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PROVINCE OF BRITISH COLUMBIA Division of Venereal Disease Control Department of Health and Welfare ANNUAL… British Columbia. Legislative Assembly 1951

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 PROVINCE OF BRITISH COLUMBIA
Division of
Venereal Disease Control
Department of Health and Welfare
ANNUAL REPORT
For the Year 1949
VICTORIA,  B.C. :
Printed by Don McDiarmid, Printer to the King's Most Excellent Majesty.
1950.  TABLE OF CONTENTS.
Page.
1. List of Tables  4
2. List of Charts  4
3. Organization Chart  5
4. Introduction  7
5. Treatment  7
6. Epidemiology  8
7. Social Service  9
8. Education  9
9. General  10
10. Statistical Section  12 STATISTICAL SECTION.
LIST OF TABLES.
Table. Page.
I. New Notifications of Venereal Infection and Rate per 100,000 Population,
1940 to 1949, inclusive  13
II. New Notifications of Venereal Infection compared with Reported Cases of
certain other Notifiable Diseases in Canada, British Columbia, and
Greater Vancouver, 1949 . -  14
III. New Notifications of Venereal Infection classified according to Diagnosis,
Sex, and Source of Reporting of Notifications, British Columbia, 1949 15
IV. New Notifications of Venereal Infection classified according to Diagnosis,
Sex, and Age-groups, British Columbia, 1949  17
V. New Notifications of Syphilis by Age and Sex, British Columbia, 1949  19
VI. New Notifications of Gonorrhoea by Age and Sex, British Columbia, 1949 — 20
VII. Rate per 100,000 Population for Total Venereal Disease by Age-groups,
British Columbia, 1941 to 1949, inclusive  21
VIII. New Cases of Syphilis reported in British Columbia by Age-groups and
Marital Status, 1949  21
IX. Total Primary and Secondary Syphilis, British Columbia, 1948  22
X. Total Primary and Secondary Syphilis, British Columbia, 1949  22
XL New Notifications of Venereal Infection classified according to Diagnosis
and Place of Residence, British Columbia, 1946 to 1949, inclusive  23
XII. Patient Visits at all Clinics of the Division of Venereal Disease Control
classified according to Diagnosis, for the Years 1940 to 1949, inclusive 29
XIII. Report of Laboratory Work done by the Division of Laboratories, 1946 to
1949, inclusive  30
XIV. Free   Medications   distributed  to   Private   Physicians   by  the   Provincial
Department of Health  and Welfare for the Treatment of Venereal
Diseases, British Columbia, 1935 to 1949, inclusive  32
XV. Places of Meeting reported as facilitating the Spread of Venereal Diseases,
1945 to 1949, inclusive  33
XVI. Places of Exposure reported as facilitating the Spread of Venereal Diseases,
1945 to 1949, inclusive  33
XVII. Contacts to Venereal Infection classified according to Investigating Agency
and Result of Investigation, British Columbia, 1949  34
XVIII. Contacts to Venereal Infection classified according to Investigating Agency
and Result of Examination, British Columbia, 1949  3.5
LIST OF CHARTS.
Chart.
I. New Notifications of Venereal Infection and Rate per 100,000 Population by
Diagnosis, reported by all Agencies, British Columbia, 1940 to 1949,
inclusive r  12
II. New Notifications of Syphilis by Age and Sex, British Columbia, 1949  19
III. New Notifications of Gonorrhoea by Age and Sex, British Columbia, 1949.... 20
IV. Patient Visits at all Clinics of the Division of Venereal Disease Control
classified according to Diagnosis, for the Years 1940 to 1949, inclusive 29
V. Free   Medications   distributed   to   Private   Physicians   by  the   Provincial
Department of Health  and Welfare for the Treatment  of Venereal
Diseases, British Columbia, 1935 to 1949, inclusive  31 X
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5  DIVISION OF VENEREAL DISEASE CONTROL.
ANNUAL REPORT FOR THE YEAR 1949.
C. L. Hunt, M.D., 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 cooperation 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 " nonspecific " 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 diseases are available to all physicians
throughout the Province, 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" type  of penicillin.    Results  with this  method  of treatment D   8 DEPARTMENT  OF  HEALTH AND  WELFARE.
appear to have been as effective as with the more inconvenient three-hourly injections
of aqueous penicillin.
Admission to hospital for treatment is now used almost exclusively for cases of
cardiovascular syphilis 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
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 diseases.
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 on the part of the metropolitan as
well as Provincial public health authorities 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 diseases,
it was decided to invite to the facilitation meetings representatives of various religious
denominations 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.
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 Police Court, 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. VENEREAL DISEASE   CONTROL REPORT,  1949. D   9
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 relationships. 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 relationships,
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 diseases
broadcast from local stations throughout the Province. These programmes' have consisted of recordings, made by Columbia University, dealing with venereal diseases
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 also an intensive period of practical work in the Vancouver Clinic.
