit was organized late in the year when the Corporation
of Mission City, the Municipality of Mission, and School District No. 75 united
their community and school health services into the North Fraser Valley Health
Unit. This Union Board of Health is just becoming organized as the year
closes and will later recommend that School District No. 76, the Municipality KK 40 BRITISH COLUMBIA.
of Kent, and the Village of Harrison Hot Springs secede from the Upper Fraser
Valley Health Unit in favour of union with the North Fraser Valley Health
Unit. This is considered most practical, as the final unit is expected to include,
additionally, the Municipalities of Maple Ridge and Pitt Meadows and School
District No. 42, to provide consolidation of local health services on the north
side of the Fraser River to 22,950 people.
Also, toward the end of the year, two of the three health units without
health unit directors obtained their full staff complement again. A well-
qualified public health physician is assuming the vacancy in the Prince Rupert
Health Unit, serving a population of 16,142, while a young physician has
accepted the position of health unit director in the East Kootenay Health
Unit, with headquarters at Cranbrook, in which 27,585 persons reside. Both
these units have been operating under the supervision of acting directors for
a little more than a year. One health unit, the Peace River Health Unit, the
most northerly unit in the Province, continues without a full-time director,
as has been the case since 1944, but it is anticipated that these circumstances
will not exist much longer.
In the last Annual Report, it was pointed out that only eight of the planned
eighteen health units were in operation, three of them without qualified unit
directors. As a direct result of this year's progress, there are now eleven
health units in operation, only one without a qualified director. These, in
conjunction with the metropolitan services of Vancouver, Victoria and Esquimalt, provide complete health unit service for 83 per cent, of the people in
British Columbia.
Over a period of ten to twelve years, moves toward the formation of
organized public health services in the New Westminster area have been considered periodically. The proposals have never been entirely satisfactory, with
the result that the negotiations have never gone beyond the preliminary discussion stage. Proposals advanced during the past year have been much more
acceptable to the parties concerned, and it is now hoped that a health unit may
come into being early in 1950. The proposed unit will unite the local health
services of New Westminster, Port Moody, Port Coquitlam, Fraser Mills,
Municipality of Coquitlam, and School Districts Nos. 40 and 43 under one
Union Board of Health to provide a planned, uniform type of service in all
areas. This unit will be in the nature of a unique experiment in public health
services in British Columbia, since it consolidates an urban area with several
smaller organized communities, which had built up their public health nursing
and sanitary inspection services over the past ten years. It is anticipated this
type of health unit will serve as a guide to the formation of others of the same
type, where large urban populations are neighbouring on smaller, somewhat
rural communities.
During the past year, it had been hoped that a complete public health
service in the form of a health unit would become operative in Trail and
district. Certain moves toward its formation were advanced, but it was found
impossible to interest a physician in assuming the directorship. It is the next
area to receive consideration and should be under way early in the new year.
When completely organized it will serve a population of 32,801. DEPARTMENT OF HEALTH AND WELFARE, 1949. KK 41
Following the opening of that unit, the formation of one for the Kamloops
area is next on the priority schedule. Local health services in this area were
compelled to vacate their office quarters in the school and were accommodated
in unsatisfactory premises in a vacant storeroom. Plans for the construction
of a health and welfare building were well under way at the close of the year.
This building will provide excellently appointed offices and sufficient clinic
space for a new unit to fulfil their requirements for many future years. This
proposed unit is planned to provide service to 24,100 people.
Sanitation difficulties during the year, particularly with regard to water-
supplies, required that the staff personnel from the South Okanagan Health
Unit provide consultative services to the health officer at Princeton. To fulfil
completely the needs there, it is proposed that School Districts Nos. 16 and 17
be added to the South Okanagan Health Unit; representations suggesting such
a move have been placed before the South Okanagan Union Board of Health
for their consideration and opinion. If that board approves, it is likely these
districts will be invited to join their services with that organization.
Progress has continued within the metropolitan health services, in which
some reorganization has been gradually undertaken to establish each unit as
a more or less self-contained entity, responsible for the health services of its
own area. The North Shore Health Unit, reorganized within the metropolitan
service a year ago, has become satisfactorily consolidated to provide more
efficient administration of services in that area. Unfortunately, staff problems
have created some difficulties, but it is hoped these will be rectified within the
near future to provide stabilization in the service.
Expansion in public health dentistry, mental hygiene, child welfare, public
health education, public health nursing, sanitation, and nutrition services were
all possible under the Federal health grants, as a result of recommendations
submitted by the Senior Medical Health Officer. Details of these services will
be found in the Annual Report of the Metropolitan Health Committee.
Similar expansion was possible in Victoria-Esquimalt Health Unit, in which
plans for advancement of public health education and mental hygiene were
forwarded as a direct result of the Federal health grants. In this case, these
two special services are to be provided conjointly to the neighbouring Saanich
and South Vancouver Island Health Unit. In this regard, a study of the health
services in these two health units was conducted during the year by the Public
Health Educator, utilizing the evaluation schedule of the American Public
Health Association, which revealed that the several services were being conducted on a high level as compared with the public health indices in other areas
in United States and Canada.
Quarterly meetings of the health unit directors, including the senior officers
of the metropolitan areas, were held in February, April, and September to
discuss changes in policies and services and to review present programmes.
Such meetings permit an expression of the practicability of the programmes
in the field and result in a uniformity of service throughout the Province, while
permitting single units to test new services prior to their adoption as a definite
programme. KK 42 BRITISH COLUMBIA.
INTERDEPARTMENTAL RELATIONSHIPS.
Certain other fields of Government, concerned with service to the public,
are engaged in tasks which often require co-operative action with local health
services. The fields of welfare and health are closely related in their types
of services and are becoming more closely united on the local level. This is
very evident in the Vernon and Kamloops areas, where the administration is
becoming housed in the same building, developing a co-operative relationship
of public service.
A most harmonious agreement was developed during the year between the
Department of Agriculture and this Department to provide a co-operative
supervision of milk production. In the past, each Department maintained an
inspection service on the farm and in the plant, almost entirely unrelated in
effort. Several meetings between representatives of the two Departments
during the year resulted in the development of a joint programme which
provides for co-ordination of inspections to avoid duplication. Reports on all
tests and inspections are provided to both Departments so that the interested
individual inspectors are furnished with complete information on each milk-
producer and each plant from both the agricultural and the health view-points.
This collaboration was evolved to incorporate more effectively the intent of the
" Milk Act " and the " Health Act," requiring the officers of the Department of
Agriculture to deal with the production of the milk and the sanitary inspectors
to concern themselves with the quality of the milk supplied to the consumer.
The joint programme has been in effect for several months, with apparent
success, and should become more efficient and effective as further experience
leads to minor improvement in the plan. It has proven the justification of
interdepartmental collaboration in the promotion of improved public service.
MORBIDITY STATISTICS.
The need for a morbidity study to supply information on the total amount
of sickness in various age-groups, the time lost to the individual and to industry,
the amount and types of treatment involved, the costs of such sickness, and
many other factors has been mentioned. The study of the methods of conducting
such a survey in all the Provinces of Canada is now being made.
In the meantime, records of the morbidity due to specified notifiable disease
is maintained from year to year. In the past, these reports have made comparisons between the total numbers reported from year to year without any
attempt to allow for the effect that population changes might have on them.
This year, the statistics are being shown on the basis of rates per 100,000
population, and future comparisons can be made on a sound statistical basis
from year to year. It is anticipated this will more correctly assess any upward
or downward trend in the individual disease ratios to indicate more clearly the
trends of certain diseases in the Province. The comparison of the rates for
1948 and 1949 are shown in Table I, page 45.
From this table it will be noted there was an upward trend in the Provincial
morbidity picture, the rate increasing from 2,184.1 per 100,000 population for
1948 to 3,147.8 per 100,000 for 1949. The major responsibility for this would
seem to lie in the increase in the childhood communicable infections of chicken- DEPARTMENT OF HEALTH AND WELFARE, 1949. KK  43
pox, measles, and mumps, which was predicted in the last Annual Report.
There was, however, a significant increase in cancer reporting, which requires
some consideration. The incidence of syphilis showed a downward trend, but
all other notifiable diseases showed a fairly stationary trend.
During the year, plans for improvement in reporting of the notifiable
diseases were devised, based upon follow-up reporting to the various medical
health officers of the positive laboratory reports for their areas. It was pointed
out that recent specimens submitted to the laboratory had been reported positive,
indicating possible clinical disease and requesting the medical health officer to
investigate. It is self-evident that an intensification of effort by each health
officer is needed when a study of the reported incidence of certain diseases is
compared with the number of positive laboratory reports. For example, only
16 cases of undulant fever were reported, yet 194 positive laboratory reports
were recorded; only 1 case of paratyphoid fever was reported, yet 10 paratyphi
B patients were investigated bacteriologically, while 163 other cases of salmonellosis were reported by the laboratory, compared to the 95 reported clinically.
There were as many cases of typhoid fever (17) reported clinically by the
physicians as by the laboratory bacteriologically—the only instance in which
there was exact coincidence. Even in diphtheria there was some variation,
12 cases reported as compared with the 20 positives found by the laboratory;
an explanation of this latter difference lies in the fact that some of the patients
who were positive carriers were not reported as cases. There is, however,
sufficient variation to indicate that reporting of notifiable diseases in certain
instances presents only a fraction of the actual number of cases. This is
probably also true in influenza, in which there would seem to be some unreliability of reporting, as evidenced by the very few reported this year (4.2 per
100,000) as related to the number of a year ago (114.4 per 100,000).
In last year's report, attention was directed to the very low incidence of
measles (382.3 per 100,000) during 1948, with the prediction that a peak might
be expected in 1949. A very definite increase was recorded (966.3 per 100,000),
but this is somewhat less than in other epidemic peak years.
Mumps also exhibited an appreciable increase, from a rate of 93.2 per
100,000 for 1948 to a rate of 387.3 per 100,000 for 1949, four times as many
cases.
The trend occasioned a year ago toward a decrease in the incidence of
whooping-cough has been continued during 1949, the rate for 1948 of 26.3
dropping to 19.2 this past year. It is felt that the immunization measures
carried on in recent years are beginning to have their effect in lessening the
disease which formerly had such severity among infants.
Poliomyelitis exhibited an upward trend during 1949, the majority of the
cases being centred in Vancouver and the Lower Mainland, where it reached
epidemic proportions. Although the epidemic taxed the facilities of the communicable disease hospital in Vancouver, the lessons gained through experience
with previous recent epidemics were again brought into play to deal with the
situation, with the result that every suspected and actual case received immediate
and thorough attention.
There was a significant increase in the number of cases of cancer reported,
315.0 per 100,000 in 1949 as compared with a rate of 230.3 in 1948.   This may KK 44 BRITISH COLUMBIA.
be the result of improved reporting, as more patients seek early medical
attention on the basis of the educational programme of the Cancer Society
coupled with the more effective diagnostic measures continually being improved
and brought into practice. Whatever the cause, it merits consideration, since
the efforts of recent years have continually urged recognition of early symptoms,
and early treatment for these measures present the immediate major hope for
control of this disease.
The continued encouraging trend in diphtheria shown last year was
continued through 1949, there being only one-third as many cases this past
year, a rate of 3.2 in 1948 as compared to 1.1 in 1949. Carrier conditions in
certain individuals create the greatest hazard, their presence indicating the need
for continued vigilance toward maintenance of a high community immunization
status throughout the Province. The follow-up of these carriers, in endeavours
to overcome the harbouring of virulent positive organisms, places demands upon
clinical and laboratory facilities, possibly more so upon the laboratory than
any other.
Tick paralysis occurred again during the year in two instances, emphasizing
the fact that this diagnosis must be kept in mind during the spring season when
wood-ticks are common throughout the Province.
A case of anthrax occurred in the Fraser Valley, where one human contracted the condition from a cow. This was an unusual and serious occurrence
which precipitated an immediate investigation by Department of Agriculture
officials to prevent further spread to other herds. It is felt the situation is
presently under control.
The complete list of the diseases reported from the various areas of British
Columbia by the medical health officers is recorded in Table II, page 46. DEPARTMENT OF HEALTH AND WELFARE, 1949.
KK 45
Table I.—Incidence of Notifiable Diseases in British Columbia
(including Indians).
1948.
1949.
Notifiable Disease.
Number
of Cases.
Rate per
100,000
Population.
Number
of Cases.
Rate per
100,000
Population.
1
1
3,509
18
7,370
287
12
23
10
1
32
3,833
12
47
1
1
10,765
4,314
225
1
19
567
1
95
491
102
859
3
2
9
4
2,202
17
16
3
214
0.1
2
2,492
24
6,087
164
35
31
36
0.2
230.3
2.2
562.6
15.2
3.2
2.9
3.3
0.1
315.0
1.6
661.6
25.8
Diphtheria	
1.1
2.1
1.0
0.1
41
3,615
3.8
334.1
2.9
344.1
1.1
1,238
114.4
4.2
0.1
0.1
Measles	
4,137
1,008
118
2
12
405
7
41
383
382.3
93.2
10.9
0.2
1.1
37.4
0.7
3.8
35.4
966.3
387.3
20.2
0.1
1.7
Rubella	
Salmonellosis—
50.9
0.1
Other	
8.5
44.1
157                     14.5
9.2
1,018
3
4
6
94.1
0.3
0.4
0.6
77.1
0.3
0.2
0.8
0.4
2,178
22
66
15
285
201.3
2.0
6.1
1.4
26.3
197.7
1.5
1.4
0.3
19.2
23 632        1        2.184.1
35,066
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Cloverdale	
Coquitlam	
Creekside	
Crescent Beach	
Creston	
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EH DEPARTMENT OF HEALTH AND WELFARE, 1949. KK 49
REPORT OF THE DIVISION OF PUBLIC HEALTH
NURSING.
Monica M. Frith, Director.
INTRODUCTION.
Nursing service is a vital component of any health programme—hospital,
medical care, and public health, whether these! be individualized or organized
on a group basis.
The importance of nursing as a community service has been brought more
and more to the attention of the public with the unprecedented demand for
nursing care, which has yet to be met.
Contributing to this increasing need have been the expansion of hospital
facilities available to individuals requiring hospital care through the institution
of the Hospital Insurance Plan, increased emphasis on early diagnosis and
treatment, and the greater awareness of the preventive aspects of disease.
Public health authorities have to some extent been responsible for stimulating
this demand for nursing care and therefore are prepared to assist in planning
to meet this need for nursing service.
Although more nurses are engaged in nursing in British Columbia than
ever before, there still exists a shortage of qualified personnel. Public health
nursing, as a specialized branch of nursing, has felt the effects of the general
shortage. By making the best possible use of the available nurse-power, a
satisfactory ratio of public health nursing staff to general population has been
maintained, in spite of the greater demand arising from the opening of new
nursing districts and from a rapid population increase.
It is recommended by Haven Emerson in his " Local Health Units for the
Nation," and also by the National Organization for Public Health Nurses, that
one public health nurse serve not more than a population of 5,000 where a
generalized public health programme is carried, that is, when school nursing
is included but not bed-side care of the sick. If the public health nurse is to
give health guidance and bed-side care to the entire family, it is recommended
that one public health nurse should be provided for every 2,000 people.
In British Columbia the ratio of public health nurses to population is 1 to
4,000. This figure represents an adequate coverage when two important factors are considered. First, travel conditions, particularly in the more rural
areas, make it more difficult and time consuming to provide public health service
than in more urban areas. Second, public health nurses, although not attempting to carry a complete bed-side nursing care programme in every district,
have been increasing gradually the amount of nursing care given in the home
on a demonstration and treatment basis.
PERSONNEL.
Staff Changes.
During the past year there have been a great many changes in the public
health nursing staff.
Forty-one nurses were newly appointed. Twenty-eight nurses left the
staff: eight to be married or return to their home duties, twelve to attend KK  50 BRITISH  COLUMBIA.
university, eight for basic public health nursing training, four for more
advanced public health studies, and seven for other reasons, for example, retirement, return to institutional work, missionary work, etc. In all, there has been
an over-all increase of four staff public health nurses during the year. One
nurse transferred to the Division of Venereal Disease Control, while another
took advantage of the opportunity of one year of planned experience with the
Child Guidance Clinic in Vancouver.
The field staff at the end of December totalled 111 members. From Table
III it may be seen that 28 per cent, of the staff are in the first year of service,
while over 63 per cent, have served for less than three years.
Table III.—Length of Service of Public Health Nurses with
Provincial Health Department as shown in 1949.
Years of
Service.
1	
Public
Health
Nurses.
    31
    20
     16
    21
      6
Years of
Service.
7 	
Public
Health
Nurses.
.      4
2 	
8 	
       1
3 	
9 	
      2
4 	
5 _     	
10-15
Total	
8
6 	
      2
______ 111
Internship Plan.
Once again it has been necessary to take on staff a limited number of
registered nurses. They have been placed in carefully selected districts under
the close supervision of a senior or supervising nurse, who carries through
with a planned orientation course, which permits the nurse to gradually assume
responsibility for a public health nursing district.
Registered nurses taken on staff on this basis must have signified their
intention of completing a course in public health nursing at a recognized university, following a period of experience with the Department. During the
past year, the division was fortunate in being able to recommend eight registered nurses, who had demonstrated their ability as potential public health
nurses, for bursaries under the Federal Government professional training
grants. Only one registered nurse decided not to continue in public health.
These nurses have accepted the bursaries on the understanding that they will
return to the Provincial field staff for a minimum period of two years following the completion of their course. With the withdrawal of eight registered
nurses from field positions, it has been necessary to find replacements. Since
a sufficient number of qualified public health nurses were not available this
fall, it was necessary to employ an additional group of registered nurses. It is
hoped that this group will qualify for bursaries, and, with the return of the
first group of public health nurses trained under this plan, that there will be
greater stability within the service.
New Districts.
The division was fortunate to have experienced public health nurses available to open the three new public health nursing districts which were organized during the year, with funds provided through Federal health grants. DEPARTMENT OF HEALTH AND WELFARE, 1949. KK 51
In March, in response to local request, the Gibsons Landing service, formerly partially subsidized through grants from the public health service, was
reorganized, and a public health nurse was placed in the area covered by School
District No. 46. This extended the public health nursing area beyond the
territory covered by the Victorian Order of Nurses, giving service to Bowen
Island, Egmont, Pender Harbour, and Halfmoon Bay. A Victorian Order
nurse was retained in the district.
In the fall, the Howe Sound and Kettle Valley public health nursing
services were also organized. The Howe Sound service has its headquarters
at Squamish and includes Britannia Beach, Woodfibre, and the Pemberton
Meadows area. The Kettle Valley service has its headquarters at Greenwood
and serves the surrounding area, extending to Beaverdell, Bridesville, Rock
Creek, and Westbridge.
Notwithstanding the fact that service was extended to new districts, the
percentage of the total population covered by public health nursing service
remains at 94.9 per cent, a very slight increase over last year, due largely to
the general population increase in British Columbia and the fact that the new
services were organized in areas with small scattered populations.
SERVICE ANALYSIS.
Each year it is necessary to assess the public health nursing programme
by statistical methods in order to obtain a critical analysis of the various
activities being carried out to determine whether an efficient service is being
rendered to the community in as economical a manner as possible. This year
a time-study covering a three-week test period in October and November was
completed by ninety-two nurses. It is hoped that broad analysis of the results
of the study will indicate the need for either increasing or decreasing various
services and activities, while the study of each report by each individual public
health nurse will point out areas where services should be altered in a specific
manner in order to meet local needs more efficiently.
Table IV.—Comparison of Total Time in per Cent, spent on Specified
Activities by Public Health Nurses in Period 1946-1949, as indicated
by Time Studies.
Year.
1946.
1947.
1948.
1949.
17.7
3.6
18.6
10.8
16.9
18.1
11.9
5.9
16.0
4.6
18.7
11.6
13.1
18.8
17.2
7.0
19.1
6.3
20.3
11.1
20.9
16.3
6.0
5.8
17 4
18 1
Professional clerical	
16.8
9.4
Travel             	
18.3
Other             	
14.2
4.2
Totals  	
100.0
100.0
100.0
100.0
Table IV gives a breakdown of various activities by broad groupings by per
cent, of total time, with a comparison of the same types of activities for each
year since 1946. Table V gives a detailed breakdown of some of these larger
activity groups for 1949. KK 52 BRITISH COLUMBIA.
Table V.—Per Cent, of Total Time spent by Public Health Nurses in
Selected Activities as indicated by Time Study in 1949.
Activity.                                                                                                   Per Cent. Per Cent.
Visits to schools     17.4 17.4
Child Health Conference (total)      7.3
Professional time        5.8 	
Non-professional clerical       1.5 	
Home visits       17.1
Prenatal        0.5 	
Infant       3.2 	
Postnatal        1.0 	
Pre-school        3.0 	
School       3.1 	
Nursing care       1.9
Tuberculosis        1.7
Venereal disease       0.3 	
Other      2.4 	
Other activities     58.2 58.2
Totals  100.0 100.0
It is interesting to note that in order to give the services shown in Table IV,
overtime has been necessary. The upward trend of overtime, from 5.9 per
cent, in 1946 to 7 per cent, in 1947, has been lowered to some extent by the
addition of clerical assistants in 1948 and 1949. This overtime should be considered in relation to a total day's activity rather than in relation to a specific
activity. In other words, nurses tend to render specific services and to account
for the overtime as clerical or travelling time, while in reality the work they
have planned for a specific day may necessitate the expenditure of time in
addition to their prescribed daily working time. The public health nurses are
to be commended for their unselfish desire to render the service to the best of
their ability at the expense of their own time. However, it is hoped that by
more careful planning of time all but the emergency service overtime may be
eliminated.
In addition, public health nurses, as residents of local communities, take an
active part in many of the local organizations related directly or indirectly to
health, for example, Parent-Teacher Association, Women's Institute, Cancer
Association, Tuberculosis Association, Registered Nurses' Association, etc.
Participation in these organizations is essential to the success of the general
health programme but automatically increases the amount of time which the
public health nurse must spend on her total programme.
Training Programme.
As public health activities have become more comprehensive, it has been
necessary to continue in-service educational programmes to keep the staff up to
date on current practices and new developments in the public health field. Staff
and regional study group meetings, as well as the annual institute, have offered
stimulation and guidance in the development of new programmes. For example,
during the past year an audiometer hearing-test programme was instituted, and DEPARTMENT OF HEALTH AND WELFARE, 1949. KK 53
a cancer programme was started in a number of selected areas. Use of the
Woods quartz lamp was outlined. Arrangements were made through the Division of Health Education to provide the staff with the latest technical knowledge
on the use of visual-education equipment. Through meetings on a local level,
opportunities have been available to promote better understanding of the work
being carried out by other specialized workers, for example, social welfare, etc.
