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PROVINCE OF BRITISH COLUMBIA Fifth Report of the DEPARTMENT OF HEALTH AND WELFARE (HEALTH BRANCH) (Fifty-fourth… British Columbia. Legislative Assembly 1951

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 PROVINCE OF BRITISH COLUMBIA
Fifth Report of the
DEPARTMENT OF HEALTH
AND WELFARE
(HEALTH BRANCH)
(Fifty-fourth Annual Report of Public Health Services)
YEAR ENDED DECEMBER 31st
1950
VICTORIA, B.C.
Printed by Don McDiarmid, Printer to the King's Most Excellent Majesty
1951  Office of the Minister of Health and Welfare,
Victoria, B.C., January 4th, 1951.
To His Honour Clarence Wallace, C.B.E.,
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, 1950.
A. D. TURNBULL,
Minister of Health and Welfare. Department of Health and Welfare (Health Branch),
Victoria, B.C., January 4th, 1951.
The Honourable A. D. Turnbull,
Minister of Health and Welfare, Victoria, B.C.
Sir,—I have the honour to submit the Fifth Report of the Department of Health
and Welfare (Health Branch) for the year ended December 31st, 1950.
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. A. D. Turnbull
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.(CE.),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. Director,  Division of  Tuberculosis
Control.
J. H. Doughty, B.Com., M.A.     - Director, Division of Vital Statistics.
C. L. Hunt, M.D., M.R.C.S., L.R.C.P.     -      -      Director, Division of Venereal Disease Control.
Deputy Minister of Health and Provincial Health Officer.
Deputy Provincial Health Officer
and Director, Bureau of 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.  TABLE OF CONTENTS
Introduction— Page
Local Health Services  \\
New Tuberculosis Hospital  11
Clinic and Laboratory Building  12
Chest X-ray Services  12
Public Health Education on the Local Level  13
Public Health Institute and Other Conferences  13
National Sickness Survey :  13
Preventive Dentistry  14
Red Cross Blood Transfusion Service  14
Civil Defence •  14
Participation in Conferences and Meetings  15
Accommodations  15
Population Characteristics    15
Causes of Death in British Columbia  16
Visitors    17
Report of the Health Branch Office, Vancouver Area—
Bureau of Special Preventive and Treatment Services  19
Voluntary Health Agencies  20
Civil Defence  22
Federal Health Grants  22
Report of the Bureau of Local Health Services—
Administration  28
Development and Expansion  28
Personnel Changes    30
Bi-annual Health Officers' Meetings    31
Interdepartmental Relationships  31
School Health Services    32
Sickness Survey and Statistics  33
Table I.—Incidence of Notifiable Diseases in British Columbia  (Including
Indians)  35
Table II.—Table Showing Cases of Notifiable Diseases in the Province of
British Columbia for the Year 1950  36
Report of the Division of Public Health Nursing—
Present Status of Service   40
Public Health Nursing Training Programme .  41
Student Programme  41
Service Analysis . r  42
New Programmes and Special Services  43
Awards for Distinguished Service  44
Table I.—Comparison of Provincial Public Health Nursing Staff Changes
during the Period 1941 to 1950  45
Table II.—Number of Years of Service of Field Staff in December, 1950  45
Table III.—Comparison of Time Spent by Public Health Nurses in Specified
Activities as Indicated by Time Studies in November, 1949, and May,
1950 :  46
Report of the Nutrition Service—
Consultant Service to Local Public Health Personnel  47
Consultant Service to Institutions        :  48
Consultant Service to Other Departments and Organizations  49 Y 8 BRITISH COLUMBIA
Report of the Division of Preventive Dentistry— page
Dental Man-power  50
Fluoridation of Communal Water-supplies  50
Dental Programmes  51
Transportable Dental Equipment  52
Dental Health Education .  52
Personnel  53
British Columbia Dental Association  53
Summary  53
Report of the Division of Public Health Engineering—
Water-supplies  54
Sewage-disposal .  55
Stream-pollution  56
Milk  57
Tourist Camps  57
Slaughter-houses .  57
Frozen-food Locker Plants  58
Shell-fish  58
Industrial Camps ._ 1  58
Summer Camps  58
Special Sanitary Surveys  59
Personnel  — 59
General  59
Report of the Division of Vital Statistics—
In Memoriam   61
Introduction  61
Completeness of Registration  61
Registration of Births, Other than Indians and Doukhobors  63
Registration of Deaths  64
Registration of Marriages  64
Documentary Revision  65
District Registrars' Offices, Inspections, etc   65
Administration of the " Marriage Act "  66
Administration of Sections 34 to 40, Inclusive, of the " Wills Act "  67
Vital Statistics Information for Health Units  67
Statistical Services  67
Statistical Procedures in Local Health Units  70
Manual of Instructions for District Registrars  70
General Office Procedures  70
Conclusion  71
Report of the Division of Public Health Education—
Consultative Service —. 72
Materials  72
Pre-service Training  73
In-service Training .  74
Conferences and Talks _  74
Staff Changes  74 DEPARTMENT OF HEALTH AND WELFARE,  1950 Y 9
Report of the Division of Laboratories— pAGE
Tests for Diagnosis and Control of Venereal Diseases  75
Tests Relating to Tuberculosis Control  76
Food-poisoning and Gastro-intestinal Infections  76
Bacteriological Analyses of Milk and Water Samples  77
Other Types of Tests  77
Branch Laboratpries  77
General Comments  78
Table I.—Statistical Report of Examinations Done during the Year 1950  80
Report of the Division of Venereal Disease Control—
Treatment  81
Epidemiology :  82
Social Service  83
Education  84
General  85
Report of the Division of Tuberculosis Control—
Continuing Projects  88
New Projects  88
Clinics  89
Institutions  90
Nursing  91
Social Service  91
Conclusions — 91  Fifth Report of the Department of Health and Welfare
(HEALTH BRANCH)
(Fifty-fourth Annual Report of Public Health Services)
YEAR ENDED DECEMBER 31st, 1950
G. F. Amyot, Deputy Minister of Health
INTRODUCTION
The problems, achievements, and hopes of the Health Branch for the year 1950 are
presented in detail in the sections of this Report which concern the various bureaux,
divisions, and services.   In this introduction the year's outstanding events are summarized.
Before proceeding to describe these, Health Branch officials must emphasize the fact
that most, if not all, of the activities and progress have depended upon the co-operation
extended by other departments of government, professions, and voluntary agencies.
Officials of these many organizations continued to give freely of their advice and guidance,
and so rendered marked assistance in advancing the public health programme.
LOCAL HEALTH SERVICES
Practically all activities of the Health Branch are directed toward the citizens of the
Province through the " front-line " field staff of public health physicians, public health
nurses, and sanitary inspectors. The most efficient administrative organization for performing these activities and services on the local level is the health unit—the 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. In co-operation with Municipal
Councils and School Boards, the Health Branch was successful in establishing two new
health units. This brought the total to thirteen units officially organized and in operation. These thirteen units, together with the city health departments of Greater Vancouver and Victoria-Esquimalt, provide modern generalized public health services to 82.3
per cent of the population of the Province. When the more limited services of 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 98
per cent of the population. It should be noted that these percentages are based on
calculations which do not include Indians within the meaning of the " Indian Act."
Such Indians are wards of the Federal Government, although the Provincial Health
Branch, by arrangement with Federal authorities, does provide certain services.
NEW TUBERCULOSIS HOSPITAL
After many years of planning and delays, the last months of 1950 saw the actual
commencement of construction of the new tuberculosis hospital at Fifty-ninth Avenue
West and Heather Street, Vancouver. This hospital, when fully completed, will contain
528 beds and, together with existing beds, should meet more adequately the demand for
some years to come.    However, the first phase of construction will be limited to the
11
PROVINCE*-   uaRARY
VICTORIA, B. C. Y 12 BRITISH COLUMBIA
central administrative and service facilities (for the complete 528-bed hospital) and one
wing of 264 beds. All financial arrangements for this first phase have been finalized, and
it is hoped that construction will be completed by March 31st, 1952. It is then planned
to proceed, without pause, with construction of the second wing.
CLINIC AND LABORATORY BUILDING
Because Vancouver is the largest population centre of the Province, several important services of the Health Branch have their headquarters in that city. These are the
office of the Assistant Provincial Health Officer, the Division of Laboratories, the Division
of Tuberculosis Control, and the Division of Venereal Disease Control. Unfortunately,
these are located in buildings quite widely separated from one another. Further, all but
the Division of Tuberculosis Control are housed in quarters which have long since become
obsolete. The Division of Laboratories, located in four old wooden houses on Hornby
Street, is at a particular disadvantage. Not only do the cramped quarters make it
extremely difficult for the laboratory staff to maintain its high standard of efficiency, but
the structural features of the houses also present a very real fire-hazard. For the past
several years there has been considerable preliminary planning of a proposed clinic and
laboratory building, to be constructed adjacent to the Vancouver unit of the Division of
Tuberculosis Control on property now owned by the Vancouver General Hospital.
Although there are still certain financial obstacles to surmount, very definite progress was
made during 1950. Decisions with respect to the layout of laboratory, clinic, and office-
space were reached, the site was surveyed, and the drawing of actual working-plans was
begun. It is anticipated that actual construction will begin during 1951. Pursuant to
an agreement made with the Red Cross Blood Transfusion Service, it is planned to allocate
one floor of the new building to the blood processing and distribution depot of that
important public health service.
CHEST X-RAY SERVICES
During the years 1943 to 1950 the people of British Columbia and the Health
Branch were fortunate in having made available to them three mobile X-ray units purchased by the British Columbia Tuberculosis Society and presented to the Government
for mass chest X-ray surveys. These " buses " toured the Province on prearranged
schedules and provided outstanding service in the tuberculosis-control programme. They
were not only a means of detecting tuberculosis, but also a sound medium of educating
the public because each survey in a given area required a prior " campaign " involving
very considerable publicity and community organization. In 1949, however, it became
evident that this method, although still valuable, was becoming very costly when consideration was given to the small number of new tuberculosis cases discovered by it.
Further, the organizational work required of the public health field staff before each
" campaign " was proving so time-consuming that other public health duties were suffering. As a result, it was decided to discontinue the use of one completely worn-out unit
and to assign one of the remaining two units to the Greater Vancouver metropolitan area.
Funds derived from the Federal Tuberculosis Control Grant were used to purchase stationary miniature X-ray equipment and place these new machines in general hospitals
and public health offices in as many areas of the Province as possible. By the close of the
year there were thirty-four machines located at strategic points throughout British Columbia, with others to be added as required. One important advantage resulting from this
new method is the fact that local residents may obtain free chest X-rays at any time
during the year. The costs of the X-ray films are also defrayed by the Federal Tuberculosis Control Grant. The one mobile unit retained in the Health Branch service is being
used in those areas of the Province not effectively served by the miniature equipment. DEPARTMENT OF HEALTH AND WELFARE,  1950 Y  13
PUBLIC HEALTH EDUCATION ON THE LOCAL LEVEL
All public health personnel—and most particularly the field staff—have, as a major
responsibility, the education of the public in matters of health. This is not simply a
matter of publicity. It is not confined to such activities as making speeches, distributing
pamphlets, or even simple " teaching " of individuals and groups. Public health education is a matter of helping the people to recognize their health problems and needs, of
stimulating them to take appropriate action, and of guiding them in this action. Since the
beginning of public health services in the Province, this important work has been performed by the public health physicians, nurses, and sanitary inspectors serving in the
field. For some years, however, there have been plans to add to these " teams " public
health educators—persons professionally trained in the methods of health education.
Until this year, shortage of trained personnel has prevented the taking of this progressive
step. However, in November, 1950, a fully qualified public health educator, professionally trained at the School of Public Health, University of North Carolina, was added
to the staff of the Central Vancouver Island Health Unit with headquarters at Nanaimo.
Stated in general terms, it will be her responsibility to supplement and co-ordinate the
health education activities of the other members of the unit staff who, themselves, must
continue to be " public health educators." Although this is the first occasion on which
such a specialist has been placed in the Provincial local health services, it is planned to
make similar placements in other health units as professionally trained personnel become
available.
PUBLIC HEALTH INSTITUTE AND OTHER CONFERENCES
For the four days beginning April 11th, the public health field staff met in Victoria
with senior officials of the Health Branch and representatives of the city health departments of Greater Vancouver and Victoria. At the 1950 sessions of this annual Public
Health Institute, the chief speaker was Dr. Nathan Sinai, of the School of Public Health,
University of Michigan. Dr. Sinai, an international authority in public health administration, gave a series of seven lectures on medical care. Prominent parts in the Institute's programme were taken by members of the Health Branch, who presented papers,
participated in symposia, and led discussions. The obvious educational benefits of
these in-service training meetings were enhanced by Dr. Sinai's ability not only to present
outstanding lectures himself, but also to serve as chief discussant following the other
presentations.
The full-time medical health officers (health unit directors of the Provincial staff and
the senior medical health officers of Greater Vancouver and Victoria) met on two
occasions in conferences led by the Deputy Minister of Health and the Deputy Provincial
Health Officer. Other senior officials of the Health Branch attended all or part of the
sessions to assist in planning and clarifying policies and procedures relating to the public
health service. Although the broad features of the agenda were prearranged, the meetings
themselves took the form of round-table discussions, which provided all those present
with the opportunity of presenting and clarifying problems.
NATIONAL SICKNESS SURVEY
For many years there have been collected and made available statistical data concerning death and its causes. Although these mortality statistics are accurate and useful
in planning public health programmes, there has been, throughout the world, a dearth
of information with respect to sickness itself. Morbidity statistics have been confined
largely to the communicable diseases and diseases of a special or dramatic nature, and
have not been extended to include the sicknesses and complaints of the commoner types.
There has been compiled very little formal information with respect to the incidence Y 14 BRITISH COLUMBIA
of sickness as it besets the individual and the family. In view of the fact that such
sickness is of vast economic importance and has immense bearing on the happiness and
well-being of the people, plans were laid, on a Canada-wide scale, to conduct a morbidity
study or " sickness survey," which is now in progress and which will assist in judging
the adequacy of treatment services. Using funds from the Federal Health Grants, all
Provinces are participating. In British Columbia the actual task of collecting the information was begun in October of this year. A representative sample of households was
chosen, and the families were invited to take part in the survey. In this Province the
information is collected by public health nurses who visit the households at monthly
intervals to receive the " history of family sickness " which has been recorded by the
householder. It is anticipated that the results of the survey will prove of inestimable
value in planning future health programmes.
PREVENTIVE DENTISTRY
It is the object of the Division of Preventive Dentistry, in co-operation with the
dental profession, to endeavour to curtail dental disease, with its grave results in childhood, adolescence, and adult life. The keystone of the long-range programme is to
include within the staff of each local health unit a full-time dental director. A readjustment with respect to local financial contributions was made in October, with the result
that local areas are showing an increasing desire to participate.
An alternative, although more limited, programme utilizing the services of private
dentists was successfully organized in ten communities during the year. (Only three
such programmes operated during 1949.)
In addition, the Division stands ready to establish a travelling dental clinic for
children in the more remote rural areas and has equipment available for the purpose.
Unfortunately, it has not been possible to attract a suitably qualified dentist to undertake
this work. In fact, the shortage of dentists presents the greatest obstacle to the development of the programme of preventive dentistry as a whole.
RED CROSS BLOOD TRANSFUSION SERVICE
During 1950 considerable advances were made in this important public health
programme which is operated by the Canadian Red Cross Blood Transfusion Service
for the people of British Columbia. All personnel of the Health Branch have co-operated
with the local Red Cross chapters. The Provincial Government provides certain funds
to assist in defraying the costs of general maintenance services in clinics and offices. The
Provincial Government also gives financial aid with respect to transportation costs in
cases where transportation cannot be provided by normal means. As the supply of
blood donors is still too small to meet possible emergency conditions, plans are under
way to develop a more extensive blood donor panel.
CIVIL DEFENCE
The Health Branch took an active part in the planning and organization of this
now vital problem. The Deputy Minister of Health was appointed to the Provincial
Government Civil Defence Planning Committee, which made great progress in assembling
data and laying plans to co-ordinate the civil defence programme in British Columbia.
As a member of this Committee, he attended a four-day exercise on civil defence in
Seattle, Wash., and was one of the four B.C. delegates in attendance at a national
conference on the same subject. The Assistant Provincial Health Officer was selected
to attend a course in atomic, bacterial, and chemical warfare at Camp Borden during
November. He returned from the course with much information which has already
proved of value in general planning, as well as planning for specific Health Branch
activities.    Because large responsibilities in civil defence must rest with local authorities, DEPARTMENT OF HEALTH AND WELFARE,  1950 Y 15
every effort has been made to inform and guide personnel of local health services in
order that they may be in a position to assist in the development of local committees and
programmes.
PARTICIPATION IN CONFERENCES AND MEETINGS
In addition to the civil defence meetings mentioned above, the Deputy Minister of
Health attended several other conferences at the national or international level and, in
his capacity as an official representative of the Health Branch or, in some cases, the
Provincial Government, participated actively in the discussions and planning.
As Provincial Health Officer, he is a member of the Dominion Council of Health
and attended the meeting of this body in Ottawa in April, 1950. (A second meeting of
the Council, planned for the fall of the year, was cancelled.)
In March the Deputy Minister served as a member of the faculty and co-study-group
leader at a Mental Hygiene Institute in Seattle, Wash. This ten-day Institute provided
an intensive course for public health administrators. It was conducted by the United
States Public Health Service and the Medical School of the University of Washington
in co-operation with the State health departments of Washington, Oregon, and California
and the Provincial health department of British Columbia. This Province was also
represented on the faculty by Dr. C. H. Gundry, psychiatrist of the Metropolitan Health
Committee of Vancouver. The medical officer for Victoria-Esquimalt and three health
unit directors of the Provincial service attended the course.
In December the Deputy Minister of Health attended the Dominion-Provincial
Conference in Ottawa and served as one of the technical advisers to the British Columbia
delegation.
ACCOMMODATIONS
Although there was no actual improvement in the matter of office accommodations
during 1950, it is hoped that the early months of the new year will bring relief from
the overcrowding in the Victoria offices of the Health Branch. In co-operation with
the Chief Architect, Department of Public Works, plans have been made to provide much
needed space when the new Provincial Government building on Government Street is
opened. (An earlier section of this Report has dealt with the plans for the Vancouver
offices of the Health Branch.)
POPULATION CHARACTERISTICS
The population of British Columbia continued to increase during 1950. The midyear estimate of the population, as made by the Dominion Bureau of Statistics, placed
the total at 1,138,000, this being an increase of 24,000 over the previous year's estimate.
Somewhat over half of this increase was due to the excess of births over deaths in the
Province, while the remainder resulted from immigration.
An important feature of the population of this Province is the increasing proportion
of persons in the older age-groups. This fact is of considerable significance to the public
health administrators, inasmuch as the health problems of the aged are materially different than those in the younger age-groups. Moreover, it is this aging of the population
which has been responsible for the gradual rise in the death rate in this Province, Over
70 per cent of deaths in British Columbia occur at ages over 60 years. An increase in
the proportion of population at these ages will obviously have considerable effect on the
mortality rate.
There are, however, other important developments taking place in the population
structure in British Columbia. An increasing number of children are being added to
our population through births, and if this trend continues at its present rate, the gradual
aging of our population will be retarded or even reversed.    Since 1941 the population Y 16 BRITISH COLUMBIA
under 10 years of age has increased by 81 per cent, from 114,300 to 207,400, while
in comparison the population 60 years of age and over has increased by only 60 per cent,
from 110,500 to 176,100. The population 10 to 59 years of age, inclusive, increased
27 per cent, from 593,000 to 754,500, during the period 1941 to 1950. Thus, in 1941,
13.9 per cent of the total population was in the 0-9 age-group and 13.5 per cent in the
60 years and over age-group, while in 1950, 18.2 per cent of the total population was
in the 0-9 age-group and 15.5 per cent in the 60 years and over age-group.