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 Vanereal Disease Control." A copy
of this latter publication has been sent to every practising physician in the Province,
and gives information on criteria of diagnosis as well as 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 diseases
and promiscuity being considered as symptoms of much deeper faults in our social,
moral, and educational systems.
Regular weekly clinical meetings have been held throughout the year, where
lectures have been given and problems discussed by attending clinic physicians on
matters relating to venereal diseases.
Papers were read by Dr. Hunt at a meeting of the Vancouver Medical Association
and at the refresher course in medicine given at the Vancouver General Hospital on D  10 DEPARTMENT OF HEALTH AND WELFARE.
" 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 diseases, 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 diseases 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 diseases.
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 syphilologist
of 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.
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, Ont., 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 VENEREAL DISEASE  CONTROL REPORT, 1949. D  II
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. Elliott's transfer.
Following upon the resignation of Miss Jean Gilley, Miss Dryden has been appointed
branch secretary to the Division. Her wide knowledge and experience should prove
valuable to the Division.
Miss 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 Wyness, senior social service worker with the Division, has returned from
the university at Portland, Ore., 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. D  12
DEPARTMENT OF  HEALTH AND WELFARE.
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DEPARTMENT  OF  HEALTH AND  WELFARE.
The figures for total venereal-disease cases reported in this Province for 1949 show
no appreciable change over the preceding year. This is considered to be due to the
special efforts made in case-finding during this period, as well as to the policy of treating as suspected gonorrhoea many cases in whom the infection could not be definitely
proved.
Treatment is inexpensive, harmless, simple, and effective, and where reasonable
suspicion exists, its use is felt to be justified as a public-health measure. This policy
has resulted in an increase of 2.4 per cent, in the total number of cases of gonorrhoea
reported, though the rate per 100,000 has fallen slightly.
The figures for infectious early syphilis (primary and secondary) show a gratifying decrease of 41.8 per cent, over 1948, only 139 cases being reported in all.
Blood-testing surveys have been carried out among comparatively large, selected
groups. This has led to the detection of approximately fifty freshly diagnosed cases of
syphilis in its later forms. In spite of this, there has been a slight decrease in the
figures for late (other) syphilis reported during the year.
It is hoped that with a maintenance of our present efforts at case-finding, and the
effective treatment of early infection, the late crippling forms of syphilis, with their
considerable expense to the community, will ultimately be almost eradicated in this
Province.
A slight increase in reported cases of " other venereal diseases " is noted. This is
due to a temporary arrangement at the Vancouver Clinic, whereby non-specific urethritis is being investigated and treated as a venereal disease. This is being done in
order to determine the predominating causative factors and the most effective means
of treating these conditions.
TABLE II.—NEW NOTIFICATIONS OF VENEREAL INFECTION COMPARED
WITH REPORTED CASES OF CERTAIN OTHER NOTIFIABLE DISEASES
IN CANADA, BRITISH COLUMBIA, AND GREATER VANCOUVER, 1949. .
Notifiable Disease.
Canada.
British
Columbia.
Greater
Vancouver.
59,908                 10,765
49,080                   7,370
25,941        i         4,683
25,676                   4,314
13,276                   2,202
9,088                       491
8,222                       214
2,186
3,360
2,795 VENEREAL DISEASE CONTROL REPORT, 1949.
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2,513
1,181
2,237
1,389
848
1,952
1,254
698
107
72
35
40
22
18
105
25
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24
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3,019
1,505
2,555
1,605
950
2,211
1,429
782
129
85
44
45
25
20
127
44
83
34
22
12
9
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1,786
1,280
506
39
32
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Eh D  16 DEPARTMENT OF HEALTH AND WELFARE.
A decrease of 10 per cent, is shown in the number of cases of venereal disease
reported by private physicians. On the other hand, cases reported by the clinics have
shown an increase of nearly 7 per cent., almost all of which increase was reported from
the Vancouver Clinic. This is a measure of the blood-testing survey results and
extra-investigative procedures being carried out at this clinic during the past year.
In view of these figures, it will be observed that there has been a change in the
relative proportion of cases notified by clinics and by private physicians, the figures
being 56.5 per cent, and 39.5 per cent, respectively. It is not felt that there has been
any falling-off of notifications of venereal disease by private physicians.
There has been an over-all decrease of 14 per cent, in the total number of syphilis
cases reported. It will be noted, however, that there has been a slight increase in both
cardiovascular syphilis and neurosyphilis. This increase is evident in the figures
reported by both clinics and private physicians, and may be due partly to an improvement in the use of diagnostic facilities.
Treatment given early in the course of cardiovascular syphilis is generally
considered to be effective in arresting the progress of the disease, while its results
are disappointing in those cases where extensive structural damage has occurred.