Public health nurses have continued to provide field training for undergraduate nursing students as well as for graduate nurses taking the university
postgraduate course in public health nursing.
Undergraduate nursing students from the Royal Columbian Hospital in
New Westminster, St. Paul's Hospital and Vancouver General Hospital in
Vancouver, St. Joseph's Hospital in Victoria, and the Royal Inland Hospital in
Kamloops have had short, planned orientation programmes. Public health
nurses have assisted with the public health lectures at St. Joseph's and the
Royal Jubilee Hospitals in Victoria, as well as at the Royal Columbian and the
Royal Inland Hospitals, and the Provincial Normal School in Victoria. This
programme has given students some appreciation of the opportunities for nursing in the public health field and already has proved to be an effective method
of recruiting nurses.
Public health field experience for postgraduate nursing students from the
University of British Columbia was provided for eighteen nursing students for
a one-month period, while fourteen were with the field staff for two weeks.
Through the co-operation of public health nursing field agencies with the Committee on Co-ordination of Theory and Field Practice, increased opportunities
have resulted in providing the public health nursing students with well-rounded
programmes of experience planned in relation to the previous experience record
of the student. In addition to the British Columbia nursing students, one
student from the University of Manitoba received field work for one month.
Senior public health nurses have accepted responsibility for planning orientation programmes for the registered nurses who have been appointed to
the staff on a temporary basis. Although this programme is time-consuming,
especially since the senior nurses carry large districts, it has proved to be the
only method available for providing nursing service during the critical nursing
shortage.
A plan of orientation for trained public health nursing staff has also been
carried out. This has consisted of overlapping of experience with the public
health nurse leaving the area and a plan for public health nurses trained outside
British Columbia to have special experience as required with the various divisions of the Provincial Health Department and other health agencies.
PUBLIC HEALTH NURSING SUPERVISION.
Through the local public health nurse in the district and her public health
nursing activities in the home, school, and the community, all the available
resources of the Provincial Health Department are channelled to the people of
British Columbia.
Supervision is necessary to ensure a quality of service which will meet
acceptable standards. The National Organization for Public Health Nursing
recommends a ratio of one full-time supervisor to ten staff public health nurses. KK 54 BRITISH COLUMBIA.
This goal is being approached gradually through a plan of experience and training on the staff for potential candidates. As public health nurses demonstrate
administrative ability in the field, additional responsibilities for supervising
student nurses, registered nurses, and new staff public health nurses are gradually added.
During the year a supervisor was appointed to the West Kootenays, supervising in the Trail, Nelson, New Denver, Arrow Lakes, and Kaslo districts.
A supervisor was also appointed to the Saanich and South Vancouver Island
Health Unit, her territory extending beyond the health unit to include Howe
Sound, Powell River, and Gibsons Landing. In addition, following a course in
supervision at the University of Toronto, one supervisor was placed in the
Fraser Valley at Abbotsford, and she will be available to the New Westminster
Health Unit when it is organized.
One full-time supervisor continues on the staff of the Central Vancouver
Island Health Unit, while the supervisor for the Northern Interior continues to
cover the Peace River, Prince Rupert, and Cariboo areas.
Miss Margaret Campbell returned after completing the Master of Public
Health course at the University of Michigan, and was appointed Assistant
Director, Public Health Nursing.
During the past year, the senior group of nurses carrying supervisory
responsibilities met twice in Victoria for special conferences to discuss practical
methods of improving service through supervision. The group also assisted
with the revision of various records and manuals and completely revised the
daily report form. A progress evaluation scale for public health nurses was
also completed and is being tried in the districts this year.
For the second time, the staff were fortunate in having Miss Marion
Murphy, assistant professor, public health nursing, from the University of
Michigan, to conduct an advanced course in public health nursing supervision
for a period of two weeks. It was attended by nineteen senior public health
nurses from the field staff, and representatives from the Metropolitan Health
Committee in Vancouver and the Victoria City Health Department. The course
was made possible by Federal health grants and provided an excellent opportunity for supervisors to discuss and work out in a democratic way the problems being faced in their districts.
SPECIAL SERVICES.
The Division of Public Health Nursing has continued to work closely with
the Divisions of Venereal Disease Control and Tuberculosis Control, particularly
in relation to nursing affairs. The additional nurse who had been centred with
the Division of Tuberculosis Control to do special work in connection with the
Mobile Survey Units was released to open a new public health nursing district,
following completion of her project. The public health nurse representative
with the Division of Tuberculosis Control, Miss Doris Bullock, continues to
co-ordinate activities within the tuberculosis institutions and clinics with those
of the public health nursing field staff. The Tuberculosis Manual for Public
Health Nurses is in the process of revision.
One rural epidemiology worker from the Division of Venereal Disease
Control has continued to give specialized assistance to the public health staff in DEPARTMENT OF HEALTH AND WELFARE,  1949.- KK  55
their districts in relation to the venereal disease programme. Public health
nursing staff have assumed greater responsibility for venereal disease epidemiology on the local level.
Following a trial survey of the crippling diseases of children in the
Matsqui-Abbotsford-Sumas public health nursing service, plans were drawn up
for a survey to be completed throughout the Province over a one-year period.
Dr. Donald Paterson, as chairman of the Sub-committee on Crippling Diseases
of Children, is working closely with the Bureau of Local Health Services, the
field staff, and the Division of Vital Statistics. The survey is being carried out
in conjunction with the general programme. It is expected that the results of
the survey will indicate where the emphasis should be placed in providing the
best preventive and treatment services for children suffering from crippling
diseases.
Members of the central office staff of the Division of Public Health Nursing
have represented public health nursing on various committees—the Educational Policy Committee, the Labour Relations Committee, and the Public Health
Nursing Committee of the Registered Nurses' Association of British Columbia.
The Director of Public Health Nursing is a member of the Provincial Red Cross
Committee, the Provincial Junior Red Cross Committee, the Committee on the
Co-ordination of Theory and Practice at the University of British Columbia, as
well as the Senate Sub-committee of the University of British Columbia which
is studying nursing education in British Columbia.
Excellent contributions to the general health programme have been made
by related services, that is, the Victorian Order of Nurses, the Red Cross, and
the Indian Health Services, as well as lay groups, including the Women's
Institute, Parent-Teacher Association, the I.O.D.E., and service clubs. Their
generous assistance and splendid co-operation are greatly appreciated.
Through the Public Health Nursing Council, the public health nurses have
had the opportunity of clarifying their problems with one another at their
annual meeting in Victoria. The Council has brought forward suggestions for
improving the service and has also directed the interests of the public health
nurses toward the broad field of nursing. This was evidenced by the appointment of an official representative to attend the International Nursing Conference at Stockholm, Sweden.
During the year, the Division of Public Health Nursing was happy to provide two distinguished nurse visitors with information relative to Provincial
and National nursing surveys.
Miss Dorothy Percy, of the Federal Department of Health and Welfare,
visited the Province with a view to determining how the nursing need for
Canada might be met on a broad basis.
Miss Lucile Petry, Assistant Surgeon-General, United States Public Health
Service, studied the adequacy of the public health service in relation to the
broad picture of nursing in British Columbia as part of the James A. Hamilton
and Associates Report on Hospital Services in British Columbia. Miss Petry
in her report states: " The Health Branch of the Department of Health and
Welfare has an exceedingly well-conceived plan for public health nursing services in the Province and has succeeded in implementing the plan extensively.
The combination of local and Provincial financing and design of programme KK  56 BRITISH COLUMBIA.
bring sound planning and operation. The fact that the Provincial Health
Department nursing service is often first on the scene and aims at a comprehensive service should avoid the complications found elsewhere, where two or
more services with slightly different functions must later go through the difficult stages of co-ordination and final integration. . . . The desirable trend
toward generalization of public health nursing services is well advanced
here. . . . The nurses in this service are generally well prepared and receive
expert and dynamic leadership. A stimulating permissive atmosphere pervades
the service, and co-operative planning is evident both among nurses themselves
and between nursing service and the administration."
This report by Miss Petry has been most encouraging to public health
nurses who have seen the need for more extensive health service and have felt
that the service should expand more rapidly than has been possible.
The fact that the public health nursing service has been able to maintain
its strength in spite of great difficulties is a great tribute to the high calibre of
the public health nurse, who joins the public health nursing staff willing to give
unselfishly of her time and personal comfort in order to bring public health
nursing service to British Columbia residents. DEPARTMENT OF HEALTH AND WELFARE, 1949. KK 57
REPORT OF THE NUTRITION SERVICE.
E. M. Yvonne Love and Doris L. Noble, Consultants.
INTRODUCTION.
During 1949 the programme of the Nutrition Service continued to be
directed toward meeting the needs of public health staff for consultant service
on all matters related to nutrition.
The staff of the Nutrition Service has not increased, although the continuing development of local health services has brought additional demands on the
nutrition consultant programme. The further extension of the consultant programme to local public health personnel has been an important achievement of
the Nutrition Service during the past year.
CONSULTANT SERVICE TO LOCAL PUBLIC HEALTH
PERSONNEL.
During home and school visits, clinics, and conferences, the field staff give
advice concerning the wise selection and use of foods for the promotion of
health. Problems such as those related to low-cost meal planning, school lunch
programmes, and prenatal and infant diets are encountered, and food habits
must be considered in dealing with other health problems in the community.
The purpose of the consultant programme to local health services is to provide
technical data and direct assistance to the field staff in order that they may deal
most effectively with these problems. An important part of this programme is
that of visits to each health unit. During 1948 the nutrition consultant was
able to spend some time in seven health units in the Province. The visit was
arranged to coincide with a monthly staff meeting of the unit. At this time the
nutritionist has dealt with problems and questions from the field staff and has
reported on new developments in the field of nutrition and discussed the application of this information in the local health programme. The remainder of the
time in the health unit has been spent in visiting the public health nurse in her
own district in order to give direct assistance. Many of the public health nurses
have requested direction with school lunch problems. Frequently the visit has
included the observation of school lunch programmes, analysis of problems, and
recommendations. In most areas public health nurses have asked for direction
in advising families on low-cost meal planning.
It is planned to continue visits to health units during the coming year, since
this is proving to be an effective method of meeting the needs of the field staff.
The nutrition consultant has worked with the local public health personnel
in two areas where special studies of food habits have been possible. In an
Okanagan district, public health nurses and teachers co-operated on a project
of improving the school lunches. A study was made of the food eaten by the
children at lunch-time. From the information gained, it was possible to make
specific suggestions for better lunches to the parents and pupils. After several
months, a second study showed a marked improvement in the content of lunches
brought to school. Such a method of demonstrating the actual need promotes
results of an education programme. KK 58 BRITISH COLUMBIA.
In another area of the Province public health nurses, teachers, and local
doctors are working together on a comprehensive study of food-habits of the
school children and a long-term education programme. A week's record of
foods eaten by the school children was obtained early in the school term. This
information has been correlated with that of school medical examinations and
soil conditions in the area in order to assess the extent of the nutrition problem.
A programme to improve food-habits is now under way, in which the school
lunch committee and Women's Institute are co-operating with school and health
personnel. This project is the first of such an extensive nature to be carried
out in the Province. The Nutrition Service is providing technical direction
throughout this study and has analysed over 1,000 diet records of the school
children.
The nutrition consultant held two conferences with the senior public health
nurses during their refresher course last summer. It was possible, with this
group, to review the entire consultant programme to field staff and to plan the
further development of the programme in line with needs and problems which
were brought to the fore.
In addition to field trips and conferences, a number of requests and specific
problems from public health personnel have been dealt with through correspondence and articles in the staff bulletin. To illustrate the variety of problems
that has been met, the following will serve as examples:—
(1) Analysis of individual diet records where studies have been conducted to assess food-habits.
(2) Preparation of study outlines on various topics of food and nutrition for the guidance of local study groups.
(3) Specific recommendations where problems of food selection were
influenced by such conditions as reduced income, long-term illness,
and other disabilities.
(4) Preparation of menu guides and quantity recipes where a school
lunch programme was planned or in operation.
The programme for consultant service to field staff is planned under the
supervision of the Director of Local Health Services and in close co-operation
with the Director of Public Health Nursing and other divisions.
CONSULTANT SERVICE TO INSTITUTIONS.
Consultant service to institutions has been continued under the administration of the Director of Local Health Services. The objective is improved
food-habits of the people who are served in such establishments.
This service has been developed in line with requests for information on
the various phases of food service, including food selection, preparation, effective equipment, and organization of staff. In each case, an analysis is made of
existing conditions with an outline of suggested recommendations. These are
discussed with the personnel concerned and assistance is given to implement
changes and improvements.
In the past year, continued service to Provincial gaols has included Oakalla
Prison Farm, Women's Gaol at Prince George, and Nelson Gaol. At Oakalla
Prison Farm and Prince George, an analysis of the average food consumption
is completed annually, as recommended in the revised rules and regulations. DEPARTMENT OF  HEALTH AND WELFARE, 1949. KK  59
Related factors affecting food service, including food cost accounting, food
selection, storage, preparation, equipment, and staff supervision, are also given
consideration in these reports, and many improvements have been made toward
increased efficiency of operation.
Continued assistance has been given to Fairbridge Farm School until
recently, when circumstances have necessitated that it be closed.
With the opening of accommodation for patients under treatment at the
British Columbia Cancer Institute, consultant services have been provided in
organizing and supervising meal service.
Consultant service to hospital administrators, in relation to food service,
has been discontinued from this Department during this past year due to the
reorganization in Hospital Insurance Service.
CONSULTANT SERVICE TO OTHER DEPARTMENTS AND
ORGANIZATIONS.
Throughout the year the Nutrition Service has received the closest cooperation from other departments concerned in any way with problems or
activities of the consultant programme.
Conferences with the nutritionists of the Greater Vancouver Metropolitan
Health Committee, University Extension Service, and Home Economics Department have been held during the year. These meetings have provided an opportunity for a review of activities and have facilitated joint planning toward
meeting mutual problems. This group has completed a booklet dealing with the
economical selection and preparation of foods in the home for the reference use
of health and welfare personnel.
Consultant service on matters of nutrition education in schools and the
evaluation and revision of pamphlets has been provided for the Department of
Education.
At the request of the teaching staff, the nutrition consultant has assisted
with the planning and development of the nutrition course for public health
nursing students at the University of British Columbia.
Throughout the year, the Nutrition Service has had the closest co-operation
from the staff of the Bureau of Economics and Statistics on problems of food
budgets and costs.
Conferences have been held with the Department of Agriculture on matters
relating to soil content in various localities, food production and processing.
COMMENTS.
Staff shortages were experienced in the Nutrition Service during the year.
Miss Doris Noble returned to the staff in May, on completion of a certificate
course in public health at the University of Toronto. Shortly thereafter, Miss
Yvonne Love spent a period of four months on loan to the British Columbia
Hospital Insurance Service in connection with hospital food studies.
With the service of two nutritionists again available in the fall, it was
possible to divide the responsibility for consultant programme to field staff by
assigning each nutritionist to one section of the Province. This arrangement
will facilitate closer working relationship with local public health personnel
during 1950. KK 60 BRITISH COLUMBIA.
REPORT OF THE DIVISION OF PREVENTIVE
DENTISTRY.
F. McCombie, Acting Director.
INTRODUCTION.
The Division of Preventive Dentistry has been established during the past
year with the object of improving the dental health of the people of British
Columbia.
The most common disease of civilized man is dental caries. Untreated
caries or other dental diseases will cause dental ill-health. Diseased teeth and
surrounding tissues produce a lowered resistance to general infection and disease, and may be the original cause of a systemic condition causing chronic
suffering and even death. Dental diseases are, in the vast majority of cases,
preventable, or most certainly the incidence may very significantly be reduced.
That dental disease should be vigorously attacked is recognized now as being
a public health measure long overdue. Furthermore, it is recognized that the
improvement of dental health cannot fail to help to improve the general health
of the people, and lower the incidence of, and deaths attributed to, many general
infections and diseases.
Due to the shortage of dental personnel throughout the Dominion, if for
no other reasons, it is obviously impossible at the present time to remedy immediately all dental defects within the Province. However, it is the hope of the
division to concentrate immediate attention on the possibilities of preventing
dental disease, with particular emphasis on care of the younger children.
Furthermore, it is hoped that in successive years it may be possible to continue
to safeguard these children from the ravaging destruction of dental disease, and
have a generation grow up that is dentally fit and unmarred by the dental
cripples so evident to-day.
It is appreciated that, at the present time, there exist within the Province
many areas where there are insufficient dentists to meet the requirements of the
communities. In co-operation with the College of Dental Surgeons of British
Columbia and the British Columbia Dental Association endeavour is being made
to improve this situation.
ESTABLISHMENT OF THE DIVISION.
Dr. F. McCombie was appointed as Acting Director of the division early in
1949. He has since visited many communities of the Province to assess the
available dental facilities and to suggest possible means for improving the
dental health of the people of this Province.
From the information gained from these tours and from the latest published research on dental health, the policy of the division was formulated. This
policy is prevention. To implement this policy the objectives of the division
are summarized as follows:—
(1) To provide consultation and assistance to local health units in the
formation and development of a preventive dental programme,
and to supervise operation of these programmes. DEPARTMENT OF HEALTH AND WELFARE, 1949. KK  61
(2) To advise the Department of Health on all problems including or
affecting dentistry or dental health.
(3) To promote a dental health educational programme.
(4) To encourage the location of dentists in rural districts and assist
in their location.
(5) To serve as a link between the Provincial Department of Health
and the dental profession.
(6) To organize and assist the existing resources of the dental profession in this Province so as to endeavour to solve the problems
resulting from dental decay.
(7) To organize and encourage research projects aimed at controlling
dental caries and other dental diseases.
PERSONNEL.
The Acting Director left in September to attend the School of Hygiene,
University of Toronto, for a year's postgraduate study leading to a diploma in
dental public health.
Dr. W. G. Hall joined the division in August from the staff of the Faculty
of Dentistry, University of Alberta. He has been deputizing for the Acting
Director, and will be appointed as the dental director in the first health unit of
the Province to establish a comprehensive dental programme.
DENTAL HEALTH EDUCATION.
Education in dental health is of primary importance in assisting the people
of British Columbia to arrest the appalling annual increase in dental disease.
To this purpose all available dental health educational materials are
reviewed by the division, and, wherever suitable, supplies are stocked for distribution through local public health personnel. A library of audio-visual aids
pertaining to dental health has been built up and is maintained by the Division
of Health Education for loan to local health units and other interested groups.
A limited number of text-books relating to dental health have been issued to each
local health unit to facilitate instruction in this subject to lay groups by local
public health personnel. Further books of reference and periodicals are now
held by the central library of the Department. Short articles pertaining to
dental health are regularly prepared by the division for inclusion in the two
monthly publications of the Department.
The Acting Director sincerely appreciates the opportunities made available
to him to address the Annual Institute of the Department and the senior public
health nurses at their biannual conference. It is hoped that by these means it
was possible to help make known to the field staff the latest possibilities in the
prevention of dental disease.
Through the Division of Public Health Education and in co-operation with
the Department of Education it has been possible to suggest revisions in the
school curriculum for junior and senior high school grades to include specifically, and by detail, dental health education. It is believed that no programme
of preventive dentistry can attain its maximum potentialities without the
co-operation and assistance of the Department of Education in this respect. KK  62 BRITISH COLUMBIA.
However, it is advised that a child free of dental disease is a child more receptive to education and less likely to be guilty of absenteeism.
ADVISORY SERVICE TO LOCAL PUBLIC HEALTH PERSONNEL.
The division, throughout the year, has answered numerous inquiries from
the field staff regarding dental problems, local dental programmes, and dental
health educational material. Information is forwarded monthly to the field
staff regarding all new supplies of local pamphlets, posters, and audio-visual
aids.
By personal visits of the Acting Director and by correspondence, the division, in co-operation with local public health personnel, has helped many communities study the possibilities of establishing local dental programmes. It is
hoped that several such programmes will be commenced during the coming year
with the co-operation and assistance of local dental practitioners.
Requests for greater dental facilities are frequently received by the division
from many parts of the Province. These requests are referred to the Council
of College of Dental Surgeons of British Columbia, who, with the British Columbia Dental Association, are endeavouring to persuade recently graduated dentists, and others, to locate in communities outside the metropolitan areas of
Greater Vancouver and Victoria.
DENTAL PROGRAMMES.
Various types of dental programmes have been evolved by the division and
finalized in consultation with representatives of the British Columbia Dental
Association. These programmes are based on the preventive aspects of dentistry, and wherever possible will incorporate dental treatment services to preschool and Grade I school-children. This age-group has been selected so as to
make available to the youngest children a comprehensive dental service before
mass destruction of their teeth makes the problem expensive and difficult, if not
impossible, to control. In subsequent years, it is hoped that it may be possible
to provide similar care for the older children and, in addition, to maintain in
good dental health the children treated in previous years.
It is at present planned that during the coming years full-time dental
directors shall be appointed to local health units. The duties of such directors
will include the encouragement and supervision of local dental programmes
within the health unit area, the direction of educational programmes to assist in
the improvement of dental health, the study of the effectiveness in the field of
proven research methods for decreasing the incidence of dental disease, and the
provision of preventive dental treatment for pre-school children and those in
the lower grades.
In an endeavour to increase forthwith the dental services available to young
children, other programmes have been designed whereby the services of private
dental practitioners, working in their own offices, may be utilized for preventive
dental programmes by communities requesting them. In this programme a local
committee is formed to organize their local dental programme for young children in conjunction with a private dental practitioner; his services are paid for
monthly on a schedule agreed to by the British Columbia Dental Association.
The Department will reimburse the committee to the extent of 50 per cent, of DEPARTMENT OF HEALTH AND WELFARE, 1949. KK  63
the payments made to the dental practitioner on the presentation of prescribed
forms notating the treatment rendered to, and the time spent with, each child.
To endeavour to make such programmes possible in areas where, at present,
there is no resident dentist, two further programmes have been established.
First, a system of grants-in-aid has been made available to encourage dentists
to locate in rural communities at present without a resident dental practitioner.
Second, basically equipped dental offices may be established by the Department
in the smaller rural communities with travel allowance available to a near-by
dentist for him to visit such offices in his capacity as a private practitioner.
To qualify for either of the above grants, such dentists will be required to
co-operate with the local community in a preventive dental programme such as
outlined in the preceding paragraph.