The birth rate, excluding Indians, showed a slight decline during 1950, standing at
23.3 per 1,000 population, compared to the rate of 24.1 in 1949. However, this is
still a higher rate than prevailed in any year between 1914 and 1947. The rate of
natural increase during 1950 was 13.7 per 1,000 population.
CAUSES OF DEATH IN BRITISH COLUMBIA
One measurement of the health standards of the Province is obtained by the accurate
recording of the causes of death. Mortality statistics by themselves do not constitute
a complete appraisal of the health of the people, but they do provide important information which merits close study.
The mortality rate, excluding Indians, showed little change from that for the previous year, having been 9.7 deaths per 1,000 population. However, the fact that the
over-all death rate has remained substantially unchanged in spite of the increasing
proportion of people in the older age-groups is indicative of an improvement in mortality
conditions, and this is borne out by the age-specific death rates. This year, in the non-
Indian population, the age-specific mortality rates have declined in each age-group under
60 years. The mortality rate for the 0-19-year group was 2.6 per 1,000 population in
1950, while in 1949 it was 2.8. The lowest age-specific rate—namely, 1.6 deaths per
1,000 population—was found in the 20-39-year age-group. In 1949 the rate in this
group was 1.7. The rate in the 40-59-year age-group declined from 7.1 per 1,000
population in 1949 to 7.0 in 1950. The mortality rate in the age-groups 60 years and
over was 43.3 in 1950, as compared to 41.4 in 1949. The percentages of deaths
occurring in each age-group were 8.1 per cent in the 0-19-year group, 5.3 per cent in
the 20-39-year group, 16.4 in the 40-59-year group, and 70.2 in the 60 years and over
age-group.
The non-Indian infant mortality rate was 22.6 per 1,000 live births in 1950, indicating a reduction over the 1949 rate of 25.8. Premature birth continues to be the
leading cause of infant deaths, accounting for 19.4 per cent of all infant deaths. Congenital malformations, the second leading cause of infant deaths in 1950, showed a slight
proportional decrease, having declined from 16 per cent in 1949 to 14.5 per cent in
1950. Birth injuries resulted in 13.6 per cent of the infant deaths this year, compared
to 12.0 per cent in 1949. The fourth leading cause of infant deaths was asphyxia and
atelectasis, which caused 12.6 per cent of all infant deaths.
There were 22 maternal deaths this year, or a rate of 0.9 per 1,000 five births.
This was a decrease from the rate of 1.3 in 1949.  .
With the introduction of the Sixth Revision of the International List of Diseases,
Injuries and Causes of Death, comparisons between the mortality for certain causes in
1950 and in the preceding years cannot be made with complete accuracy in all cases.
No attempt has been made to give such comparisons in the following summary of mortality from specific causes of death among the non-Indian population. Special studies are
at present under way on a national level to establish comparability factors to help bridge
the gap between the old and the new methods of classifying causes of death.
Heart-disease, the leading cause of death, accounted for the loss of 3,493 fives,
or almost one-third of the total deaths. The death rate from this cause was 315.0 deaths
per 100,000 population.   The greatest number of these deaths—namely, 3,179—were DEPARTMENT OF HEALTH AND WELFARE,  1950 Y  17
attributed to arteriosclerotic and degenerative heart-disease. Chronic rheumatic heart-
disease caused another 194 deaths, and other heart-diseases, 120 deaths.
Cancer was the second leading cause of death, having resulted in 1,682 deaths
during the year, or 15.7 per cent of the total deaths. The cancer death rate was 151.7
per 100,000 population. The third leading cause of death was vascular lesions of the
central nervous system. This disease took 1,178 lives, giving a death rate of 106.2 per
100,000 population. Specific causes in the vascular lesion group were cerebral haemorrhage, which caused 708 deaths; cerebral embolism and thrombosis, which caused 311
deaths; and other vascular lesions, 159 deaths.
Accidents accounted for the loss of 762 lives, or 7.1 per cent of all deaths during
the year, placing them in fourth place with a death rate of 68.7 per 100,000 population.
The leading cause of death under this heading was accidental fall, 175 deaths having
arisen from this cause. This constituted almost one-quarter of all accidental deaths.
Motor-vehicle accidents killed 165 people during the year, accounting for more than
one-fifth of the deaths from accidents. Drowning resulted in 116 fatalities. Blows
from a falling object caused 54 deaths. The greatest proportion of accidental deaths
occur in the home. Of the non-transport accidents which took place in 1950, 46.0 per
cent took place in or on the home premises. Accidents occurring on an industrial place
accounted for 15.7 per cent of the non-transport accident fatalities. Thus, over 60 per
cent of the fatal non-transport accidents occurred in either the home or in industry.
Hypertensive disease was the fifth leading cause of death during 1950, the death
rate from this disease being 44.8 per 100,000 population. Diseases of early infancy,
in sixth place, took the lives of 354 infants under 1 year. In seventh place was pneumonia, which caused 318 deaths. In eighth, ninth, and tenth places respectively were
tuberculosis, with 229 deaths; suicides, with 194 deaths; and nephritis, with 152 deaths.
The foregoing ten' leading causes of death accounted for over four-fifths of all deaths
among the non-Indian population.
As might be expected, the pattern of deaths varies according to the different age-
groups. In the 1-19-year age-group, accidents were the leading cause of death, accounting for almost two-fifths of the total. The second leading cause in this age-group was
cancer, which resulted in 29 deaths, or 10 per cent of the total. Pneumonia caused
almost 10 per cent in the 1-19-year age-group.
Nearly one-third of the deaths in the 20-39-year age-group were caused by accidents.
Cancer again held second place, with a total of 68 deaths, or 12 per cent of the total for
this age-group. There were 54 suicides in the 20—39-year age-group, and 47 deaths as
a result of heart-disease.
In the 40-59- and the 60-79-year age-groups the two leading causes of death are
the same. Diseases of the heart lead, and cancer is in second place. In the 40-59-year
age-group there were 539 deaths from heart-disease, constituting 31 per cent of the
total deaths in that group, while 402 persons died from cancer. In the same age-group,
accidents, the third leading cause of death, caused 151 deaths. In the 60-79-year
age-group 37 per cent or 2,095 deaths resulted from heart-disease. Cancer caused 1,028
deaths and vascular lesions 732 in this group.
In the age-group 80 years and over, heart-disease was the leading cause of death,
while vascular lesions of the central nervous system was in second place. Cancer
dropped to third place in this age-group.
VISITORS
The Health Branch was honoured during the year by numerous distinguished visitors
from various parts of the world who came to study the health programme in this Province
either on their own initiative or at the direction of a sponsoring agency. Included among
these were Dr. Nathan Sinai, Professor of Public Health at the University of Michigan; Y  18 BRITISH COLUMBIA
Dr. Harbans Indarjit Singh, Director of Maternal and Child Health and Welfare for the
Punjab (India); Dr. K. C. Yeo, Deputy Director of Health Services at Hong Kong;
Mr. Yasuo Tsujimura, United Nations Social Welfare Fellow from the Ministry of Social
Welfare in Japan; Mr. R. E. Peers, who is the assistant secretary for the King Edward's
Hospital Fund for London (England); Dr. G. G. Hatcher, Assistant Professor in Public
Health Administration at the University of Toronto; Dr. Chang Hoey Chan, Canada-
U.N.E.S.C.O. Fellow in Public Health 'from Malaya; Dr. R. H. Riley, Director of the
Maryland Department of Health, Baltimore; and Dr. K. I. S. McLeod, who was sent by
Dr. Sinai to study B.C. Health Branch methods as part of a field-trip in the completion
of a master's degree from the University of Michigan.
The majority of these visitors were referred to British Columbia by the International
Health Division of the Rockefeller Foundation or by the World Health Organization.
The development of the present programme of public health in British Columbia
has come about because of the interest, loyalty, and co-operative group planning of the
staff of the Health Branch and of those in related services. The willingness to tackle
the many problems and find acceptable solutions has been outstanding on the part of the
staff. The Deputy Minister wishes to express his gratitude and appreciation for a task
well done. DEPARTMENT OF HEALTH AND WELFARE,  1950 Y  19
REPORT OF THE HEALTH BRANCH OFFICE, VANCOUVER AREA
G. R. F. Elliot, Assistant Provincial Health Officer
BUREAU OF SPECIAL PREVENTIVE AND TREATMENT SERVICES
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 nongovernment 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.
Local Health Services
Although local health services are not a direct responsibility of this Bureau, it is not
possible to compile a report without mention of same. Due to the location of this Bureau
in Vancouver, an increasing number of matters are being referred to this office. This is
only natural, since individuals and organizations in the Vancouver area are becoming
more familiar with the Vancouver office, and in many cases it is more expedient to handle
problems in this manner. This not only includes local health services but a certain
number of other Departmental matters as well.
During this year two somewhat alarming outbreaks of a gastro-intestinal infection
were investigated by this office. One was in a church camp for underprivileged children
and the second was in a prominent hotel in the Fraser Valley. Both of these have been
covered completely in separate reports to the Deputy Minister of Health.
The year 1949-50 saw the enlargement of the North Fraser Valley Health Unit and
the reorganization of the Upper Fraser Valley Health Unit. The Assistant Provincial
Health Officer attended several meetings of interested municipal and School Board
agencies concerned in this matter.
Close supervision of all local health services in the Fraser Valley was maintained
throughout the year, and close liaison with the Simon Fraser Health Unit and Vancouver
Metropolitan Health Committee.
Frequent consultations are held with the Deputy Provincial Health Officer, Victoria,
in all matters relating to local health services, which are under his immediate jurisdiction.
Co-ordination of the services in the Lower Mainland with those in other areas of the
Province is thereby ensured, in addition to uniformity of policy and administration.
Vancouver Divisions of the Health Branch
The Divisions of Tuberculosis, Venereal Disease, and Laboratories, all being an
integral part of this Bureau, naturally received a fair amount of attention during the year.
The location of the Assistant Provincial Health Officer in Vancouver, where these three
major Divisions are also located, is a relatively recent inauguration, and it is felt that to Y 20 BRITISH COLUMBIA
date it has had worth-while results. In general administration, these three Divisions
continue to deal directly with the Deputy Minister of Health, Victoria, and the details
of their activities will be found in their individual Divisional Reports.
The Vancouver office of the Statistical Section of Division of Vital Statistics, including the office of sickness survey under the Federal Health Grants, was moved in September
to the same location as this office. The results of this move have been valuable, not
only from the administrative view-point, but also from the view-point that the assistance
obtainable from the Statistical Section is readily available in this new location.
New Building
The work of this Bureau and of these Divisions will be much more easily managed
when all are housed in the one building which is now in the planning stage. A fair
amount of time has been spent with architects, engineers, Vancouver General Hospital
officials, and Health Branch personnel in attempting to get this most urgent construction
expedited. The present housing of the Division of Laboratories in particular is completely unsuitable, as is also the building occupied by the Division of Venereal Disease
Control. In addition, the property on which the Division of Venereal Disease Control
is at present located will likely be required in the near future for either University Medical
School or Vancouver General Hospital buildings. It is thus quite apparent that this
new health laboratory building is a most urgent matter.
Faculty of Medicine, University of British Columbia
The year saw the official opening of the new Medical School at the University of
British Columbia. It is fortunate for the Department of Health and Welfare of this
Province that the dean of this faculty, as well as the assistant to the dean, are most
conscious of the preventive and sociological aspects of medicine. There has developed
an excellent relationship between the Medical Faculty and the Health Branch. Both
are cognizant of one another's problems, with much mutual aid being planned.
VOLUNTARY HEALTH AGENCIES
A number of voluntary organizations located in Vancouver receive grants from
the Provincial Government, and the Health Branch therefore has official representation
on each of the governing bodies of these organizations. It is felt that the people of this
Province are being well served by these voluntary organizations.
The activities of the British Columbia Cancer Foundation, Western Society for
Physical Rehabilitation, and the Canadian Arthritis and Rheumatism Society (B.C. Division) are outlined separately in this report. In general, however, the Assistant Provincial
Health Officer has actively participated in the programme planning of these organizations,
and a most amicable relationship has developed. Budgets are reviewed with great care,
and it is felt that economy is being practised in a fairly satisfactory manner.
In addition to these organizations, limited time was given to the Vancouver Preventorium, Greater Vancouver Health League, and other meetings of various types, but
related to health matters in the Province of British Columbia. During the year many
visits were made to all major hospitals in the Vancouver and Victoria areas on Departmental matters, such as the inauguration of the Provincial biopsy service and requests
for assistance from the Federal Health Grants.
British Columbia Cancer Foundation
This organization, named as the agent of the Provincial Government for the treatment and control of cancer in this Province, continues to make forward strides in its
programme. The Province of British Columbia pays the operating charges of the main
treatment centre, known as the British Columbia Cancer Institute, and the nursing home,
both located in Vancouver, and the consultative and diagnostic clinics located throughout DEPARTMENT OF HEALTH AND WELFARE, 1950 Y 21
the Province; the British Columbia Cancer Foundation has remained responsible for
capital expenditure.
During the year, consultative clinics were opened at Nelson, Trail, and Cranbrook,
making a total of seven places in the Interior of British Columbia where these services
are available.
A good deal of discussion and investigation has been carried on during the year as
to the necessity and possibility of opening a treatment centre in Victoria. This remains
under active discussion, and a final decision is hoped for soon.
The British Columbia Cancer Foundation, using private funds, is planning a new
building on the site adjoining the present British Columbia Cancer Institute. This
building will be most modern and should have sufficient space for cancer diagnostic and
treatment requirements for the next ten years. The board of directors of the British
Columbia Cancer Foundation is fully cognizant of the additional responsibilities this new
building will bring upon the Health Branch in regard to operating costs. This matter
is under close scrutiny at present, and it is hoped sound estimates of future operating
costs will be available in the near future.
Provincial Biopsy Service
The Provincial biopsy service, although not under the auspices of the British
Columbia Cancer Foundation, is an integral part of the cancer-control programme.
Under the Federal Health Grant for Cancer, provision has been made for biopsy services
related to cancer to be carried out by those hospitals employing certified pathologists
at no cost to the patient. In addition, the private physician has free choice of pathologist.
This service, which was inaugurated in February of this year, is proving to be most
satisfactory and extremely popular with the patient, the physician, and the pathologist.
Western Society for Physical Rehabilitation
During the year the Western Society for Physical Rehabilitation received assistance
from both the Federal Health Grants and the Provincial Government toward the construction of an additional twenty beds. This organization continues to do excellent
work and to give leadership in the rehabilitation problem amongst paraplegics, not only
in British Columbia, but in all of Canada. There is only one other similar organization
in Canada at the present time. The services given by the Western Society for Physical
Rehabilitation were improved and extended by the establishment of a brace-shop at the
centre this year. A well-trained brace-maker is employed. Although the service is
presently limited to those attending the centre, it is hoped that this will eventually provide
brace-making services for the Province as a whole.
Further expansion of this programme took place when an out-patient unit for
cerebral palsied children was opened at the Rehabilitation Centre this spring. The
training for these children includes speech therapy as well as formal and informal educational classes.
Canadian Arthritis and Rheumatism Society (B.C. Division)
This organization has shown continual expansion, with an increasing number of
patients being served during the year.
During the year additional stationary clinics were opened at St. Paul's Hospital,
Vancouver, and the Royal Jubilee Hospital, Victoria. Mobile units were put into operation at Kamloops, Trail, Vernon, Kelowna, and Penticton. At the present time this
organization employs a total of ten physiotherapists and one orthopaedic nurse, who are
engaged in giving therapy and advice in the management of arthritis, not only to patients
attending the stationary clinics in hospitals, but also to patients in their homes.
One of the major problems of this organization at present is the difficulty of obtaining hospital beds in order that certain types of arthritis could receive much more
satisfactory treatment. Y 22 BRITISH COLUMBIA
CIVIL DEFENCE
Civil defence has become a most important subject during the year. The Assistant
Provincial Health Officer attended an exercise in Seattle for two days in August and in
November was sent to Camp Borden to take the course in atomic, bacteriological, and
chemical warfare. In recent weeks it has required an increasing amount of time, and
with the present international situation it would appear this time would increase still
further.
FEDERAL HEALTH GRANTS
General
The total amount available to British Columbia for the fiscal year 1950-51 is
$2,859,341, an increase of $204,118 over the previous year. The Mental Health Grant
was increased by $60,131, due to an increase in the total amount available for distribution to the Provinces. The basis of the General Public Health Grant increased again
this year from 40 cents to 45 cents per capita, making an additional amount of $68,500
available to British Columbia. Other grants increased slightly, as population is one of
the factors governing distribution.
Administration
Attention has been given to two important points raised by the Department of
National Health and Welfare—namely, the advisability of controlling the proportion
of the grants allocated to continuing projects and the need for economy. In regard to
the former, the percentage of available funds allocated to continuing projects has
increased each year, and this automatically reduces the amount available for new
services. As far as practicable, economy without curtailment of services has been
requested because of other commitments the Federal Government may have, in view of
the international situation.
The Health Survey Committee met once during the year to review progress made
and to discuss future plans. There has been no change in the membership of this
Committee during the year.
The Health Survey Committee meeting was attended by Dr. G. E. Wride, Assistant
Director, Health Insurance Studies, Ottawa. In September, Dr. F. W. Jackson, Director,
Health Insurance Studies, visited the Province. Personal discussions with these two
Federal officials, who are directly concerned with the Federal Health Grants, have done
much to facilitate the administration of the grants in British Columbia.
Another factor which has assisted in the administration of these funds is the
co-operation received from the Departmental Comptroller and his staff. All accounts
and claims are processed by this office, and up-to-date information is always available
regarding the status of the grants.
The policy has been adopted this year of having all equipment and any substantial
quantities of supplies purchased through the British Columbia Purchasing Commission
to provide a closer control of such purchases. In this connection the very able and
willing assistance given by the Provincial Government Buying Agent in Vancouver has
been most worth while.
Grants Received, Year Ended March 31st, 1950
Complete figures are now available for the first two fiscal years the Federal Health
Grants have been in operation. During the year ended March 31st, 1950, an amount
of $1,726,141, or 65 per cent of the total available, was allocated, as compared to
$2,012,613 or 79 per cent in the previous year. However, the amount expended
increased from $1,094,151 in the first year to $1,310,311 in the second year, indicating
that approved projects were implemented to a greater extent.    In addition, the Province DEPARTMENT OF HEALTH AND WELFARE,  1950                            Y 23
only receives the amounts actually expended.    It is interesting to note also that this
increase in amount expended applied to all the grants except the Crippled Children's
Grant.    Plans under this grant have been purposely limited, pending the development
of a Provincial programme for crippled children.
The amount allocated and expended by British Columbia for the year ended March
31st, 1950, compares favourably with the average for all Provinces.    This Province
expended 47.6 per cent of the total available, whereas the average for Canada was 47.3
per cent.    These figures, which are supplied by the Department of National Health and
Welfare, exclude the Health Survey Grant, as it is non-recurring.
The amount available under each grant for the year ended March 31st, 1950, is
given in the following table, together with the amount allocated for approved projects
and actual expenditures:—
Comparison of Amounts Approved and Actual Expenditures with Total Grants
for the Year Ended March 31st, 1950
Gran!
Total Grant
Approved
Actual Expenditures
Amount
Total
Grant
Amount
Total
Grant
Crippled Children ..__  ___.  	
$43,043
43,043
1,033,864
43,043
368.9651
286,6401
7,515
41.S0S
432,800
294,502
1
| Per Cent
$22,839    |        53
39,394    |        91
575,904    1        53
43.043     1       100
$17,895
34,746
429,682
43,043
170,732
221,567
7,340
3,565
295,276
86,465
Per Cent
41
81
39
100
46
77
98
8
68
29
Hospital Construction   	
Mental Health                                  	
233,449
286,570
7,515
4,500
402,879
110,048
63
100
100
11
93
37
$2,655,223
$1,726,141    |        65
1
$1,310,311
49
1 Includes supplementary vote lor payment of 1948-49 accounts.
Assistance to Departments and Agencies outside the Provincial
Government
During the three years the Federal Health Grants have been available, $1,193,034
has been allocated from all grants, excluding hospital construction, to numerous agencies
apart from Provincial Government services.    This assistance has provided for additional
staff, professional training, and purchase of equipment.    It has made possible the establishment of new services and expansion of others by municipal health departments,
voluntary health agencies, and hospitals.    It has also made possible at the University
of British Columbia the introduction of courses in clinical psychology, medical and
psychiatric social work, as well as research allied to public health.