In view of this, special efforts are being made to detect and treat the condition in its
early stages.
Neurosyphilis is also being discovered to an increasing extent in its asymptomatic
(early) stages by the greater frequency with which physicians are carrying out
examination of the cerebrospinal fluid.
The incidence of prenatal syphilis has not materially changed, and efforts are being
made to encourage the carrying-out of prenatal blood tests on all women in pregnancy.
No cases of ophthalmia neonatorum were reported in 1949. VENEREAL DISEASE  CONTROL REPORT, 1949.
D 17
TABLE IV.—NEW NOTIFICATIONS OP VENEREAL INFECTION CLASSIFIED ACCORDING TO DIAGNOSIS, SEX, AND AGE-GROUPS, BRITISH
COLUMBIA, 1949.
,_■
Gonorrhoea.
Syphilis.
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Totals        	
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M.
4,524
3,019
3,694
2,513
3,694
2,513
771
451
100
75
39
19
110
50
293
156
52
39
119
80
21
16
22
10
15
6
30
26
29
20
F.
1,505
1,181
1,181
320
25
20
60
137
13
39
5
12
9
4
T.
4
4
....
4
M.
3
3
....
3
F.
1
1
....
1
T.
6
6
6
M.
4
4
....
4
F.
2
2
2
T.
7
5
5
2
2
M.
F.
7
5
5
2
2
...
....
T.
7
5
5
2
1
1
M.
1
1
1
....
F.
6
4
4
2
1
1
T.
338
300
300
35
11
3
14
2
4
1
1
2
M.
128
115
115
10
3
5
1
....
1
1
2
F.
210
185
185
25
8
3
9
1
4
T.
1,281
1,189
1,189
80
26
4
28
16
3
3
7
5
M.
802
753
753
38
18
1
11
5
3
6
5
F.
479
436
436
42
8
3
17
11
3
1
T.
M.
943
661
864
618
864
618
72
36
17
15
9
4
24
9
18
7
4
1
""
7
7
F.
282
246
246
36
2
5
15
11
3
T.
492
415
415
65
19
7
12
19
1
4
1
1
1
6
6
M.
376
324
324
40
17
6
6
7
1
2
1
6
6
F.
116
91
91
25
2
1
6
12
2
1
1
T.
M.
360
254
292
217
292
217
63
33
4
3
2
1
10
5
26
12
1
13
9
....
2
2
5
1
2
1
3
3
F.
106
75
75
30
1
1
5
14
1
4
....
4
1
T.
M.
267
189
199
148
199
148
61
34
3
3
5
3
2
1
27
12
2
2
18
11
2
1
1
1
1
3
3
4
4
F.
78
51
51
27
2
1
15
....
7
1
1
....
T.
M.
189
143
116
96
116
96
65
40
4
3
1
1
8
4
31
19
4
3
16
10
1
6
5
2
2
F.
46
20
20
25
1
4
12
1
6
1
1
T
134
69
69
61
4
1
1
33
4
15
2
1
4
M.
101
60
60
38
4
1
20
'3
8
1
1
3
F.
33
9
9
23
1
13
1
7
1
1
T.
88
36
36
51
1
1
1
24
8
12
3
1
1
M.
67
33
33
33
1
1
14
2
11
3
1
1
F.
21
3
3
18
1
....
10
6
1
T.
92
28
28
64
3
1
2
26
13
16
3
M.
72
26
26
46
2
1
2
15
12
12
2
....
F.
20
2
2
18
1
11
1
4
1
T.
52
9
9
43
1
27
8
5
?.
M.
41
9
9
32
....
1
18
6
5
2
....
F.
11
11
9
2
T.
26
5
5
21
1
11
3
4
?
M.
24
4
4
20
1
11
3
3
2
F.
2
1
1
1
1
T.
13
2
2
11
1
5
4
1
M.
13
2
2
11
1
5
4
1
....
F.
-
T.
M.
4
4
2
2
2
2
2
2
2
2
....
F.
	
....
T.
M.
221
136
158
105
158
105
63
31
7
5
4
1
6
4
28
10
4
3
9
5
2
1
1
2
2
F.
85
53
53
32
2
3
2
18
1
4
1
1
....
Source: Notifications of Venereal Infection, Form N.l. D 18 DEPARTMENT OF HEALTH AND WELFARE.
The highest age incidence of venereal infection still remains in the 20-29 age-
group, with a slight preponderance between the ages of 20 and 24.
The proportion of males to females infected in each age-group remains almost
identical through the years and reveals an interesting pattern:—
Before the age of 20, females exceed males in the proportion of approximately
2:1.
After the age of 20, this ratio is reversed, with males predominating, the proportion gradually increasing in later years to 3:1 or more.
The figures for early infectious syphilis appear to follow this same trend, while
in the latent stages, females show a slight preponderance throughout, thus reflecting
the fact that early syphilis is more difficult to diagnose, and may therefore pass undetected, in the female.