For larger communities desirous of establishing and operating their own
dental clinic, and employing therein full-time or part-time dentists, annual
grants are available, which include refund by this Department of 60 per cent,
of the initial cost of the equipment in such a clinic.
DENTAL HEALTH COMMITTEE OF THE BRITISH COLUMBIA
DENTAL ASSOCIATION.
In conclusion, it is to be recorded that the above programmes are endorsed
and supported by the Dental Health Committee of the British Columbia Dental
Association. In this respect, this report would be incomplete without recording,
with deep appreciation, the diplomacy and untiring efforts of the chairman of
this committee, Dr. J. Ewart Gee, D.D.S., also the help of Dr. A. Poyntz, D.M.D.,
member of the College of Dental Surgeons of British Columbia, and Dr. D. J.
Sutherland, D.M.D., of the British Columbia Dental Association. The Dental
Health Committee, representative of the dental profession of the entire Province, met on numerous occasions, some members travelling especially from the
Interior to attend the meetings, and gave much thought and consideration to
the problems affecting the dental health of the people of the Province. Drs. Gee,
Poyntz, and Sutherland, in addition to attending these meetings of the committee, met with the Department on numerous occasions to discuss these problems. As a result of their efforts, these programmes were evolved and have
been circularized to the dental profession in the belief that, with their sincere
co-operation, a beginning will be made to help improve the dental health of
the people of British Columbia. KK 64 BRITISH COLUMBIA.
REPORT OF THE DIVISION OF PUBLIC HEALTH
ENGINEERING.
R. Bowering, Director.
INTRODUCTION.
The Division of Public Health Engineering is concerned with factors in the
environment that affect the health of the public. The technical staff of the division includes properly qualified professional engineers and sanitary inspectors.
Included within the scope of the Division of Public Health Engineering are
water-supply sanitation, sewage-disposal, milk-plant sanitation, industrial-plant
sanitation, shell-fish sanitation, sanitation of eating and drinking places, sanitation of housing and tourist resorts, sanitation of frozen-food locker plants, and
the miscellaneous items which are included in the term " Environmental Sanitation."   This report will deal with the various features under specific headings.
WATER-SUPPLY.
There are approximately 150 separate water-supply systems in British
Columbia. There is a public water-supply system in each of the thirty-five
cities in British Columbia. Most of these water-supplies are municipally owned
although some are privately owned. There are public water-supplies in twenty-
three of the twenty-seven district municipalities in the Province. In some of
the district municipalities, there are several separate water-supply systems to
serve separate townsites. In some of the district municipalities, a considerable
number of the people use private water-supplies. Thirty-three of the thirty-
eight villages in the Province have public water-supply systems. These again
are mainly municipally owned. In addition to the water-supply systems in the
organized municipalities, there are a number of water-supply systems in the
unorganized territory. It is estimated that, based on the 1948 population estimate, 835,690 people use water from public water-supply systems. This
amounts to 80 per cent, of the population of the Province. One of the most
important responsibilities of the division is to be sure that these public water-
supply systems provide safe water.
The " Health Act " requires that all plans of new waterworks construction
be approved by the Deputy Minister of Health. In studying the plans for
approval, the source of supply and the distribution system are gone over very
carefully in order to see that no public health hazards exist. In many instances,
the division is able to suggest alterations to the plans that are of benefit to the
local water authorities.
Chlorination equipment has been installed and is in use in about thirty
water-supply systems. There are two water-filtration plants in the Province.
Most of the water-supplies in British Columbia are drawn from surface sources
by gravity into the distribution areas.
In addition to approval of plans, sanitary surveys of a number of the existing water-supplies were carried out. An increased interest on the part of local
water authorities in water safety is apparent. With the increased staff of
sanitary inspectors, mentioned in the 1948 Report, it has been possible to do
sampling of public water-supply systems on a much greater scale. In addition
to this, the results of the samples that are taken may be judged more intelligently. DEPARTMENT OF HEALTH AND WELFARE, 1949. KK 65
About 20 per cent, of the population of the Province use private water-
supplies. The sanitary inspectors do a considerable amount of work in taking
samples from and making sanitary surveys of private water-supplies. Literature is distributed showing how to make wells safe from contamination.
There have been a number of requests in the past year for information on
how to improve water which has chemical defects. With the assistance of the
laboratory provided by the Division of Public Health Engineering of the Department of National Health and Welfare, a considerable amount of service to the
public has been rendered in advising on how to treat water to make it more
potable.
It is hoped that in 1950, with the appointment of the additional public
health engineering personnel which were covered in the Federal health grants,
a more intensive programme on water safety will be carried out.
SEWERAGE AND SEWAGE-DISPOSAL.
Sewerage and sewage-disposal is an important feature of the work of the
division. Sewerage and sewage-disposal falls naturally into two classes—the
private sewage-disposal system and the public sewerage system.
The " Health Act " requires that plans of all new sewerage-works construction be approved by the Deputy Minister of Health. In studying the plans submitted for approval, the sizes and grades of the sewers in the collection system
are carefully checked. The method of sewage treatment and disposal is also
carefully considered, taking cognizance of the body of water into which the
sewage is to be discharged. Most of the sewerage systems in British Columbia
are built in line with good standards. The pollution of streams and tidal bodies
of water by domestic sewage has not yet become a serious problem in British
Columbia. However, it is recommended that studies be made during the coming
year to appraise the total effect of discharge of domestic sewage into the waters
of the Province.
The year 1949 saw the commencement of the construction of the new
sewerage system and sewage-disposal plant at White Rock. Also, during the
year, the ratepayers of Saanich again rejected the sewerage-construction bylaw, although the proportion of persons in favour greatly increased.
There are now forty sewerage systems in the Province. There are twelve
sewage-treatment plants. It is estimated that 583,500 people are served by
public sewerage systems.   This amounts to 54.2 per cent, of the population.
Almost 500,000 people in the Province have their sewage disposed of by
private sewage-disposal systems. This means that the septic-tank problem in
British Columbia is a major one. Standard plans have been prepared showing
the proper method of constructing septic tanks and private sewage-disposal
systems. These have been very widely distributed and very widely used.
Standard plans for sanitary privies have also been produced. The problem of
sewage-disposal in urbanized unorganized territory is still a serious one. In
certain types of soil the septic-tank method of sewage-disposal does not work
well unless each house is located on a sufficient area of ground. The result is
that the need for sewerage systems is urgent in some of our unorganized territories and also in some of our municipalities. A committee was appointed by
the Honourable the Minister to look into this problem late in 1949. It is
hoped that this will result in some improvement. KK  66 BRITISH COLUMBIA.
The Province does not have a set of standards regarding sewage-collection
and sewage-treatment. Studies have been made during 1949 toward the adoption of such standards. It is quite probable that in 1950 a set of recommended
standards will be published for the guidance of engineers preparing plans and
specifications for sewerage systems.
STREAM-POLLUTION CONTROL.
The problem of the pollution of streams by wastes other than that produced
by domestic sewage is coming to the forefront generally in North America. In
British Columbia, the " Health Act" and regulations give the Minister fairly
wide authority to prevent pollution of streams from any cause. It is proposed
that, should engineering personnel be available, a survey of the pollution status
of the Fraser Basin and probably of the Columbia Basin in British Columbia be
commenced in 1950 to assess the total effect of pollution produced by domestic
sewage and by industrial wastes.
The prevention of pollution is not only a public health problem. Pollution
creates a problem for any industry which uses water, including agriculture,
fisheries, tourist trade, and many other industries. It is felt that an appraisal
of the present pollution of all types, together with an appraisal of the capacity
of the streams to receive pollution, will be of great value at a time when the
Province is on the threshold of major industrial development. It is proposed
therefore that, with the greater availability of engineering personnel, work be
started on this important matter early in 1950.
MILK SANITATION.
There were no major epidemics that were proved to be milk-borne in
British Columbia during the year. With the increased use of pasteurized milk,
milk-borne epidemics should become quite rare. 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.
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. Quality of the milk
itself is a responsibility of local health authorities. The work of the Division
of Public Health Engineering in regard to milk is mainly that of 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. In addition
to the taking of samples to be sent to the laboratories operated by the Division
of Laboratories, a considerable amount of field testing of milk is now being done
by the sanitarians. Kits have been provided to each of the sanitary inspectors
for the carrying out of resazurin tests and for the carrying out of phosphatase
tests. The continuous co-operation between the Health Branch and the
Department of Agriculture in the matter of milk sanitation is definitely improving the quality of the milk sold to the people of British Columbia.
SHELL-FISH SANITATION.
A considerable amount of effort was directed toward shell-fish sanitation.
A new set of regulations governing the sanitary control of the shell-fish industry DEPARTMENT OF HEALTH AND WELFARE, 1949. KK  67
was written and passed during the year. The regulations became effective
on October 1st. The shell-fish regulations were prepared to fit in with regulations recommended by the Department of National Health and Welfare and by
the United States Public Health Service, so that free shipment of shell-fish from
British Columbia to other parts of North America could be carried out. One of
the main features of the regulations was to provide for the certification of
shucking plants and the certification of shell-stock shippers. Another important
feature of the regulations was a requirement that shucked shell-fish could not
be repacked in the Province. This has meant a considerable amount of alteration and rebuilding of shucking plants and to a certain extent altering the
methods of shell-fish marketing in the Province. By the end of the year,
eighteen shucking plants had been granted certificates of compliance with the
regulations and twenty-two shell-stock shippers had been granted certificates
of compliance.
A considerable amount of sanitary survey work was done on the oyster-
beds. Boundary Bay and Esquimalt Harbour were given very thorough sanitary surveys. It is quite probable that by the end of 1950 the quality of the
shell-fish produced, both from the nutritional and sanitary point of view, in
British Columbia will be second to none elsewhere in North America. The
division would like to record its appreciation to the Provincial Department of
Fisheries for its assistance in writing the shell-fish regulations.
Regarding toxicity in clams and mussels, sampling was continued by the
Federal Department of Fisheries during the year. Unfortunately, the amount
of sampling is not sufficient to determine adequately the extent of shell-fish
toxicity in British Columbia waters. The west coast of Vancouver Island is
still closed for the taking of clams and mussels for commercial purposes. It is
felt that this cannot be opened until much more intensive work is done on the
problem.
INDUSTRIAL-CAMP SANITATION.
With the increased staff of sanitary inspectors that were in the field during
1949, a considerable amount of attention was paid to the problem of making
inspections of industrial camps. The division has a record of 1,028 industrial
camps. It is estimated that if these camps were inspected by one man, on a full-
time basis, it would require approximately twenty-nine months to cover the
camps once. If all the sanitary inspectors had an equal number of camps in his
district, each man would take 1.33 months to inspect his camps. Thus, an
average of 11 per cent, of the sanitary inspector's time would be spent on inspection of camps. This is not possible, however, in practice. In some districts
there are only a few industrial camps and the work entailed in inspecting them
is not great. However, there are certain districts in the Province where some
modification in the programme of inspection of industrial camps may have to be
made. In one district served by two sanitarians there are 341 camps. It is
estimated that it would take one man a full year to visit these camps. Many of
these camps are in almost inaccessible places. Many of the camps are very small
and are portable. In this area, during the past year, it has been found possible
to inspect only the more permanent type of camp in the routine measure and
inspect the smaller camps upon complaint. KK 68 BRITISH COLUMBIA.
The sanitation and living conditions in industrial camps to-day are much
better than they were several years ago. The new regulations governing industrial camps that came into effect on January 1st, 1947, have now been in operation for three years.   The results have been very gratifying.
Owing to the time required for inspection of camps in some health unit
districts, it is quite possible that the inspection of all the very small camps may
have to be dropped as a routine measure. It is the intention of the division
during the year 1950 to make a very close estimate of the number of camps
which could be called permanent in nature, and attempt to have all these
inspected.    All camps will be inspected where specific complaints are received.
SANITATION OF TOURIST RESORTS.
Detailed inspection of tourist camps have now been carried on for a period
of about four years. During 1946 and 1947 a special inspector was appointed
for tourist-camp work. In 1948 it was felt that the work had been reasonably
well started and the responsibility of tourist-camp inspection was placed on the
local sanitary inspector. This policy has been continued through 1949. There
are a total of 1,112 registered tourist camps in British Columbia. This means
that there is an average of almost fifty tourist camps per sanitary inspector.
However, there was a very good coverage of the tourist-camp facilities in 1949.
Tourist camps are inspected by the local sanitarians prior to granting of a
licence. This has been very effective in bringing some of the lower-grade tourist
resorts up to standard.
In addition to the inspections made by the sanitary inspectors, the Department of Trade and Industry grades tourist camps from the point of view of
comfort and luxury.
As mentioned in the 1948 Report, the application of the regulations has
shown several weaknesses in the presently established regulations. It is hoped
that these regulations will be strengthened and improved in the year 1950.
SUMMER CAMPS.
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.
A large number of these camps were inspected during the year 1949. The
operators of these camps are very anxious to have camps of a good standard.
There have been considerable improvements in many of the summer camps
during the past two years. Summer camps that are operated by non-profit
organizations have certain problems which other types of camps do not have.
There is usually a shortage of funds, and recommendations by sanitary inspectors are made with the knowledge that economy is essential. It is felt that with
the continuation of this policy, summer camps will be greatly improved in the
next few years. DEPARTMENT OF HEALTH AND WELFARE, 1949. KK  69
ENVIRONMENTAL SANITATION OF SCHOOLS.
Detailed inspections of the environmental conditions in and around schools
are made by the local sanitary inspectors. The inspections are reported on
forms provided for this purpose. Detailed reports are prepared in the health
units and copies are prepared for the school boards. These reports are used in
programmes of improvement. With the tremendous expansion in the number
of sanitary inspectors in the field in 1949, most of the schools in the Province
were inspected.
SANITATION OF EATING AND DRINKING PLACES.
The inspection of eating and drinking places is a very important feature
of the work of the local sanitary inspector. It is the desire of the division to
have food places inspected at least four times annually. The year 1949 was the
third year of the enforcement of the regulations governing eating and drinking
places which were passed late in 1946. The good effects of these regulations
are still being felt. The eating and drinking places in the Province are gradually coming into line, and the local sanitary inspector encourages a greater
sanitation consciousness on the part of local food-handlers.
In some parts of the Province food-handling courses have been established.
The purpose of the food-handling course is to teach the personnel handling food
in public eating and drinking places the fundamentals in the safe handling of
food.
A uniform report form has been in use during the past year for the use of
inspectors reporting on examinations of eating and drinking places. The forms
are designed to show whether or not a restaurant is improving.
Many restaurants were inspected for the first time in 1949, because complete sanitary inspection service was not available to many areas until this year.
Accurate figures on the number of restaurants in the Province and estimates of the number of persons eating meals in restaurants are very difficult to
obtain. However, one sanitary inspector reports that in his area, which contains a small city and a fairly large rural area, the number of persons served
per day in restaurants is equivalent to 18 per cent, of the population of the area
served. He also reports that over 80 per cent, of the items listed on the
restaurant sanitation form are satisfactory. In areas where health units have
been established for some time, the general sanitation in restaurants and beer-
parlours is much better than that found in the areas which have not had this
service.
Sanitary inspection service will be slightly expanded in 1950 and the result
will be a more complete programme of restaurant and beer-parlour sanitation.
FROZEN-FOOD LOCKER PLANTS.
The year 1949 was the second complete year in which the regulations
governing the construction and operation of frozen-food locker plants were in
operation. While 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, they do not require the licensing of the existing
plants on an annual basis.   There were twenty-two approvals of plans for new KK 70 BRITISH COLUMBIA.
frozen-food locker plants during 1949. At the end of the year, the division had
knowledge of ninety-eight plants, either in operation or under construction.
It is estimated that there are approximately 48,500 lockers in the Province.
Estimating that each locker serves four people, it means that the locker plants
of the Province are serving almost 200,000 people.
Routine inspections of the frozen-food locker plants are made by the local
sanitary inspector. The experience gained with the operation of the regulations
indicates that certain amendments are necessary. These amendments will
probably be made in 1950.
TRAINING PROGRAMME FOR PERSONNEL.
As a result of the Federal health grants, it has been possible to provide
considerable training for sanitation personnel. In July and August, a short
course was arranged for sanitary inspectors. The attendance at the short
course was between forty and fifty. Professors W. S. Mangold and A. H. Bliss,
from the University of California, School of Public Health, conducted the course.
It is felt that this course provided a real impetus to the sanitary inspectors
employed in the Province. It is recommended that courses of this nature be
repeated in the future.
Through the Federal health grants, N. J. Goode, Assistant Public Health
Engineer, has been provided a postgraduate course in public health engineering.
Also, the Chief Sanitary Inspectors of the Cities of Victoria and Vancouver and
of the Province were provided with a five-month refresher course in sanitary
inspection at a university.
The constant improving of the qualifications of personnel required for
sanitation work will have a permanent effect on the quality of work done by
the division.
GENERAL OBSERVATIONS.
In 1949 the biggest single piece of work of the Division of Public Health
Engineering was in connection with shell-fish sanitation. This work occupied
almost the whole of the time of the Assistant Public Health Engineer, who had
been appointed in January, 1949, together with the work of two students during
the summer months. The work of approval of plans continued to be fairly
heavy in 1949. The increase in staff of sanitary inspectors, which was recorded
in the 1948 Report, threw a tremendous amount of administrative work on the
Chief Sanitary Inspector. It is quite probable that the headquarters staff will
have to be augmented in order to properly administer sanitation work throughout the Province. The adoption of better and more efficient types of record
systems in the local areas will make it easier for the division to evaluate the
work of the sanitary inspectors in the field. With the increased interest in
prevention of pollution of streams, it is quite probable that the engineering side
of the work will be brought more into focus during the year 1950.
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
division would also like to record its thanks to the officials of the Division of
Public Health Engineering, Department of National Health and Welfare, for
their 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 to the Division of Public Health Engineering. DEPARTMENT OF HEALTH AND WELFARE, 1949. KK 71
REPORT OF THE DIVISION OF VITAL STATISTICS.
J. D. B. Scott, Director.
INTRODUCTION.
The division has two main functions. The first function is statutory,
namely, the administration of the " Vital Statistics Act," the " Marriage Act,"
and the " Change of Name Act" and certain provisions of the " Wills Act."
The second function is statistical. The division is expected to give factual
information in a precise form, to check and assess results, and to make suggestions regarding further improvements to all services of the Health Branch.
Due to virtually complete registration of vital statistics amongst all of the
population, except Indians and Doukhobors, the emphasis has, in 1949, been
placed upon improving the quality of all registrations accepted. Progress has
also been made in the collection of vital statistics records of both Indians and
Doukhobors.
The Vital Statistics Council for Canada, of which the director is a member,
was again active, and further details relating to the Council are reported
hereunder.
Constant attention has been given to the revision of forms and procedures,
to the end that the maximum efficiency will be obtained with a minimum of
effort.   As a result, many forms were revised and reprinted during the year.
Lack of adequate space has continued to add to the difficulties of the staff
and general public alike. Such lack of proper facilities has a limiting effect on
productivity as well as morale.
The transfer of the office of District Registrar in Vancouver from the
Government Agency to the Health Branch enabled the division to give better
services in the largest centre of the Province.
COMPLETENESS OF REGISTRATION.
Indians.
Current Registrations.
Prior to the year 1917 there was no provision for registration of vital
statistics of Indians, but in that year arrangements were made whereby this
became possible on a voluntary basis and continued in that manner until 1943
when registration became mandatory, as for whites, by an amendment to the
" Vital Statistics Act." It naturally follows that such a system leads to inaccuracies and incompleteness in recording.
The payment of family allowance, which commenced in July, 1945, brought
particular attention to the inadequacies of Indian registrations by necessitating
the verification of many hundreds of records of births and deaths which could
not be located in the indexes. Experience soon proved that this would be a most
difficult task and that an effort would have to be made to review many registrations so as to ensure sufficient identification and verification.
An educational programme was carried out amongst the Indian Superintendents in 1946, with definite instructions being laid down, to take effect on
January 1st, 1947, aimed at ensuring more complete records in Indian Agency KK 72 BRITISH COLUMBIA.
offices, as well as establishing uniformity in the method of handling registrations by the superintendents. This was supplemented in January, 1947, by a
comprehensive project of documentary revision, described under a separate
heading hereunder. The division is continuing to follow up the progress made
in this phase of registration by maintaining frequent contacts with the Indian
Superintendents and the Indian Commissioner for British Columbia.
A considerable improvement was noted in the completeness and quality of
registration of Indian births, still-births, marriages, and deaths. Payment of
family allowance to Indians constitutes a great incentive toward completeness
of birth registration, while other factors, such as a growing need for accurate
vital statistics records by the Indian Superintendents and a greater appreciation
of the importance of this service by the Indians themselves, have all advantageously influenced the progress of registration generally.
The Indian Commissioner for British Columbia, as in previous years, has
taken a keen interest in the work conducted by the division and has wholeheartedly supported the various measures which have been implemented to
eventually attain the same standard of registration as for whites. Discussions
were held during the year between officials of the Indian Commissioner's office
and the division, resulting in a further co-ordination of policy aimed at securing
a continued improvement in the recording of vital statistics. The matters
discussed dealt with:—
(a) A continuation of the report of enrolment of new pupils in schools
in September, 1949.
(b) The submission to the Director of a copy of the nominal roll of
all agencies in the Province, with amendments from time to time.
(c) The methods to be used to maintain continuation of given names
and surnames.
(d) The collection of church records of births and marriages by Indian
Superintendents so that such records may be microfilmed by the
Director and thus serve the division as a source of reference, particularly when handling delayed registrations.
(e) The appointment within each agency staff of a Deputy District
Registrar of Births, Deaths, and Marriages and Issuer of Marriage Licences for Indians only, so as to facilitate the administration of the " Vital Statistics Act " and the " Marriage Act," particularly during the absence of the Superintendent from his office.
During the year no inspections of agency offices were made by the inspector
but instead, in six agencies, valuable assistance in documentary revision was
given for brief periods by a senior clerk. It is planned to continue this practice
in other agencies and to supplement it with routine visits by the Inspector of
Vital Statistics.
Documentary Revision.
The project of checking, typing, reindexing, and correcting registrations
filed during the period 1917 to 1946, inclusive, was continued throughout the
year.