In addition, a large portion of the general public health grant has been allocated to
the various health units and city health departments throughout the Province, to the
support of which the municipalities contribute.    Similarly, approximately $600,000 has
been allocated from the Hospital Construction Grant toward the construction of general
hospitals, to which the municipalities also contribute.
Present Status
From a review of the projects approved and expenditures made to date during the
current fiscal year, there is every indication that greater advantage will be taken of the
Federal Health Grants this year.    Over 75 per cent of the amount available has already
been allocated to approved projects, excluding the Hospital Construction Grant, as funds
not allocated in this grant are carried over to the following year. Y 24 BRITISH COLUMBIA
As a result of experience previously gained, projects are now submitted only when
there is reasonable assurance that they can be implemented within the fiscal year. It is
expected, therefore, that expenditures this year will exceed previous years, and this is
borne out by the fact that at November 30th approximately $600,000 had been expended
from all grants, excluding hospital construction, whereas total expenditures for 1949-50
were less than $900,000. More detailed information regarding the distribution of each
grant is given in the following sections of this report.
Crippled Children's Grant
The survey of crippling diseases in children, which was authorized under this grant
in 1949, was terminated on August 31st, 1950. Included in the survey were institutional
records for 1948 and 1949, school medical records, and those of private physicians.
Reports were received in respect to 19,303 children having defects. In an appreciable
number of these cases, the defects had been or were being corrected at the time of the
report. Following a study of the analysed data, the sub-committee of this grant, under
the chairmanship of Dr. Donald Paterson, presented a report in October to the Minister
of Health and Welfare with recommendations in regard to the care of crippled children
in British Columbia.
As in previous years, expenditures under this grant have been largely for short-term
projects, pending the completion of the survey of crippling diseases in children and
a programme for crippled children. Such projects include three for professional training
and a number for the purchase of orthopedic equipment. The project for the retraining
and rehabilitation of poliomyelitis patients was continued, and a submission is presently
pending in Ottawa which will permit the establishment of a brace-shop at the Western
Society for Physical Rehabilitation where orthopaedic appliances will be manufactured
and fitted for these patients.
Approval is also pending of a project to establish a training course for orthoptists
at the Health Centre for Children, Vancouver. An increased number of orthoptists will
be required in order to provide sufficient services for the treatment of the number of
strabismus cases in the Province, as indicated by the survey of crippling diseases in
children. The orthoptist, under whose direction this course will be given, is now
certified by the American Board of Orthoptists, after having taken advanced training
earlier this year under an approved project.
Professional Training Grant
The number of applicants for professional-training bursaries this year again exceeded
the amount of funds available, with the result that projects were approved for postgraduate study under the other appropriate grants.
The total number of persons who have completed training under any grant, together
with the cost of such training, is shown in the following table for the three years these
grants have been available:—
Number of Persons Completed Training and Expenditures,
Years Ended December 31st, 1948 to 1950
Number of Persons       Total Expenditures
Year ended December 31st, 1950  51 $91,358.36
Year ended December 31st, 1949  28 52,276.84
Year ended December 31st, 1948     2 2,513.28
Totals  81 $136,148.48
Both specialized and generalized courses in all fields of public health have been
taken by the above individuals. The expenditure of these funds has made possible
improvements and new developments in health services for the people of British Colum- DEPARTMENT OF HEALTH AND WELFARE,  1950 Y 25
bia.    As far as practicable, priority is given to the staff of the local' health services.
Private agencies, as well as public agencies, have benefited.
In view of the fact that all recipients of bursaries must agree to return to suitable
employment in the Province for a specified period of time, the expenditure of these funds
is considered to be a worth-while investment.
In addition to the above, four in-service training courses were given in 1949 and the
same number in 1950. Most of these courses were given by an authority in each field,
who not only lectured to the staff concerned, but conferred with them in regard to their
programmes.
Hospital Construction Grant
In January of this year it was agreed that the allocation of funds under this grant
would be the responsibility of the British Columbia Hospital Insurance Service, the
Deputy Minister of Health being responsible only for the routine processing of projects.
Close co-operation is maintained between these two departments, as well as with the
Department of Provincial Secretary, which is concerned with construction of Provincial
mental hospitals.
Since April 1st, 1950, $147,870 has been allocated from this grant, as compared
to $503,496 in the fiscal year 1949-50 and $1,107,039 in 1948-49. Several factors
have contributed to this decrease. A large amount of construction was under way at
April 1st, 1948, and immediate advantage could therefore be taken of this grant. Provincial mental hospital projects accounted for approximately one-third of the total
amount allocated, and these units are now practically all complete. Careful consideration is given to all applications for new general hospital accommodation to ensure that
it coincides with the over-all programme for the Province. The Provincial Government
and the municipalities are finding it very difficult to raise their share of the cost of construction. Plans are presently being made, however, which, it is hoped, will materially
increase the allocation under this grant,, the unused portion of which accumulates for
five years.
Venereal Disease Control
During the fiscal year ended March 31st, 1950, this grant was placed on a matching
basis. The total amount is therefore paid to the Province, providing expenditures by
the Province on venereal disease control equal the amount of the grant, and also providing the standard and extent of services given during the year 1948-49 are maintained.
This change was a welcome one to British Columbia. One of the provisions of the
Federal Health Grants was that the funds were to be used only for new or extended
services. As the venerea] disease programme in British Columbia was fairly well
advanced and well organized when these grants first came into effect, it was becoming
exceedingly difficult to plan new or extended services which could be justified.
In effect, therefore, the report on the use to which this grant has been put is the
Annual Report of the Division of Venereal Disease Control.
Mental Health
The largest proportion of this grant is, of course, allocated to the British Columbia
Mental Health Services, which are under the jurisdiction of the Provincial Secretary.
Reference to this grant is made here only to complete the report regarding the Federal
health grants.
Funds were allocated for additional technical staff required for the Crease Clinic
of Psychological Medicine and additional accommodation provided at the Provincial
mental hospitals. A Rehabilitation Department of the British Columbia Mental Health
Services has been inaugurated. The University of British Columbia received a grant
to establish a course in psychiatric social work, as well as continued assistance for their
Clinical Psychology Department. Y 26 BRITISH COLUMBIA
Indicative of the increasing awareness in the community of the importance of mental
hygiene is the fact that for the second year two teachers have been granted bursaries to
attend the mental hygiene course for teachers offered at the University of Toronto. It is
the purpose of this course to train those who, upon their return to their own classroom,
will be able to carry on formal or informal teaching programmes in mental health principles within their own school systems. In addition, a course for teachers in the training
of exceptional children was given at the 1950 session of Summer School.
Tuberculosis Control
Additional hospitals have been supplied with X-ray units in order to further the
programme of routine X-ray of all admissions. With one or two exceptions, all of the
thirty-five units originally provided for have been installed. Units are being supplied
to all hospitals having 1,200 or more admissions each year.
Funds are provided from this grant to reimburse the hospitals, through the British
Columbia Hospital Insurance Service, for the cost of these X-rays.
The policy of routine hospital admission X-rays was endorsed by the British Columbia Hospitals Association at its annual convention this year.
The education programme for professional student and practical nurses is being
expanded through provision of funds to cover expenses of the increased number of
students. Several other projects under this grant have been approved for postgraduate
training.
One of the larger allocations of funds has been for the purchase of streptomycin
and P.A.S., to make possible more general use of these two newer drugs. Both in-patients
and out-patients are receiving the benefit of these drugs, which have shown excellent
results to date.
All phases of the tuberculosis programme in this Province are receiving benefit from
this grant, further detail of which is given in the Annual Report of the Division of
Tuberculosis Control.
Public Health Research
The total amount of this grant was increased from $205,148 in 1949-50 to $308,000
in 1950—51. These funds are allocated by an advisory committee in Ottawa for specific
research projects, and the amount allocated to British Columbia therefore depends on
the number of research projects accepted.
Assistance was continued this year toward the evaluation of the antigenicity of
cholera vaccine prepared in fluid media, which is being carried out under the direction
of Dr. L. E. Ranta, Department of Bacteriology and Preventive Medicine at the University
of British Columbia.
Approval was received of a project concerned with dehydration and its correction in
infancy, but it has been cancelled as it was not possible to obtain qualified personnel.
Health Survey
Plans for the survey of all health facilities in the Province required under the
provisions of this grant include the integration of the results of the individual surveys
already completed—namely, venereal disease, tuberculosis, cancer control, and hospitals—into the over-all plan of health services and facilities in the Province. Considerable discussion has taken place with the various Provincial, local, and private services
concerned, and the report is at present being finalized. The forms supplied by the
Department of National Health and Welfare to provide the supporting statistical data
are complete, and a preliminary copy has been forwarded to Ottawa.
In December, 1949, the Minister of Health and Welfare appointed a Committee
on Nursing Services to study this problem and to make recommendations. The Committee is composed of representatives of the various Government departments and DEPARTMENT OF HEALTH AND WELFARE,  1950 Y 27
organizations concerned with the many phases of nursing, including available supply,
training, recruitment, and legislation. The services given by registered nurses, psychiatric
and practical nurses are all being considered." The actual survey of nursing in this
Province was included in the survey of hospitals conducted by J. A. Hamilton and
Associates.
In effect, therefore, this Committee is a Provincial one to advise the Minister of
Health and Welfare. It is expected the report of the Committee on Nursing Services
in British Columbia will be made early in 1951. Mrs. Rex Eaton, as chairman of this
Committee, is making a valuable contribution toward the solution of these problems.
General Public Health
The general public health grant increased again this year from $432,800 to
$501,300. A very large proportion of this grant has been allocated to the continuation
of the expanded local health services, which are outlined in the section of this Report
entitled " Bureau of Local Health Services." Provision has also been made this year
for a branch laboratory at Prince George.
Expenses in this Province in connection with the Canada sickness survey, which
is under the jurisdiction of the Director of Vital Statistics in British Columbia, are being
charged to this grant. The Provincial Health Branch, through an approved project,
has also assumed responsibility for the sylvatic plague and rodent-control survey. In
both surveys, close co-operation is maintained with the corresponding department at the
National level.
Cancer Control
Total Federal funds available for the fiscal year 1950-51 are $295,908. However, this grant must be matched by Provincial Government funds, which this year
amount to only $144,502. As a result, $289,004 is the total amount available from
both Federal and Provincial sources. The amount voted by the Province was based on
estimated expenditures required for the cancer programme for the Province, without any
curtailment either in existing services or in planned expansion of services.
Assistance was continued this year to the British Columbia Cancer Foundation to
provide d'agnostic and treatment services. A new development in the cancer programme
was the inauguration of a free biopsy service and a cytology laboratory. All of these
services are fully described earlier in this report.
An amount of $8,000 was allocated to purchase diagnostic equipment for hospitals
participating in the biopsy service in order to improve diagnostic methods and teaching
facilities in regard to cancer.
Plans have been approved for the training of additional X-ray technicians at the
British Columbia Cancer Institute. This is being done in co-operation with the British
Columbia Cancer Society, which is assuming one-half the cost.
Acknowledgment
In conclusion, one must pay tribute to the valuable assistance and co-operation
received from Department of Health and Welfare officials, the Provincial Secretary and
his Mental Hospital staff, and the Commissioner and staff of the British Columbia
Hospital Insurance Service.
Harmonious working relationships exist with the city health departments of Vancouver, Victoria, and New Westminster, the voluntary health organizations, and general
and specialized hospitals, with all of whom this office has been in contact during the year. Y 28 BRITISH COLUMBIA
REPORT OF THE BUREAU OF LOCAL HEALTH SERVICES
J. A. Taylor, Director
ADMINISTRATION
The Bureau of Local Health Services provides the direct relationship between the
various technical divisions and services of the Health Branch, Department of Health and
Welfare, and the local health departments, while offering, in addition, supervisory and
consultative service to the staffs of those local health departments. The actual provision
of public health services on a local level is vested in the local Union Board of Health,
which, as provided in the " Health Act," becomes the legally qualified body responsible to
the Councils and School Boards for the administration of the services, receiving technical
advice and assistance as required from the Bureau of Local Health Services, on request.
As the Bureau of Local Health Services is composed of a number of separate technical divisions, it was considered advisable to set up a local Health Services Council, composed of representatives of those various divisions, to more effectively and efficiently
discharge those responsibilites expected of it. Consequently, during the year, such
a council became established, composed of the Deputy Provincial Health Officer as
chairman, the Director of the Division of Public Health Nursing, the Director of the
Division of Vital Statistics, the Director of the Division of Preventive Dentistry, the
Consultant of the Division of Public Health Education, the Chief Sanitary Inspector, the
Consultant in Nutrition, and the health unit clerical supervisor. This body has been
meeting weekly to review, discuss, and modify existing policies and programmes, while
developing recommendations for new policies and programmes where required. The
recommendations of the Council are presented to the Deputy Minister of Health for final
consideration before being transmitted to the local field staff or the Union Board of
Health.
The development of an increasing number of health units throughout the Province
increases the volume of technical, supervisory, and consultative assistance requested from
the Bureau of Local Health Services, and has materially increased the work-load of the
Director of Local Health Services, who is also serving as Deputy Provincial Health
Officer. It is therefore felt advisable at this time to recommend the appointment of
a Director of a Division of Health Units, as originally provided for in the administrative
chart of the Department, who could serve to visit the various units more frequently and
regularly* to provide technical supervisory and advisory consultation in the field as the
problems occur. It is felt that the appointment of such an individual would provide the
final link to effective liaison between the local health departments and the Health Branch,
Department of Health and Welfare.
DEVELOPMENT AND EXPANSION
This year saw the development of two health units, both of which were predicted in
the last Annual Report, while there was considerable expansion and readjustment within
the existing health units to meet the requests of local communities for health unit service.
Progress herein was again materially assisted by the availability of Federal Health Grants,
without which the necessary funds to finance the services might not have been available.
In the last Annual Report, mention was made of the fact that satisfactory progress
was being negotiated toward the development of an organized public health service in
the New Westminster area, which would be composed of the local health services of
New Westminster, Port Moody, Port Coquitlam, Fraser Mills, Municipality of Coquitlam,
and School Districts Nos. 40 and 43, under a Union Board of Health to provide a planned,
uniform type of service in all areas. This unit was the first to consolidate an urban area
with several smaller organized communities which had built up their public health nursing
and sanitary inspection services over previous years.    The unit came into being in DEPARTMENT OF HEALTH AND WELFARE,  1950 Y 29
January, 1950, becoming known as the Simon Fraser Health Unit, and has now enjoyed
one full year of operation, living up to all expectations in providing satisfactory service
to the participating municipalities and School Boards.
A year ago, attempts that had been made to develop a health unit in Trail and district
collapsed because of inability to interest a physician in assuming the directorship. It is
now possible to report that a well-qualified physician has been located, and that negotiations have been finally completed, leading to the formation of the West Kootenay Health
Unit, which has as it nucleus the communities of Tadanac, Rossland, Trail, Kinnaird, and
Castlegar, together with School Districts No. 9 (Castlegar) and No. 11 (Trail-Tadanac).
With that as a commencement, it is hoped to expand that unit at some distant date to
include School District No. 12 (Grand Forks) and School District No. 13 (Greenwood).
In addition to the very definite progress in the development of those two new units,
preliminary negotiations were conducted toward the establishment of the formation of a
unit for the Kamloops area, and one for the Surrey-Delta area. Both areas are anxious
to see complete local health services become established, and only the recruitment of
qualified medical personnel to act as Unit Directors prevents the final implementation
of the plans.
It was also found possible to provide a full-time director again for the Peace River
Health Unit, thereby assuring that all existing health units were completely staffed.
This means that there are thirteen of the planned eighteen health units in operation,
providing complete health unit service for 82.3 per cent of the population of British
Columbia.
Reorganization and expansion of existing health units also became possible during
the year as a result of negotiations conducted with the various Union Boards of Health
who approved the recommendations presented to them by the Bureau of Local Health
Services toward expansion of their boundaries to include certain neighbouring areas.
No expansion was recommended unless those neighbouring areas were already provided
with public health nursing services and it was possible to consolidate that public health
nursing service with already existing public health nursing services within the established
unit. The first of such moves was made in the Similkameen area, where it was possible to
expand the South Okanagan Health Unit to include School Districts No. 16 (Keremeos)
and No. 17 (Princeton), in which are situated the communities of Hedley, Keremeos,
and Princeton. Representatives from the District School Boards became members of
the Union Board of Health, while the Government Agent at Princeton became the
representative of the large unorganized area, as provided for under the " Health Act."
The North Fraser Valley Health Unit, with headquarters at Mission City, developed
to its originally contemplated size as School District No. 42, together with the Municipalities of Maple Ridge and Pitt Meadows, entered the Union Board of Health, while
School District No. 76, the Municipality of Kent, and the Village of Harrison Hot Springs
transferred from the Upper Fraser Valley Health Unit in favour of union with the North
Fraser Valley Health Unit. There is, thus, a consolidation of local health services on
the north side of the Fraser River under one Union Board of Health to provide for all
community and school health services through one co-ordinated staff.
The Upper Fraser Valley Health Unit, with headquarters at Chilliwack, is the one
unit which has actually occasioned a shrinkage in size with the transfer of services from
it to its counterpart on the opposite side of the Fraser River. It is hoped, however, that
this will be only transitory as the original plans for this unit develop to permit expansion
eastward to include the Village of Hope and School District No. 32 (Hope). Negotiations to this end have been presented to the village authorities and the District School
Board, but have not been finalized as yet, since there is some hesitation on the part of
the District School Board to enter into the union. However, further discussions are
contemplated, in which it is hoped satisfactory explanations can be presented to offset
the present hesitation on the part of the School Board. Y 30 BRITISH COLUMBIA
In the Upper Island Health Unit, which came into being last year, it was originally
planned to include Powell River, Cranberry Lake, Westview, and School District No. 47
(Powell River), as well as the present area. Early in the year, requests were received
from School District No. 47 (Powell River), suggesting that they were desirous of
becoming affiliated with the Upper Island Health Unit. As favourable reaction was
occasioned in the preliminary approach from the two organized Villages of Cranberry
Lake and Westview, plans were made toward implementation of the original proposals
and extension of the Upper Island Health Unit to include these new areas. Progress
was made to the degree that representatives from Cranberry Lake, Westview, and School
District No. 47 (Powell River) attended a meeting of the Union Board of Health in
Campbell River to finalize the details of the expansion, but, unfortunately, during the
discussion, remarks were made which left the impression that the Union Board of Health
considered the territory presently served by the health unit as being sufficiently large
enough to gain the full time of the staff, and that further expansion at this time would
not seem indicated. This has resulted in the School District No. 47 (Powell River)
expressing a desire to continue under its present service rather than join the Upper
Island Union Board of Health. This will interfere with the expansion of the Upper
Island Health Unit, and will require that negotiations will have to be renewed and further
discussion entered into to definitely reassess the whole situation.
Finally, expansion of public health nursing services during the year permitted the
placement of a public health nurse in School District No. 64 (Ganges), and led to the
expansion of the Saanich and South Vancouver Island Health Unit to include this school
district. This, the oldest health unit in the Province, is providing service to a mixed
urban and rural population bordering on the Victoria-Esquimalt Health Unit, being
administered by a Union Board of Health which, during the year, has expressed some
interest in the possibility of consolidation of Saanich and South Vancouver Island Health
Unit services with that of Victoria-Esquimalt Health Unit to provide a complete metropolitan health service for the lower end of Vancouver Island. Any discussions that have
been held have been of a merely preliminary nature, and will require a great deal of
further consideration on the part of all parties concerned. It is felt, however, that such
a move is definitely within the realms of possibility and would be a forward step in
consolidating the health service administration of the respective areas.