This difficulty in diagnosis may also be a factor in the apparently lower incidence
of gonorrhoea in the female after the age of 20, and raises the question as to whether
this may be responsible for maintaining the high incidence of infection in males.
If this is so, it might be considered desirable to treat all females on suspicion, as
well as known contacts, even though no bacterial evidence is forthcoming.
Tertiary syphilis still remains predominantly a male complication in the later
age-groups.
The figures for prenatal syphilis remain approximately the same as for 1948,
though there appears to be a tendency for a greater number of the cases to be
diagnosed within the first nine years of life than previously. VENEREAL DISEASE  CONTROL REPORT, 1949.
D  19
CHART II.—NEW NOTIFICATIONS OF SYPHILIS BY AGE AND SEX,
BRITISH COLUMBIA, 1949.
LEGEND
MALES              ■§■
FEMALES          EMni
1
1
1
1
1
]
I
jj
■0   m   m M
0-4 5  -9 10-14       15-19       20-24    25-29     30-34    35-39      40-44    45-49    50-54      55-59      60-64    65-69     70 8
OVER
AGE    GROUPS
TABLE V.—NEW NOTIFICATIONS OF SYPHILIS BY AGE AND SEX,
BRITISH COLUMBIA, 1949.
Age-group.
Male.
Female.
Age-group.
Male.
Female.
451
3
4
10
38
36
40
320
1
2
2
2
25
42
36
25
33
34
40
38
33
46
32
33
31
30
27
25
23
18
18
11
1
32
The preponderance of males over females suffering from all forms of syphilis is
steadily declining.    The ratio was 2.4:1 in 1947, 1.57:1 in 1948, and 1.2:1 in 1949.
There is still a slight preponderance of females in the earlier age-groups (up to
25 years), but this is offset in the total figures by the larger number of males showing
late manifestations of syphilis in the older age-groups. D 20
DEPARTMENT  OF HEALTH AND WELFARE.
CHART III.—NEW NOTIFICATIONS OF GONORRHOEA BY AGE
AND SEX, BRITISH COLUMBIA, 1949.
CASES
1,000
LEGEND
males          am
FEMALES          F^\
i~
j
0-4 5-9 10-14        15-19       20-24      25-29     30-34      35-39      40-44     45-49     50-54      55-59     60-64     65-69       70 &
OVER
AGE       GROUPS
TABLE VI.—NEW NOTIFICATIONS OF GONORRHCEA BY AGE
AND SEX, BRITISH COLUMBIA, 1949.
Age-group.
Male.
Female.
Age-group.
Male.
Female.
Totals..
Under 1 year..
1- 4 years	
5- 9 years	
10-14 years	
15-19 years	
20-24 years	
25-29 years	
30-34 years	
1
115
753
61.8
324
185
436
246
91
35-39 years..
40-44 years..
45-49 years..
50-54 years..
55-59 years..
60-64 years..
65-69 years..
70 and over..
Not stated....
217
148
96
60
33
26
9
75
51
20
9
3
2
1
53
This table shows the preponderance of males over females suffering from
gonorrhoeal infections in all ages, with the exception of the ages 15-19 when females
predominate.
The ratio of males to females has diminished slightly over the past year, being
now 2.1:1 as against 2.6:1 in 1948. This has been due in some measure to a slight
increase in the number of female infections reported. VENEREAL DISEASE  CONTROL REPORT, 1949.
D  21
TABLE VII.—RATE PER 100,000 POPULATION FOR TOTAL VENEREAL DISEASE BY AGE-GROUPS, BRITISH COLUMBIA, 1941 TO 1949, INCLUSIVE.
Age-group.
1941.
1942.
1943.
1944.
1945.
1946.
1947.
1948.
1949.
25
24
21
23
29
35
25
16
9
24
19
26
17
23
24
20
10
8
35
23
24
43
19
33
9
12
10
231
326
385
616
637
709
697
523
459
821
1,046
1,133
1,383
1,525
2,069
1.921
1,413
1,451
690
770
843
953
1,039
1,547
1,306
1,036
1,012
552
619
598
619
751
986
689
555
542
499
518
543
534
699
737
607
495
454
412
375
474
573
586
565
474
361
379
271
249
272
337
446
457
438
308
307
246
265
218
309
307
292
325
238
230
.   184
133
193
196
211
232
234
141
148
149
188
141
183
188
215
208
119
162
166
113
80
106
169
157
172
100
111
73
83
74
61
53
83
81
62
64
336
392
415
508
553
677
575
419
406
0- 4 years
5— 9 years
10-14 years.
15-19 years
20-24 years.
25-29 years.
30-34 years.
35-39 years.
40-44 years.
45-49 years.
50-54 years
55-59 years
60-64 years
65-69 years.