The indexing of all the births and deaths which occurred within the period
from January, 1917, to December, 1946, of the West Coast Indian Agency and
the births of the Queen Charlotte Indian Agency was completed.   Work is pro- DEPARTMENT OF  HEALTH AND WELFARE, 1949. KK  73
ceeding on the deaths of the Queen Charlotte Agency, the births and deaths of
the Williams Lake Agency, and the births of the Babine Agency. Priority was
given to the searching of 2,305 unverified Indian births forwarded by the
Family Allowance Branch, Department of National Health and Welfare. The
value of the project was proved when intensive searching revealed that 1,069
of the unverified births were registered, of which number 4.11 were registered
under different names. This discovery enabled steps to be taken to correct
registrations which had been originally made under nicknames, phonetic spellings, given names, etc. The errors had been caused by the completion of registrations by well-intentioned but poorly informed persons without sufficient
reference being made to the agency census in order to ascertain correct spellings
of names and other details. The agencies were requested to forward delayed
registrations for the 1,236 unverified births which were not registered.
By the end of November, 5,704 registrations were reviewed, 123 were found
to be duplications, 3,529 corrections were effected, and 607 names were cross-
referenced for the indexes.
Delayed Registrations.
The difficulty of obtaining correct and sufficient verification to meet standards for accepting delayed registrations of births increases the work in this
phase of record-collection. However, the division is constantly adding to its
library of verifications and is encouraging the Superintendents of Indian Agencies to prepare and submit documentation for all those persons whose names
appear on the Indian census and whose births are known to be unregistered.
During the year, 264 applications for delayed registration of birth were
approved and many more were reviewed but held in abeyance pending submission of more adequate verification of date and place of birth.
Appointments of Deputy District Registrars.
For a considerable time it had been felt that it would be advantageous to
have an appointment of a Deputy District Registrar of Births, Deaths, and
Marriages made in each Indian Agency office so as to facilitate the handling of
both current and delayed registration work, particularly during the absence of
the Superintendent from his office. Arrangements were made with the kind
consent of the Indian Commissioner for British Columbia to have such appointments made in thirteen of the agencies in British Columbia. The persons concerned were also appointed as Issuers of Marriage Licences in order to effectively deal with the administration of the " Marriage Act " during the absence
of the Superintendent. It is hoped that this will improve the handling of vital
statistics work amongst the Indians and will result in more complete registration amongst this minority group.
Doukhobors.
Current Registrations.
The improvement in birth registration amongst Doukhobors, which was
noted in 1948, continued during 1949. This was due, in large part, to the
efforts of the special field representative and to careful planning of policy concerning the collection of vital statistics.   A study of overdue registrations for KK  74 BRITISH COLUMBIA.
the year clearly shows that the faction known as Sons of Freedom is the only
group which still opposes registration of births. Adequate follow-up work
should overcome this situation eventually. The opposition to registration experienced so frequently in the past has largely given way to mere disinterest,
which is being overcome by contacts with the field representative and by the
natural tendencies of many Doukhobors to abandon the communal form of
existence in favour of the standard of living enjoyed by those who have become
independent of the communities. Births which occurred in 1949 are virtually
all registered, with the exception of events occurring to some members of the
Sons of Freedom. With the prospect of a stronger policy in dealing with
Doukhobors, this omission will be given close attention in the coming year.
During the year, the division was successful in securing registrations of
birth of all children of the Hilliers group of Doukhobors, who had previously
opposed registration most strenuously.
In the past, there has been bitter opposition to accepting any form of
marriage except the family-type Doukhobor ceremony, which is not recognized
by British Columbia law. However, during 1949 an increasing number of
Doukhobor couples have been married by civil contract in order to ensure the
validity of their union. This is a step in the right direction and will be
encouraged.
Registration of deaths still presents problems, for, in many instances, a
neighbour of the deceased prepares a crude coffin and the burial takes place as
a family affair, without the services of a minister or an undertaker. In these
instances, knowledge of the death is often not received until some time after the
burial, and it is then very difficult to obtain a medical certification of cause of
death. A close check on the completeness of the information shown on death
registrations will have to be maintained for a considerable time to come.
Delayed Registration.
It has been found that Doukhobors seldom seek to have delayed registrations of birth filed for the sake of later benefits to the children. There must be
some immediate benefit, such as family allowance, to act as an incentive. At its
inception, family allowance was regarded by these people with suspicion, but
the number of Doukhobor applicants for the allowance is increasing and thus
previously unregistered births become known and are recorded. Employment
of Doukhobors by some of the larger companies is also assisting indirectly, as
these companies demand proof of age of employees for pension purposes.
Registration of Births, other than Indians and Doukhobors.
Current Registrations.
Except in a small number of isolated areas of the Province, there is no lack
of proper birth registration. As almost all births now occur in hospitals, a
means is thus provided to ensure the prompt collection of records, since all
District Registrars currently receive notices of births by the attending medical
practitioner, usually completed at the hospital. Having been thus notified, each
District Registrar is responsible for contacting the parents concerned and for
any follow-up work necessary to obtain a registration. DEPARTMENT OF HEALTH AND WELFARE, 1949. KK  75
The payment of family allowance has assisted greatly in securing birth
registrations promptly, but it cannot be assumed that this alone is sufficient to
guarantee the recording of all events. The mothers of illegitimate children
must be contacted shortly after confinement, otherwise it is often found that
they have moved from the locality and quite frequently are not interested in
family allowance, especially if the child is to be placed for adoption. Conversely, attempts have been made, due to ignorance or otherwise, to duplicate
registrations previously filed, and the greatest diligence must, therefore, be used
to ensure the accuracy of the facts as stated by parents.
Investigations carried out during the year have indicated that improper
records were made in ignorance rather than with obvious intent to defraud.
The information has, in most cases, been supplied in such a manner as to
supposedly protect the immediate interests of the child.
Gratitude is expressed to the medical profession and to hospital staffs for
their excellent co-operation in reporting births to the district offices. This
feature of the registration system has unquestionably contributed to the high
standard of registration presently existing.
A new foolscap-size birth registration form was put into use on January 1st,
1949. The content of this form was changed little, but the questions themselves
were rearranged and an effort made to simplify the questions so they would be
more easily understood by the general public.
Delayed Registration of Birth.
Delayed registrations accepted during the year continued to indicate that
the majority of unregistered births pertain to the period immediately prior to
the turn of the century, up to approximately 1920. Many of the remainder
were births of illegitimates or reregistrations following cancellations. The
reason for non-registration of the former group in many cases was due to the
fact that the mother moved away from the district before registering the birth
of her child. Steps are being taken to ensure that there is a minimum of loss
of registrations of current events through the same cause.
Many church records of baptisms and marriages were placed on microfilm, thus adding valuable information to the reference material used for
assisting the general public with the completion of documentation for delayed
registrations.
Effect of Family Allowance.
As has been noted each year since the inception of family allowances, many
inaccuracies in registrations have been brought to the attention of the division,
and, in most instances, records have been amended. While the payment of the
allowances has meant a considerable increase in the volume of work, it has
contributed to a higher standard of registration than existed heretofore. Many
records which were incorrect could previously have been unnoticed for many
years, but with the continuing verification of registration of births by the
Family Allowance Branch errors now seldom escape discovery beyond a comparatively short time.
Gratitude is hereby expressed to the Regional Director of the Family
Allowance Branch and his staff for assistance rendered to the division at all
times. KK 76 BRITISH COLUMBIA.
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 been an improvement in both these groups during the year,
and efforts are being made through the District Registrars to secure still better
returns in the future.
A slightly revised registration form was put into use in January, 1949.
This embodied clarification of certain questions and appears to have largely
achieved the desired results. A further revision has been necessary in order
that the portion of the form dealing with certification of cause of death will
conform to the Sixth Revision of the International Lists of Diseases and Causes
of Death. The newly amended form will be placed in the field as from January
1st, 1950.
Registration of Marriages.
The checking of completed marriage registers issued to the clergy is the
chief means of controlling the completeness of marriage registrations and has
revealed that proper recording of these events is virtually complete. However,
there is need for improvement among the Doukhobors and Indians. In both
cases the lack of registration is due to continuation of " family custom " marriages, but these are becoming fewer in number. Education of these groups
will eventually correct this situation, though a long-term programme is necessary as these forms of " custom" marriages are long established in both
minority groups.
Documentary Revision.
Owing to the varied purposes for which certificates of births, deaths, and
marriages are required, there are indeed few records which can be considered
as " dead." While the greatest volume of work is entailed in handling and
amending birth registrations, the series of marriages and deaths are also in
constant use in order that they may be kept up to date. In the birth series the
original registrations must be withdrawn from volumes in order to add notations of alteration of given names, corrections, adoption, change of surname,
and legitimation. Marriage registrations must be referred to in order to
make notations of divorce or nullity, change of name, and corrections. Revision
of death registrations consists largely in entering notations of corrections to the
information originally supplied.
Since the originals must be kept completely up to date in order that accurate certification may be issued, it follows that prompt revision is a very
important part of processing records.
.      DISTRICT REGISTRARS' OFFICES, INSPECTION, ETC.
Changes in Registration Districts.
Vancouver District.
Space was obtained in the Provincial Government building at 636 Burrard
Street in Vancouver for the establishment of a district office so that the overcrowded space in the Government Agency could be utilized for other purposes.
The change in location was made on March 15th, 1949.    Seven members of the DEPARTMENT OF HEALTH AND WELFARE, 1949. KK  77
agency, who were employed solely on work for the division, were transferred
directly to the staff of the Division of Vital Statistics, in addition to which the
District Registrar, Assistant District Registrar, and a junior clerk were drawn
from other sources. From the outset, it was apparent that the staff was inadequate to handle the large volume of work and it became necessary to add two
more members. This situation had been impossible to foresee, as several others
of the agency personnel performed part-time vital statistics duties which varied
greatly in extent from day to day.
The change in organization was accomplished with a minimum of confusion
to the division and general public alike, owing to the fact that such a large
percentage of the personnel were thoroughly experienced in their respective
duties. In addition, the District Registrar had served previously in the Vancouver Government Agency for many years prior to his appointment as Deputy
Government Agent at Penticton. The Assistant District Registrar had wide
experience, which has contributed greatly to the smooth running of that office.
As the Vancouver office is now staffed by Health Branch personnel, it means
it is able to undertake certain additional responsibilities which are not generally
carried out by district offices.
Netv Westminster District.
In the New Westminster district office the issuing of marriage licences and
solemnization of civil marriages was consolidated in the Government Agency
early in the year. This resulted in a considerable increase in the volume of
counter work for the agency, so that three persons now perform full-time duty
for the division.
Changes in other Districts.
Four offices of Deputy District Registrars were closed in 1949, after
inquiries revealed that their continuation was no longer necessary on account
of the small volume of registrations handled. These offices were at Agassiz,
Beaton, Telkwa, and Tofino. The work formerly done by these officials has
been consolidated within the offices at Chilliwack, Revelstoke, Smithers, and
Ucluelet respectively.
The former vital statistics district of Fort Fraser was consolidated with
Vanderhoof registration district in Februrary, 1949, at which time the Government Agency office at Fort Fraser was transferred to Burns Lake. The change
in registration district boundaries was so made because both the Fort Fraser
and Vanderhoof registration districts were within the police district of Vanderhoof and the District Registrar of Births, Deaths, and Marriages for Vanderhoof is a member of the British Columbia Police.
Two new offices of Deputy District Registrars were opened in order to give
better service to the public, the need for these being established by investigation
in each case. The additions were made at Armstrong as a deputy of Enderby
registration district and at Gibsons Landing as a deputy of Vancouver registration district.
Inspections.
Fourteen district offices and sub-offices in the Province were inspected
routinely, in addition to the instructional visits made to six Indian Agencies. KK  78 BRITISH COLUMBIA.
Frequent visits were made to the Vancouver office and several, during the course
of the year, to North Vancouver and New Westminster. One visit was made
to the Kootenay area to check on the progress of registration of vital statistics
of Doukhobors.
As noted in former reports, instruction regarding procedure was given to
District Registrars at the time of inspections and it has been possible to check
the approximate growth and shift of population, which information is valuable
for the statistical section as well as for general administrative purposes.
At the close of the year there were 72 registration districts under the supervision of a District Registrar and, in addition, there were 22 sub-offices, a
special representative for Doukhobors, a Marine Registrar, and 18 Indian
Superintendents acting ex officio as District Registrars of Vital Statistics for
Indians. Thirty-nine of the District Registrars were Government Agents and
Sub-Agents, 39 District Registrars and Deputy District Registrars were members of the British Columbia Police, 8 District Registrars and Deputy District
Registrars were other Government employees, while the remaining 9 were nongovernment employees. The Marine Registrar and the 18 Indian Superintendents are Dominion Government employees.
VITAL STATISTICS INFORMATION FOR HEALTH UNITS.
The system of notification of births, deaths, and still-births to public health
personnel was extended so that the Metropolitan Health Committee in Vancouver is now advised of events which occur to residents of the Metropolitan Health
District who are temporarily in other parts of the Province. In order to do
this, the District Registrars of Births, Deaths, and Marriages at North Vancouver, Vancouver, and New Westminster supply details of their respective
districts to the Committee, while the central office of the division segregates
events for the remainder of the Province and notifies the Committee directly.
This is in addition to duplicate statistical punch-cards for births and deaths and
duplicate death index cards.
Consideration is being given to a revised method of supplying to the health
unit directors information regarding births. The object of this is to assist the
public health service in carrying out its various functions, particularly regarding postnatal programmes.
Commencing in January, 1950, the Sixth Revision of the International
Lists of Diseases and Causes of Death will be taken into use and, as this will
entail slight changes in the certification of causes of death on death registrations, a closer liaison between the Director of Vital Statistics and the health
unit directors will be formed. A copy of each death registration filed on and
after January 1st, 1950, will be forwarded by the District Registrars of Births,
Deaths, and Marriages to the health unit director of the area in which the
District Registrar is located. Queries resulting from ill-defined causes of death,
etc., shown on death registrations will be channelled from the division through
the health unit directors to the private practitioners or coroners. Vital statistics are compiled by school district and organized municipalities and this data
is forwarded to the health units for their use. DEPARTMENT OF  HEALTH AND WELFARE, 1949. KK  79
STATISTICAL SERVICES.
The statistical sections of the division are responsible for the development
of statistical programmes and reporting techniques in all bureaux and divisions
of the Health Department, including health units from the planning stage to the
collection and processing of data and to the final analysis and presentation of
results. It also prepares and analyses demographic data stemming from the
registration functions of the division and from population studies. It coordinates such data with the statistics derived from the public health programme. Furthermore, it correlates wherever necessary the statistical work
of the division with that of the Federal Departments, notably the Dominion
Bureau of Statistics and the Department of National Health and Welfare. In
effect, this means that the division acts as a " Division of Health Statistics "
rather than performing duties in a limited field. Vital statistics as such are
very important because they are basic items in the book-keeping of health.
However, with the increased demand for statistical services on the part of the
Health Branch arising from the rapidly developing programme for public
health, it has become necessary to develop a centralized statistical office for the
whole Health Branch.
The division continued to assist the Health Branch in the drafting of new
forms and in the revision of existing forms to minimize duplication and to
establish uniform methods of recording wherever possible.
Demography.
Monthly summaries of vital statistics registrations are routinely completed
by the division, presenting data by age, sex, racial groups, place of residence,
place of occurrence, etc. The section continued its study on infant mortality
and has accumulated five years of a special punch-card series correlating birth
and death registrations. The incidence of maternal mortality and statistics on
the causes of death were emphasized as of particular value since they are an
important measure of the state of health in the Province. Many detailed annual
tables are prepared. Many data are available from the punch-card files and
many special tabulations were made from this source during the year.
Various population estimates were compiled during the year. Information
is given to individuals, business firms, and both official and unofficial agencies.
No charge is made for such service.
Service to Bureau of Local Health Services.
Consultative statistical service was given to health units, covering such
varied items as annual-report data for the metropolitan areas of Vancouver
and Victoria respectively; assistance in completing the evaluation schedules
of " Health Practices," recommended by the American Public Health Association, in Saanich and South Vancouver Island Health Units and also in Greater
Victoria; assistance to the Central Vancouver Island Health Unit in connection
with an epidemic of gastro-intestinal infection at Port Alberni and Alberni,
etc.    In addition, special tabulations were prepared for most health units.
A great deal of work was done by the division in the compilation and
analysis of the data collected in the Wetzel grid study. This was a special
study made in the Central Vancouver Island Health Unit area and jointly KK 80 BRITISH COLUMBIA.
carried on by the Federal Department of National Health and Welfare and
the Division of Health Units of the Health Branch of the Province.
The division helped the Nutrition Services in connection with diets in
Provincial institutions, including Oakalla. It also assisted in the statistical
analysis of the data collected for a Province-wide study of school-lunch programmes sponsored by the Parent-Teacher Association.
The information given on public health nurses' records was transferred
to punch-cards and tabulated. A change was made during the year in the
report form, which meant a redrafting of the punch-card. Each month a summary was completed showing the amount and type of work done by the nurses.
During the year, the division made special tabulations for the Director of Public
Health Nursing. The division discontinued the work of acting as a clearinghouse for public health family records. It was felt that this function could
better be done under the direct control of the Director of Public Health
Nursing.
Among other services performed for the Bureau of Local Health Services
were the preparation of the data for the annual reports of School Environmental Sanitation and Medical Inspection of Schools.
Service to Bureau of Special Preventive and Treatment
Services.
The division continued to render very tangible assistance to the Divisions
of Tuberculosis Control and Venereal Disease Control respectively in the preparation, tabulation, compilation, and presentation of their monthly, quarterly,
and annual reports. Special tabulations are prepared from time to time for
each division. Special assistance was given to the Division of Venereal Disease
Control in collecting data required for the surveys made by Dr. Stokes and
Dr. Williams respectively on the venereal disease programme of the Province.
Service to Public Health and Associated and Voluntary Agencies.
As in previous years, the division collected notifications of cancer cases
and compiled statistics therefrom. Detailed figures on causes of cancer deaths
were assembled. The division is endeavouring to assist the British Columbia
Cancer Institute in reorganization of its cancer record system.
A Province-wide survey of crippling diseases of children was commenced
during the year. The Division of Vital Statistics assisted in the preliminary
phases of the study, including the drafting of the questionnaire and a corresponding punch-card. At the close of the year it had coded several thousand
records. At the present time, there is no accurate information available to
indicate the extent of the problem of the handicapped child in this Province.
Therefore, this information should be very valuable to the Health Branch for
planning the best utilization of the Federal grant for crippling diseases of
children.
Also, assistance was given to the British Columbia Division of the Canadian Arthritis, and Rheumatism Society in preparing a monthly record of its
activities. In addition, certain discussions have been held with the organizing
secretary preliminary to the planning of a record system for the Society. DEPARTMENT OF HEALTH AND WELFARE, 1949. KK 81
Mechanical Tabulation.
Continuous use was made of the mechanical tabulation of the division
during the year, both for routine monthly tabulations and listings of various
indexes as well as for special assignments. The marriage index was completed covering all marriages filed in the division since 1872. Searching is
now much more accurate and faster than with the old hand-typed or handwritten indexes. Also during the year death-cards were punched for the
period 1872 to 1916.
Throughout the year the division prepared extensive tabulations for the
Bureau of Local Health Services, including the Divisions of Environmental
Sanitation, Public Health Nursing, and also for the Bureau of Special Preventive and Treatment Services including the Divisions of Tuberculosis and
Venereal Disease Control.
A monthly list of all social assistance cases is prepared for the Departmental Comptroller showing names, types of cases, and amount to be paid.
This listing is not static from one month to another. Many amendments have
to be made.
During the year the mechanical equipment was surveyed by the International Business Machines Company, with the result that all the printing, duplicating printing punches were replaced with combined alphabetic, numeric
punches, also an interpreter was added to the equipment of the section. This
change provides greater flexibility in production so that the division will be
better able to undertake more varied tasks in the future. Special applications
requiring other types of equipment are sent either to the Bureau of Economics
and Statistics or to the office of the International Business Machines Company
in Vancouver, depending upon wherever the work can be done first.
VITAL STATISTICS COUNCIL FOR CANADA.
In May, 1949, the Vital Statistics Council for Canada met in Ottawa for
the sixth meeting. Twenty items were placed on the agenda, the most important being in connection with the International List of Causes of Death, a report
on the adoption of Minimum Standards of Evidence for Delayed Registration
of Birth by the Provinces, also a progress report on the Model Vital Statistics
Act.
International Statistical Classification of Diseases, Injuries,
and Causes of Death.
It was reported to the Council that the regulation No. 1 adopted by the
World Health Organization was to come into force in Canada on January 1st,
1950. The Dominion Bureau of Statistics, however, will commence coding
causes of death according to both the old list and the new list for 1949. Publication of mortality data in the official vital statistics reports will be according
to the new international classification from January 1st, 1950. The Council
agreed that the material for the Provincial annual reports would be prepared
according to the three-digit breakdown in the detailed list.
It was reported to the Council that a new Medical Advisory Committee
to the Dominion Statistician was established by order in council.    The functions KK 82 BRITISH COLUMBIA.
of the new Committee cover studies in the field of international health statistics,
the relation to economic factors, and, in general, " matters of medical significance as may be required to co-operate effectively with respective agencies of
the World Health Organization in the field of vital and health statistics."
Both the United Kingdom and the United States have already established their
national committees.
The Council passed a resolution recommending that the general rules in
the manual be adhered to as far as possible in connection with the principle
of coding to the underlying cause of death. Further, it recommended that
medical certificates of cause of death showing ambiguous or doubtful information should be returned to the physician concerned for clarification. In other
words, the main responsibility for selecting the underlying cause rests with
the physician, and therefore all efforts should be directed to educating the
medical profession in the use of the certification form. It was the opinion of
the Council that exceptions and detailed instructions should be kept to an
absolute minimum because they would only tend to confuse the issue.
In order to improve the accuracy of death statistics, the Council resolved
that the coding of the causes of death done in the Dominion Bureau of Statistics
be compared with the coding in the respective Provincial offices.
Report on Minimum Standards for Delayed Registration
of Birth.
A committee of the Council reaffirmed that the Minimum Standards for
Delayed Registration of Birth, as adopted at the 1944 Vital Statistics Conference, should remain unchanged. This was agreed to by the Council. The
Provinces went on record as being willing to give full information regarding
the proof accepted for the registration of any particular case. It was reported
that the delayed registration problem is now being handled by all the Provinces
under a uniform system.
ADMINISTRATION OF THE " MARRIAGE ACT."
The administration of the " Marriage Act " is a direct responsibility of the
division. This includes checking the qualifications of persons about to marry,
particularly regarding proof of divorce, proof of age of minors, and proof of
presumption of death. Consents of parents for marriage of minors must be
reviewed and applications for orders of remarriage dealt with.