Continued liaison has been maintained with the metropolitan health services provided the Greater Vancouver area, in which organization toward self-contained local
units has been continued. Growth in the quality and quantity of service has been
consistent with the increasing population as determined by the Metropolitan Health
Committee, based on the representations of the Senior Medical Health Officer.
PERSONNEL CHANGES
The available supply of public health physicians improved somewhat during 1950
to the degree that it was possible to fill the vacancy in the Peace River Health Unit and
open two new health units, while at the same time permitting two Health Unit Directors
to accept leave of absence for postgraduate training. The Unit Director for the East
Kootenay Health Unit was granted leave of absence, effective September 1st, to permit
him to take postgraduate study toward his diploma in public health at the University
of Toronto under a Federal Health Training Grant, his position being filled by the
previous Director of the Saanich and South Vancouver Island Health Unit, who accepted
a transfer to this new area. The position in the Saanich and South Vancouver Island
Health Unit was filled by the Unit Director from the Central Vancouver Island Health
Unit, whose position was filled by the Director from the North Okanagan Health Unit,
in which a new Unit Director was placed. DEPARTMENT OF HEALTH AND WELFARE,  1950 Y 31
The Director of the Cariboo Health Unit for the past three years was granted leave
of absence for one year to permit postgraduate training in industrial hygiene, and, upon
his return, will be available to head a proposed new division within the Department.
His position in the Cariboo Health Unit was replaced by a new Health Unit Director
recently appointed to the staff.
During the forthcoming year, opportunities will be sought to permit postgraduate
training of three of the present Health Unit Directors—namely, the Directors of the Peace
River Health Unit, the Cariboo Health Unit, and the North Fraser Valley Health Unit—
to permit them to obtain their diplomas in public health. While they are absent, there
will be need for substitutes for their positions to replace them for the one year. It is
hoped that this will become possible, these substitutes being used later to permit development of new health units when the newly trained Unit Directors return.
BI-ANNUAL HEALTH OFFICERS' MEETINGS
The previous practice of holding quarterly meetings of the full-time Medical Health
Officers has been altered in favour of two meetings annually, held in. April and September.
During this past year the first meeting convened during the Annual Public Health
Institute, when an opportunity presented itself to have Dr. N. Sinai, from the School of
Public Health, University of Michigan, attend the meeting. Dr. Sinai was very favourably impressed with the type of meeting in which Medical Health Officers, Divisional
Directors, and administrative heads of the Health Branch, Department of Health and
Welfare, could sit down to study, review, and assess their common problems, and
endeavour to provide programmes to deal with those problems, while guiding the progress
of public health to meet the changing concepts in community health services.
During the fall meeting, held in September, the committee dealing with the revision
of Communicable Disease Regulations tendered its report and provided an opportunity
for each full-time health officer to present amendments and suggestions toward improvement of the regulations. It was felt that in this way the new regulations would come
into effect early in 1951, and should most satisfactorily meet the requirements of all
areas of the Province, while providing more practical regulations, consistent with modern
public health practice. At this same meeting considerable discussion was presented on
each of the subjects under review, and much was accomplished in regard to the tuberculosis programme and stationary X-ray clinics, sickness survey, and civilian defence
preparations.
INTERDEPARTMENTAL RELATIONSHIPS
A year ago an agreement was developed between the Department of Agriculture and
this Department to provide a co-operative supervision of milk production. A co-ordinated
programme has been in effect for several months, with marked success in certain areas,
but with very little success in others. It was felt advisable to reconvene another meeting
with representatives from the Department of Agriculture, including the Live Stock
Branch and the Dairy Branch, to review the duplication that exists in the milk-control
field, where there are Inspectors from Agriculture, Inspectors from the Milk Board, and
Inspectors from the local health departments, all visiting dairies and farms and conducting inspections within their separate fields, although in many instances there is overlapping. It was pointed out at this meeting that the Health Branch is functioning
strictly as a liaison between the local health departments and the Department of Agriculture, since the local Medical Health Officers and Sanitary Inspectors are appointed
municipal or local Milk Inspectors by their respective Councils under local by-laws.
Specifically, however, it was suggested:—
(a) That the multiplicity of Acts and regulations and the policies and interpretations of these should be reviewed. Y 32 BRITISH COLUMBIA
(b) That some consideration should be given toward the individual responsibilities and functions of Inspectors from the various groups represented.
(c) That certain policies in uniformity and interpretation of bacteriological
and chemical standards of milk tests should be presented.
With these considerations as the basis of discussion, the meeting reviewed the
situation and finally agreed that Inspectors in each Department should be provided with
an outline of the policies in each service, so that the one would know wherein the responsibility of the other lay. It was decided that local Milk Inspectors should make routine
visits to the dairy plants pursuant to receiving the results of the milk analysis. If matters
of particular importance arose, the Dairy Branch Inspector should visit the plant immediately. It was felt that further discussions should be held toward the development of
an integrated programme, if at all possible.
With the Department of Education there has maintained a very harmonious relationship in regard to discussions of school health services. During the year the Assistant
Superintendent of Education addressed the Annual Public Health Institute on the new
curriculum in " Effective Living " developed by that Department for introduction in the
schools in September, 1950. In return, an opportunity was afforded the Deputy Provincial Health Officer to address the School Inspectors' Convention to outline changes
in the public health services as they were related to the school health services throughout
the Province. Following a brief introduction of the subject, time had been permitted
for questions and discussions, and there was a very frank and open discussion of many
fields of this service by individual Inspectors attending that Convention. As a result of
the meeting, recommendations were garnered from the various Inspectors to be presented
in mimeograph form for consideration of the Health Unit Directors.
The two other large branches of the Department—namely, the Welfare Branch and
the Hospital Insurance Service—cannot be entirely divorced from the public health
services, and there has continued an interdepartmental relationship which, it is anticipated,
will foster a closer working relationship for the future. Arrangements were worked out
during the year whereby the collection of hospital insurance premiums in health unit
offices at Abbotsford and Trail was undertaken to assist the Hospital Insurance Service
during the change-over from the district collection of these to the new method of cyclic
billing.
SCHOOL HEALTH SERVICES
During the year the annual report for school health services for the years 1947-48
and 1948-49 were completed in a separate report entitled " Medical Inspection of Schools
Report." The major service under this heading has dealt with the provision of physical
examination of the school-children and pre-school children, and immunization of those
same groups against certain specific communicable diseases. In this regard a considerable
amount of credit must be given to the sixty physicians who, in their capacity as part-time
School Medical Inspectors, assisted by public health nurses, have completed these examinations; their contribution toward this phase of public health contributes greatly toward
the total community health, while directing attention to the health problems which can
be given attention during the early formative years of the child in the prevention of much
later physical defect, with its possible suffering.
An analytical study of the routine examinations goes on from year to year as the'
Department endeavours to determine the most efficient method of providing the greatest
service to the maximum number of pupils, while giving more individual attention to those
most in need of it. The study of the Wetzel Grid as a screening-tool, commenced in
1947, was carried through into 1950, and a very detailed report on that study prepared
by the field director for presentation to the Health Branch, Department of Health and
Welfare, and the Child and Maternal Health Branch, National Department of Health
and Welfare.   This report has been the object of considerable study by both Departments ■ . •--■:
DEPARTMENT OF HEALTH AND WELFARE,  1950 Y 33
in a desire to simplify it to provide definite recommendations for the Central Vancouver
Island Union Board of Health and the guidance of other Union Boards as to whether
this measuring-tool would serve as an adjunct in screening the pupils requiring the
greatest amount of attention. It is felt that some additional work will be necessary in
regard to this report, and it is proposed that officials from both Departments will
endeavour to re-edit the report during the future months to provide that answer.
In the meantime continued use of the Wetzel Grid is being carried on in the Central
Vancouver Island Health Unit as an integral part of the school health service in the hope
that further assessments of the values to be obtained through its use can be made to
determine if it is a practical method for use by the existing staff of the health unit, in
co-operation with the school staffs. Critical analysis of the results obtained over the
past three years will be made, bearing in mind the additional record-keeping that is
necessary, the co-operation that must be developed between the school staff and the
health unit staff, and the information obtained with the benefit to the individual pupil,
as compared with the present routine school medical inspection system.
SICKNESS SURVEY AND STATISTICS
During the year a morbidity study or sickness survey was undertaken throughout
Canada 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. In British Columbia this additional
task was undertaken by the staffs of the local health departments, with guidance supplied
by the Bureau of Local Health Services in co-operation with the Division of Vital Statistics and the Department of National Health and Welfare. The whole study is made
possible under Federal Health Grants, which provide finances for the supervisory and
clerical personnel necessary to direct the survey. The survey got under way in October
and will be continued until September, 1951, following which the data will be collated
and analysed. It is felt that the results will be of significance in determining future
medical and nursing care needs, while at the same time pointing the future trends in
public health development.
For the present the only available index of morbidity is restricted to the reports of
specified notifiable diseases, which are compiled and analysed from year to year. The
comparisons in these figures for the past three years are presented in Table I, page 35.
The so-called minor communicable diseases of childhood—chicken-pox, measles, mumps,
and rubella—continue to account for the greater proportion of the reportable diseases.
Actually, chicken-pox (439.5 cases per 100,000 population) and measles (496.3 cases
per 100,000 population) were somewhat lower than the previous year, which would
seem to indicate a waning incidence from the epidemic peak. As these diseases usually
occur in cyclical epidemics, it can be anticipated that there will be a continuing fall in
the incidence during 1951.
Significant increases in the number of cases of mumps and rubella occurred during
the past year. Mumps, with a rate of 758.7 cases per 100,000 population, almost
doubled its incidence, while rubella, at a rate of 697.3 per 100,000 population, exhibited
an incidence thirteen times greater than the previous year. The conclusion would be that
these two diseases have risen toward epidemic levels and will decline in the forthcoming
year.
An untoward increase in the number of cases of whooping-cough appeared during
1950, the rate of 152.9 per 100,000 population being the highest recorded in the past
five years. This situation created some anxiety by local health services staffs in regard
to the immunization programmes in infant and pre-school groups, and led to an intensified
educational campaign to encourage more parents toward immunization of infants and
maintenance of that immunity by reinforcing doses in pre-school years. Y 34 BRITISH COLUMBIA
Five times as many cases of diphtheria were occasioned, a rate of 5.5 for 1950,
as compared with 1.1 for 1949. Mention should be made that the high figures were
reflected by the epidemic in the Peace River and Alaska Highway areas during the latter
part of 1949 and early 1950. This was the highest incidence in the past three years
and indicates the vigilance needed to maintain a high immunity level.
A very gratifying situation occurred in the case of poliomyelitis, in which the
decrease evidenced a year ago was continued to the level of 6.4 cases per 100,000 population. This characteristic for this disease to wax and wane in incidence defies explanation, since little enough is known of the epidemiological features to do so.
The number of cases of salmonellosis was considerably increased to a rate of 13.4,
as compared with 8.5 in 1949 and 3.8 in 1948. It is recognized that, in part, this
increase can be explained by an increased interest on the part of the physicians to investigate and confirm gastro-intestinal complaints resulting in laboratory indication that
Salmonella organisms are the causative agents involved. At the same time it is recognized that this incidence only indicates a trend, since it is questionable if all the samonel-
losis occurring will ever be definitely recorded. Many patients with gastro-intestinal
symptoms never seek medical care and, therefore, the cases go unrecognized. At the
same time it is significant that the trend has been consistently upward, recorded both in
the number of sporadic cases occurring and the number of localized explosive epidemics
affecting groups of persons. Four of these latter received investigation during the year,
one by the Simon Fraser Health -Unit, affecting thirty-four persons attending a picnic,
incriminated improperly prepared turkey. A second, affecting a children's summer
camp, was suspected to be due to contaminated water-supply, due to poor camp sanitation, while a third, in a hotel, also felt to be due to water contaminated through poor
sanitation. The fourth, investigated by the Victoria-Esquimalt Health Unit, occurred
among a group attending a social evening and was evidently due to contaminated food,
although the source and means of spread were never definitely uncovered.
Scarlet fever and septic sore throat should be noted together, since both are due to
a similar type of infection affecting the same part of the body and an increased incidence
in one is usually mirrored by a similar response in the other. Significant increases in
both were seen during the past year, but, as in the past, the infections have been mild
and uncomplicated.
The complete list of notifiable diseases as reported from the various areas of British
Columbia by the Medical Health Officers is recorded in Table II, page 36.
The total number of reportable diseases has been somewhat higher than in past
years, the rate being 3,569.1 for 1950, as compared with 3,147.8 for 1949 and 2,184.1
for 1948. This may reflect nothing more or less than a greater number of communicable
infections, which it is known fluctuate considerably from year to year in any case.
It should be recalled, however, that a definite plan was evolved a year ago, designed to
promote an improvement in reporting by physicians and local health services. Whether
this has occurred or not is still conjectural, since there is definitely greater numbers of
positive laboratory reports than actually reported clinical cases. Further studies in this
problem are to be conducted in the future by the Bureau of Local Health Services in
co-operation with the Division of Laboratories and the Division of Vital Statistics. DEPARTMENT OF HEALTH AND WELFARE,  1950
Y 35
Table I.—Incidence of Notifiable Diseases in British Columbia
(Including Indians)
Notifiable Disease
1948
Number
of
Cases
Rate per
100,000
Population
1949
Number
of
Cases
Rate per
100,000
Population
Number
of
Cases
Rate per
100,000
Population
Actinomycosis.
Anthrax	
Botulism	
Cancer	
Cerebrospinal meningitis _
Chicken-pox.
Conjunctivitis (acute).
Diphtheria 	
Dysentery—
Amcebic	
Bacillary	
Encephalitis-
Epidemic hepatitis-
Erysipelas 	
Gonorrhoea 	
Infant diarrhoea	
Influenza 	
Leprosy __ —
Malaria	
Measles	
Mumps	
Poliomyelitis .
Puerperal septica_mia_.
Rheumatic fever	
Rubella	
Salmonellosis—
Paratyphoid fever-
Other	
Scarlet fever 	
Septic sore throat..
Syphilis	
Tetanus	
Tick paralysis	
Trachoma	
Trichinosis..	
Tuberculosis	
Typhoid fever..
Undulant fever ..
Vincent's angina-
Whooping-cough-
Totals	
2
2,492
24
6,087
164
35
31
"li
41
3,615
1,238
4,137
1,008
118
2
12
405
7
41
383
157
1,018
3
4
6
2,178
22
66
15
285
0.2
230.3
2.2
562.6
15.2
3.2
2.9
3.3
3.8
334.1
TlT4
382.3
93.2
10.9
0.2
1.1
37.4
0.7
3.8
35.4
14.5
94.1
0.3
0.4
0.6
201.3
2.0
6.1
1.4
26.3
1
1
3,509
18
7,370
287
12
23
1
10
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
0.1
315.0
1.6
661.6
25.8
1.1
2.1
0.1
1.0
2.9
344.1
1.1
4.2
0.1
0.1
966.3
387.3
20.2
0.1
1.7
50.9
0.1
8.5
44.1
9.2
77.1
0.3
0.2
0.8
0.4
197.7
1.5
1.4
0.3
19.2
1
3,125
15
5,001
280
63
1
189
1
46
36
3,579
11
460
5,648
8,634
73
1
33
7,935
35
152
871
183
630
1
1,828
11
22
6
1,740
0.1
274.6
1.3
439.5
24.6
5.5
0.1
16.6
0.1
4.0
3.2
314.5
1.0
40.4
496.3
758.7
6.4
0.1
2.9
697.3
3.1
13.4
76.5
16.1
55.4
0.1
6.4
160.6
1.0
1.9
0.5
152.9
23,632
2,184.1
35,066
3,147.i
40,616
3,569.1 Y 36
BRITISH COLUMBIA
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Y 37
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IS Table II.—Table Showing Cases of Notifiable Diseases in the Province of British Columbia                           ><
for the Year 1950—Continued                                                                                     £
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H DEPARTMENT OF HEALTH AND WELFARE,  1950 Y 39
REPORT OF THE DIVISION OF PUBLIC HEALTH NURSING
Monica M. Frith, Director
Ten years ago the first Director of Public Health Nursing was appointed in British
Columbia. Since that time public health nursing has continued its steady development,
increasing each year in scope and quantity. A short summary of the history of public
health nursing in British Columbia follows, showing significant changes which led to the
present status of the service.
Public health nursing commenced in British Columbia with the appointment of the
first public health nurse to Saanich, April 13th, 1917. In 1921 three nurses were
appointed to Saanich Municipality and two to Duncan, thus marking the organization of
a Public Health Nursing Service.
The amendment to the " Public Schools Act" that same year, which financially
assisted Boards of School Trustees and allowed them to employ nurses on the same basis
as teachers, gave impetus to the development of the nursing service. The programme
emphasized school health service, while, in addition, a bedside-nursing programme was
carried in some areas.
As the University of British Columbia had inaugurated a training programme for
public health nurses in 1919, by 1928 the requirement of graduation from a postgraduate
course in public health nursing was put into effect for all nurses employed in the public
health field.
In 1929 there were twenty-five public health nurses in the field staff and twenty-five
school nurses in cities and municipalities, all employed on a local level.
A programme of tuberculosis control was gradually evolving. In 1921 a public
health nurse was appointed to do specialized tuberculosis district work in Vancouver
through funds available from the Rotary Clinic. By 1935 five nurses were employed in
this specialized programme, serving in the Greater Vancouver, area and Burnaby. In
1928 a public health nurse was appointed by Tranquille Tuberculosis Society to travel
with the travelling chest X-ray clinic and to assist with the development of the tuberculosis-control programme on a local level. This service was later taken over by the
Division of Tuberculosis Control and a field consultant appointed in 1939.
In 1935 the generalized health service was set up in the Greater Vancouver area
with the establishment of the Metropolitan Health Committee. With the inauguration
of the new health service, public health nurses became generalized health workers and
were no longer employed only as school nurses or tuberculosis nurses.
In Provincial areas the public health nurse was gradually adding more health services
to the basic school health, bedside-nursing, and tuberculosis programmes, with the
objective of a complete community public health nursing service.
With the appointment of the first Director of Public Health Nursing in 1940, the
desirable trend toward the generalized public health nursing service was given further
impetus in Provincial public health areas. This was encouraged by the change in the
" Public Schools Act" in 1944, whereby the grants formerly paid to the School Board
by the Department of Education on behalf of public health workers were transferred to
the Provincial Board of Health. Technical approval of the service in the schools was
assumed by the Provincial Board of Health, thus bringing about the development of more
uniform standards of school health and general public health nursing service.
Public health nursing districts were set up in new areas in response to local demand,
with local School Boards forming the nucleus of the local advisory Public Health Nursing
Committee. As each school had its own School Board, as many as eight or ten School
Boards might join together for the purpose of organizing and operating a public health
nursing service, with assistance from the Provincial Board of Health. Y 40 BRITISH COLUMBIA
In 1946, following the Cameron Report issued by the Department of Education,
public health nursing districts were reorganized to coincide with the boundaries of the
newly formed school districts. At the same time the service was refinanced in order
to equalize the local cost of service to the community. This was set at 30 cents
per capita. In Provincial areas, public health nursing staff became direct Provincial
Government employees and, as Civil Servants, became eligible for such benefits as the
superannuation scheme and Provincial salary schedule. Personnel policies for public
health nurses were thus standardized throughout the Province.
Although the method of financing the local public health nursing service changed,
public health nurses continued to be considered local employees, responsible jointly to
their own local Public Health Advisory Committees and to the Provincial Health
Department.
The public health nursing service has been the pioneer health service, forerunner
to the more complete health unit service. Public health nurses have played a significant
part in creating a demand for the more complete health service. Public health nursing
districts are being incorporated into health units as they become organized. It is hoped
that, before too long, complete health unit service will be available to all parts of British
Columbia.