70 and over.
All ages	
There is a remarkable similarity between the rates in the various age-groups in
1948 and 1949.   This is true for all age-groups.
The peak rates lie between the ages of 20 and 30, as noted in previous years.
A hitherto unrecorded analysis of these figures indicates that this is largely accounted
for by the high incidence of new infections—principally gonorrhoea—acquired at this
time of life.
A reference to Table VIII indicates that infections in this group predominate
extensively in males who are not bound down by the marriage tie. Moreover, this is
the age of greatest sexual activity in the majority of individuals. These two factors
are probably largely responsible for the preponderance of venereal infection in this
age-group.
There is a marked influence upon the rate of infection in single persons where the
figures are included for widowed, divorced, and separated individuals.
TABLE VIII.—NEW CASES OF SYPHILIS REPORTED IN BRITISH COLUMBIA
BY AGE-GROUPS AND MARITAL STATUS, 1949.
Single.
Unmarried.*
Married.
Age-group.
Male.
Female.
Male.
Female.
Male.
Female.
No.
Rate.
No.
Rate.
No.
Rate.
I
No.       Rate.
No.
Rate.
No.
Rate.
15-19	
20-24	
25-29	
30-34	
7     |       18.9
23 1       79.5
24 j     113.2
18    ]    141.7
14    j    152.2
12    |    164.4
11 1    193.0
4    j      76.9
9    |    160.7
12 j    214.3
6    1    120.0
22
21
12
4
3
1
2
1
64.5
82.0
91.6
52.6
63.8
32.3
90.9
55.6
7
28
26
21
16
16
15
9
16
22
12
18.9     !     22     j       64.8
79.3     ]     25     j       95.8
119.3 |     17     !     118.9
155.6          10    [    105.3
• 155.3    j      8    [    109.6
181.8     j       8     1     133.3
205.5    |    11    |    189.7
126.8    |      8    j    129.0
195.1    |      5    I       68.5
244.4 j      7    [      83.3
133.3    !      4    1      47.1
2
10
7
19
16
18
24
27
16
19
16
1,000.0
133.0
29.4
59.9
54.1
63.6
93.8
112.5
65.8
84.1
88.4
3
15
19
14
22
17
14
15
11
11
6
130.4
77.3
57.1
38.8
35-39        	
68.5
40-44	
62.3
45-49	
50 54
61.1
71.8
55-59     	
55.8
60-64	
65-69     	
65.5
53.1
1
* Includes single, widowed, divorced, and separated. D 22
DEPARTMENT OF HEALTH AND WELFARE.
TABLE IX.—TOTAL PRIMARY AND SECONDARY SYPHILIS,
BRITISH COLUMBIA, 1948.
(Age specific rates per 100,000.)
Age-group.
Male.
Female.
Number.
Rate.
Number.
Rate.
15-19	
20-24	
25-29	
30-34..              	
7
35
26
24
17
10
8
7
4
5
1
2
18.7
79.5
59.1
54.4
44.6
27.5
25.2
23.0
12.2
15.8
3.8
5.7
17
18
13
8
6
5
1
3
46.8
39.1
27.7
17.8
35-39.                 	
16.1
40^14	
45-49    .           	
15.6
3.6
50-54	
11.2
55-59	
60-64	
65-69	
TABLE X.—TOTAL PRIMARY AND SECONDARY SYPHILIS,
BRITISH COLUMBIA, 1949.
(Age specific rates per 100,000.)
Age-group.
Male.
Female.
Number.
Rate.
Number.
Rate.
15-19            	
3
19
19
23
4
6
4
4
1
3
8.1
44.4
41.7
50.9
10.0
16.2
12.2
12.9
3.1
9.5
11
11
7
3
2
2
1
1
1
1
30.1
24.2
14.7
20-24	
25-29	
30-34	
35-39	
40-44	
6.0
3.5
3.7
3.7
4.0
45-49	
50-54    	
55-59 .-...
60-64	
65-69	
These tables well illustrate the over-all reduction in the primary and secondary
syphilis rates. Particularly marked is the reduction in the two age-sex groups which
formerly showed the highest susceptibility to early infection—namely, males between
20 and 24 years in whom the rate is reduced from 79.5 to 44.4, and females between
15 and 19 years with a reduction from 46.8 to 30.1. This marked reduction in primary
and secondary syphilis rates is the result of concentrated effort aimed at diminishing
the reservoir of early syphilitic infection. VENEREAL DISEASE  CONTROL REPORT, 1949.
D  23
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Te
Un
Area N
Un
Area N
Un
Area JN
Un
Area jN
Un
Area JN
Un
fc « s b    a
S    0    HH    HH                 *
<                       fc VENEREAL DISEASE  CONTROL REPORT, 1949.
D 29
The figures given in this table are again indicative of the areas from which the
greatest number of venereal-disease cases is notified.