Owing to the small number of caveats lodged each year it had not hitherto
been considered necessary to print a special form for the purpose. However,
as the handling of caveats required to be made more uniform, a form was
devised and placed in use. In addition, a review of the caveats outstanding
for several years was made and many names were cleared from the list.
A revised list of those cases still outstanding was sent to the district offices
throughout the Province.
Before being authorized to solemnize marriages in British Columbia, it is
necessary for ministers and clergymen to be registered with the division.
When an application for such recognition refers to a denomination which is
not yet registered, an investigation is made in order to determine whether the
group is a bona-fide religious body, as required by the " Marriage Act."    The DEPARTMENT OF HEALTH AND WELFARE, 1949. KK 83
points which are given particular attention include the method of ordination
of ministers, the growth and extent of the denomination, its rites pertaining
to the solemnization of marriage, and its possibilities of continuity of existence.
A personal visit to the locality in which the group functions is made by the
Inspector of Vital Statistics in those areas which are reasonably accessible, and
in other localities by the District Registrar. These full inquiries provide a
protection to properly constituted denominations and the general public alike.
During the year one new denomination was recognized and seven applications were under consideration as at December 31st, 1949.
All current marriage registrations are checked to ensure that every marriage has been performed by a duly registered clergyman or Marriage Commissioner.
A further revision was made in the consolidated Form M. 2, Statutory
Declaration; Form M. 3, Notice of Marriage; and Form M. 4, Marriage
Commissioners Certificate of Compliance. This reprint shows more clearly
the requirements to be fulfilled in order for a marriage licence to be issued or
a civil marriage to be performed. It is of considerable assistance to district
officials and the general public, both in providing concise instructions and in
avoiding misunderstandings between officials and the public.
ADMINISTRATION OF THE " CHANGE OF NAME ACT."
A further reprint of Forms CN. 2 and 3, covering an application for
change of name, was made. Instructions on these forms and on Form CN. 1
have been clarified.
A form-letter containing concise instructions to the general public regarding procedure, fees, etc., was revised. Also, a similar form-letter was furnished
to the District Registrars for distribution to the general public.
The number of applications for change of name which were approved
during the year remained almost the same as in 1948.
ADMINISTRATION OF SECTIONS 34-40, INCLUSIVE,
OF THE  "WILLS ACT."
In 1945 an amendment, was made to the " Wills Act," providing that any
person could file with the director a notice regarding the execution of a will,
date of the will, and its location. It was also made possible for subsequent
changes to be made on account of new wills, codicils, etc.
Upon receipt of proof of death of the testator, a search of such notices may
be made so that settlement of the estate may be completed. In order that the
records may be readily available, it is necessary that wills-notices be numbered
and indexed at frequent intervals. Indexes themselves must be periodically
rerun in order to avoid lengthy searches. Hollerith punch-cards are prepared
from the original notices and it is, therefore, possible to prepare or rerun the
indexes with a minimum of effort.
It is interesting to note that the first notices filed in accordance with the
above amendment were received in April, 1945, and that only forty-seven notices
were filed by December 31st, 1945. In 1946, the first complete year in which
the notices were filed, a total of 394 reports were received, but for 1949 the
number had grown to 1,562, almost all of which were notices of wills currently KK 84 BRITISH  COLUMBIA.
executed. In 1947 there were 2,254 notices filed, but many of these referred
to wills made during a period of many previous years and hence the number
was extraordinarily large. The number had dropped to 1,363 in 1948, as almost
all of these then represented notices of wills currently executed.
No figures are available for 1945 to show how many revenue searches for
wills-notices were made, but by the end of 1949 these had reached almost 400
per month.
GENERAL OFFICE PROCEDURES.
Processing of Mail.
The new combined cash-register receipt, application form, suspense sheet,
and reply form (V.S. 30), which was put into use in the central office on
January 1st, 1949, has proven a great success and has greatly simplified handling
of correspondence. With the introduction of this form, the direction of correspondence was centralized in one clerk, who controls the disposition of incoming
mail and who also ensures that, in the outward mail, delivery instructions of the
applicants have been observed, that the appropriate type of certification has
been issued, and that any other special instructions have been followed. This
rearrangement of routine has virtually eliminated complaints as to incorrect
mailing of documents.
Free Verification and Certification.
The Application for Interdepartmental Free Searches and Certificates was
again revised and, due to its changed uses, it was renamed Interdepartmental
Verification (Free). It was printed as a three-part form with interleafed
one-time carbon so that the office making the request for verification prepares
the details and sends the form to the division, where the information is checked
and (or) amended according to the original record. The form is then date-
stamped, initialled by a senior member of the staff, and returned to the originator. A copy is provided for the originating office when the form is first
prepared and also for the division, in addition to the copy or copies which are
returned to the originator. Separate single sheets are added, as necessary, in
order to do this. The procedure eliminates the preparation of Forms V.S. 23,
24, and 25 which were, respectively, Certificate of Birth, Certificate of Death,
and Certificate of Marriage—for pensions purposes only. Where the above
verifications are not suitable for the department concerned, a positive photographic print (described in more detail hereunder) is provided. As the average
number of free searches approximates 500 per month, the use of the new form
has saved a considerable amount of clerical time in the central office.
Special means were found necessary in order to fulfil the needs of certain
departments and yet keep to a minimum the number of verifications made per
Form V.S. 8a, Interdepartmental Verification (Free).
The Old-age Pension Board has been supplied with a numbered weekly list
of deaths of persons 70 years of age and over. This list has been typed weekly
from the death registration files and has met the requirements of the Old-age
Pension Board auditors, who must verify dates of death of pensioners in order
to properly adjust pension accounts. A further refinement of this list, in the
form of a combined mechanical tabulation and typewritten list, will be issued
as from January 1st, 1950. DEPARTMENT OF HEALTH AND WELFARE, 1949. KK  85
The British Columbia Government Hospital Insurance Service must adjust
premium rates due to change in status of insured persons and (or) their
dependents. The onus for reporting births and marriages was left with such
persons, but the division undertook to supply the Hospital Insurance Service
with a monthly death-index in duplicate as from January 1st, 1949, and, in
addition, a weekly death-index in duplicate as from May 1st, 1949.
Section 3 of the " Children of Unmarried Parents Act" requires that each
District Registrar shall notify the Superintendent of Child Welfare of the birth
of every illegitimate child registered in his office. However, it has been found
more satisfactory that such notifications should be sent direct from the division
and, accordingly, during the year, an arrangement was worked out whereby
the Director furnishes the Superintendent with a positive photographic print
of the original registration of birth of every illegitimate child registered
throughout the entire Province. This action ensures completeness and uniformity of the data supplied.
Revision of Forms and Certificates.
Form V.S. 8, Application for Certification, was radically changed so as to
provide the division with information as to the reason for which certification
is being requested so that the appropriate certification can be issued, as well as
furnishing a form which is relatively simple for the public to complete. Supplies
were distributed amongst all the District Registrars and to many law firms in
order that applications received at the division will contain a maximum of the
required details for searching and for mailing replies.
Form V.S. 11, Alteration of a Christian or Given Name; Form V.S. 12,
Statutory Declaration (for correction of an error) ; Form V.S. 15, District
Registrar's Letterhead; and Form V.S. 17, Statutory Declaration (for legitimation) were all revised and reprinted with concise explanations for the use of
each being shown thereon. This has resulted in a saving of time both in the
district offices and the central office, since the forms are more self-explicit than
heretofore and hence fewer need be returned for corrections or additions.
Since the Vancouver district office is now part of the division, special forms
and form-letters, where necessary, were printed for that office so as to handle,
as much as possible, all the routine work with a minimum of effort. In addition,
time-saving form-letters were supplied to other district offices in accordance
with local needs. The F.L. 36, Instruction for Correction of a Birth Registration, proved particularly helpful in handling birth registrations which had
to be returned to parents for correction.
A new stock of birth certificates for use as laminated copies was printed
and embodies the use of a counterfoil. This has reduced duplication of effort
in the accounts section and at the same time has produced information on the
duplicate which is more complete than existed previously, thus assisting greatly
in tracing misplaced certificates, as well as in tracing original files when requests
for duplicates of certificates are received. The new stock of paper birth
certificates for District Registrars has likewise been printed with counterfoils.
Change in Delayed Registration Procedures.
Delayed registrations of births, deaths, and marriages, after acceptance at
the central office, are no longer forwarded to District Registrars to be included KK; gg BRITISH COLUMBIA.
with returns. This change in procedure minimizes the possibility of documents
being lost in the mail and also results in more rapid delivery of certificates
to applicants for delayed registration. As soon as a delayed registration is
accepted at the division it is placed on file and the District Registrar is merely
requested to inform the director as to the district registration number allotted
to the record.
Methods to Improve Registrations.
A good deal of study was given to methods of improving the over-all quality
of registrations. This was considered necessary both from the legal aspect of
such records and for obtaining better microfilm impressions of registrations.
Under the system which was devised to solve the problem, all letters of advice
regarding additions or corrections requested by the District Registrars or the
central office are preserved for future reference. In the central office, the
processing of current records has also been changed in that the checking of all
registrations is now carried out prior to numbering, so that only complete
records are placed on permanent files. This has eliminated a great deal of
refilming which had formerly been necessary and has decreased the number
of cards which have to be repunched by the mechanical tabulation staff.
Microfilm Procedures.
Filming of Documents.
The microfilm operators filmed 15,680 files relating to delayed registration
of birth in order that much-needed space could be made available by the
destruction of the original files themselves. In addition, a start was made on
filming files pertaining to alteration of Christian names. When this project is
completed, further space for volumes of registrations can be gained by the
destruction of the original correspondence files. Sixty-six volumes of transcripts, containing over 30,000 individual records of baptism, were placed on
microfilm, as well as numerous volumes of baptismal records loaned by various
churches throughout the Province for this specific purpose.
Positive Prints.
On April 1st, 1949, a new type of certification was introduced in the form
of " positive photographic prints." These documents embody a projected
enlargement from a 35-mm. microfilm image combined with a contact print
certification, on a sheet of paper 7% inches by 8% inches. The prints can be
produced in reasonably large quantities and with fair rapidity. They are neat
in appearance, durable, free from possible errors in transcription, and have
been well received both by the official agencies and the general public. They
are used in place of the certified copies hitherto issued and for each series,
that is, births, deaths, and marriages where more complete details are required
than are shown on the typewritten transcripts.
Standardization in Size of Registrations.
Since the introduction of the new birth registration form in January, 1949,
it has been possible to standardize the binders used for filing registrations in all
series except still-birth and Indian.    The former will be on a standard-sized DEPARTMENT OF HEALTH AND WELFARE, 1949. KK  87
sheet to fit the new binders as from January 1st, 1950. Stocks of blank Indian
registration forms will be punched to fit both the present type of binders used
for filing Indian records and the new binders. Such standardization assists
materially with the planning of space requirements for the permanent storage
of registrations. A further minor change in binders has proved helpful when
attempting to locate volumes rapidly. This consists of a different colored
backing for each series of registrations, that is, brown for births, green for
deaths, and red for marriages.
Many hundreds of old files dealing with the non-registration of births of
school children were again reviewed and searched in the birth indexes. As a
result, it was found that many events have been properly recorded since the
correspondence originated (that is, 1933 onwards), and it was thus possible
to destroy many of these letters. The correspondence relating to events which
are still apparently unregistered was retained so that it will be on hand when
applications to register are eventually received.
PROBLEMS OUTSTANDING AT THE END OF THE YEAR.
Goal in Registration.
The ideal situation under this heading would be prompt, complete, and
accurate registration of every birth, still-birth, death, and marriage occurring
in the Province. It can be truly stated that as far as quantitative registration
is concerned there is little more which can be desired, except amongst Doukhobors and Indians, though definite progress is being made with both these
minorities. A special field representative is continuing to work among the
Doukhobors and frequent contact is maintained between the division, the Indian
superintendents, and the Indian Commissioner. Improvement in transportation
and educational facilities is bound to have an advantageous effect in this work.
Some delays in registration of births have occurred during the latter part of the
year and steps are being taken to ensure that there will not be any consequent
loss of current registrations. Many delays regarding birth registration are
caused by ignorance or disinterest of parents, but even more are the results of
efforts to conceal illegitimacy, sometimes complicated by false identification
of a mother at the time of admission to hospital.
Much improvement has been made in the over-all quality of registrations
during 1949, but this feature will continue to be a real challenge for some years
to come, especially in the death series. In the more remote regions of the
Province it is often very difficult to obtain full personal details of deceased
persons, particularly if no relatives can be contacted to supply such information.
Also, people frequently die in inaccessible areas without medical attention, and
adequate certification of cause of death is thus exceedingly difficult to procure.
Owing to the large number of positive photographic prints issued, a great
deal of attention must continue to be directed toward better quality in birth
and marriage registrations. The term " quality " must be interpreted as including legibility, the use of non-fading ink, the elimination of abbreviations in
names, dates, etc., full and sufficient answers to questions on registration forms,
correct signatures, properly initialled corrections to original statements, and
the like.   The fact cannot be overemphasized that all registrations are important KK 88 BRITISH COLUMBIA.
legal documents and as such may be demanded in court at any time. Hence all
possible measures must be taken to ensure the highest standard of original
records. District Registrars have rendered excellent co-operation in improving
both quantity and quality of registrations in the past and will be encouraged
to continue their good efforts.
There has not been any indication of overregistration of births, although
this possibility is not being overlooked. Each fraudulent or improper record
is carefully investigated before any decisive action is taken. The Inspector of
Vital Statistics must continue to be ever watchful for any suspicion of duplication in birth registration, as numerous types of fraud could be perpetrated
through the use of false certificates.
Since virtually all births now occur in hospital, there is a certain amount of
duplication between the Form 3, Physician's Notice of Birth, and Form V.S. 26,
Monthly Return of Births (submitted from all hospitals in the Province).
A careful study is being made with a view to a consolidation of the two reports,
with possibly a more widespread distribution so as to include the directors of
established health units. It is hoped that a revised procedure, more suitable
to all concerned, may be adopted in the forthcoming year.
Legislation.
No changes were made in the " Vital Statistics Act," " Marriage Act," or
" Change of Name Act," all of which are administered by the director. There
is, however, an indication that certain provisions of all these Acts need strengthening and (or) amending to bring them into line with changing conditions.
The amendments under consideration do not involve major changes in policy or
procedure but must be carefully investigated before being recommended to the
Legislature. The matter will be reviewed in the forthcoming year so that, if
possible, the suggested revisions could be considered at the 1951 Session of the
Legislature.
General Office Manual.
Owing to pressure of other office business, including a thorough study of
several procedures in processing registration, the material which had been
gathered for the above publication was held in abeyance. An effort will be
made to complete the project in the forthcoming year so that all routines in
the division will be committed to writing and thus be easier to study when
consideration is being given to making any subsequent revisions. Such clarification of instructions also helps to standardize the treatment of all work carried
on within the division and to avoid any misunderstanding of interpretation of
accepted procedure.
National Register of Vital Statistics.
Experience gained in the use of the National Register since July, 1945, has
brought out the need for keeping the National Index Section of the Dominion
Bureau of Statistics aware of differences between the National Register and the
Provincial Vital Statistics Index and has pointed the way toward maintaining
agreement between them. Many discrepancies were discovered by the Family
Allowance office and a system was devised and placed in operation so as to DEPARTMENT OF HEALTH AND WELFARE, 1949. KK 89
utilize such information by originating a form in the Family Allowance office,
to be checked in the Vital Statistics office, and, where necessary, the details
relayed to the Dominion Bureau of Statistics in order that amendments could be
made to the National Register. The Dominion Bureau of Statistics must prepare its punch-cards from microfilm, whereas the Family Allowance office can
check the original and any supplementary application for Family Allowance
when in doubt about spelling of a name and also can contact the division in
order to verify spellings from an original registration. In this way, punching-
errors at the Dominion Bureau of Statistics, caused by errors in names, can be
corrected through advice supplied by the Family Allowance office and the Division of Vital Statistics. Information concerning the correction of other errors
or the addition of supplementary details is passed, routinely, by the division to
the Dominion Bureau of Statistics. However, queries are sometimes raised by
the Dominion Bureau of Statistics regarding the answers to various questions
on registration forms, and consideration is being given to an improved method
of transmitting supplementary information to the Dominion Bureau of Statistics to provide for earlier use of amended film than previously. A reasonably
good system of this inter-office advice has been instituted, but it appears that
there is room for improvement and an effort will be made to accomplish this
in the next year.
Certification of Documents.
The production of positive photographic prints appears to have solved any
problems which could have arisen over the issuance of long-form certificates, as
no adverse comments have been received regarding this form of certification.
Consideration has been given to replacing the long-form parchment death certificates with an abbreviated document of the same style. However, the stock
on hand indicates that a reprint will not be necessary before the fall of 1950.
Certification of Causes of Death.
With the adoption of regulation No. 1 of the World Health Organization
by Canada, it becomes imperative that the certification of causes of death by
physicians be improved. This is largely a matter of education. Health unit
directors are the most effective persons to introduce the subject to their confreres. The division will have to refer all doubtful cases to the health unit
directors for querying by the attending physician or coroner. Results cannot
be obtained overnight. A continuing programme of education in the principles
of certification will have to be maintained both by the division and the health
unit directors.
Public Health Statistics.
In the last quarter of the year, a great deal of thought was given to the
reorganization of the statistical sections of the Division.
The addition of new public health programmes and the extension of existing ones in the Health Branch have been largely implemented with the aid of
Federal health grants. Consequently, the responsibilities of the statistical sections of the division have increased considerably. Without the authorization of
a continuing Federal health grant project for health statistics, involving the
employment of three additional statisticians, it would have been impossible for
the division to fulfil its proper functions. KK  90 BRITISH  COLUMBIA.
The statistical sections have been patterned to tie in closely with the general
organization of the Health Branch. For instance, one statistician is to head up
the work connected with the Bureau of Local Health Services, another is to give
service to the Bureau of Special Preventive and Treatment Services, a third
has been assigned to related health services not coming directly under these two
bureaux. Another statistician has been assigned to deal with the customary
demographic functions peculiar to a vital statistics office. A fifth statistician
was appointed as a consultant and to act in a liaison capacity between the central office of the division and the services of the branch located in Vancouver.
Within the framework of this organizational pattern, it should be possible
to meet not only the present demands of the Health Branch but also the urgent
requirements for additional service in the immediate future. The major problem facing the division for the forthcoming year is to put the reorganization
into full and effective operation. DEPARTMENT OF HEALTH AND WELFARE, 1949. KK 91
REPORT OF THE DIVISION OF PUBLIC HEALTH
EDUCATION.
Kay Beard, Consultant.
INTRODUCTION.
" Education does nothing for people. Education helps people to do things
for themselves, and if health is a state of complete physical, mental, and social
well-being, then health education is helping people to live in such ways that
their ways of living will contribute to their physical, mental, and social well-
being."
The above statement by Dr. Thomas Parran outlines briefly the purpose
of health education. As a part of a Provincial service, this division cannot
work directly with individuals throughout the Province toward the accomplishment of this aim. The health education programme of the community is the
responsibility of the local public health staff.
This educational programme represents an increasingly large proportion
of the work of local public health personnel. In each local public health unit
or district, public health education must be planned and conducted by the health
unit director, public health nurses, and sanitary inspectors as a part of their
already onerous and varied programme. Each meeting attended, each clinic
held, and each individual interview presents important educational opportunities. The full utilization of these opportunities requires specialized study
and detailed preparation which cannot possibly be included in the already heavy
schedule of the present staff without seriously curtailing the service programme.
The importance of a well-planned and widespread programme of community
health education to the success of local public health services is well recognized
by local public health personnel, and increasingly urgent demands have been
made for full-time assistance from persons trained in methods of public health
education.
Since it has not been possible as yet to provide full-time public health education personnel in local health units, the efforts of this division have been
devoted to providing consultative service and materials to meet the most urgent
educational needs of local public health personnel.
LOCAL HEALTH SERVICES.
During 1949, assistance to local public health services has been provided in
the following ways: Visits to local health units, consultative service by correspondence, supplying of reference materials on loan and general materials
for distribution, loan of visual aids, and preparation of special materials on
request.
The most tangible form of assistance has been through visits to local
health units. Four units and three nursing districts were visited during 1949,
and discussions were held on the particular health education problems of each
area as well as those problems common to all areas, such as utilization of visual
aids, methods of filing reference materials, and motivation of health education
in schools. KK  92 BRITISH COLUMBIA.
In addition to visits, an increasing number of requests for assistance were
met through correspondence and by loaning reference materials. This service
provides to the public, through their local public health service, reliable information on unusual phases of public health not readily available through local
channels.
Through funds available from Federal health grants, a basic library of
seven public health reference books was supplied to each public health office,
and an additional eight books to each proposed or established health unit centre.
These books form the nucleus of a local public health library which provides
a readily accessible source of technical information for public health staff.
In addition, they may be made available to any interested individual or group
seeking technical public health information.
VISUAL AIDS.
Through the assistance of Federal health grants, audio-visual equipment,
including a film projector, film-strip projector and record player, has been supplied to each of the eighteen health unit centres. The provision of audio-visual
equipment has resulted in a greatly increased demand from local public health
staff for visual-education materials. As a result, the film library has been
increased to include eighty-five films and forty-nine film-strips. A further
expansion will be necessary early in the new year.
To prepare local public health personnel for the increased use of visual
aids, a series of short demonstrations was presented at the Annual Public
Health Institute in April. Since time did not permit the presentation of a
complete course on this occasion, a series of one-day courses in health unit
centres has been planned to teach the local staff the use and care of the equipment and to discuss the utilization of audio-visual materials. To date three
of these classes have been presented. The remainder of the series is scheduled
for completion during the new year. This course has not only provided
valuable information for the public health field staff but has served as a
stimulus to improve their techniques in visual education.
The discussions on utilization of visual aids have stimulated interest in
the preparation of study guides for films. A number of these have been prepared by the staff of this division, and several public health nursing study
groups are engaged in the preparation of others. It is hoped that through
these combined efforts it may be possible to provide study guides for all films
in the library.
As in other years, a large number of films have been previewed with a view
to purchase, and those of value in the public health programme have been added
to the film library. Films of particular interest to other departments have
been referred to the appropriate department, and, on several occasions, film
previews have been conducted for members of other departments.