PRESENT STATUS OF SERVICE
The public health nursing service has continued to extend its territory and this year
added School District No. 64 (Saltspring and adjacent islands), which became part of
the Saanich and South Vancouver Island Health Unit; School District No. 50 (Queen
Charlotte Islands), which became part of the Prince Rupert Health Unit; School District
No. 31 (Merritt), which is part of the Kamloops Public Health Nursing Service. Additional nurses were added at Kamloops and at Prince George to take care of the increased
demand for service. With the addition of these areas and New Westminster, which is
part of the Simon Fraser Health Unit, public health nursing service is now available to
98 per cent of the population of British Columbia.
At the close of the 1950 year there are 121 field and supervisory positions in public
health nursing. Although two of these positions are not filled, this represents an increase
of six available positions over last year.
Table I shows a comparison of the Provincial public health nursing staff changes
during the ten-year period 1941-50. Although the staff turnover was 67 per cent, this
year it is interesting to note that this is considerably below last year, when it was 82 per
cent, and only 7 per cent over the average for the past nine years. However, with a staff
increase of 175 per cent over the past ten years the volume of work in administering the
service has increased considerably.
There were thirty-three appointments to the service. Ten of this group, however,
were public health nurses returning to the staff following university training in public
health nursing. Five had completed the course in public health nursing at the University
of British Columbia during the past year, four were recruited from outside the Province,
five came from other public health agencies, while one public health nurse had not been
employed in public health recently.    Eight do not have public health nursing training.
Thirty-one nurses left the staff: ten for further university training; thirteen to be
married or for family reasons; one nurse transferred to the Division of Tuberculosis
Control and one to the Simon Fraser Health Unit. One is on leave of absence because of
illness.
Although the number of transfers was less than last year, more senior nurse positions
were involved. New senior nurses were appointed to the East Kootenay Health Unit
at Cranbrook, the North Okanagan Health Unit at Vernon, the Peace River Health Unit
at Dawson Creek, the Upper Island Health Unit at Courtenay, Kamloops Public Health
Nursing Service, and Matsqui-Sumas-Abbotsford Public Health Nursing Service.    Full- DEPARTMENT OF HEALTH AND WELFARE,  1950 Y 41
time public health nursing supervisors were made available to the South Okanagan Valley
Health Unit at Kelowna and to the Simon Fraser Health Unit at New Westminster. Staff
and senior public health nurses are promoted to these positions following demonstration
of ability as staff workers.
As shown by Table II, 32 per cent of the staff are in the first year of service, while
85 per cent have four years' experience or less.
The rapid turnover and the relatively short experience of the nurses indicate a
constant need for supervision and for a planned recruitment programme to keep a steady
flow of nurses into the public health nursing field.
The Internship Plan for nurses has contributed materially to keeping up the standard
of public health nursing service and has helped to recruit nurses to the public health
field. The fact that only twenty-eight students are registered in the course in public
health nursing at the University of British Columbia this year would indicate that
insufficient numbers of public health nurses are being prepared to meet the public health
nursing needs of the Province.
PUBLIC HEALTH NURSING TRAINING PROGRAMME
Internship Plan
This year we were fortunate to be able to plan for the return to our staff of the nine
nurses who had completed their course in public health nursing at the University with
assistance of Federal Health Grants under the Internship Plan. Because of their previous
experience with the Department, they were able to assume responsibility for new districts
readily and were available for placement soon after the completion of the University year,
thus providing a better continuity of service than is possible if the number of applicants
for positions is unpredictable.
During the year ten registered nurses were taken on staff under the training plan for
registered nurses. Under this scheme registered nurses who expect to take their academic
training in public health nursing at an early date are given the opportunity of working on
the staff to gain experience and to determine their suitability for this type of work. These
nurses are given a careful orientation course planned by the Senior Public Health Nurse
before they assume complete responsibility for districts. Seven of this group and two
from the staff of the Simon Fraser Health Unit were given bursaries through Federal
Health Grants in order to assist them financially to obtain certificates in public health
nursing.
In order to meet the expanding need for service and to fill current vacancies, it has
been necessary this fall to add more registered nurses to the staff.
Great tribute should be paid to the senior nurses, who, along with their other heavy
duties, have accepted nurses without public health training and carefully prepared them
to carry a nursing district safely under supervision.
STUDENT PROGRAMME
During the past year the usual field facilities were offered to public health nursing
students at the University of British Columbia and to undergraduate nursing students in
nursing training-schools. Twenty-seven university nursing students received planned
experience with a field service. In order to use centres distant from Vancouver, the
Department has continued to subsidize the students' transportation costs to these areas.
Undergraduate experience was provided for fifteen students from St. Joseph's Hospital in Victoria for a total of fifty-eight days. Royal Inland Hospital at Kamloops sent
twelve senior nursing students for one day's observation and for additional field-trips.
Centres in the Lower Fraser Valley have been used for students entered in the affiliation
course at the Division of Tuberculosis Control. Y 42 BRITISH COLUMBIA
Members of the public health nursing staff from Central Office, the supervisors of
Saanich and South Vancouver Island Health Unit and the Simon Fraser Health Unit,
and the senior nurses from Surrey and Kamloops have assisted with lecture courses in
public health nursing in schools of nursing.
The public health nursing study groups have continued with programmes of staff
education, studying topics selected for the benefit of the group concerned. Regional
study groups make up the Public Health Nursing Council of the Division of Public Health
Nursing.
The aims and objectives of the Council are stated as follows:—
(1) To integrate the district study groups which are formed to keep abreast
with modern developments as found applicable to the public health nursing programme by giving an opportunity for each group to report its
programme and projects at each annual meeting.
(2) To give an opportunity at the end of each general meeting for the Provincial public health nurses to discuss common problems and make constructive recommendations to the Director of Public Health Nurses for
her consideration.
(3) To give public health nurses an opportunity for a meeting with the Director at the Annual Institute and so promote understanding between field
staff and central office.
The Public Health Nursing Council has brought forward many worth-while problems
for consideration and has been an important factor in unifying the public health nursing
group. Through a Federal Health Grant project it was possible for the Council to send
three representatives to the Canadian Nurses' Association annual meeting in Vancouver
in June. Additional public health nurses were given time off to attend this meeting. One
of the important topics discussed was the " home care " programme at Montefiore Hospital, New York. This subject is of vital interest to the public health nurses, as similar
plans may be developed in this Province in the future.
Public health nursing staff from the Lower Mainland and Vancouver Island were
privileged to attend the annual pediatric refresher course at Vancouver General Hospital
in September.
Public health nursing developments are brought to the attention of the staff through
the monthly publication Public Health News and Views.
The Annual Institute remains one of the most popular and effective methods of staff
education. Here members of the staff have the opportunity of discussing their health
problems in an objective manner in relation to similar problems throughout the Province,
away from the immediate demands of the district.
SERVICE ANALYSIS
In a constant effort to improve the quality of public health nursing service and to
render it in the most efficient and economical manner, a critical analysis of the individual
case-load and the methods used in giving service must be made regularly.
A study of the time spent on various activities by the public health nurse was again
made by all public health nursing field staff. As time studies were formerly done in the
fall only, a time study was conducted in May of this year in order to determine whether
the seasonal variation would have any significant bearing on the service rendered. Table
III shows a comparison of time spent by each public health nurse, as indicated by time
studies in November, 1949, and May, 1950. It is interesting to note that there is no
significant difference in the time spent in various activities during the two periods studied.
Overtime in May can be attributed to the special typhoid immunization clinics held when
floods threatened. Many of these clinics were conducted in the evening on the staff's
own time. .
DEPARTMENT OF HEALTH AND WELFARE,  1950 Y 43
A time study for clerks was held in May, at the same time as that for public health
nursing staff. From the results of the two studies it was possible to make recommendations for greater efficiency in clerical routines and to increase clerical assistance to public
health nurses in order to make more time available for professional public health nursing
activities.   It is hoped that further studies will show that this has been accomplished.
NEW PROGRAMMES AND SPECIAL SERVICES
The public health nurse is an important member of the health team, because she is
the individual who is responsible for the generalized public health nursing service as it is
directed toward each individual and toward the family unit.
The service has continued to expand and broaden, requiring that the public health
nurse readily adapt herself to new programmes as the emphasis shifts towards the less
spectacular but equally important phases of health as related to our economic and social
system.
This trend has been exemplified during the past year by such developments as the
survey of crippling diseases of children. A total of 3,918 children were examined in
Provincial areas, and reported by survey card to the committee investigating the extent
of crippling diseases of children. It is anticipated that the survey will give valuable data
to the committee to assist in planning for the best possible resources for the prevention
and treatment of crippling conditions.
In September public health nurses commenced visiting the 1,078 families who are
taking part in the Canada-wide sickness survey which has been initiated by the Federal
Government. This study will measure the total amount of sickness among the population
being surveyed and will show the type of medical, dental, hospital, and nursing care
received, as well as the amount of money being spent for this purpose, and should indicate
the extent to which the population is receiving needed care and treatment. The survey is
being carried on over a one-year period. British Columbia is the only Province in which
public health nurses are responsible for collecting the information. As the families being
surveyed are scientifically selected, the survey affects only certain areas of the Province.
To meet the extra demand on public health nursing time for this purpose, eleven part-
time nurses have been employed to assist with the general health programme, and the
Assistant Director, Public Health Nursing, has been assigned to supervise a region of the
Province.
The cancer programme has been extended as the result of the cancer consultative
services set up in the following centres: Penticton, Kelowna, Vernon, Kamloops, Nelson,
Trail, Prince Rupert, and Cranbrook. This has provided rural areas with expert consultative advice on treatment and diagnosis of cancer.
It is anticipated that greater emphasis will be placed on the mental health programme
following the return of Miss Lucille Giovando from the University of Minnesota, where
she is completing a mental hygiene course in preparation for a consultant position in
public health nursing.
One public health nurse returned to the staff following completion of a year's experience at the Child Guidance Clinic. The opportunity of receiving this experience is
appreciated, and it is hoped that other public health nurses may take advantage of a
similar programme.
Home-maker services which have been carried on by voluntary agencies have
demonstrated their value in the health programme. This is particularly evident in the
Kelowna area, where the Kelowna Home Service has been functioning since 1947, and
in the Chilliwack area, where a similar service has been sponsored by the Red Cross. In
the future it is hoped that similar services will be made available to more areas of the
Province. Y 44 BRITISH COLUMBIA
Public health nurses continue to increase the amount of nursing care given in the
home on a demonstration and short-term basis. The number of injections has also
increased, partly due to the use of streptomycin, which is being given by the public health
nurses to tuberculous patients in rural areas.
The Division of Venereal Disease Control has continued to assist public health staff
with the local venereal disease programme. The rural epidemiology worker, who is
a public health nurse, has been able to visit the main health centres. She has stimulated
interest and greater activity in this phase of the generalized programme.
The Senior Public Health Nurse assigned to the Division of Tuberculosis Control in
Vancouver, Miss D. Bullock, resigned to be married. She has been replaced by Miss
F. Primeau, who was formerly Senior Nurse in the Kamloops Public Health Service.
Plans are being devised to make optimum use of the hospital miniature X-ray survey units,
since the mobile chest X-ray units are no longer available for community surveys. The
General Policies Manual for field staff was revised this year.
During the year, changes in the " Workmen's Compensation Act " extended coverage
to public health nurses for tuberculosis.
Investigation has been under way into the possibility of the Red Cross outpost
nursing staff assuming public health duties in certain isolated areas of the Province.
Public health staff of certain areas of the Province continue to carry responsibility
for Indian health services.
Central Office nursing staff continued to act on a number of nursing committees,
including the Red Cross Nursing Committee, the Junior Red Cross Crippled and Handicapped Committee, the Public Health Nursing Curriculum, and educational committees
of the Registered Nurses' Association of British Columbia, the Provincial Nursing Services
Committee, the University Senate Committee on Nursing, and the Committee on Theory
and Field Practice.
AWARDS FOR DISTINGUISHED SERVICE
Two public health nurses, Miss Aileen Bond, Senior Nurse in the Peace River Health
Unit, and Miss Amy Wilson, Indian Health Service, White Horse, received Distinguished
Service Awards for heroism shown in combating a diphtheria epidemic starting at Halfway
Valley in the Peace River. This action involved personal sacrifice and risk beyond the
normal call of duty and was an excellent example of co-operation between the Federal
and Provincial health services in joint action for the protection of the public health. The
Distinguished Service Awards were presented to the nurses at the Institute by the Acting
Minister of Health and Welfare, the Honourable E. T. Kenney, acting for the Honourable
George S. Pearson. These are the first awards of this kind in British Columbia. The
action of the nurses adds a magnificent chapter to the developing history of public health
nursing in Canada.
Although two public health nurses received awards for special action, tribute should
be paid also to all the nurses of the staff, who have given loyal and steadfast service
throughout the year. Their actions have not been, perhaps, as spectacular, but their
efforts have been fully appreciated. Through this steady progress the objectives of
public health will be accomplished. DEPARTMENT OF HEALTH AND WELFARE,  1950
Y 45
Table I.—Comparison of Provincial Public Health Nursing Staff Changes
during the Period 1941 to 1950
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
44
26
59
10
8
8
47
31
66
11
9
11
52
37
71
17
12
8
56
33
59
13
11
9
64
48
75
22
16
10
77
88
117
42
27
19
98
65
65
37
11
17
111
52
46
24
14
14
115
94
82
41
28
25
121
81
Staff turnover (percent) _ 	
New appointments —__ 	
Resignations _	
67
331
31-
17
1 Returning from university.
2 To university.
Table II,
Number of
Years of
Service
1 ____
2 _____
3 _
4 _
5 _____
-Number of Years of Service of Field Staff as at
December, 1950
Number of
Public Health
Nurses
___ 38
___ 21
___ 20
.__ 21
_ 5
Number of
Years of
Service
7	
8 _____
9 _____
10-15
Number of
Public Health
Nurses
__    2
...    3
Total
119 Y 46 BRITISH COLUMBIA
Table III.—Comparison of Time Spent by Public Health Nurses in Specified
Activities as Indicated by Time Studies in November, 1949, and May, 1950
Per Cent, 1949      Per Cent, 1950
Visits to schools  17.4 17.2
Child health conferences—
Professional   5.8 5.6
Non-professional  0.7 0.7
Other  0.8 0.8
Totals       7.3 7.1
Home visits—
Prenatal visits  0.5 0.5
Infant visits  3.2 3.4
Postnatal visits  1.0 1.1
Preschool visits   3.0 3.0
School visits  3.1 4.2
Nursing care  1.9 1.9
T.B. nursing care  1.7 1.7
V.D. nursing care  0.3 0.2
Other nursing care   2.4 1.3
Totals     18.1 17.3
Office—
Clerical-professional   15.1 13.5
Clerical-non-professional   8.6 5.1
Telephone calls—nurse  1.5 1.6
Telephone calls—clerk  0.3 0.3
Other—office   3.0 3.9
Totals     28.5 24.4
Conferences  _•  6.1 5.2
Travel  18.3 17.6
Meetings—
Attended   3.1 4.0
Addressed   0.6 0.4
Totals :______      3.7 4.4
Other activities       1.7 6.8
Grand totals 1  100.0 100.0
Overtime        4.2 9.8 DEPARTMENT OF HEALTH AND WELFARE, 1950 Y 47
REPORT OF THE NUTRITION SERVICE
E. M. Yvonne Love and Doris L. Noble, Consultants
The responsibility of the Nutrition Service is that of assisting with the prevention of
illness and promotion of health through improving food habits. It is recognized that
this cannot be accomplished solely by supplying advice on what to eat. Selection of
foods is influenced by availability and price, and motivation to eat the right foods, as well
as knowledge of a good diet, is needed to change food habits. Clearly, there are many
components to the nutrition problem.
During 1950 the programme of the Nutrition Service has been planned to provide
additional emphasis to methods and activities which have been found to produce significant results.    These activities are described in the ensuing report.
CONSULTANT SERVICE TO LOCAL PUBLIC HEALTH PERSONNEL
The staff in health units and nursing districts have, as one of their responsibilities,
the counselling and advising of individuals and families regarding selection and use of
nourishing foods. To assist them in dealing most effectively with community nutrition
education, the nutritionist serves in a consultative and advisory capacity to local public
health personnel throughout the Province. The Provincial area now has been divided
between the two Nutrition Consultants, thus making it possible for each nutritionist to
give concentrated service to her particular area.
During the year eleven health units and six nursing districts have been visited. While
in a health unit, the Nutrition Consultant meets with the entire staff at a regular monthly
meeting. The purpose of the meeting is to review those developments in nutrition which
have practical application to the community, to discuss food habits and conditions in the
area, and effective methods of improving conditions. In January a field report form was
prepared for use in tabulating specific information, as to food habits, school-lunch programmes, and local problems, during interviews with each staff member. As a result,
more specific data on conditions in each area are now available to assist in the continual
evaluation of needs and subsequent direction of activities.
A major project this year has been to assist public health personnel in studying the
pattern of foods eaten by children in order to determine essential foods that are neglected
in their daily meals. This information is then used as the basis for developing a programme with specific emphasis on local problems. The method is to obtain from each
child a record of the foods eaten over a five-day period. This is carried out under the
supervision of the teacher and public health nurse as a school health project. The
records are analysed by the Nutrition Consultant, and the findings are interpreted to the
health unit. The first study, conducted in the East Kootenay in 1949, proved the effectiveness of this approach. In addition to a second study in the East Kootenay, the programme has been extended through public health staff to include studies in South Vancouver Island and a north coast area. In the analysis of more than 3,000 records this
year, it has been possible to gain a greater insight into the actual foods consumed by the
children. In each area the three major deficiencies in children's diets have been milk,
a Vitamin D preparation, and foods rich in Vitamin C. These are important foods for
children, since they are essential for best growth and development and good health. In
addition, there was an excessive consumption of sweet foods, such as candy, soft drinks,
and cake. Not only are these foods expensive, since they contain little food value, but
they also dull the appetite and help promote tooth decay. In view of these findings, it
has been recommended that the follow-up programme in each area give special emphasis
to the four major problems. To assist in these programmes, the Nutrition Service has
prepared pamphlets dealing with each of the four topics and supplied visual aids and out- Y 48 BRITISH COLUMBIA
lines for adult study groups. Where studies have been made, public health personnel
have reported an increased interest in improving food habits by parents and children
alike. In view of indications of similar conditions in other parts of the Province, and
the effectiveness of this simplified approach, a four-point programme of nutrition education is now recommended to all health units.
A new project, introduced during the year, has been that of rat-feeding experiments
in schools. This was proven successful in Vancouver schools during 1949, and ensuing
publicity has developed considerable interest in other areas of the Province. One such
experiment was conducted in Trail schools in the fall, and further demonstrations have
been planned for several schools in the Fraser Valley and Vancouver Island. One group
of rats is fed on a poor lunch, often typical of the children's, and the second group is fed
a recommended adequate lunch. The children are able to observe the effect of the two
contrasting diets on the weight of the rats over a period of several weeks. The experiment illustrates vividly the importance of food in growth, appearance, and disposition,
and is effective in encouraging improved food habits among the children.
Additional consultatitve service is provided to local public health personnel through
demonstration talks, correspondence, and advisory articles in the staff bulletin. During
the year a variety of problems have been dealt with in this manner. The following will
serve as examples: Demonstration talks to prenatal and family groups for the guidance
of public health nurses; methods of determining needs and facilities for school-lunch
programmes; menu plans and recipes for school-lunch programmes in operation; preparation of study guides on nutrition topics for adult groups; recommendations for the selection of food on a low income; preparation of pamphlets requested by public health
personnel.
A large number of inquiries relative to food problems are received weekly from
individuals and forwarded with technical data to local health personnel.
CONSULTANT SERVICE TO INSTITUTIONS
The consultant service to institutions is developing in line with requests for information on the various phases of food service, including food selection, preparation, selection
and arrangement of equipment, and organization of staff.