Greater Vancouver (Area 4b) is responsible for about 62 per cent, of all cases
notified in the Province.
There is an increase over the figures for 1948 in the number of cases notified,
which increase is entirely due to the greater number of gonorrhoea cases treated in the
Vancouver Clinic.
A special effort has been made to bring in and to treat all known contacts to infection, even in those cases where a definite diagnosis could not be established. This was
felt to be necessary in view of the considerable pool of undiscovered infection which
must still exist in certain areas, and which must be responsible for the comparatively
large number of authentic cases of gonorrhoea still occurring.
This policy keeps the figures high, but should in time bring about a marked reduction in the number of infections occurring in the area.
CHART IV.—PATIENT VISITS AT ALL CLINICS OF THE DIVISION OF VENEREAL DISEASE CONTROL CLASSIFIED ACCORDING TO DIAGNOSIS, FOR
THE YEARS 1940 TO 1949, INCLUSIVE.
PATIENT    VISITS
100,000
80,000
60,000
40,000
20,000
10,000
8,000
6,000
4,000
—
—
-
—
^^-x-^^^
TOTAL
-
-^
.--
	
•--
N.
•-•-•.
—  —_   __
S
— — J
YPHILIS
—   —-
»*
	
-""—•~^_
^^                *
mm^^            H
	
NOT    YET
S
0
-
-
AGNOSED
-
—
—
1940
43
44
TABLE XII.—PATIENT VISITS AT ALL CLINICS OF THE DIVISION OF
VENEREAL DISEASE CONTROL CLASSIFIED ACCORDING TO DIAGNOSIS, FOR THE YEARS 1940 TO 1949, INCLUSIVE.
Total.
Syphilis.
GONORRH<EA.
Not yet diagnosed.
Year.
All
Clinics.
Vancouver
Clinic.
All
Clinics.
Vancouver
Clinic.
All
Clinics.
Vancouver
Clinic.
All
Clinics.
Vancouver
Clinic.
1940	
1941	
'55,678
42.863
36,410
36,170
46,961
46,898
56.385
51.129
43,871
3.6.551
43,294
32,357
28.046
28,929
36.069
35,657
41,856
38,180
32,480
27,934
38,346              30,288
28,712              21,636
24,173      |      18.6SG
1      22.389              18.573
10,038                8,315
8,107                6,406
7,584                5,927
9,331                7,366
13,021               10,580
9,692                8,065
11,382                9,297
9.799                8,051
8,480                7,014
9.102      1        7.858
7,294
6,044
4,653
4,450
9,174
10,909
4,691
4,315
1942	
1913	
3,433
2,990
1944	
24.766
26,297
30,047
28,291
24,894
16,335
19,468
20,084
23,158
21,986
19,166
13,139
6,021
1945	
7,508 '
1946. :...
14.956
9.401
1947         	
13,039       j         8,143
1948	
10,517                 6,292
1949	
11.114       1         6.937 D 30
DEPARTMENT OF HEALTH AND WELFARE.
The anticipated decrease in patient attendances at the clinics of this Division is
well demonstrated in this table, the decrease amounting to 16.7 per cent, below the
figures for 1948.
A further analysis shows the following interesting figures:—
Syphilis.—In 1948 there were 319 cases and 24,894 patient visits; that is, 78 visits
per case. In 1949 there were 262 cases and 16,335 patient visits; that is, 62.3 visits
per case.
These figures show in a striking manner the effect of our newer methods of treatment in cutting down the number of attendances necessary for the treatment and
follow-up of syphilis cases.
Gonorrhoea.—In 1948 there were 2,045 cases and 8,480 patient visits; that is, 4
visits per case. In 1949 there were 2,237 cases and 9,102 patient visits; that is, 4 visits
per case.
Since the treatment of gonorrhoea with penicillin was already well established in
1948, no appreciable change was to be anticipated. The only factor which would be
likely to influence the number of patient visits for gonorrhoea in future years would be
an alteration in the follow-up supervision after treatment has been given.
TABLE XIII.—REPORT OF LABORATORY WORK DONE BY THE DIVISION OF
LABORATORIES RELATING TO THE DIAGNOSIS AND TREATMENT OF
VENEREAL DISEASES FOR ALL AGENCIES IN BRITISH COLUMBIA, 1946
TO 1949, INCLUSIVE.
Examination.
1946.
1947.
1948.
1949.
Gonococcus cultures	
Gonococcus microscopic examinations	
Treponema pallidum microscopic examinations
Serological tests for syphilis	
12,664
34,743
1,093
177,908
11,219
34,589
854
152,437
10,322
33,990
605
167,816
10,508
33,851
454
173,092
The work carried out by the Division of Laboratories on behalf of this Division
continues to increase as regards blood-testing, 5,276 more tests being done in 1949 than
in 1948.