A revised film catalogue has been prepared, which, at the request of the
field staff, contains more complete film descriptions than are usually included
in catalogues of this type. This necessitated viewing all films in the library
in order to rewrite the descriptions. The revised catalogue is scheduled for
distribution early in the new year. A descriptive catalogue of film-strips has
also been prepared and distributed. DEPARTMENT OF HEALTH AND WELFARE, 1949. KK  93
Experiments have been carried out in the production of slides, utilizing
the microfilm equipment of the Division of Vital Statistics. Through their
co-operation, the present possibilities and limitations of this method have been
determined and several sets of slides of charts and graphs have been produced.
With some additional equipment, it may be possible to include the production
of a greater variety of slides.
In co-operation with the National Film Board, a series of film showings
was planned and conducted for the Western Conference of Social Work held
in Victoria in May.
MATERIALS,
A large volume of reference materials has been requested by field staff
during the year. As a result, more books and other reference materials have
been ordered than in previous years, particularly in the fields of mental hygiene
and child development. It is encouraging to note the increasing interest of
public health personnel and of community groups in developing a greater
understanding of the effects of the mental environment of the young child.
The importance of an active mental-hygiene programme in public health has
long been recognized, and the role of the public health nurse in assisting
parents to understand their children, and to provide for them a happy, healthy
environment, is an important part of this programme. The present staff of
this division can assist through the provision of reference materials and suggestions, but the responsibility for arousing interest in, and providing guidance
for, local groups remains with the local public health personnel.
A classified list of books included in the reference library has been completed and is ready for distribution early in the new year. At the same time
the card-index systems for books and pamphlet material were completely
revised and brought up to date. This is a task which required the efforts of
two persons over a period of several months, but the resulting system should
greatly improve the functioning of the library and reference section.
Improvements have been made in the system of ordering materials for
distribution and reference. This work has been centralized and a method of
recording orders has been developed which will prove valuable in ordering
materials in the future.
As in the past, the staff of the Provincial Library has provided invaluable
assistance in obtaining information and providing technical advice.
The Health Bulletin completed its nineteenth year of publication. During
this year, considerable research into the functions of this type of publication
was conducted, and plans for improvement in the format and content were
made. Unfortunately, the resignation of the editor in August has again delayed
any major revision of this publication. In its present form, however, it continues to serve as a useful source of information to interested groups and
individuals who receive it.
SCHOOL HEALTH.
During 1949, it has been possible to devote a larger proportion of time to
school health. At the request of the Department of Education, the senior
health educator spent the month of July in planning the health phases of the
revised curriculum in " Effective Living," which will include health, guidance, KK  94 BRITISH COLUMBIA.
and family relations in one course. The planning of such a course is a most
progressive step. The implementation of this course by interested and well-
qualified teachers should do much to improve the health of the coming generation, both from a personal and a community standpoint. The curriculum is
being planned to help students to help themselves by providing them with a
necessary background of scientific knowledge on which to build, by developing
an inquiring attitude, and by linking health improvement with basic interests
of adolescents.
Other projects in school health include the preparation of articles for the
" British Columbia Schools," and the assembling of kits of reference materials
for public health nurses to supply to school health teachers. This material,
requested by senior public health nurses, has proved a valuable stimulus to
better health teaching in some districts.
A plan for the production of materials on school environment has been
discussed with other Provinces and information services of the Department of
National Health and Welfare. Suggestions concerning subject-matter and
treatment have been forwarded from this office, and it is hoped that these
materials will be produced by the National Department during the coming year.
Other school health reference materials which have been in a partly completed stage are still delayed until additional staff with teaching experience
can be obtained. These reference materials for teachers, when completed,
would provide a most useful guide in the implementation of the new curriculum.
PRE-SERVICE TRAINING.
The orientation programme, planned to acquaint new staff members with
the programmes and policies of the department, has been continued during this
year. Courses were planned and conducted for six newly appointed health
unit directors, two health educators, one senior clerk, and one Junior Red Cross
worker. Although this programme has made large demands on the time of
the health education staff and senior members of all divisions, it serves a valuable purpose in familiarizing new appointees of the department with policies
and programmes. It is difficult to estimate the value of this programme since
the results of such training manifest themselves at intervals over a long period
of time. The importance of job training is widely recognized in industry, and
although the results may not be as tangible it is considered to be a most worthwhile procedure in public health.
IN-SERVICE TRAINING.
In-service training programmes held during 1949 included the Annual
Institute, attended by public health workers throughout the Province, two
health unit directors' meetings, a two-week conference for senior public health
nurses, and a ten-day conference for sanitary inspectors. The Health Education Division assisted in the provision of visual aids and reference materials
for these conferences. Lectures were given to students in the public health
nursing class at the university, third-year nursing students at Royal Jubilee
and St. Joseph's Hospitals, and teachers in the Junior Red Cross class at the
Summer School. DEPARTMENT OF  HEALTH AND WELFARE, 1949. KK  95
In addition to these special programmes, educational material is provided
to public health personnel through the monthly news-letter. This medium is
also a means of circulating information regarding new projects in health education undertaken by local personnel throughout the Province.
STAFF CHANGES.
Three health educators joined the staff during 1949. Miss Joan List, who
had formerly been employed on a temporary basis, joined the staff in January,
and proceeded in September to the University of North Carolina for a full year's
postgraduate work, on a fellowship provided through Federal health grants.
Miss List is a science graduate trained in physical education and has considerable teaching experience, a most useful background for her work in health
education. Miss Hilary Castle joined the staff in January and Paul Nerland
in September. Miss Castle and Mr. Nerland are science graduates, a necessary
prerequisite for acceptance to a postgraduate school of public health. Miss
Hope Spencer resigned in July of this year to accept the position of executive
secretary with the Greater Vancouver Health League.
A noteworthy advance in health education in British Columbia was made
this year when the Victoria-Esquimalt Health Department added a local health
educator, Keith MacDonald, to its staff. This is the first appointment of a
health educator in a local health department in British Columbia. Mr. MacDonald, a graduate in science, who has completed one year of postgraduate
study in agriculture, is now on leave of absence for postgraduate study in
public health education, and will resume his duties in the fall of 1950.
Applicants for additional positions in public health education are still being
sought. The difficulty of obtaining suitable candidates at the present salary
has hampered recruiting efforts during the year. It is hoped, however, that
at least one or two positions may be filled early in the new year in order to
train public health educators to meet the insistent demand from health units
for local health education services. An increase in the central office staff is
also necessary if the division is to keep pace with the increasing volume of
work which is resulting from a more widespread understanding of the functions
and services of this division. KK  96 BRITISH COLUMBIA.
REPORT OF THE DIVISION OF LABORATORIES.
C. E. Dolman, Director.
INTRODUCTION.
During 1949, the Division of Laboratories carried out nearly 380,000 examinations, of which about 315,000, or roughly 80 per cent, were done in the central
laboratories in Vancouver. These totals represent an increase of approximately
7 per cent, over those for the previous year. Almost all this increase occurred
in the main laboratories, although there is good reason to believe that many
branch laboratory activities would have shown at least similar degrees of
expansion if trained technical staff had been available to them. In Table VI
are classified the comparative totals for 1948 and 1949.
The tendency alluded to in last year's report, for an increasing percentage
of specimens to be sent to the Vancouver Laboratories from sources outside the
Greater Vancouver area, has persisted. Over one-quarter of all reports from
these laboratories go to physicians and public health officials stationed in other
areas of the Province, whereas until recent years the corresponding ratio was
only one-tenth. This trend is gratifying in so far as it reflects growing recognition, by the physician and health official in rural areas and small towns, of the
importance of public health laboratory work, and also to the extent that it is a
consequence of the division's policy to centralize responsibility for the more
complex types of tests. However, there is a disturbing possibility, which must
be faced, that many specimens now reaching Vancouver from the Province at
large might better have been examined closer to their places of origin; and,
further, that for every specimen shipped a long distance several might have
been sent to a near-by laboratory. The circumstances which have hitherto prevented any expansion in branch laboratory facilities will be discussed in a later
section of this report.
TESTS FOR DIAGNOSIS AND CONTROL
OF VENEREAL DISEASES.
As in previous years, tests relating to venereal diseases accounted for about
75 per cent, of the total tests done. However, it should be stressed again that
other types of procedures are apt to be far more intricate and costly. Specimens examined for the Division of Venereal Disease Control on the whole proved
the most time-consuming, since they more frequently entailed supplementary
and quantitative tests, owing to the high incidence of syphilis among the
patients from which they came. The great majority of blood specimens reached
us, however, from practising physicians, most of whom now appear very conscious of the importance of these sero-diagnostic checks.
In co-operation with the Division of Venereal Disease Control and the
Indian Health Services, Department of National Health and Welfare, this
division was glad to take part in several blood-test surveys of Indian groups
living in the Interior and northern parts of the Province. These surveys indicated rather unexpectedly wide fluctuations in the probable incidence of syphilis
among these groups. The division continued to examine blood specimens, without charge, for the Canadian Navy, Army, and Air Force.   The findings pointed DEPARTMENT OF HEALTH AND WELFARE, 1949. KK 97
to a gratifyingly low incidence of syphilis in the armed forces. This observation
apparently applies in general to the population at large, and is borne out by
another marked drop in the numbers of dark-field examinations requested.
But it should be emphasized that these trends chiefly reflect benefits accruing
from introduction of newer methods of treatment and prophylaxis, especially
penicillin therapy. There is no evidence whatever suggesting any diminished
frequency of exposure to the risk of infection.
During 1949, the results were received of the fourth sero-diagnostic survey,
launched in November, 1948, under the auspices of the Laboratory of Hygiene,
Department of National Health and Welfare, Ottawa. The tabulated summaries
of performance indicated a very high standard of specificity and sensitivity in
the tests carried out on 100 selected blood specimens shipped from Ottawa to
the main laboratories in Vancouver. The Laboratory of Hygiene also arranged,
in November, a second refresher course in syphilis sero-diagnostic methods.
This was again attended by Miss Mabel Malcolm, senior bacteriologist, who
remained throughout the year in charge of this important activity. The course
was of roughly three weeks' duration, and included two weeks spent at the
Laboratory of Hygiene in Ottawa, with another week given to observation of
arrangements at the Ministry of Health Laboratories for the Province of
Quebec, in Montreal, and at the Department of Health Laboratories for Ontario,
in Toronto. Miss Malcolm also took the opportunity of stopping off a day in
Regina, for observation and discussion of procedures at the Provincial Laboratories for Saskatchewan.
Microscopic examinations of smears for gonococci and gonococcus cultures
conducted for the Division of Venereal Disease Control remained practically
unchanged in numbers. But the laboratories gained the impression that there
has been a reduction in both the percentage and the actual numbers of positive
specimens, particularly among cultures received from the clinic. It was felt
that some part of this apparent reduction may have been due to faulty methods
of handling culture plates at the clinic. With this in mind, and at the invitation
of the director of the division concerned, one of our senior bacteriologists, A. R.
Shearer, visited the Vancouver Clinic on several occasions and demonstrated
the correct methods of inoculating and treating gonococcus culture plates prior
to their being shipped to the Division of Laboratories for incubation and subsequent examination.
TESTS RELATING TO TUBERCULOSIS CONTROL.
There was a very substantial increase in the numbers of cultures for
M. tuberculosis, owing to growing tendencies to request repeat examinations at
short intervals from the same patient, and to submit stomach washings for culture from suspected cases of pulmonary tuberculosis. This trend represents
a heavy burden to the division, in terms of work-hours and of risk to personnel.
On its own initiative, the division undertook in the main laboratories a comparative study of the incidence of positive sputum specimens, as detected by the
cultural and direct microscopic methods. Similar inquiries have been made
into the question whether inoculation of suspected tuberculous material into
guinea-pigs yields results significantly superior to direct cultural methods.
While the former procedure, in skilled hands, appears to give a slightly higher
percentage of positive results, it is questionable whether this advantage is KK 98 BRITISH COLUMBIA.
commensurate with the difficulties inherent locally in the procurement and
maintenance of a guinea-pig colony. During the greater part of the year under
review, it was necessary for the central laboratories to abandon or curtail
animal inoculations, owing to retirement of our guinea-pig supplier and our
inability to secure a dependable alternative source. Arrangements were finally
made, through the Division of Tuberculosis Control, whereby the guinea-pig
colony at Tranquille Sanitorium would be enlarged, as soon as possible, to permit
an assured supply sufficient for the needs of the Division of Laboratories.
FOOD-POISONING AND GASTRO-INTESTINAL INFECTIONS
The customarily large number of outbreaks of staphylococcal food-poisoning
were identified during the year, particularly in the summer months. There was
also another botulism episode—the third such occurrence in British Columbia
within the past five years. It is a striking fact that these three outbreaks are
the only recorded examples of bacteriologically proven botulism in Canada to
date. In the 1944 Nanaimo outbreak, due to canned salmon improperly processed at home, there were three fatal cases. The 1948 Grand Forks episode,
comprising two fatal cases, was due to asparagus bottled on a farm under
very unhygienic conditions. The most recent episode, which occurred early in
October, 1949, involved two persons in Vancouver, one of whom died while the
other recovered after consuming home-pickled herring. Thus, in all, there have
been, in recent years, seven known cases of botulism, six of them fatal, in
British Columbia. On such a record, the disease can hardly be regarded as a
great rarity in this Province, and its high mortality rate alone should warrant
redoubled efforts by all those concerned with public health education to emphasize and help avert the dangers of botulism.
The Nanaimo outbreak was proved due to the rare and little-known Type E
Clostridium botulinum, while the Grand Forks cases were due to the more common Type A organism. In both instances, corresponding strains were isolated
from near-by garden soil, and this would seem to point to the probable source
of the contaminations. By co-operative effort between this division, the Western Division of Connaught Medical Research Laboratories, and the Department
of Bacteriology and Preventive Medicine at the University of British Columbia
it was established that the recent cases of botulism from pickled herring were
again due to Type E organisms. The evidence so far available points to these
organisms having probably gained access to the herring from the intestinal
contents of the fish rather than from an exogenous source. To the relatively
well-known hazards incidental to consumption of any uncooked food-stuff
which has been subject to pollution by human hands must therefore now
perhaps be added the special risk, however remote, that pickled herring may
convey a fatal dose of preformed botulinus toxin, elaborated from organisms
derived from within the fish itself. It should be added that, in this particular
instance, the toxin was presumably manufactured during the interval between
catching the fish and their subsequent storage in a deep-freeze locker, and
possibly also during the twenty-four-hour period elapsing while they thawed
out prior to being pickled. Such an event could befall the most fastidious
housewife, and the only certain preventive measure would be to cook the
herring either immediately before addition of the vinegar and spices or just
prior to eating the fish. DEPARTMENT OF HEALTH AND WELFARE, 1949. KK  99
Acute gastro-enteritis due to micro-organisms of the Salmonella-Shigella
groups (that is, typhoid-paratyphoid-dysentery infections) occurred more frequently than in 1948. Over 150 separate cases of salmonellosis were identified,
and more than 20 cases of shigellosis, or bacillary dysentery. These figures
represent the highest annual total so far noted for British Columbia, except for
the year 1946, when there were several extensive epidemics traced to public
eating-places. In 1949, the total mostly represented isolated individuals or
small familial group infections. There was no evidence that any of these infections were conveyed from animals to man, although several of the Salmonella
types identified locally are known to be transmissible to man from either sick
or healthy animals. It should be emphasized that if animal reservoirs of
Salmonella infection be not already present in British Columbia they are almost
bound to develop sooner or later. In any event, utmost care should always be
exercised to prevent pollution of human food-stuffs with animal excreta, particularly from rodents, while animals whose flesh, milk, or eggs are sold for
human consumption should be subject to rigorous inspection. Moreover, the
definite possibility that water-borne Salmonella outbreaks could originate from
infected animals in, for example, the Greater Vancouver watershed has been
overlooked by those who contended an unchlorinated surface water-supply will
be safe provided the watershed be guarded against human intrusion. These
comments seem especially pertinent in view of the fact that throughout the past
six years in British Columbia first or second place in frequency of isolation has
been held by <S. typhi murium, a Salmonella type notorious for the wide range
of wild, domestic, or laboratory animal species which it appears capable of
infecting.
Apart from S. typhi murium, which was isolated from over sixty different
patients during the year, S. typhi itself, and also S. paratyphi B. and S: newport
were each obtained from roughly twenty individuals. These four types, and to
a lesser degree S. oranienburg and S. bareilly, should be regarded as relatively
widespread and endemic in British Columbia. After being unrepresented in
1948, S. thompson and S. bredeney reappeared, while no less than five Salmonella
types were identified which had not previously been isolated in this Province.
Of these, the following types are well known in other parts of North America:
S. anatum, S. kentucky, S. manhattan, and S. potsdam. The remaining organism
represents a new Salmonella type. Its antigenic composition was determined
by a co-operative effort, in which this division was joined by the Western Division of Connaught Medical Research Laboratories and by the Salmonella Typing Centre of the Laboratory of Hygiene, Department of National Health and
Welfare. The formula under the Kauffmann-White schema is XVI:C-1,5, and
the designation Salmonella Vancouver is proposed for it. There are no clues to
the route followed by these strains in effecting their entry into British Columbia.
Some of them may be expected to become established among human and possibly
animal carriers. The increasing variety and incidence of Salmonella infections
in the Province alone provide a cogent argument for a more complete epidemiological service.
Incidentally, a tendency for the daily press to use the term " salmonellosis "
rather loosely led, in the autumn, to complaints from representatives of the
fishing and canning industries that the public might presume some connection
between these infections and salmon.   There is, of course, no such relationship. KK 100 BRITISH COLUMBIA.
The derivation of the generic term Salmonella is from Dr. Salmon, discoverer
of the prototype strain (now known as S. cholerae suis), and the term has come
to stay among bacteriologists. Any system of nomenclature which helps to
enlighten the public with respect to the causation and prevention of the different
forms of bacterial food-poisoning is welcomed by this division. References to
" ptomaine poisoning " still regrettably appear, tending to perpetuate the mistaken notion that only decomposing food can be toxic or infective for man.
On the other hand, the division certainly recognizes the unfortunate consequences of any reduction in consumer demand for fresh or canned salmon, and
deplores the term " salmonellosis " being bandied about by those who do not
appreciate its significance. A reasonable compromise for the present would
seem to be that the term be used where necessary on laboratory reports sent
out to practising physicians and health officers, but that when public health
officials have occasion to make statements to the press bearing on a proven food-
borne outbreak of salmonellosis the phrase " bacterial food infection" be
employed. This is sufficiently definitive for most occasions. However, if the
public interest requires that more specific information be divulged, this might
best be done by stating that the infection was " due to a micro-organism of
the Salmonella group, so-called after its discoverer, Dr. Salmon." In those
instances where a definite food-stuff has been incriminated, it would appear
desirable, from the standpoint of public health education, to specify it, briefly
indicating the factors which apparently led to the outbreak.
The incidence of shigellosis (bacterial dysentery) has slowly declined in
this Province during the past five years. Throughout this period the numbers
of Salmonella organisms isolated in any given year have always greatly exceeded
the corresponding numbers of Shigella organisms. In 1949, over 150 Salmonella strains were isolated from separate individuals, whereas only around thirty
Shigella strains were identified. Apart from the fact that alternative animal
hosts are an almost unknown feature of Shigella infections, there are no significant differences between the modes of transmission in shigellosis and salmonellosis. These apparent disparities in incidence are not easily accounted for, but
a lower liability for cases of shigellosis to develop the carrier state and the
reputed tendency for Shigella organisms to die out in faeces specimens in transit
to the laboratory may be contributory factors.
Shigella ambigua (one case) and Sh. newcastle (four cases) made their
first known appearance in British Columbia during 1949. The emergence of
these new types serves as a reminder that shigellosis may at some future date
present problems as formidable as those involved already in salmonellosis.
BACTERIOLOGICAL ANALYSES OF MILK
AND WATER SUPPLIES.
The upward trend in bacteriological tests of milk- and water-supplies,
especially the former, was maintained during the year. Milk samples underwent a greater than 50 per cent, increase, while phosphatase tests for efficient
pasteurization doubled in number. About three-quarters of these types of tests
were done on samples collected from the Greater Vancouver licensing area.
Lamentably few municipalities outside Vancouver enjoy the security afforded
by compulsory pasteurization ordinances, duly checked by phosphatase tests. DEPARTMENT OF HEALTH AND WELFARE, 1949. KK 101
The demands are heavy upon the division for establishment of additional milk-
and water-testing facilities in several centres of the Province remote from
existing branch laboratories. The division recognizes the advantages of
decentralizing the performance of many of these tests, and is doing all within
its present limited powers to further this objective. But it seems relevant to
urge here that the main issues be not obscured. The only adequate safeguard
for supplies of milk and milk-products is efficient pasteurization. Over the
years, the division has more than played its part in spreading this gospel.
Meanwhile, the central laboratories have kept in continual circulation several
boxes for shipping iced specimens into Vancouver, and close co-operation has,
on the whole, been achieved between the division and the sanitary inspectors
who collect and express the specimens.
Brucellosis, as in previous years, presented difficult laboratory problems.
There were several instances noted of really high serum agglutinin titres
against Brucella abortus, but this micro-organism was not isolated by blood
culture on any occasion. This situation contrasts with that obtaining a few
years ago, when it was customary for at least two or three cases of acute human
brucellosis to be detected primarily on the basis of laboratory evidence. However, questions bearing on the laboratory's role in suspected cases of sub-acute
or chronic brucellosis remained troublesome. The significance of circulating
Brucella agglutinins in low or medium titre, of brucellergen skin reactions, and
of the results of opsono-cytophagic tests, cannot be interpreted categorically by
the laboratory worker, who is usually supplied with little or no clinical data.
When, as fairly often occurs, the results of the foregoing tests conflict, the total
findings must be assessed in the light of the clinical and epidemiological evidence.
This is the responsibility of the clinician and medical health officer and not of
the laboratory worker. The latter's main task is to secure accurate performance
of the most specific tests available. The difficulties which have always beset the
diagnosis of brucellosis have become aggravated recently by the enthusiasm
of a small group of physicians for specific therapy (using antibiotics such as
streptomycin and aureomycin, with or without sulpha-drugs) in cases of vague,
chronic illness having mild fever but no localizing signs. In view of this
situation and of the growing conviction among most public health laboratory
directors that the opsono-cytophagic test was particularly prone to fluctuations
depending upon personal technique, the decision was made during 1949 to cease
carrying out this test, unless the circumstances were quite exceptional.