This year, emphasis has been given to methods of food-cost accounting, a factor
which has an important bearing on the control of food costs. A method of accounting is
being established whereby foods are tabulated according to food-groups, such as meats,
vegetables, and fruits. This enables administrators to assess at a glance the changes in
cost within each food-group from month to month and facilitates the analysis at this office
of the nutritive value of food purchased.
Assistance has been provided to Oakalla Prison Farm; women's gaol, Prince George;
New Haven; hospitals under the Division of Tuberculosis Control and the British
Columbia Cancer Institute.
An intensive study was made of the food service at the Jericho unit of the Division
of Tuberculosis Control. The study related to the number and organization of the
personnel and the effective use of kitchen-space. Recommendations are now being
implemented by food administrators and others concerned.
In a food-study at the Tuberculosis Pavilion, Royal Jubilee Hospital, emphasis was
directed toward achieving greater patient satisfaction through a change in the organization
of the food service. This was accomplished by implementing minor changes in the use
of present facilities.
Assistance has been given to personnel in Hospital Services Division, British Columbia Hospital Insurance Service, in relation to such problems as requirements for kitchen
staff, equipment, and food-cost accounting. DEPARTMENT OF HEALTH AND WELFARE,  1950 Y 49
CONSULTANT SERVICE TO OTHER DEPARTMENTS AND
ORGANIZATIONS
Consultant service is provided to other departments and Provincial organizations
whose programmes are related in any way to the field of nutrition education. Many
community workers, such as teachers, members of Parent-Teacher Associations and
Women's Institutes, welfare workers, in addition to public health personnel, are concerned
with such activities as school-lunch programmes, school and community education.
Unified direction of activities and clarification of data from the Provincial level is necessary to promote co-operative activities of these community workers toward the ultimate
objective of improved food-habits.
At the request of the Department of Education, the School Lunch Manual for
teachers is being rewritten at this office. A great deal of preparation has been required
in compiling this Manual, since it is recognized that there is need for practical reference
material on this subject. Technical data have been supplied also to the Director of
School Broadcasts for teacher reference in connection with radio broadcasts on school
lunches.
A committee, composed of professional nutrition representatives from various fields,
meets each month in Vancouver. Much has been gained by mutual exchange of information and discussion of programmes and problems. A project of the committee this
year has been the evaluation of the booklet " Family Meals," which was prepared by the
group in 1949. Discussion of the booklet with local health and welfare personnel,
together with comments from nutritionists in other Provinces, has provided valuable data
for revision of the booklet for final printing. The committee also sponsored an Institute
on Nutrition for health and welfare staff in Vancouver.
The fist of adequate food allowances for individuals of all ages is presently being
revised, in co-operation with the Vancouver Nutrition Committee. The list is of value
for computing the cost of an adequate weekly food allowance for individuals or families.
On completion it will be submitted to the Bureau of Economics and Statistics, for guidance
in compiling the cost of food index, and to the Welfare Branch of this Department.
This year, objectives and activities of the Nutrition Service have been discussed with
key groups of students, including nurses, dietitians, and public health nurses at the
University.
Articles on special phases of the service have been requested and submitted for
inclusion in Canadian Nutrition Notes, the Federal Lunch at School bulletin, the
" Steward's Corner " of the Prison World, B.C. Teacher magazine, B.C.'s Welfare, and
the Health Bulletin.
Although it is difficult to evaluate specific results in a programme
to improve food habits, there has been increased interest and participation in this field by public health personnel and the community as
a whole during 1950. Y 50 BRITISH COLUMBIA
REPORT OF THE DIVISION OF PREVENTIVE DENTISTRY
F. McCombie, Acting Director
" From . . . to . . . there was a long succession of local school reports concerning early dental decay, with its almost universal incidence and grave results in childhood, adolescence and adult life—its insidious poisoning of the body, malaise, lassitude,
debility and glandular infection."*
This was not written regarding British Columbia during 1950. This was the description of the days preceding a school dental service in another country over forty years ago.
Yet, unfortunately, it is equally true of the children of this Province to-day.
During the past year, significant progress has been made to endeavour to help
improve this sad situation. Plans have been modified and improved in the light of a
year's experience. Transportable equipment to facilitate the carrying-out of this task has
been designed and is now in production. Those chosen by the dental profession to act as
their leaders have repeatedly expressed their willingness and desire to be of assistance.
But, to care for more than a few of the children, men and women to undertake this task
are as yet lacking.
DENTAL MAN-POWER
At the time of writing, British Columbia is second only to one other Province in the
ratio of dentists to population, and much better served than the average for the whole
country. Yet, would anyone assert that to-day there are sufficient dentists in this Province, especially outside the metropolitan areas? Furthermore, as far as is known of
students of this Province presently studying to be dentists, insufficient numbers will be
graduating in the coming years to maintain the present ratio against the anticipated
population increase of this Province. It is also reported that the numbers of students
from this Province entering dental schools of recent years have rapidly declined. Is it
that the younger students not eligible for D.V.A. grants are unable to afford both the
cost of tuition and that of proceeding to and living in another Province or State because,
as yet, no facilities for their training exist within this Province?
Studies have shown that the effective services rendered by a dentist to his patients
may, with the help of a dental assistant and dental hygienist, be increased by as much as
50 to 60 per cent. As yet, the " Dentistry Act " of this Province makes it unlawful for
a dentist to allow a dental hygienist to work under his supervision to help increase his
service to his patients. Even if this Act were so amended, no facilities exist within this
Province, or indeed, within Canada, for young women to.receive the necessary education.
Yet, that an urgent need for their services exists in private dental offices, school dental
services, and the preventive dental services of local health units cannot be denied.
Numerous letters throughout the year have been received by this Department from
organizations representing many communities of the Province. These communities ask
not for free or " socialized " dentistry, but that the services of a dentist or more dentists
be made available to their community, especially to care for the children. The people of
this Province are becoming increasingly aware of the dangers of dental ill-health. The
facilities available for dental treatment have not kept pace with this demand. In the
years to come, the demand will become greater, whilst the facilities will decrease, unless
a satisfactory solution is found to increase the available and effective dental man-power
of the Province.
FLUORIDATION OF COMMUNAL WATER-SUPPLIES
In June, 1950, a ray of hope broke through the dark clouds. The United States
Public Health Service announced that the results of experiments, where communal water-
* Sir George Newman:  The Building of a Nation's Health. DEPARTMENT OF HEALTH AND WELFARE,  1950 Y 51
supplies had been artificially fluoridated for periods up to five years, were encouraging.
They announced that their policy in this regard was changed to read " using scientific
methods and practices, communities desiring to fluoridate their communal water-supplies
should be strongly encouraged to do so."
However, the hope that by this means the incidence of dental decay might be very
significantly reduced was short-lived. Personal communications from those directing the
experiments on which the decision was based showed that the leading authorities in this
field were far from agreed that the efficiency of this method was proven. Investigations
into the technical aspects of the process revealed that the cost of installation of the necessary equipment for most communities of this Province would not be inexpensive, and that
the most careful routine supervision of the equipment by trained personnel would be
necessary.
Taking all these factors into consideration, this Department, therefore, announced
its policy regarding fluoridation of communal water-supplies, as follows: " In communities where a strong public demand has developed, and the procedure has the full approval
of the local medical and dental societies, the local health authorities, and others responsible for the communal health, applications may be made to this Department for permission to fluoridate public water-supplies."
DENTAL PROGRAMMES
Ten communities, outside the metropolitan areas, have, during the past year, most
successfully organized dental programmes assisted by private resident dentists treating
children of the area in their own dental offices. Only three such programmes operated
during 1949. In each case the success of the programme has been the result of the tireless efforts of a local committee of voluntary workers. This division has made grants to
these programmes to the extent of 50 per cent of the total remuneration to the dentists
giving of their time for this service, the moneys for these grants being largely received
through a Federal Health Grant. The balance of the cost of these programmes has been
raised by the local committee, in part by a flat charge of $2, $3, or $4 to the parents of
the children receiving treatment, together with contributions from School Boards, Parent-
Teacher Associations, etc. In the first year of operation of such programmes the service
is restricted to pre-school and Grade I children; each year it is hoped that it may be
possible to extend the service into the next senior grade, continuing the service to the
children treated the previous year.
The programme for including within the staff of local health units a full-time dental
director is considered the keystone to the long-range policy of this Division. The arrangements for the health unit areas' contributions to the cost of such programmes were considered desirable of readjustment. In October the new arrangements were announced
whereby, of the total estimated annual cost of such programme—namely, $9,000—it was
agreed that the local contributions should be $2,000 the first year, $2,500 the second
year, and $3,000 in the third and subsequent years. Since then, School Boards of four
health unit areas have signified their desire to have a preventive dental service added
to the other health services provided by the local health unit. It is reported that two
other health unit areas are actively discussing the possibilities of requesting this service.
A member of this Division, now receiving postgraduate training in this field, will be available this summer to fill one of these vacancies. As the situation stabilizes, the remaining
vacancies will be advertised to the dental profession.
Until such services cover the whole of the Province, this Division is desirous to
establish a travelling dental clinic to provide a service to the children of the more remote
rural areas. Equipment for this purpose stands ready. But to attract a suitably qualified
dentist to undertake this task has not yet been possible. Y 52 BRITISH COLUMBIA
The College of Dental Surgeons of British Columbia during the year has granted to
seven dentists having satisfactory qualifications annual permits to practise in specified
rural communities of the Province. The number of dentists resident in the smaller rural
communities of the Province, though improved during the year, is still a subject of grave
concern. Grants-in-aid for dentists to reside in communities as yet without a resident
dentist have been made available. This Division has offered to equip with basic equipment branch dental offices for such dentists as are willing to visit periodically communities too small to anticipate a dentist residing therein. However, no applications in respect
of either these two programmes have been received.
During the past year, grants to School Boards of metropolitan areas in respect of
school dental services have been revised on a more equitable basis, but, due to the
limitation of the current Provincial estimates, could not be significantly increased. However, prior to this the grants had remained unchanged since before 1940 and to-day
represent only approximately 31 per cent of the total annual cost of such services. It is
hoped that within the forthcoming budget these grants may be raised to approximately
45 per cent of the total annual cost.
TRANSPORTABLE DENTAL EQUIPMENT
Whilst planning travelling dental clinics and the work of dentists to be attached to
the staffs of local health units, it was apparent that some form of transportable dental
equipment would be a necessity. The commercial market was explored in Canada, in
the United States, and in Europe, but no satisfactory equipment suitable for the task
within this Province was located. Dr. W. G. Hall, of this Division, was therefore
requested to design a set of such equipment. The pilot models of this equipment were
received in late summer, and consist of a dental chair of tubular steel, which may be
broken down and transported in a wooden case, and a composite metal cabinet, complete
with operating lights, dental engine, cuspidor, water-tank, and storage for instruments,
drugs, and materials. Through the courtesy of the Director of the Greater Victoria
School Dental Service, Dr. Hugh Clarke, field trials were undertaken. The basic principles and design of the equipment were most warmly praised, and a series of minor
modifications were helpfully suggested. Through moneys made available by Federal
Health Grants, six sets of this equipment are now in production. The final design of this
equipment, we are informed, is awaited with keen interest by the Department of National
Health and Welfare, Ottawa, several other Provinces, and in the United States.
DENTAL HEALTH EDUCATION
The work of evaluating, selecting, ordering, and distributing dental health education
material has continued throughout the year. During the past decade considerable progress has been made in the attainments of scientific research into the causes and prevention of dental disease. It was not, therefore, surprising when it was noted that the content
of many of the health text-books used in the schools was out of date in this regard. The
best available booklet, Your Teeth—How to Save Them, was therefore obtained, revised
where necessary, reprinted, and has been made available for distribution to all schools
throughout the Province. This booklet is now recommended by this Division and the
British Columbia Dental Association as an authoritative source for the teaching of the
prevention of dental disease. Further dental health educational films have been added
to the film library, whilst all continue to be in high demand by the field staff for showing
to interested lay groups.
The task of treating the vast quantity of dental disease to-day existing within the
Province would be impossible under any scheme with the present dental man-power. The
importance of preventing dental disease by dental health education cannot, therefore, be
too greatly stressed. DEPARTMENT OF HEALTH AND WELFARE,  1950 Y 53
PERSONNEL
In June of this year the Acting-Director of the Division returned from the University
of Toronto, having attained a diploma in dental public health. In September Dr. W. G.
Hall left to attend the University of Michigan for postgraduate training in public health,
children's and preventive dentistry, a course leading to a Master in Public Health.
BRITISH COLUMBIA DENTAL ASSOCIATION
The Dental Health Committee of the British Columbia Dental Association, under
the very active chairmanship of Dr. J. Ewart Gee, has continued to be of very considerable assistance to this Division. The Committee wrote to every student of this Province
anticipating graduation in dentistry during the last year. Each student was informed of
the vacant appointments within this Division and of the need of dentists in the rural
communities of the Province. That they were not successful in attracting any graduate
to join this Division does not detract from their effort in this regard. In addition, this
Committee, and in particular its chairman, has provided throughout the ye*ar the finest
possible liaison between the dental profession and this Division. This Committee has
taken considerable pains to keep the dental profession informed of the programmes
developed by this Division, and has continuously solicited the co-operation of the profession in endeavouring to help improve the dental health of the people of this Province.
Under the chairmanship of Dr. William Miller, the Public Relations Committee of
the British Columbia Dental Association is exclusively studying this winter how it can be
of greatest assistance to this Division. This Committee is planning to prepare material,
including the provision of slides, to assist all members of the dental profession in presenting talks to lay groups on the prevention of dental disease. To the writer's knowledge,
little material in this field has as yet been published. It will be, therefore, with real
appreciation that the results of the work of this Committee will be received by the dental
profession and by this Division.
SUMMARY
That the foundations on which this Division is developing its programme are scientifically sound, and also a practical approach to the problem, there is no doubt. That
there exists a shortage of effective dental man-power has been drawn to your attention.
Further, it is recorded that unless provisions are made for the future, and these provisions
made forthwith, the situation will of itself not improve, but rapidly deteriorate to the
detriment of the health of the people of this Province.
Meanwhile, it is the object of this Division, supported by the dental profession of
British Columbia, to endeavour to reduce, if not eliminate, dental disease " with its grave
results in childhood, adolescence and adult life—its insidious poisoning of the body,
malaise, lassitude, debility and glandular infection." Y 54 BRITISH COLUMBIA
REPORT OF THE DIVISION OF PUBLIC HEALTH ENGINEERING
N. J. Goode, Acting-Director
Environmental sanitation has been defined by a committee of the World Health
Organization as " The control of those factors in man's physical environment which
exercise, or may exercise, a deleterious effect on his physical develpoment, health, and
survival." It is obvious from this definition that this is a very broad subject, as it is
concerned with all the external conditions and influences that affect man.
Another means of envisioning enviromental sanitation is to contrast it with the
medical services in public health. Medical personnel are concerned with altering man to
fit his environment, whereas persons working in environmental sanitation are concerned
with controlling the environment for the benefit of man. An example of the difference
between these types of service is contained in the prevention of typhoid fever. When a
person is immunized against typhoid fever, the person, and not the environment, is
changed. However, when a water-supply is treated to prevent typhoid germs reaching
the consumer, then the environment, and not man, is changed. This illustration brings
into focus the difference between the two types of service. It is important to note, however, that the two services are supplementary, as the goal of both is to improve the
public health.
A review of the history of public health in British Columbia shows that the kind
of work carried out by this Division has changed continuously. These changes were
partly a result of altered circumstances, and partly a result of the work accomplished by
this Division. Ten years ago a good deal of emphasis was placed on improving the
sanitation in canneries. Now this phase of the work requires little time, as the industry
is using better waste-recovery processes and the operators have improved living accommodations for their employees. Instead, the Division is currently becoming interested
in stream-pollution and its prevention. Little work in this connection has been carried
out in the past and there is not too great a need for actual control of industrial wastes at
present, but, in anticipation of the problem increasing, it seems advisable to do some
research now in order that reasonable standards can be devised and implemented for the
control of stream-pollution in the future.
During the past ten years the number of personnel trained in the field of environmental sanitation has increased greatly. In 1940 the Division consisted of only one
person—the present Director, Mr. Bowering—who had had any training in public health.
However, to-day there are four. Similarly, in 1940 the sanitation staff in the field was
composed of two sanitary inspectors, whereas now there are twenty-four. Such an
increase has not meant a reduction in the amount of work per person; instead, the
increased field staff has shown that there are numerous problems which were not evident
before. For these to be supervised adequately, a larger staff in the Division may be
required in the future.
Each phase of environmental sanitation is a separate entity in itself, and, therefore,
each subdivision of the work of the Division will be discussed under a separate heading
in this report.
WATER-SUPPLIES
Public water-supplies are important in public health because they can be a means
of transmitting disease to large numbers of people. For this reason the Division does as
much as possible to make these supplies safe, both by advising the installation of protective
works for the physical plants and by encouraging the use of safe practices by the operators.
Periodic examinations are made of water-supplies as a check on the effectiveness of the
control of the plants. These examinations include bacteriological and chemical analyses
of water samples and sanitary surveys.    This work is all carried out by the sanitary ■  ' ■    •':.
DEPARTMENT OF HEALTH AND WELFARE,  1950 Y 55
inspectors in the field, but when necessary, or when requested, consultative service is
provided by members of this Division. Samples for bacteriological analysis are taken
routinely and forwarded to the Division of Laboratories for testing, whereas chemical
samples are forwarded to the laboratory of the Public Health Engineering Division of the
Department of National Health and Welfare. With these three devices it is possible to
judge the safety of a water-supply and advise on means of obtaining additional protection.
The " Health Act " requires that plans and specifications of proposed water-supply
systems, or extensions to existing systems, be approved by the Department. This Division reviews this material and recommends alterations if the plans do not provide for
adequate protective works.
There are approximately 160 community water-supplies in the Province. During
the year, sanitary surveys were made of forty of these supplies. In addition, plans and
specifications of improvements or extensions to twenty-four water-supplies were approved.
These approvals covered proposed expenditures of $1,500,000.
The Department has two hypochlorinators available for use in emergencies. These
are stored in a central location and forwarded for installation if emergency conditions
arise in any public water-supply. As these machines do not automatically proportion the
chlorine solution, and as they thus require constant attention, they are not suitable for
long-term installations. As a result, their use is recommended only when a specific
emergency exists and, if possible, a time-limit is set for their removal.
These chlorinators have been more or less in constant operation during the year.
One installation was made to treat water from a source of doubtful safety during the time
another source was being connected to the system. Another installation was made to
disinfect water from a doubtful source in order to augment an inadequate supply.
Numerous meetings were attended by members of the Division to present information on recommended changes to water-supply systems. Some were public and other
were attended only by commissioners or the operators of the supply. At these meetings
an effort was usually made to review the shortcomings of the system and suggest means
of improving the safety of the supply.
Approximately 20 per cent of the population of the Province obtains water from
private sources. There are a great variety of sources and qualities of water obtainable
from these sources. Consequently, the problems presented by them are very diverse, and
practical solutions are often difficult because of the limited amount of capital available.
Because of these factors, relatively more of the Division's time is spent in suggesting
solutions to these problems than in dealing with public supplies. Most of the problems
presented by private supplies are dealt with locally by the sanitary inspectors. This Division, however, assists by distributing standard plans for wells, by acting as consultants to
the sanitary inspectors on individual problems, and by dealing with problems arising in
areas not covered by sanitary inspectors.
SEWAGE-DISPOSAL
Sewage is another term for used water, as it is primarily the disposal of wastes by
water carriage. This is especially evident when it is realized that 99.9 per cent of
domestic sewage is water. The remaining 0.1 per cent is the offensive portion. Because
of this, the primary problem in sewage-disposal is to separate the solids from the liquids.
Following this separation, each component is disposed separately. The solids are usually
stored in digestion chambers until such time as they are no longer objectionable. The
liquids may be discharged directly to a watercourse if sufficient dilution is available, or
they may be further treated to remove the dissolved material and the bacteria.