Much credit is due to the Division of Laboratories for the great volume of work
accomplished under very difficult circumstances during the past year. VENEREAL DISEASE  CONTROL REPORT, 1949.
D 31
CHART V.—FREE MEDICATIONS DISTRIBUTED TO PRIVATE PHYSICIANS
BY THE PROVINCIAL DEPARTMENT OF HEALTH AND WELFARE FOR
THE TREATMENT OF VENEREAL DISEASES, BRITISH COLUMBIA, 1935
TO 1949, INCLUSIVE.
37,500
30,000
22,500
15,000
7,500
LEGEND
ARSENICAL   (AMPOULES)    	
BISMUTH        (IN CCS)          	
SULPHONAMIDE    I100GRSI—.-_
PENICILLIN    (1,000,000 UNITS) «
1
/
/
y
\
\
\
/
/
/
/
"-^
\
\
\
/
/
/
f
/
f
\
\
1
\
\
v
-*""■"
4
/
/
/
1
+ "**
^~~
\
1
1
L
A
/
,— •
f*
\
1
1
1
h
\
\
1
1
m m^m m
^
^
/
*
/
s
/
\
\
\
*s*
1
1
1
1
1
1
1
1935
38
39
40
41 42 43 44 45 46 47 48
1949
This chart indicates in a striking manner the gradual but definite changes which
have occurred in our methods of treating venereal diseases, with particular reference
to syphilis.
The use of arsenicals is steadily diminishing. This is, to some extent, due to the
decreasing amount of syphilis in the Province, but even more to the change-over to
penicillin as the treatment preparation of choice at the present time.
It is envisaged that arsenical preparations will be used in ever-decreasing quantities in the treatment of syphilis, though certain limited indications for its use will no
doubt remain for some considerable time.
The enormous decrease in the use of sulphonamides is reflected in the figures for
1949. These drugs have been almost completely superseded by penicillin in the treatment of gonorrhoea, their use being retained only for special cases or for certain other
types of venereal infection.
Penicillin is being used in the treatment of all cases of gonorrhoea, as well as in
all stages of syphilitic infection. This is well borne out by the great quantities of
penicillin supplied to private physicians during 1949 for the treatment of venereal
diseases. D 32
DEPARTMENT OF  HEALTH AND WELFARE.
Many other drugs, not shown in this table, continue to be supplied free of charge
to private physicians for the treatment of venereal diseases or conditions arising
from them.
TABLE XIV—FREE MEDICATIONS DISTRIBUTED TO PRIVATE PHYSICIANS
BY THE PROVINCIAL DEPARTMENT OF HEALTH AND WELFARE FOR
THE TREATMENT OF VENEREAL DISEASES, BRITISH COLUMBIA, 1935
TO 1949, INCLUSIVE.
Year.
Arsenicals
(Ampoules).
Bismuth
(CO.
Sulphonamide
(Gra'.ns).
Penicillin
(1.000.000
Units).
Penicillin
O. & w.
(100.000
Units).
Streptomycin
(Grams).
1935
6.332                         390
6,456                      1,397
12.192                   15,539
1936    	
1937                          	
55,485
1938
12.666                  16.125
10.933                   21,270
10.212                  22,029
10,955                   22,566
.12,636                   27,024
11,162                  26,300
12.005                  23,350
17.147                   27,580
20.586                   33,375
18,328                  35,325
15,601                   26,625
11.481                      21.775
281,745
252,930
336,825
469,998
772,301
583,786
883,986
950,719
308,565
213,829
165,195
2,422
1939
1940.           	
1941
1942
1943	
1944	
1945	
678
1,498
1,415
1,580
9,768
1946	
	
1947
1948	
7,059
1949	
567 VENEREAL DISEASE
CONTROL REPORT,
1949.
D 33
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DEPARTMENT OP HEALTH AND WELFARE.
Reference to these tables will give an indication of the places where meetings take
place and contacts occur among those who report for the treatment of a venereal
infection.
Beer-parlours and cafes still remain the most frequently named places of meeting
of those contracting their disease. Dance-halls appear to have become somewhat less
of a problem in facilitating the spread of venereal diseases.
Among places of exposure, hotels and rooming-houses still remain the most serious
problem, though there has been a slight decrease in the frequency with which these
premises have been named. This is probably largely due to the excellent co-operation
and praiseworthy efforts of the British Columbia Hotels' Association in dealing with
such problems when these are brought to their attention.
The co-operation of the Vancouver City Police Department has also been of the
greatest assistance to this Division and has done much to assist in controlling and
reducing those factors facilitating the spread of venereal diseases.
TABLE XVII.—CONTACTS TO VENEREAL INFECTION CLASSIFIED ACCORDING TO INVESTIGATING AGENCY AND RESULT OF INVESTIGATION,
BRITISH COLUMBIA, 1949.
Investigated by
i
u
1>   .