Tests of water samples for the presence of the Coli-aerogenes group of
micro-organisms increased in the central laboratories from 6,930 in 1948 to
7,942 in 1949, or by 15 per cent. Nearly three-quarters of these samples came
from sources outside the Greater Vancouver Metropolitan Health Area. The
laboratories are now in a position to handle more frequent specimens from the
intakes and from various points along the distributing system of the Greater
Vancouver Water District. In view of the extraordinary situation which obtains
from the public health standpoint, in respect of the water supplied by this
authority, the carrying out of such examinations at shorter intervals should be
welcomed by every one of the nearly 500,000 consumers concerned. Attention
was drawn to this situation in our annual report for 1948, but not until the
North Shore floods in late November and early December did it become generally KK 102 '      BRITISH COLUMBIA.
known, through the press, that for over two years water from the Capilano
intake had been chlorinated at its source. Citizens living in the area, roughly
bounded on the east by Main Street, have thus been supplied—for the most part
entirely unknown to themselves—with safe drinking water. Other citizens,
receiving supplies from the Seymour intake, have been served with potentially
hazardous untreated water.
The floods, of course, resulted in a turbid water-supply and raised bacterial
counts. Yet, despite the conviction expressed by public health and medical
association officials, and also by the Board of Trade, that all drinking water
distributed in the Greater Vancouver area should be chlorinated, the decision
was reaffirmed that the water-supply of about half the citizens of Canada's third
largest city should remain unprotected by chlorination. In this report this
division must be content to reiterate the following points in connection with
water safety:—
(1) The internationally accepted standards of the United States Public
Health Service for the bacteriological analysis of drinking-water
supplies rest upon interpreting the presence of organisms of the
Coli-serogenes group as presumptive evidence of pollution with
human or animal excreta.
(2) The consensus is that these standards need to be more, rather
than less, stringent, particularly when applied to large municipal
water-supplies.
(3) The allegation that no human beings can enter the watershed is
irrelevant, even if it could be substantiated. The earlier references
in this report to salmonellosis clearly show that excessive numbers
of Coli-ae-rogenes organisms of animal origin in a water-supply
may indicate a hazard to human health, because of the possible
coincident presence of lesser numbers of disease-producing
bacteria.
(4) To suggest that chlorination need not be instituted until disease-
producing bacteria have actually been detected in the water under
test is analogous to bolting the stable-door after the horse is stolen.
By the time such bacteria were isolated, thousands of citizens
might be incubating, or already suffering from, a water-borne
enteric infection.
The division is not yet able to provide an adequate Province-wide water-
testing service for small municipalities and the owners of private wells. As
branch laboratory resources improve, this situation may be remedied. But it
must be emphasized that bacteriological examinations of single specimens, or
even of a small series of specimens from a given source, is of very limited
usefulness. A sanitary survey of the site, with special regard to possible sources
of pollution, and to faulty construction of the installation, should in any event
always precede the submission of samples for laboratory tests. With this
principle in mind, we have referred many requests for well-water examination
to the Division of Environmental Sanitation.
OTHER TYPES OF TESTS.
Among miscellaneous tests, those relating to diphtheria loomed by far the
largest.    Cultures for C. diphtheria? totalled nearly 20,000, an increase of DEPARTMENT OF HEALTH AND WELFARE, 1949. KK 103
roughly 30 per cent, over the 1948 figure. The division may here fittingly repeat
the comment made in last year's report, that " diphtheria remains far more
prevalent in this Province than it should be." The section responsible for
examining suspected diphtheria swabs, under the able supervision of Miss C.
Reid, appeared to be continually faced either with a suspected new outbreak
of the disease or with problems relating to the release of convalescent carriers
and contacts. Here, again, the final responsibility for making these decisions
must rest with the physician and the health officer, but it is inevitable that these
persons should seek guidance from the laboratory in the interpretation of
phenomena which have at times been very puzzling. For example, the type of
bacillus implicated in one outbreak apparently changed its characteristics,
presumably as a result of bacterial variation. Another outbreak (and occasionally even the same patient) yielded more than one type of C. diphtherias,.
Again, patients and carriers sometimes appeared to interchange different
strains of diphtheria bacilli. Fluctuating reactions to virulence tests were
also noted among successive cultures isolated from the same patient or group
of patients.
Such findings have been experienced in many laboratories, particularly
in recent years, and perhaps represent, in part, an effort of adaptation by
diphtheria bacilli to widespread immunization programmes. At any rate, these
hitherto rare occurrences may eventually come to be regarded as almost commonplace responses on the part of the parasite to a changing host-environment.
They certainly should not be deemed evidence of poor laboratory technique.
The division is glad to acknowledge here the typing service for strains of
C. diphtherias which was again offered by the Laboratory of Hygiene, Ottawa.
Very close concordance has been obtained between our reports and those
returned in due course by Dr. Bynoe. Finally, with regard to the vexing
question of what criteria should be followed in determining the release from
quarantine of convalescent or chronic carriers, the underlying principle here
would seem to be that the carrier, no matter how intractable, ceases to be a
menace if all the potential contacts be effectively immunized.
The number of Paul-Bunnell tests for infectious mononucleosis increased
from 739 in 1948 to over 1,000, or by roughly 40 per cent. Requisitions for
these tests have practically doubled in the last two years, although there is no
convincing evidence that the disease is locally prevalent. Incidentally, this is
the only test relating to presumed virus infections now carried out as a routine
by this division, although the division is still prepared, should the occasion
warrant, to perform the complement-fixation test for smallpox. The central
laboratories have agreed to act as intermediary in the shipment of specimens
relating to certain suspected virus infections to the Laboratory of Hygiene at
Ottawa.' Strict conditions have been imposed by that laboratory respecting the
clinical data which must accompany such specimens, and also as regards the
times and modes of collecting and shipping the samples. This commitment is
liable to prove onerous, without being as satisfactory as the operation of a virus
section under this division's own auspices.
Cultures of throat swabs for hasmolytic staphylococci and streptococci
continued to mount, nearly 4,000 of these being reported on during 1949.
Several outbreaks of rather severe scarlet fever and of streptococcal pharyngitis
were thus identified.    Microscopical examinations for intestinal parasites also KK  104 BRITISH COLUMBIA.
increased, to the extent of over 25 per cent.   However, there was no evidence
of any greater incidence or variety of such parasites.
BRANCH LABORATORIES.
In June, a Federal public health grant made possible the appointment of
A. R. Shearer as a senior bacteriologist and also as supervisor of branch
laboratories. The main purposes of this appointment were to facilitate closer
integration between branch and central laboratory activities, and to provide
information bearing on the location and organization of any new centres it
might seem desirable to establish for the performance of certain public health
laboratory procedures.
With these aims in view, Mr. Shearer made various trips during the last
four months of the year which enabled him to visit all the then existing branch
laboratories, at Prince Rupert, Kamloops, Nelson, Nanaimo, and Victoria. He
also surveyed the situation at Prince George, Vernon, Kelowna, Penticton,
Cranbrook, and Courtenay. All of these cities, except Penticton, had become
headquarters of full-time health units, and all of them had certain claims to
consideration as possible centres for small laboratories, where at least bacteriological analyses of milk and water might be conducted.
Very helpful co-operation was received from directors of branch laboratories and health units, from sanitary inspectors, and from many others,
including local practitioners consulted during this extensive survey. A series
of reports prepared by Mr. Shearer for the director of this division and many
discussions about future branch laboratory policy will provide the basis for
recommendations to be submitted in due course to the Deputy Minister of
Health. Meanwhile, it may be stated that there appears no possibility of
establishing new branch laboratories in the immediate future because of the
lack of adequately trained persons available. An ill-trained or careless technician, left to his or her own devices in a small town, may actually prove more
of a menace than a help to the community. This division is regrettably unable
to assist in the training of the needed personnel, owing to its extremely overcrowded and unsatisfactory quarters. Until these major difficulties are
alleviated, our soundest policy is to seek to improve the facilities of the present
branch laboratories. A threefold approach is proposed, and some measures
have already been introduced along each of the following lines:—
(1) Improved Equipment.—Two laboratories have been supplied with
a high quality electric incubator. Considerable quantities of
glassware have also been distributed. These items were purchased
under a Federal public health grant made to the division expressly
for extension of branch laboratory services. They will permit an
enlarged programme of milk- and water-sample testing.
(2) Enlargement of Geographic Areas covered.—There is a natural
tendency for a branch laboratory centred in a small city to restrict
its fields of interest to the demands of its own citizens and to be
slow in offering its resources to " outsiders." This kind of
parochialism can be broken down by tactful leadership from
headquarters, with emphasis upon the democratic significance
of a broad concern for our neighbours' health.    At least two DEPARTMENT OF HEALTH AND WELFARE, 1949. KK 105
laboratories, when requested to extend their coverage of milk
and water analyses to territory under the jurisdiction of another
health unit, readily agreed to do so, up to the limit of their
resources.    Indeed, in one instance, the board of directors of a
certain hospital offered to assign more rent-free space for laboratory work which might reach it from centres up to 200 miles away.
(3) Provision of Short Refresher Courses.—For the past several years,
the central laboratories have gladly provided,  on occasion, a
refresher course of one or two weeks' duration to a visiting technician from some branch laboratory.   From our standpoint, the
chief obstacles to widening the scope of this mutually beneficial
arrangement have been shortages of staff and accommodation.
On the other hand, the branch laboratories have been chiefly
handicapped by the unavailability of substitute personnel and by
lack of funds to cover the travelling expenses and board incurred
by their representatives in visiting Vancouver.   During the spring,
the senior technician and two other technicians from the Royal
Jubilee Hospital laboratory at Victoria each spent one week at the
central laboratories.   The value of this experience to themselves
and, therefore, to their public health laboratory responsibilities
is best summed up in these words written by their own laboratory
director:   " Our three technicians have returned to this hospital
extremely enthusiastic over the time spent in your laboratory.
They have introduced many changes in the short time they have
been back and have given us many altogether new and different
ideas.   No expenditure the hospital has ever made, I am sure, has
increased the efficiency and accuracy of our procedures as has this
one.   ..."   Such gratifying testimonials encourage the division
to spare no effort to further these opportunities as circumstances
permit.   In fact, it is hoped to secure a Federal public health grant
in the coming year, which will permit reimbursement of the larger
branch laboratories for the costs entailed in sending one or more
of their technicians to Vancouver for brief refresher courses in
the central laboratories.
The division records with regret the resignation of Dr. R. E. Coleman,
effective August 31st, 1949, from his position as pathologist at the Prince
Rupert General Hospital and as director of the branch laboratory at Prince
Rupert.    The technician hired by the hospital to replace Dr.  Coleman was
found to have no time available for public health laboratory work, and so far
it has not proved possible to find a suitably qualified person to take over this
work.    The Prince Rupert branch laboratory is therefore not operating for
the present.    This is especially regrettable because of the extensive area which
Prince Rupert could logically serve as a centre for the referral of specimens.
Until the situation can be rectified, specimens are being sent to the central
laboratories, where necessary by air mail.
Miss Jessie Craig, R.N., senior technician at the Royal Inland Hospital,
Kamloops, also resigned at the end of the summer. Her departure made it
necessary to have the sero-diagnostic tests for syphilis transferred to the cen- KK 106 BRITISH COLUMBIA.
tral laboratories. The Kamloops branch laboratory, which is under the direction of Dr. F. P. Sparkes, thus operated at a reduced turnover for the last four
months of the year.
The remaining branch laboratories, located at the Royal Jubilee Hospital,
Victoria; the Kootenay Lake General Hospital, Nelson; and the Nanaimo General Hospital, experienced increases in specimens examined ranging up to 10
per cent. We are glad to record our appreciation of the good work done at
these three branches, under the direction of Dr. R. G. D. McNeely, Miss Betty
Johnson, and George Darling respectively. The activities of the branch laboratories for 1948 and 1949 are set forth in Table VII.
GENERAL COMMENTS.
As in past years, the central laboratories have continued to discharge many
responsibilities beyond those indicated in Table VI. These obligations tend to
become increasingly onerous. For instance, the demand for biological products
relating to the control of communicable diseases continued to mount. That
the very substantial sum appropriated for these products was so economically
spent was largely due to the efficiency with which Mrs. M. B. Allen, who is in
charge of the office, checks all requisitions and redistributes surplus products
sent back to the laboratories. Again, especially large shipments had to be
made throughout the year—glassware and specimen outfits to branch laboratories, milk- and water-sample containers to sanitary inspectors, and innumerable packages for practitioners. The clerk in charge of supplies, Miss B.
Thomson, has handled these miscellaneous tasks most effectively. Reference
should also be made here to the increasingly troublesome burden entailed for
the office staff in the multiplying demands from various quarters for copies of
laboratory reports. This burden is now excessive, and a new system will have
to be devised in the near future.
The director was consulted, chiefly by mail or telephone, by all sorts of
people and about an extraordinary variety of questions. Fortunately, the
assistant director, Miss D. E. Kerr, was able to cope satisfactorily with many
of the telephoned inquiries. A high percentage of these inquiries bear on the
interpretation of our laboratory reports, particularly those relating to serological tests for syphilis. Co-operation with the Division of Venereal Disease
Control has indeed been manifested in numerous ways. The division was glad
to arrange, for instance, that for a fortnight during the summer Mr. Shearer
should take charge of the laboratory work of the Division of Venereal Disease
Control. This afforded him an opportunity for noting the techniques currently
in use there, and he has since made several practical suggestions regarding
possible improvements.
Research Activities.
Apart from the so-called " routine " tests and this consultative work, there
were frequent requests, from many quarters (ranging from the lay public to
the coroner), for special investigations. The division has adhered firmly to
the principle of launching such researches only at the request of registered
physicians or their authorized representatives, and then only when, in the
opinion of the staff, the time and trouble entailed were commensurate with the
importance of the problem.    Under these provisoes, three particularly inter- DEPARTMENT OF HEALTH AND WELFARE, 1949. KK  107
. esting projects were initiated during the year. Two of these, namely the
isolation of Salmonella Vancouver and the Type E. botulism episode due to
home-pickled herring, have already been mentioned. The other concerned two
cases of rat-bite fever, involving Indian infants living in North Vancouver,
from both of whom Streptobacillus moniliformis was isolated by blood culture.
These inquiries, which will eventually be the subject of technical reports, were
all pursued as co-operative ventures jointly with the Department of Bacteriology and Preventive Medicine and the Western Division of Connaught Medical
Research Laboratories.
Conferences and Publications.
The Director attended the annual meeting of the Technical Advisory Committee on Public Health Laboratory Services to the Dominion Council of Health,
held in Ottawa early in December under the auspices of the Laboratory of
Hygiene, Department of National Health and Welfare. These meetings furnish
most valuable opportunities for the exchange of views on numerous technical
topics as well as for discussion of present and possible future Government
policy in relation to matters affecting the Provincial laboratories throughout
Canada.
After this conference, the Director attended the annual meeting of the
Laboratory Section, Canadian Public Health Association, held in Toronto, where
he presented a paper on the two cases of Type E botulism due to home-pickled
herring. A paper on S. Vancouver, under the joint authorship of Dr. C. E.
Dolman, Dr. L. E. Ranta, and Miss V. G. Hudson, all of Vancouver, and also
of Dr. E. T. Bynoe and two of his associates in Ottawa, has been accepted for
publication by the Canadian Public Health Journal. A paper by Dr. Dolman,
entitled " The Aetiology, Epidemiology, and Control of Influenza," was published in the April and June, 1949, numbers of the Canadian Journal of Comparative Medicine.
Accommodation.
Attention has been drawn for more than a decade, in successive Annual
Reports, to the serious handicaps under which the headquarters of the division
labours. The unsuitability and inadequecy of the quarters cannot be overemphasized. They are fire-traps of the worst order, are intermittently and
unavoidably infected with rodents, and the heating and ventilation arrangements are deplorable. At the year-end, during a severe cold spell, almost all
the sinks became plugged from freezing of the drains, one furnace and one gas
hot-water heater disintegrated, while two of the houses were rendered uninhabitable through freezing of taps and hot-water pipes. Only extraordinary
good humour and forbearance on the part of the whole staff made it possible
for the laboratories to remain operating in this crippled condition. A similar
situation obtained last year, and the division surely cannot be expected to
endure these working conditions any longer without some definite assurance
that satisfactory alternative accommodation is shortly forthcoming.
Meanwhile, the division must perforce continue to improvise. It has managed to scrape by each year by exercise of good-will and by constant concern
for effecting improvements in our internal methods and policies. The possibilities here are, of course, seriously limited by physical circumstances.    As an KK  108 BRITISH  COLUMBIA.
example, one may cite the installation of two mechanical washing-machines.
Their introduction released a small room previously used for hand-washing of
Kahn-test tubes. This room was converted into a laboratory and attached to
the tuberculosis and miscellaneous section, under the capable supervision of
Miss J. McDiarmid. The additional space thus made available permitted a
consolidation in the one section of all laboratory work relating to tuberculosis
control. Unhappily, there is no room for further washing-machines of this
kind in the glassware-cleaning and outfits-making section.
During the year, it was decided to hold monthly evening meetings of the
senior technical staff. The problems facing the division are becoming so complex that it seemed sound policy to encourage those in charge of the various
sections to share in a wide appreciation of the nature of these problems. The
meetings have been very helpful, and the policy will be continued.
The relations of this division with the medical profession and with other
divisions of the Department of Health have remained cordial and co-operative.
It remains only to record the director's appreciation of the fine example set
by all senior staff members, which has contributed so much, under trying
circumstances, toward maintaining a high morale throughout the division. DEPARTMENT OF HEALTH AND WELFARE, 1949.
KK 109
Table VI.—Statistical Report of Examinations done
during the Year 1949.
Out of
Town.
Metropolitan
Health Area.
Total in
1949.
Total in
1948.
Animal inoculation  _ 	
Blood agglutination—
Typhoid-paratyphoid group	
Brucellosis    — 	
Infectious mononucleosis	
Miscellaneous  	
Cultures—■
M. tuberculosis —     	
Typhoid-Salmonella-dysentery group.. ._
C. diphtherias    	
Hemolytic staphylococci and streptococci...
Gonococcus  	
Miscellaneous __ _._    	
Direct microscopic examination for—
Gonococcus   	
M. tuberculosis (sputum)	
M. tuberculosis (miscellaneous).— 	
Treponema pallidum  	
Vincent's spirillum    	
Ringworm  _ 	
Intestinal parasites  _._ 	
Serological tests for syphilis—
Blood-
Presumptive Kahn  _	
Standard Kahn .  	
Quantitative Kahn.______ 	
Complement fixation  	
Cerebrospinal fluid—
Complement fixation   	
Quantitative fixation	
Cerebrospinal fluid—
Cell count	
Protein     	
Colloidal reaction   	
Milk-
Bacterial count  	
Coli-eerogenes    	
Phosphatase      	
Water—
Total bacterial count __ 	
Coli-serogenes  	
Unclassified   _ 	
Sputum cultures (special study).
Totals	
148
3,710
1,684
197
869
744
3,337
1,067
505
3,800
5,592
869
46
71
*
160
23,190
4,910
1,024
4,867
584
51
312
550
624
843
843
457
100
5,484
159
3,019
69,824
438
7,700
4,937
831
15
2,858
3,414
16,451
2,752
10,508
821
30,051
3,347
2,858
408
302
*
401
96,715
17,431
4,586
16,863
2,600
271
1,211
2,029
2,519
1,392
1,391
1,255
810
2,458
377
1,591
241,591
586
11,410
6,621
1,028
23
3,727
4,158
19,788
3,819
10,508
1,326
33,851
8,939
3,727
454
373
561
119,905
22,341
5,610
21,730
3,184
322
1,523
2,579
3,143
2,235
2,234
1,712
910
7,942
536
4,610
869
13,036
6,184
739
26
2,608
5,058
14,689
3,092
10,322
1,264
33,990
9,015
2,608
605
439
1
460
111,739
23,939
5,838
22,864
3,141
295
1,588
2,579
3,141
1,421
1,421
877
851
6,930
424
311,415
292,053
* Under " Unclassified.' KK 110
BRITISH COLUMBIA.
Table VII.—Number of Tests performed by Branch
Laboratories in 1949.
Examination.
Kamloops.
Nanaimo.
Nelson.
Prince
Rupert.
Victoria.
Total,
1949.
Total,
1948.
65
49
129
36
65
1,428
705
40
194
Blood agglutination—
286
295
596
164
445
105
52
12
4
860
609
8
Cultures—■
15
461
266
2,638
2,638
597
461
282
2,745
2,792
597
76
1,934
6,306
439
37
116
15
313
20,113
16,416
729
2,623
154
464
698
665
526
2,130
1,968
948
1,028
2,586
185
214
Typhoid-paratyphoid-dysentery group
36
30
16
6
62
261
50
62
64
•     336
377
23
2,868
Haemolytie  staphylococci  and  strepto-
2,498
744
12
258
1,016
11
65
Direct microscopic examination for—
193
934
3
99
164
1,048
3,815
402
22
89
12
207
20,113
1,718
385
2,623
2,628
6,687
246
Treponema pallidum.. 	
15
65
8
9
10
3
75
126
Ringworm     ,„.
14
31
2,346
6
56
280
Serological tests for syphilis—
Blood—
3,915
205
16,944
7,029
133
1,408
17,860
215
2,770
Cerebrospinal fluid—
Kahn    ...    	
89
9
177
464
417
322
428
953
953
893
930
1,033
9
448
Cerebrospinal fluid—
99
88
41
76
14
49
123
65
63
114
49
104
97
135
22
6
8
310
310
727
Protein ...       	
536
559
Milk-
Bacterial count __ 	
688
691
2,309
2,202
Miscellaneous (phosphatase and reduc-
6
348
1,024
Water—■
98
755
111
582
327
2,647
367
Totals, 1949  	
Totals, 1948
4,495
5,822
6,858
6,257
11,756
11,659
2,761
3,338
43,715
40,658
69,585
67,734
Note.—Prince Rupert operations discontinued after August 31st, 1949. DEPARTMENT OF HEALTH AND WELFARE, 1949. KK  111
REPORT OF THE DIVISION OF VENEREAL
DISEASE CONTROL.
C. L. Hunt, Director.
INTRODUCTION.
The trend in venereal diseases in general shows a slight but definite decline
throughout the Province. The greatest and most gratifying improvement has
been shown in relation to syphilis, early infections having shown a decline of
over 50 per cent, in 1949 over 1948.