In British Columbia most communities dispose of untreated sewage by piping it to
the nearest body of water. This has been an adequate means of sewage-disposal in many
cases, as there has been sufficient dilution in these bodies of water to absorb the material Y 56 BRITISH COLUMBIA
without creating offensive conditions. As the population of the Province increases, and
as the need for clean water increases, more and more communities will find it necessary
to provide some form of sewage treatment.
At the present time eight communities provide partial treatment for their sewage and
five provide complete treatment. The remaining 145 communities, which have public
water-supplies, either discharge untreated sewage to a body of water or the treatment of
the sewage is left up to the individual householder.
Seven of the sewage-disposal systems in the Province were inspected during the year.
In addition, plans were reviewed and approved for two new sewage-disposal plants at
Duncan and Field.
In the unsewered communities most sewage is treated in septic tanks. These tanks
usually give adequate treatment in sparsely populated areas, but they are not adaptable
for use in built-up areas. Because of the extensive use of septic tanks, standard plans of
septic tanks have been compiled by this Division and are available (through local health
grants) to persons living in outlying areas, but where this means of disposal causes a
nuisance, the community, through the local Medical Health Officer, is advised to install
a sewerage system.
Individual problems often arise in septic-tank installations. These problems usually
involve a difficulty in disposing of the effluent. This is often due to the type of soil in
the area, and special means have to be devised to take care of such conditions. Advice
was given on three disposal problems of this nature in the Peace River District.
Sewage-treatment facilities at Oakalla Gaol were completed during the year. The
system, which includes an Imhoff tank and a trickling filter, was designed by this Division.
Upon completion, advice was given to the operators on the proper maintenance and
operation of the units.
A report was compiled on the sewage-disposal from Essondale. The present means
of disposal were reviewed, and a more adequate system suggested.
STREAM-POLLUTION
Stream-pollution in British Columbia has not yet reached a point where it is of
major concern. Except for a few isolated instances, the quantity of dilution water is
sufficient to absorb the polluting material without marked degradation of the stream.
This, of course, is a desirable condition, but in order to keep streams in this condition, or
to improve them, it will be necessary to devise standards and implement them. A number
of preliminary steps have been taken with these objectives in mind.
An attempt was made to determine the extent of the pollution being discharged to
the Fraser River. A survey was made of all plants discharging wastes to the lower
portion of the river. (The Vancouver harbour area was also included, as it is directly
affected by the waters of the Fraser River.) An estimate was made of the type, the
strength, and the point of discharge of these wastes. This survey was undertaken so
that the general extent of the problem could be determined, and was conducted in
co-operation with the Dominion-Provincial Board, Fraser River Basin. More extensive
work on this portion of the Fraser River is now planned by the Board, but, because of
staff limitations, this Division will not be able to take a very active part in the work in
the near future. However, it is the intention of the Division to give assistance in this
work whenever possible.
An approach was made to the problem created by the discharge of mine tailings in
the Pend d'Oreille River and its tributary. This study was made in co-operation with
the Washington State pollution-control authority on an informal basis. If further investigations are required, it is felt that they should be referred to the International Joint
Commission. DEPARTMENT OF HEALTH AND WELFARE,  1950 Y 57
A survey was made of the pollution problem in Luk-a-kuk Creek. The plants
contributing to pollution were visited, and preliminary plans made for measuring the
amount and strength of the polluting material being discharged. Excellent co-operation
is being obtained, and it is anticipated that the condition of this creek can be improved
in a relatively short period of time.
The Division is represented on the Pollution Control Council, Pacific Northwest
Basin, an informal organization formed to determine policies and study problems of
common interest to pollution-control authorities in the area. Alaska, Idaho, Montana,
Oregon, and Washington are also represented on this Council. Work has been done on
suggested standards for the prevention of industrial-waste pollution, the treatment of
domestic sewage, and water-quality.
MILK.
Milk in this Province is controlled by the Departments of Agriculture and Health.
Employees of the Department of Agriculture inspect the cows, barns, and pasteurizing
plants. Medical Health Officers and local sanitary inspectors are concerned with the
quality of the milk produced. To enable them to judge milk-quality, they are supplied
with kits for field testing, although for more precise testing they forward samples to the
Division of Laboratories. When the results of these tests indicate that the quality of
the milk is not satisfactory, the local health unit, assisted by this Division and in co-operation with the Department of Agriculture, further investigates the supply to determine the
reason for the unsatisfactory samples and prevent their recurrence. In addition to acting
as a consultant in milk-quality, the Division assists the local health units to devise and
enforce local milk by-laws. This year two by-laws were reviewed and recommendations
were made for amendments to two others.
TOURIST CAMPS
There are 1,170 tourist camps operating in British Columbia. The control of these
camps is vested in a number of government departments. The BritishColumbia Government Travel Bureau of the Department of Trade and Industry is the co-ordinating body
which rates the camps and issues or cancels licences upon receiving recommendations
from the other interested departments. The departments are represented on the Licensing Authority by the Commissioner and the Assistant Commissioner of the British Columbia Travel Bureau; the Commissioner, British Columbia Game Commission; the Assistant Deputy Minister of Lands; and this Division of the Department of Health and
Welfare. If any member of the Authority believes that a tourist camp will not be
operating in the public interest, he may recommend a licence not be granted.
Before this Division recommends that a licence be granted to a tourist camp, the
sanitary inspector in the area is asked to review the sanitation. Upon receipt of his
report the Division forwards a recommendation regarding a licence to the Tourist Bureau.
SLAUGHTER-HOUSES
A certificate of approval is now required by the Medical Health Officer before
a slaughter-house can be operated. If the slaughter-house is satisfactory, the certificate
is forwarded to the Department of Agriculture with a recommendation that a licence be
issued. Previously, this procedure was not necessary, but the " Stock-brands Act" was
recently amended to require licensing of all slaughter-houses west of the Cascade Range.
With such legislation in effect, the task of controlling the sanitation in these places has
been greatly accelerated and simplified.
The inspection of the slaughter-houses is carried out by the sanitary inspectors in
the field, but this Division gives consulting service when requested.    The Division also Y 58 BRITISH COLUMBIA
provides sample plans of suggested slaughter-house layouts as a means of assisting the
operators in obtaining adequate sanitary control of their operations.
FROZEN-FOOD LOCKER PLANTS
The Division continued to review the operations of all the locker plants in the
Province. Local sanitary inspectors visit these plants routinely to make certain that they
are operating according to the regulations. Plans and specifications of proposed plants
were reviewed by the Division, and, following approval, thirteen were constructed and
placed in operation during the year. There are now a total of ninety-nine plants operating
in the Province.
SHELL-FISH
The regulations governing this industry have been in effect for more than a year.
It has been necessary, for a number of reasons, to change the system of control three
times during this period, but, despite this lack of continuity, considerable improvement
has taken place in the twenty-four shucking plants in the Province. It is a great satisfaction to note the change from haphazard operations in inferior locations to well-planned
operations in suitable plants. This satisfaction is expressed not only by the Division
because of the increased protection to the public health, but also by the individual
operators because of the increased pride in their product.
During the year the inspection of the plants was transferred from the Division to the
local health units. This change will require that the local health units supervise the plants
in their area and that this Division issue the yearly certificates, maintain liaison with the
Dominion Government and the United States Government, and be responsible for the
surveys of shellfish-growing areas.
During the period when control was being transferred, it was noted that amendments
to the regulations would be necessary to make this type of control effective. These
amendments were devised and brought into force.
All phases of the regulations were not in force during the year because of the
difficulties presented by the changes in the types of control. Those sections of the regulations which have the most effect on the safety of shell-fish products were enforced, and
plans are being made for enforcing the other sections during the coming year.
INDUSTRIAL CAMPS
Plans were made during the year to inspect most of the isolated industrial camps
in the Province. Before the inspections were started a survey was made of the camps in
the Interior so that it would be possible to determine the time required to make complete
inspections of all camps coming within the jurisdiction of the regulations. Following the
survey, the routine detailed inspections were continued by sanitary inspectors. Co-operation from the International Woodworkers' Union and the Interior Lumbermen's Association was given for both the survey and the individual inspections.
SUMMER CAMPS
The sanitation of summer camps in the Province is reviewed yearly. Following
inspections of individual camps, recommendations are forwarded to the Welfare Institutions Licensing Board. As there are no local inspectors covering the area occupied by
the majority of the camps, this work is usually done by a member of this office. Due to
the pressure of work, the number of inspections is usually restricted, and it was possible
to inspect only four camps during this summer season. DEPARTMENT OF HEALTH AND WELFARE, 1950 Y 59
SPECIAL SANITARY SURVEYS
A number of special surveys was made during the year. One was made of the
sanitary facilities of the Village of Squamish in an attempt to find a method of improving
waste-disposal. Another survey was made of the heating and ventilation in the kitchen
at the T.B. unit at Jericho. The third survey was made of the area adjacent to Minto
which was flooded by Gun Creek. Sixty-one of the affected premises were visited, and
the local residents were advised of suitable clean-up procedures. The other survey was
made of the area adjacent to Saxe Point on the southern part of Vancouver Island where
tidal and bacteriological studies were conducted to determine the probable effect of discharging sewage in the area. Reports were prepared of all of these surveys, and, where
necessary, suggestions were made for improving the situations.
PERSONNEL
The work of the Division was somewhat disrupted during the year by the unusual
number of staff changes. No one member of the staff was available for duty during the
entire year. C. R. Stonehouse, the Chief Sanitary Inspector, returned in February after
taking a special course for sanitary inspectors at the University of California. This was
a short intensive course of public health subjects normally given to full-time students.
J. H. Doughty-Davies, Jr., joined the staff in June after graduating in civil engineering at
the University of British Columbia. As Mr. Doughty-Davies has worked for the Division
during a number of summers, he brings with him an appreciation of its duties. A good
deal of his time was spent in conducting surveys with the assistance of an engineering
student employed during the summer months. N. J. Goode returned in June from Johns
Hopkins University after completing a postgraduate course in sanitary engineering.
R. Bowering, Director, is on leave of absence from the Division. In October he accepted
a temporary position with the World Health Organization of the United Nations, and is
presently engaged in public health work in Korea.
GENERAL
The Division was represented on two committees concerned with the qualifications
of sanitary inspectors. One of these, the Screening Committee, was formed to review
the qualifications of persons wishing to become sanitary inspectors, so that time and
money will not be needlessly spent on giving field training to unsuitable persons. The
other, the Examining Board, was attended by the Director, who acted as Chairman.
This Board conducted examinations for fourteen persons attempting to obtain Canadian
Public Health Association certificates in sanitary inspection. The duties of the Chairman
included making arrangements for the examinations and grading of papers.
A report was prepared on the aspects of environmental sanitation which would be
of concern for civil defence. A list was made of suggested preparations that organized
communities should make in order that some measure of protection is available in case of
emergencies. Suggestions were given for public water-supplies, sewage-disposal systems,
garbage-disposal, and mass lodging and feeding places. These subjects were reviewed in
a general manner so that the outline would be of use to all communities.
The Director, Mr. Bowering, was loaned to the Department of Health and Welfare
of Manitoba, and spent two weeks in Winnipeg giving assistance and advice in flood
sanitation during the disastrous flooding of the Red River. The experience gained from
his work during the Fraser River flood in 1948 was of considerable assistance in this
emergency.
Two conferences were attended by members of the Division. The Director attended
a conference of Provincial and Dominion public health engineers in Ottawa. This was
the first such conference held, and discussions were conducted on a number of matters of Y 60 BRITISH COLUMBIA
mutual interest.   The Chief Sanitary Inspector attended an annual meeting of the Canadian Institute of Sanitary Inspectors at Montreal.
In conclusion, there are innumerable unsolved problems in environmental sanitation in the Province. These problems arise in aspects of subjects previously noted in this
report, which are partially being attended to at present, and in subjects where no control
has yet been attempted. Two examples of the former type of problem involve the
necessity for more adequate control and supervision of public water-supplies and sewage-
disposal systems, and examples of the latter are regulations to govern the shrimp and crab
industries and the disposal of industrial wastes. These are a few of the facets of the
environment over which additional legislation could be of value. However, with the
present staff, it is obvious that all phases of the work cannot be dealt with at one time,
and, therefore, during the coming year an attempt will be made by this Division to solve
those problems which are of greatest immediate importance to the public health. DEPARTMENT OF HEALTH AND WELFARE,  1950 Y 61
REPORT OF THE DIVISION OF VITAL STATISTICS
J. H. Doughty, Director
IN MEMORIAM—J. D. B. SCOTT
On March 14th, 1950, the Division of Vital Statistics suffered a great loss in the
untimely death of its very able Director, J. D. B. Scott.
Mr. Scott considered himself, above all else, a public servant, and he discharged the
responsibilities of his office with that high ideal foremost in his mind. As a result of his
interest, foresight, and planning, the Division incorporated many progressive methods
and procedures in the fields of vital registration and public health statistics.
Mr. Scott was a member of the American Association of Registration Executives,
the American Public Health Association, and the Canadian Public Health Association,
being a former Chairman of the Vital Statistics Section. As Director, he was a member
of the Vital Statistics Council for Canada, an organization that has made valuable contributions toward the improvement of national and international vital statistics.
To those who were privileged to work intimately with him, Mr. Scott endeared
himself as a loyal friend and a valued counsellor.
INTRODUCTION
Although the statutory functions of the Division remained unchanged, progress has
been made during 1950 in the development of public health statistical services. The
statutory duties comprise the administration of the " Vital Statistics Act," the " Marriage
Act," the " Change of Name Act," and certain sections of the " Wills Act." The
statistical functions consist of providing statistical data not only on births, deaths, and
marriages, and other phases of the Division's activities, but also of carrying out the
statistical requirements of all the other divisions of the Health Branch. With the increased
demand for public health statistics created by new or enlarged public health services and
projects, a greater volume of statistical work was undertaken this year.
Continued emphasis was placed on attaining a high quality in the registrations
accepted. Improvement was noted in the collection of vital statistics records for both
Indians and Doukhobors, although these groups continued to present problems to the
Division.
A study of office routines was commenced during the year, and, as a result of
certain changes which were made in procedure, it became possible to reduce the staff
establishment of the central office by one person.
An important statistical project undertaken in 1950 was this Province's participation
in the national sickness survey. In addition, the survey of the crippling diseases of
children, which was commenced in 1949, was concluded this year, although the tabulation and analysis of the data collected will continue in 1951.
COMPLETENESS OF REGISTRATION
Indians
Current Registrations
Efforts were made to retain the close contact with the Indian Superintendents and
the Indian Commissioner for British Columbia, in order to further the standards of
Indian registration which had been reached in 1949. However, restricted travel allotments made this more difficult. There are many problems peculiar to Indian registrations
which are not found in other groups of the population, and the solution of such problems
is aided by personal interviews by the Inspector of Vital Statistics. Y 62 BRITISH COLUMBIA
There is an increasing appreciation on the part of the Indian Superintendents of the
nature and importance of all vital statistics registration, but much still remains to be done
in the field of Indian registrations. For many generations, Indians have changed their
names, both given and surnames, at will. To terminate such a long-standing practice
requires careful education of the people to the reasons for maintaining a continuity of
names. This can only be done slowly and methodically, for the majority of Indians
have no knowledge of the restrictions imposed by the " Change of Name Act " or the
" Vital Statistics Act," nor have they an adequate understanding of the necessity for
uniformity and accuracy in documentation. Therefore, there is need for the Indian
Superintendents to be constantly vigilant when registrations are being accepted in order
to ensure that the details agree with other documentation on agency files. Only in this
way can the standard of Indian registration be elevated to the level attained for the
remainder of the population. Nevertheless, gratifying improvement was noted in the
registration of Indian vital statistics, and efforts will be continued in this direction during
1951.
As in former years, the Indian Commissioner for British Columbia was kept advised
regarding the progress of Indian registration, and his whole-hearted co-operation was
forthcoming. Through his assistance, there was a continuation and expansion of several
policies outlined in the Annual Report of this Division for 1949, including the following:—
(a) Submission of report of enrolment of new Indian pupils in schools in
September, 1950, as a means of checking for completeness of birth registration, continuity of names, etc.
(b) Submission to the Director of a copy of the latest nominal roll of members
in all agencies in the Province, with monthly amendments thereto.
(c) Submission to the Director of many church records of baptisms and
marriages. These records were microfilmed and are now used as a basis
of verification when considering applications for delayed registrations and
for corrections of existing records.
During the year, visits were made by the Inspector of Vital Statistics to six agency
offices. As well as checking the methods used in obtaining registrations, the Inspector
was able to give some assistance to the Superintendents in registration procedures.
Documentary Revision
The project of checking, correcting, typing, and reindexing Indian registrations filed
during the period 1917 to 1946, inclusive, was continued throughout the year.
During 1950 all the registrations of births and deaths of the Williams Lake Agency
and of the deaths in the Queen Charlotte Agency were revised and cross-checked. The
agency copies of registrations, when completed, were placed in permanent binding and
returned to the agency offices, along with a typewritten cross-reference index, prepared
by this Division.
Work in progress at the end of the year comprised largely the birth and death
records from Stuart Lake Agency, as well as birth records from Babine and Fort St. John
Agencies.
The returns of newly enrolled pupils for the 1949-50 school term were not all
received by this Division until the spring of 1950, when ninety-seven schools reported
a total of 1,930 pupils enrolling for the first time in September, 1949. These returns are
of considerable value, since they provide an important means of checking completeness
of Indian birth registrations as well as a method of verifying names and other personal
particulars. The checking of the above returns revealed that in 55 per cent of the names
there were discrepancies among the school records, the agency nominal rolls, and the
birth  registrations.    Where necessary,  the latter were  amended,  while information DEPARTMENT OF HEALTH AND WELFARE,  1950 Y 63
necessary for correcting the school records or the agency nominal rolls were referred to
the schools and (or) the agencies for attention.
Delayed Registrations
Valuable additions were made in 1950 to our collection of Indian baptismal records,
thus assisting materially in the processing of applications for delayed registrations. In the
past, many births occurred in isolated localities without a medical practitioner or even
a midwife in attendance, and hence the problem of sufficient verification to support
applications for delayed birth registrations becomes a very real one. An attempt is being
made to secure complete birth registrations for all Indians now living. During the year
489 applications for delayed registration of Indians were approved. In addition, many
cases were pending at the end of the year, most of which were awaiting additional
documentation.
Deputy District Registrars in Indian Agency Offices
Through the kind consent of the Indian Commissioner for British Columbia, an
arrangement was completed in 1949 whereby a senior clerk in the various agency offices
was appointed as Deputy District Registrar and Issuer of Marriage Licences.    The
advantages of this plan became quite apparent in 1950, as is partially shown by the
increase in the number of delayed birth registrations effected.    Not all agencies were
included in this development, but it is hoped that as staffs become sufficiently trained this
service may be expanded.
Doukhobors
Current Registrations
As a result of policies developed in recent years for stimulating Doukhobor registration, the orthodox Doukhobors generally do not oppose registration, although continuing
education appears necessary in order to obtain the co-operation that is required. However, a very real problem remains with the faction known as the Sons of Freedom. This
group stubbornly persists in refusing to obey the laws regarding registration of vital
statistics. The Division continued to employ a field representative to work with the
Doukhobors, and it is felt that the results obtained have justified the appointment.
In a few instances, Sons of Freedom have been persuaded to comply with registration
requirements. There has been a continuation of the tendency of the Doukhobors to
accept the civil form of marriage, solemnized by a Marriage Commissioner. However,
the number of such ceremonies remains relatively small.
Little change is noted in the problems concerning the registration of deaths. Due to
the remoteness of some Doukhobor settlements, there are instances where deaths occurred
and burials took place weeks or even months before knowledge of such events was
received by the District Registrar of Births, Deaths, and Marriages. Efforts are continually being made to educate the people to their duties in such cases, but the problem
has remained relatively constant.