A
QJ
W
A
H-J
B
S
OJ
Hi
So?
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1   io B
B o'£
I
1
Result of Investigation.
>-H>
H
H
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£
«^c5
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s
s
cj
Pi
*J«
iS o!
a
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Examined by clinic	
665
476
63
20
16
1
n
8
70
	
	
Examined by private physician	
401
100
16
53
35
127
58
4
7
i
Failed to report for examination..
42
27
4
2
1
4
4
	
Investigated,   already   diagnosed,
32
11
■ 1
2
5
2
2
9
588
282
25
61
63
4
123
142
59
1
20
17
Found to be ex-Province	
10
6
2
1
1
	
	
Investigation not indicated	
2,198
	
887
177
1,134
329
325
1
2
	
	
1
Totals	
4,407
961
106
162
139
462
134
27
216
888
1
177
1,135
Note.—The above figures cover the period of October, 1948, to September, 1949.
From Table XVII it will be seen that of a total of 4,407 named contacts, 2,207 were
considered to need, and to have sufficient basic information to undertake, further
investigation. Of these 2,207 contacts, 988 (or 45 per cent.) were investigated by the
Division of Venereal Disease Control, and 541 (or 25 per cent.) by other health agencies, in many cases on the basis of information supplied by the Division. The results
of these contact investigations are summarized in Table XVIII. VENEREAL DISEASE  CONTROL REPORT, 1949.
D 35
TABLE XVIII.—CONTACTS TO VENEREAL INFECTION CLASSIFIED
ACCORDING TO INVESTIGATING AGENCY AND RESULT OF EXAMINATION, BRITISH COLUMBIA, 1949.
13
+j
0
H
Investigated by
Result of Examination and
whether or not previously
diagnosed.
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Infected with primary syphilis—
29
7
1
4
2
1
28
  1    	
Totals	
36
.      5
2
  |    	
1
28
Infected with secondary syphilis—
13
8
4
l
1
  1    	
1 1    	
1
1
13
Totals	
21
4
l
1 1      1    	
1
1
13
'   1     	
Infected with other syphilis—
!
116 1        2
55 1      22
l
2
6
3   j         1
2  |       10
    1     	
9
5
103
1
4 1    	
......
   1    	
Totals                  	
171
24
3
6
5  |      11
9  1    	
9  |    103  |    	
1
Infected with gonorrhoea—
659
484
8
281
50
1
24
1
21
1
56
1  1
15  |        9
   1    	
|             1
4 ]    643 j
28  1      1    	
  1      I    	
Totals    	
1,143
289
50
25
22
57
16
9
32   |     643   j     	
Infected with chancroid—
1              |
    1         1     	
    1   1     	
Totals	
   I    	
   1    	
    1         1     	
Infected  with   lymphogranuloma
venereum  or granuloma inguinale—
   1    	
Totals -	
   1    	
   j     	
    1     	
Incomplete examination—
3
2
3
1
  1    	
1
   |     	
   I     	
  |      |        1
    1    	
Totals	
5   |         4  |         |     	
   1    	
1  1    	
    |         |        |     	
Negative—■
1      1
98 |      1    	
496 |    259 |      25
9  |        4  |        1
1
42
1 j
26  j      56
1  ]        3
1
43
2
1 ]      94
40  j        3
    |     	
    |     	
Totals 	
603 |    263 |      26
43
28 |      59
44
2
41  1      97  |       1    	
Investigation not indicated—
I             1
  1      1    	
  1      1    	
1,315 1       |    	
1
   1    	
   1    	
1                           1
  1      |      I    	
2 1        3  1    177  1 1,133
Totals            	
1.315   I     ......   I     	
  1    	
2  1         3  1    177  1 1.133
1
1
1
|
1
Note.—The above figures cover the period of October, 1948, to September, 1949. D 36
DEPARTMENT OP HEALTH AND WELFARE.
TABLE XVIIL—CONTACTS TO VENEREAL INFECTION CLASSIFIED
ACCORDING TO INVESTIGATING AGENCY AND RESULT OF EXAMINATION, BRITISH COLUMBIA, 1949—Continued.
-p
o
Investigated by
Result of Examination and
whether or not previously
diagnosed.
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33
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Not stated—
1,113
372
26
86
83
	
335
63
15
131
1
1
Totals	
1,113
372
26
86
83
335
,     63
15
131
1
1
Totals-
918
1,050
2,439
14
570
377
1
'     78
27
2
74
86
5
50
84
2
122
338
2
68
64
12
15
10
73
133
881
3
4
177
1
1,134
Totals	
106
162
139
462
134
27
216
888
177
1,135
Note.—The above figures cover the period of October, 1948, to September, 1949.
VICTORIA, B.C.:
Printed by Don McDiarmid, Printer to the King's Most Excellent Majesty.
1950.
1,295-560-8676

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