The figures for gonorrhoea have remained fairly steady. In Vancouver,
it has been felt that there remains a pool of infection which is difficult to
eradicate, and special efforts have been made by the epidemiological section of
the division, with the co-operation of the Vancouver City Police, to bring in all
suspects for examination. Many persons who are examined in this way show
doubtful symptoms but lack confirmation of gonorrhoea infection. In view of
the recognized difficulty in isolating the organism in many cases of chronic
infection, it has been decided to treat these patients on clinical and epidemiological evidence. It was realized that this would have an adverse effect upon
the statistical figures for the Province, but as a public health measure it was
felt to be justified. A certain number of these patients are now being diagnosed
as " non-specific " infections provided that extensive and repeated examinations
are negative for gonorrhoea, but treatment is given nevertheless.
Free diagnostic and treatment facilities continue to be given at the various
clinics of the division, while private physicians are making use of the free
consultative service provided at these clinics to an ever-increasing extent.
Particularly does this apply in the Vancouver area.
Free drugs for the treatment of venereal disease are available to all persons
in the Province through their physicians, as well as free consultative service
by letter or telephone whenever a physician requests it.
The co-operation of private physicians in notifying fresh cases of infection,
as well as in carrying out procedures recommended by the division, appears
to be improving, though there are still some areas in which difficulties occur.
TREATMENT.
A new treatment schedule for syphilis was drawn up in February, 1949,
and distributed to every physician and hospital in the Province. At that time,
the older prolonged courses of treatment with arsenic and bismuth were discontinued. Penicillin became the drug of choice in all stages of syphilitic infection, though this was followed in most instances by a short course of arsenic
and bismuth, since it was felt that in the present stage of our knowledge it
was unwise to discard completely the old, well-proven remedies.
Owing to the shortage of beds during the summer months there has been a
tendency to use, to an ever-increasing extent, the ambulatory form of treatment
with " delayed absorption " types of penicillin. Results with this method of
treatment appear to have been as effective as with the more inconvenient three-
hourly injections of aqueous penicillin. KK 112 BRITISH COLUMBIA.
Admission to hospital for treatment is now used almost exclusively for cases
of cardiovascular or neurosyphilis.
Treatment of gonorrhoea has undergone some modifications in the Vancouver Clinic. In view of the fact that a small percentage of patients with
gonorrhoea must be considered as having been contacts also to syphilitic infection, it was felt desirable in conformity with the most modern accepted practice,
to treat all gonorrhoea cases admitted to the Vancouver Clinic with 1.2 million
units of delayed-absorption type of penicillin. It is hoped that by this means a
cure will be effected in a certain number of syphilis cases in their incubation
stage, thus cutting down the spread of infection.
Intensive investigation is being carried out at the Vancouver Clinic on so-
called non-specific urethritis, but it will be some months before any definite
conclusions are available from this study.
Vancouver Clinic attendances are showing a steady decrease, even though
the number of patients brought in for investigation remains fairly constant.
This reflects the greater effectiveness of modern forms of treatment for venereal
disease.
Streptomycin is being used for treatment of resistant cases of gonorrhoea,
both in the clinics and by private physicians throughout the Province.
EPIDEMIOLOGY.
The epidemiological section of the Division of Venereal Disease Control is
responsible for directing and advising on problems relating to case-finding and
case-holding throughout the Province. There is a growing tendency, however,
to delegate an ever-increasing responsibility to health unit directors and public
health nurses in the field, who have indeed rendered valuable and efficient
service.
There has been most gratifying co-operation from the metropolitan authorities and from all the divisions of the Provincial Department of Health in all
matters relating to epidemiology.
Meetings continue to be held at intervals of three to four months for discussion of outstanding problems relating to the facilitation of the spread of
venereal diseases. Attendances at these meetings have been excellent and have
included representatives from the Vancouver and Victoria City Police Departments, the British Columbia Provincial Police, Indian Health Services, Department of National Health and Welfare, British Columbia Hotels Association,
Liquor Control Board, and the Vancouver City licence inspector, as well as the
senior medical health officers from Vancouver and Victoria. These discussions
have covered a wide field and have been most helpful to the division, as also has
been the co-operation shown throughout by the various individuals and groups
concerned.
In view of the moral and social factors underlying the spread of venereal
disease, it was decided to invite representatives of various religious denominations to the facilitation meetings in an endeavour to enlist their help. The
enthusiastic co-operation of the clergy in matters relating to venereal disease
control has been more than gratifying, and it is felt that much can be done by
them in attacking the problem in moral and social directions. DEPARTMENT OF HEALTH AND WELFARE, 1949. KK  113
Special mention should be made of the assistance given by the Vancouver
City Police Force, headed by Chief Constable Walter Mulligan, and by Detective-
Sergeant Fish and his morality squad. Their efforts, combined with the Male
and Female Diagnostic Clinics held in the Vancouver City Gaol, have been
responsible for the detection of a large number of cases which had lapsed from
treatment, as well as almost 8V2 per cent, of all the neiv cases of venereal disease notified among females each year throughout the Province.
Two blood-testing surveys were carried out during the year, as a result of
which a total number of sixty new syphilis cases were discovered out of 680
persons examined. As a result of this survey forty-nine patients were placed
on treatment.
SOCIAL SERVICE.
The role of the social service worker is assuming a place of steadily increasing importance in the venereal disease control programme.
It is appreciated that social factors, such as unhappy homes, poverty, frustration, loneliness, and many other forms of emotional stress, play a considerable part in contributing to promiscuous sexual relationship. In view of this,
every new patient reporting to the Vancouver Clinic is granted an interview
with a social service worker, by whom an attempt is made to detect and assess
any underlying social or psychological problem. Such problems are dealt with
at this level whenever possible, but certain of the more serious problem patients,
as well as habitual " repeaters," are referred to a psychiatrist for further
psychological investigation and, if necessary, treatment.
It is felt that the services rendered by the social service workers have been
of considerable value in many instances, while their work is affording some
insight into many of the underlying problems associated with promiscuous
sexual relationship, particularly in the Vancouver area.
EDUCATION.
The Division of Public Health Education is primarily responsible for
general public education in venereal diseases throughout the Province. There
has, however, been close liaison throughout with the Division of Venereal
Disease Control, the latter Division taking most of the direct responsibility in
the Vancouver area.
Much valuable assistance has been given by the Health League of Canada,
under whose auspices there has been a series of radio programmes on venereal
disease broadcast from local stations throughout the Province. These programmes have consisted of recordings made by Columbia University dealing
with venereal disease from various aspects.
Talks and discussions have been held with small lay groups from time to
time, as well as lectures to groups of students of nursing and social welfare and
to nurses engaged in industrial medicine.
There is a regular venereal disease instruction course for student nurses
at various training hospitals throughout the Province, which, in the case of the
Vancouver General Hospital, includes an intensive period of practical work in
the Vancouver Clinic. KK  114 BRITISH  COLUMBIA.
There has been a revision of the Reference Manual for Clinic Physicians,
incorporating recent developments in diagnosis and treatment, as well as a new
and revised edition of the booklet " Procedures and Services in Venereal Disease Control." A copy of this latter publication has been sent to every practising
physician in the Province. It gives information on criteria of diagnosis and on
the various services available to the private physician in the investigation and
treatment of venereal disease cases.
A booklet has been prepared setting forth various " Factors in Venereal
Disease Control," wherein an attempt is made to show the wider moral and
social implications which must be taken into consideration in any control programme—venereal disease and promiscuity being considered as symptoms of
much deeper faults in our social, moral, and educational systems.
At regular weekly clinical meetings held throughout the year, lectures have
been given and problems discussed by attending clinic physicians on matters
relating to venereal disease.
Papers were read by Dr. C. L. Hunt, Director of the Division of Venereal
Disease Control, at a meeting of the Vancouver Medical Association and at the
refresher course in medicine given at the Vancouver General Hospital on " The
Interpretation of Positive Blood Serology " and on " Penicillin in the Treatment of Syphilis " respectively.
One of the highlights in the educational field was the visit of Dr. John
Stokes, the world-renowned authority on venereal disease, for three days in
May. He devoted the entire period of his visit to the affairs of the Division of
Venereal Disease Control, giving valuable assistance and advice in diagnostic,
treatment, and administrative problems, as well as lectures to the Vancouver
Medical Association and at Medical Ward Rounds at the Vancouver General
Hospital. His visit proved highly educative and instructive, not only to physicians employed by the division but also to many outside physicians and public
health personnel.
The British Columbia Medical Centre Library has now been established in
the new building of the Division of Tuberculosis Control. A proportion of the
necessary funds has been made available by the Division of Venereal Disease
Control for its foundation and operation, the Director of the division having
been made a member of the library committee. There is thus some assurance
that adequate up-to-date literature on venereal disease is available for both
medical graduates and for those in training.
The Director of the division has made various journeys to other centres
and outlying areas of the Province for the purpose of discussing with medical
groups and individual practising physicians any outstanding problems relating
to venereal disease. It is felt that these visits have been particularly helpful
in establishing good-will as well as in clarifying problems on both sides.
Visits have also been made by the Director and by the consulting syphilolo-
gist to this division to other venereal disease centres for the purpose of exchanging information in an endeavour to improve the services offered by our own
division.
Projects have also been approved and funds provided through Federal
health grants for special training of medical and nursing personnel in public
health and venereology at approved schools in the United States. DEPARTMENT OF HEALTH AND WELFARE, 1949. KK 115
Mention should be made of the excellent paper read by Chief Constable
Walter Mulligan, of the Vancouver City Police Force, at the Chief Constables'
Convention at Windsor, Ontario, in September. This paper, describing the part
played by the Vancouver City Police in co-operating with the Division of
Venereal Disease Control, has been widely read and approved by health authorities throughout Canada and has served as a pattern for similar efforts in other
centres.
GENERAL.
The physician in charge of clinics attended the Conference of Provincial
Directors of Venereal Disease Control, which was held in Ottawa in February.
This conference was concerned primarily with administrative problems, with an
endeavour to bring some measure of uniformity into general Provincial policies.
Figures were produced at this meeting to show that approximately 10 per
cent, of new cases of venereal disease notified in British Columbia were transient
persons or persons who had been diagnosed elsewhere prior to taking up residence in British Columbia.
The need for new and more convenient quarters for the division is becoming
ever more urgent, frequent minor repairs being needed to keep the present
premises fit and safe for occupation.
Owing to difficulties engendered by the poliomyelitis epidemic during the
summer, all beds normally placed at the disposal of this division for the treatment of venereal disease cases were unavoidably surrendered for the emergency
period.
There have been some changes in personnel in all branches of the division,
notably the transfer of Dr. G. R. F. Elliot from the position of Director to that
of Assistant Provincial Health Officer. Every good wish goes with him to his
new fields, which, fortunately at present, are not far removed. His inimitable,
driving personality as well as his wise counsel and advice will be sadly missed,
but will fortunately, still be available to the division when the need arises.
The division has been fortunate in adding to the full-time medical staff a
well-qualified physician, who holds his diploma in public health, and who has
taken over the duties of physician in charge of clinics, the previous holder of
that title having now assumed the directorship, following Dr. Elliot's transfer.
Following upon the resignation of Miss Jean Gilley, Miss I. Dryden has
been appointed branch secretary to the division. Her wide knowledge and
experience should prove valuable to the division.
Miss Alice Beattie, senior epidemiologist, has been given a year's leave of
absence in order to take up her studies for a higher degree in public health
nursing at Washington State University.
Miss Enid Wyness, senior social service worker with the division has
returned from the university at Portland, Oregon, where she has been engaged
in a postgraduate course in social studies.
Federal grants, which have made many of these educational projects possible, have done much to augment and improve the efficiency of the venereal
disease control programme in this Province.
Finally, an expression of deep appreciation is due especially to all those in
other divisions and departments whose generous and unstinted co-operation has
been responsible for the successful operation of this division, especial mention
being made of the Deputy Minister of Health, whose generous help and understanding have ever been a constant source of encouragement. KK 116 BRITISH COLUMBIA.
REPORT OF THE DIVISION OF TUBERCULOSIS
CONTROL.
W. H. Hatfield, Director.
INTRODUCTION.
The Division of Tuberculosis Control has made some advances in its programme during 1949, but has continued to work under the serious handicap of
lack of sufficient beds. It had been hoped that the new sanatorium planned for
Vancouver would be started during the year, but this hope has not been fulfilled.
It is now expected that it will be sometime in the spring of 1950 before construction gets under way. The other facilities of the division have now been
quite well rounded out, but until an adequate number of beds is available for the
treatment of all the tuberculous patients who require hospital care very little
further progress can be made in the control of this disease.
The most outstanding improvement within the division during the year
was the opening of the new surgical and teaching facilities at the Vancouver
Unit. This has provided the division with the most up-to-date surgical facilities
to bring to the patient every modern method of therapy. This addition has
shown the place it can play in the teaching programme of doctors, nurses, and
lay people interested in health work, and the improved set-up for surgery will
allow full opportunities for the newer developments in chest surgery to be
offered to the tuberculous patients in this Province.
At Tranquille further improvements in the physical plant were made
during the year.
Considerable thought has been given to the expenditure of money coming
to the Province under Federal health grants. Projects continued from the
previous year were occupational therapy for out-patients, home-care service,
medical library, postgraduate training for members of the medical and nursing
staff.
During 1949, expansion in services of the division provided by these grants
was as follows:—
Additional staff:  Senior interne, Vancouver Unit; nursemaids, Vancouver Preventorium; instructor in tuberculosis nursing; senior
executive nurse, surgical department, Vancouver Unit.
Payment for the administration of streptomycin.
Payment for admission X-rays in general hospitals.
Rehabilitation programme.
Clinical research in electrocardiography.
In-service training.
The problem of obtaining properly trained medical personnel still remains
with us. It would appear that the main reason for this is the low salary range
paid by the Department for specialists. All our institutions have been somewhat understaffed from the standpoint of physicians, and it has not been possible to carry out anything except the most essential consulting service in the
rural areas. It has been previously recommended that there should be a complete review of medical salaries, and it is hoped that some action will be taken
in this regard this year. DEPARTMENT OF HEALTH AND WELFARE, 1949. KK 117
Despite the handicap of insufficient beds, there is still some improvement
in the over-all tuberculosis picture in the Province. The total death rate shows
a further drop, although when this is broken down into racial groups it is found
that there is some slight increase in the white death rate. It is to be noted
further, when this is analysed, that the increase is in the group between 60 and
80 years of age.
The number of new cases discovered during the year amounts to 2,201,
which is an increase over last year. This broken down into racial groups shows
the following: Indians, 577; other than Indians, 1,624; and into age-groups:—
Indians. Other than Indians.
0- 4  79                  0- 4  48
5- 9  94                  5- 9  42
10-14  96                10-14  33
15-19  75                15-19  71
20-24  45                20-24  169
25-29  33                25-29  216
30-39 -.__. 46                30-39  300
40-49  45                40-49  229
50-59   22                50-59  214
60-69  23                60-69  189
70-79  10                70-79  82
80 over  3                80 over  13
Not stated  6               Not stated  18
During the year, an assessment has been made of the methods of case-
finding and it is planned to make considerable changes in this regard during
1950. It has been decided to eliminate the mass X-ray survey programme as
presently being carried out by the division and in its place to install X-ray
equipment in general hospitals and local health units so that rather than
sporadic mass X-ray surveys there will be available X-ray facilities on a
day-by-day basis. The responsibility then of the case-finding programme is
transferred where it logically belongs—to local health services. It is further
planned to carry out fairly extensive tuberculin-testing programmes in certain
areas in an endeavour to establish the present incidence of infection for comparison with previous large tuberculin-testing surveys.
The rehabilitation programme which was initiated by the British Columbia
Tuberculosis Society as a demonstration was taken over during the year by the
Division of Tuberculosis Control, this being made possible by the Dominion
health grants.
During the year, the division was pleased to have a number of visitors
from various centres throughout the world, a number of whom spent some time
here looking into our methods of tuberculosis control. These visits usually
proved to be mutually advantageous.
A number of the doctors of the division attended scientific meetings during
the year, and seventeen papers were prepared for presentation at these meetings.
CLINICS.
The number of clinics operated by the division remains the same, but the
extent of the work within these clinics continues to grow and some of them are KK  118 BRITISH COLUMBIA.
becoming distinctly overcrowded. More space is required in both the Vancouver
and New Westminster Clinics. Travelling clinic work has continued to be
carried on mainly by X-ray technicians. A considerable number of X-rays
have been taken throughout the Province and were referred to our main
centres for interpretation. This is not a satisfactory consultative service and
can be made satisfactory only by obtaining specialists who are able to travel
to the patient and consult with local physicians.
During 1949, 197,096 people were X-rayed in the survey clinics. It is
expected that with the new programme at least an equal number will be X-rayed
and that some of the groups that are now missed will be examined. In the mass
X-ray surveys, it has been noted that there are a fair number of people with
heart-disease found. A study made during the year uncovered approximately
four times as much heart-disease as tuberculosis.   This is being studied further.
Of the 197,096 persons examined in survey clinics, 3,196 or 1.6 per cent,
were referred to diagnostic clinics, which is lower than the previous year. Of
the group referred for further study, 524 or 16.4 per cent, were diagnosed as
tuberculous. These tuberculous diagnoses were as follows: Primary, 2.9 per
cent.; minimal, 68.7 per cent.; moderately advanced, 24.2 per cent.; far
advanced, 4.2 per cent.
There were 41,203 examined in the diagnostic clinics, which is an increase
over the previous year. The out-patient pneumothorax work remains about the
same with 10,993 refills given. The total number of examinations, including
both survey and diagnostic clinics, was 238,299. Including out-patient treatments, the total number of patient-visits to all clinics and survey units was
248,701, which is an increase from the previous year of 17,580.
INSTITUTIONS.
Certain improvements were made in existing institutions during the year.
Some of these have already been mentioned. The most notable improvement
was in Vancouver, with the opening of the institute provided by the British
Columbia Tuberculosis Society through Christmas seals.
At Tranquille the new home for nurses was opened and is proving a valuable addition. Alternating current has been made available and a new telephone
system with a private switchboard installed. Windows have been placed in the
porches throughout the infirmary building, allowing patients to use this part of
the building during the winter. One section of two porches has been renovated
to form two wards, giving accommodation for nine patients instead of five. It
is planned to continue with the alterations in this building during the forthcoming year. New furniture has been supplied throughout the staff quarters,
which has made a great difference in the appearance of the accommodation and
in the comfort of the employees. The administration building has been remodelled throughout and is now a modern office building. Over a mile of
cement sidewalks has been laid and there has been a considerable addition to
the hard-surfaced roads at the institution. There are further much-needed
improvements which have been planned at Tranquille, and it is hoped that at
least some of these will be accomplished during 1950.
It had been hoped that the new sanatorium would at least have been started
during 1949, but there were continued delays and not until the end of the year DEPARTMENT OF HEALTH AND WELFARE, 1949. KK 119
had the specifications been finally written. It is expected that the plans will go
out for tender the first of the year.
Unfortunately, it is necessary to once again report that St. Joseph's Oriental
Hospital, which is considered by the division to be an unsatisfactory hospital for
the care of tuberculous patients, is still in operation.
During the year, due to the epidemic of poliomyelitis, it was necessary for
the division to remove its patients from the Vancouver Isolation Hospital for a
period of fourteen weeks. This deprived us of thirty-five beds during this time
and was a very disturbing situation to many patients.
NURSING SERVICE.
Tuberculosis nursing, like other specialties and nursing generally, is in a
transitional stage due to the current changes and expanding needs. Encouraging progress is noted as the year's activities are reviewed.
The nursing department will benefit from projects under the Dominion
health grant plan. Three senior nurses are taking postgraduate courses, and
provision is made for the establishment of two new nursing positions at the
Vancouver Unit. These are a supervisor for the new surgical unit and a second
instructor for the affiliation course in tuberculosis nursing. The expansion in
the teaching department is necessary due to the increased number of affiliate
and postgraduate students and to the reorganization of the curriculum and
clinical assignment of the course. The closer integration of theory and practice
throughout the course has resulted in a more confident approach and greater
satisfaction and interest in tuberculosis nursing on the part of the students.
Isolation technique is standardized in the various units except for a few
minor adaptations to suit local conditions.
Completion of the definition of nursing positions by the Civil Service Commission will be helpful to the Provincial and local administration for purposes
of recruitment and placement. Although the quota of nurses varies, particularly
at Tranquille, the nursing service in all of the units met the demands without
serious curtailment or closing of beds. A considerable number of nurses have
come to British Columbia during the past year, but shortages are general and
still acute, particularly in rural and small-town areas.
As there has been an increasing tendency for nurses to be interested in
surgical rather than medical wards, increased attention is being given to showing the interest and value of nursing care in the non-surgical case.
SOCIAL SERVICE.
During the past year the staff situation improved and, although there were
several changes in social service staff, the numbers remained up to strength.
There have been three major developments due to the Federal health grants
which have affected the social service work. The first was the appointment to
the division of a full-time rehabilitation officer, who works very closely with the
social workers and has given a great deal of help in the work done with the
patients. The second was the appointment of a full-time occupational therapist
to the Metropolitan Health Committee staff. Occupational therapy in the home
is now an additional resource for patients when they leave hospital. The third
development is the establishment of a proper home-making service for tuber- KK  120 BRITISH COLUMBIA.
culous patients. The money for this service was granted to the Metropolitan
Health Committee, but the actual service is administered by the Family Welfare
Bureau. Members of the social service department act on the technical advisory
committee. The social workers feel that they benefit from the plan almost as
much as the patients, as the time and energy that used to be spent on make-shift
plans can now be used in other ways. At the end of the year, there were seven
full-time home-makers and four part-time home-makers in patients' homes.
BUDGET.
There will be no increase in the services rendered by the Division of Tuberculosis Control during the ensuing year. Any increase in budget is due to
factors beyond the control of this division, such as increased commodity prices,
increased wages, and cost-of-living bonus.
CONCLUSION.
As has been reiterated on previous occasions, the great need of the Division
of Tuberculosis Control is increased bed accommodation. When this is provided,
the programme of the division will be well rounded out. The other great problem is obtaining properly trained physicians, and this cannot be solved until
the salary situation with reference to physicians is altered.
The voluntary agency continues to play an important part in the tuberculosis programme in the Province of British Columbia. There has been complete co-operation between the division and the British Columbia Tuberculosis
Society, and much has been achieved which would not have been possible without the Society. It is felt that the private agency still has an important place
in a programme such as that of the Division of Tuberculosis Control.
VICTOBIA, B.C.:
Printed by Don McDiabmid, Printer to the King's Most Excellent Majesty.
1950.
745-350-7286

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