Delayed Registration
Application for delayed registration of birth continued to be received, and indications
are that this situation will exist for some years to come. The field representative
endeavoured to clear up as many outstanding registrations as possible, but unless there
was some definite immediate incentive to obtain a birth certificate, it was difficult to rouse
sufficient interest to bring the cases to a conclusion.
REGISTRATION OF BIRTHS, OTHER THAN INDIANS AND DOUKHOBORS
Current Registrations
Apart from Indians and Doukhobors, there is virtually complete registration of
births within the Province, although some delays occur in registering births of children Y 64 BRITISH COLUMBIA
born in remote areas. Almost all births in settled areas now occur in hospitals, in which
case each District Registrar receives notification from the hospital and from the attending
physician. Parents are then advised of their responsibility and are supplied with instructions for completing a birth registration. Therefore, the only events which may escape
the attention of the District Registrar are births which occur at home without medical
attention. These are exceedingly few, and generally the lack of registration is brought
to light in a relatively short time when application is made by the parents for family
allowance.
A few attempts to disguise true parentage on birth registrations were discovered.
Investigation of each case revealed that the inaccurate details were usually given in the
mistaken belief that the child's interests were being protected, rather than from a strictly
fraudulent motive.
The medical profession and hospital staffs alike, through their excellent co-operation
in furnishing notifications of births, again contributed substantially to the high standard
of completeness of birth registration presently enjoyed. The appreciation of the Division
is expressed to these groups for the valuable services rendered.
Delayed Registration of Birth
The bulk of the delayed registrations of birth accepted during the year covered
births which occurred prior to 1920. Of the other delayed registrations filed, many were
of illegitimates and others were reregistrations following cancellations.
The Division continued to render all possible assistance to the public in the matter
of obtaining delayed registration of birth. Many additions were made to the library of
church records of baptisms and marriages. In most cases, these additions were obtained
by microfilming church records and returning the originals to the custody of the respective
churches. As well as providing valuable supporting evidence for delayed registrations,
this microfilming of the church records is valuable to the churches themselves as a means
of record preservation should the originals be lost or destroyed.
One of the most valuable sources of verification in support of applications for delayed
registration of births is the early census records maintained by the Census Division of
the Dominion Bureau of Statistics at Ottawa. Many persons have been able to obtain
a delayed registration of birth from the evidence contained in these early census records
when it had been impossible to obtain satisfactory verification from any other source.
REGISTRATION OF DEATHS
Except in isolated areas where travel conditions are difficult, virtually all deaths are
registered without delay. Only amongst the Indians and the Doukhobors do some deaths
go unregistered, and even with these groups, progress is being made. As in the case of
birth registration, a system of cross-checking has been established which ensures that
virtually every death becomes registered.
Effective January 1st, 1950, this Province adopted the new form of medical certification of the cause of death which had been recommended by the World Health Organization. This internationally accepted form of medical certification of the cause of death
was almost identical with the form previously in use in this Province, and, therefore, its
acceptance presented little difficulty.
REGISTRATION OF MARRIAGES
The responsibility for registering marriages, except civil marriages, rests with the
officiating clergyman. The periodic checking of marriage registers issued to the clergy
continued to show that the system is an efficient one and that the clergymen themselves
are most attentive to their statutory duties in this regard. Whenever a new marriage
register is supplied to a clergyman, the completed book is called in for review.   Should a DEPARTMENT OF HEALTH AND WELFARE,  1950 Y 65
marriage be recorded in the church register without a corresponding registration having
been received by this Division, steps are immediately taken to secure the delinquent return.
A problem still exists among the Doukhobors, who generally persist in being married
by Doukhobor custom only. This is, of course, not so much a problem of registration as
it is one of the solemnization of a form of marriage recognizable under the laws of this
Province. Every effort is being made to help the Doukhobors to understand the importance of accepting a legal form of marriage.
DOCUMENTARY REVISION
This Division now has well over a million registrations of births, deaths, and marriages on file, and there is a constant demand for making notations and corrections on
these registrations. While the bulk of this documentary revision relates to birth registrations, the series of marriages and deaths are also in constant need of amendment. In
the birth series, the original registrations must be withdrawn from volumes in order to
add notations of alteration of names, corrections, notations of adoptions, or of legitimation. Marriage registrations must be amended to show notations of divorce or nullity,
change of name, and corrections. Amendments to death registrations usually consist of
corrections made by the informant.
An increase over the previous year was noted in the number of alterations of
Christian names of children under 12 years of age, and in the number of authorized
corrections made to records already on file. Adoption notations, changes in surname,
and divorce notations remained approximately the same as in 1949. Likewise, there
was little change in the number of legitimations of birth which were accepted.
Prompt revision of original registrations is a very important part of record maintenance, inasmuch as there is a constant demand for certificates which are based on these
original registrations. All registrations which have been amended are immediately
remicrofilmed, and the indexes are amended accordingly.
DISTRICT REGISTRARS' OFFICES, INSPECTIONS, ETC.
Changes in Registration Districts
Vancouver Districts
Since the Vancouver District office was established and made an integral part of the
Division of Vital Statistics in March, 1949, it has contributed greatly in dealing with
problems which previously had required personal attention from a representative of the
Victoria staff. This has been especially valuable in investigational work. Preliminary
investigations may be carried out and reports prepared in Vancouver so that only the
final stages of the problem cases require the attention of the central office staff.
Trail District
Following the transfer from British Columbia Police to Royal Canadian Mounted
Police, it was decided by the administrative officers of the latter group to consolidate the
accommodation of their Trail Detachments. Due to the physical limitation of the new
space, it became impossible for a member of the police detachment to continue his
appointment as District Registrar of Births, Deaths, and Marriages, and Marriage
Commissioner.
Arrangements were subsequently made with the Superintendent of Motor-vehicles
whereby the clerk in charge of the Trail office of the Motor-vehicle Branch was vested
with these appointments on a temporary basis until a more permanent arrangement can
be made. The speedy co-operation of the Motor-vehicle Branch in this regard prevented
an embarrassing disruption of service in the Trail Registration District. Y 66 BRITISH COLUMBIA
Changes in Other Districts
After careful investigation by the Inspector of Vital Statistics, it was considered
expedient to close the office of the Deputy District Registrar at Chase and to consolidate
the services under the District Registrar at Kamloops. It was felt that the small volume
which had been handled at Chase did not justify the continuation of the service, particularly in view of the improved travel conditions which give the residents of that area easy
access to Kamloops.
Members of the British Columbia Police have served as District Registrars and
Deputy District Registrars in forty-two of the offices and sub-offices throughout the
Province. Accordingly, when the policing of the Province was transferred to the Royal
Canadian Mounted Police on August 15th, 1950, these offices became staffed by Royal
Canadian Mounted Police personnel.
Inspection
Fifty-two offices and sub-offices covering the lower half of Vancouver Island, Fraser
Valley, Okanagan, East and West Kootenays were visited by the Inspector of Vital
Statistics during the year. In addition, brief instructional visits were made to six Indian
Agencies. Several visits were made to the Vancouver office, as well as those at New
Westminster and North Vancouver. The purpose of these visits is to check the work
that is being carried out in the district offices and the procedures employed, to discuss
difficult cases with the District Registrars, and to carry out field investigations as required.
At the close of the year there were seventy-two registration districts under the
supervision of District Registrars, in addition to which there were twenty-two sub-offices,
a special representative for Doukhobors, a marine registrar, and eighteen Indian Superintendents who act ex officio as District Registrars of Vital Statistics for Indians only.
Thirty-six of the District Registrars are Government Agents and Sub-Agents, while
members of the Royal Canadian Mounted Police are serving as District Registrars and
Deputy District Registrars in charge of thirty-nine offices and sub-offices. Twelve offices
are staffed by other Government employees, such as Gold Commissioners, and the
remainder by non-Government employees. The marine registrar and the eighteen
Indian Superintendents are Dominion Government employees. At the present time
there is no District Registrar for the Registration District of Clayoquot, but the functions
of that office are carried out by the Government Agent at Alberni.
ADMINISTRATION OF THE "MARRIAGE ACT"
During the year, applications for registrations from two previously unregistered
denominations were accepted. In addition, applications for registration from four other
denominations were under consideration as at December 31st, 1950. Each application
is carefully investigated according to the requirements of the " Marriage Act " in order
to ensure that only bona-fide religious groups are accorded the privilege of solemnizing
marriage.
All current registrations of marriage are checked to ensure that the officiating clergyman has been duly registered pursuant to provisions of the " Marriage Act." In seven
cases it was discovered that the clergyman had not been authorized to solemnize marriage,
and appropriate action was taken to validate the ceremony.
Applications for an order of remarriage pursuant to section 47 of the " Marriage
Act" were approved in twenty-three cases.
A revision was made in Form M. 11, Certificate of Publication of Banns, in order
to provide more explicit instructions to the clergy. DEPARTMENT OF HEALTH AND WELFARE,  1950 Y 67
ADMINISTRATION OF SECTIONS 34 TO 40, INCLUSIVE,
OF THE " WILLS ACT "
Requests for searches of wills notices has continued to increase, the monthly average
for 1950 being approximately 450. In order to facilitate the searching, a consolidated
index of wills notices for the period 1945 to 1949 was prepared and put into use.
As no specific forms were prescribed under the " Wills Act " for furnishing notices
of filing of wills, there has been a lack of uniformity in the size, shape, and content of
the notices received, thus creating a difficult filing problem. A recommended form was
therefore devised and distributed to many law firms and trust companies in an effort to
overcome this difficulty. This action has helped considerably, but more widespread use
of these forms by the legal profession would be of further assistance.
A new form of application for a wills search was also prepared and distributed.
By its use the applicant furnishes sufficient details to enable a more thorough search to
be made than was previously possible.
In 1950 over 2,200 wills notices were filed. This was an increase over the 1949
total of 1,562 notices filed.
VITAL STATISTICS INFORMATION FOR HEALTH UNITS
Commencing in January, 1950, a copy of every death registration was forwarded
by the District Registrars to the health unit director of the area in which the deceased
was resident. Thus, for the first time, the public health field staff had complete and
up-to-date information covering deaths in their areas. Arrangements were also made
whereby any queries that became necessary regarding the statement of the cause of
death as shown on the death registrations should be channelled from the Division of
Vital Statistics through the health unit directors to the private practitioners or Coroners.
The response of both the health unit directors and the practising physicians to this
system of querying has been good, and it has resulted in more complete and accurate
statistics on causes of death.
Equally important to the health unit is current information regarding births. At
the present time a brief notification is sent to the health unit from the District Registrar
of every birth that takes place. However, it was felt that more detailed information
would be of great value to the health unit particularly if it could be obtained by them
very shortly after the birth had occurred. Considerable attention was given to this
problem during the year, and a suitable plan of action was worked out. The Physician's
Notice of a Live Birth or Still-birth has been augmented to include additional items of
public health significance, and it will be prepared in duplicate. One copy will be forwarded immediately by the District Registrars to the appropriate health unit, while the
other copy will serve as a temporary working record for the District Registrar, and will
subsequently be transmitted to the central office of the Division for statistical processing.
As well as providing more complete birth information to the health units with a minimum
of delay, the new system will reduce the work involved for the District Registrars, since
it will no longer be necessary to prepare extracts from the birth registrations.
STATISTICAL SERVICES
The duties of the statistical sections of the Division are not limited to the collection
and compilation of vital statistics, but include a wide variety of services to a number of
different groups. Within the Department of Health, this includes the provision of
population estimates and other vital statistics data, the setting-up and revising of records,
forms, and recording procedures, the preparation of special articles of a statistical nature
relative to public health, and the provision of routine statistical services required by the
various divisions.    Assistance is given to the Divisions of Tuberculosis Control and Y 68 BRITISH COLUMBIA
Venereal Disease Control in the preparation of their monthly, quarterly, and annual
reports, and in the completion of special assignments on request. Service to other
departments of the Government consists mainly of the provision of population estimates
and data on vital statistics.
Numerous requests are received from companies and private individuals for information of a statistical nature. These requests are dealt with on their merits and without
charge to the company or person concerned.
During the year the Division was fortunate in securing the services of two additional statisticians under provisions of the Federal Health Grants. It thus became
possible, for the first time, to plan for adequate statistical services to all sections of the
Health Branch of the Department of Health and Welfare. It is the aim of the statistical
sections not only to meet the immediate statistical needs of the Health Branch, but also
to anticipate avenues of additional service and to plan accordingly.
Demography
The registrations of births, deaths, still-births, marriages, etc., which come in to
the Division of Vital Statistics are the basis of a wide variety of useful statistics. Cross-
classifications are made according to age, sex, racial group, place of residence, place of
occurrence, etc. These data are summarized in monthly reports and are available upon
request. Each quarter a summary report is prepared for the Health Bulletin. Special
tabulations are prepared monthly for the Metropolitan Health Committee in Vancouver
and for the Victoria-Esquimalt Union Board of Health. A detailed statistical report is
published annually in accordance with the " Vital Statistics Act." Population estimates
are compiled for use within the Department in calculating birth rates, morbidity and
mortality rates, and for other purposes. As there has been no accurate count of the
population since the Dominion Census of 1941, population estimates have become less
reliable during the last few years. The period since the census has been one of marked
population increase, and hence estimates for small areas of the Province become
increasingly hazardous.
Public Health Statistics
As well as the routine statistics provided to the Divisions of Tuberculosis Control
and Venereal Disease Control, a number of special tabulations were prepared. A follow-up
report on tuberculosis cases was completed in 1950. This report covered patients discharged from tuberculosis institutions and followed up at six, twelve, and twenty-four
months after discharge.
A special study was made on cancer morbidity and mortality in this Province, and
the results were published in the bulletin of the Health Branch. Also published in the
bulletin were articles on accidental deaths, the new International Statistical Classification
of Diseases, Injuries, and Causes of Death, and the quarterly reports on vital statistics.
The special study on infant mortality based on birth-death linkage was continued, and
an analysis of the data covering the last five years was begun.
A statistical analysis of a nutrition study was completed during 1950 for the Nutrition Service. Also completed was a series of graphs covering all important phases of
vital statistics and health statistics in this Province during the last five years.
During the latter part of the year the Division compiled the data for the Statistical
appendices to the Provincial health survey report, which has been carried out in each
Province under the Health Survey Grant. The full-time services of one of the research
assistants of the Division was diverted to this assignment.
At the request of the Director of the Division of Tuberculosis Control, a review of
the entire record system and recording procedures of the Division of Tuberculosis Control
was undertaken by this Division. A preliminary report containing recommendations
was presented to the Director and the staff of the Division of Tuberculosis Control at the DEPARTMENT OF HEALTH AND WELFARE,  1950 Y 69
annual meeting of the Division on November 15th, 1950. Following a meeting with
the senior medical staff of the Division of Tuberculosis Control, all main policies regarding the record system were agreed upon. However, a great deal of detail work is still
required to give effect to those policies.
Survey of the Crippling Diseases of Children
The survey of the crippling diseases of children was concluded on August 31st of
this year, by which time over 22,000 reports on crippled children in this Province had
been received. The information contained on these reports has been placed on punch-
cards, and preliminary tabulations have been made. Detailed cross-classification of the
data will be concluded in the early part of 1951.
Sickness Survey
A comprehensive survey of the incidence and prevalence of illness, and of the
amounts spent on the various types of medical care, was undertaken throughout Canada
during the year. The survey is being conducted as a co-operative effort between the
Department of National Health and Welfare and the respective Provincial Departments
of Health, and comes in response to the steadily increasing demand from many quarters
for reliable information on the volume and frequency of sickness suffered by the
Canadian people.
The organization of the broad aspects of the survey was carried out by the Department of National Health and Welfare, with the Dominion Bureau of Statistics providing
technical help and advice. The actual process of carrying out the survey has been
undertaken by the respective Provinces. In British Columbia the survey has been organized under the Division of Vital Statistics, with a full-time director of the survey appointed
under this Division. Throughout the Province, public health nurses are being used as
the enumerators, with health unit directors acting as regional supervisors. In the metropolitan areas of Greater Vancouver and Victoria the municipal public health nurses are
serving as enumerators under the supervision of the Medical Health Officers.
The information sought is being obtained by means of a sample survey. In this
Province approximately 2,200 households, or about 6,000 people, are included in the
sample. The sample has been scientifically chosen in such a manner that it is representative of the Province as a whole. The various economic and industrial areas of the
Province are included in the sample in proportion to their size in the total population,
and the sample is so drawn that every person in the Province has an equal chance of
being included.
The sample has been designed to provide information on a Provincial basis concerning illnesses of the most frequent occurrence, and not to give precise information
respecting relatively uncommon conditions. The line has been drawn at illnesses with
an annual incidence of 2 or more per 100 population. Data concerning illnesses which
occur less frequently than twice per hundred population per year will also be available,
but they will be less precise than those for the more common illnesses. However, even
for many of these less common conditions, fairly accurate national estimates will be
available even though reliable rates by Provinces separately will not be possible.
The survey is being conducted on a household basis, so that as well as yielding
information about individuals and their sickness experience, it will also provide considerable data on the experience of family groups and of household groups. The selected
households are being visited once a month for a period of one year, and the details of
all illnesses suffered by the occupants are collected. The enumerators have been carefully trained in order that the information which they record will be as accurate as
possible, and that it will be unbiased by anything the enumerator might say or do.
The data collected will be used in two ways. Firstly, and of prime importance, as
a basis for Provincial and National estimates concerning sickness, medical care, and Y 70 BRITISH COLUMBIA
expenditures for medical care; and, secondly, as an account of the experience of a specific
group of families. The estimates will be of two types. On the one hand, there will be
measures of the volume of such items as the total amount of sickness, the extent of
disabling illnesses, the amount of medical care and other types of health care received
for this amount of sickness, volume of dental care, and the volume of expenditures for
various types of health care. On the other hand, there will ensue estimates of the
incidence and prevalence of different kinds of illnesses which occur as frequently as
twice per hundred population per year.
It will be clear that the present survey will not, by any means, tell all one might
like to know about illness in our population, but it will, for the first time, provide the
broad picture of sickness and of unfulfilled needs. It will indicate in what direction
additional information must be sought, and it will be of paramount value to the medical
profession in assisting the profession to apply its skills and resources to the greatest effect.
STATISTICAL PROCEDURES IN LOCAL HEALTH UNITS
Early in 1950 a study of records and statistical procedures in the health units in the
Province was undertaken in order to assess the status of the present record system and
also to lay plans for an improved, standardized system. Considerable variation existed
in procedures employed by the various offices, each having developed its own records
independently. It was felt that the development of a uniform procedure manual, which
would be made available to all health units, would be an important contribution to local
health services. Considerable time has been given to this project during the year, and
the first drafts have been made of a manual of recording and statistical procedures for
health units.
MANUAL OF INSTRUCTIONS FOR DISTRICT REGISTRARS
A complete revision of the Manual of Instructions for District Registrars, Marriage
Commissioners, and Issuers of Marriage Licences was completed during the year. This
revision was carried out by the Inspector of Vital Statistics, and it includes many suggestions which were received from the field staff. The instruction manual has proved to
be of great assistance to the District Registrars and Marriage Commissioners in the field,
and it has played an important part in improving the quality and efficiency of the vital
statistics registration system.
GENERAL OFFICE PROCEDURES
The new procedures for the processing of mail and certificates which were put into
effect in the previous year proved very satisfactory, and only minor additional changes
were necessary in 1950.
A new style of short-form death certificate was placed in use in the Victoria office
during August, and similar certificates will be used by the District Registrars as present
stocks become exhausted. The use of the short-form certificate is an important forward
step in vital statistics practice and is one which is strongly advocated by the Vital
Statistics Council for Canada. The new certificate is based on the principle that the
greatest possible protection should be given to the public in preventing the unnecessary
disclosure of facts which might be harmful or prejudicial to the family and relatives of
the deceased. Previously, death certificates had shown the primary and contributory
causes of death as certified by the attending physician or Coroner. This information
may lead to considerable embarrassment, and even malice and harm, when the death
has been due to a mental condition, venereal disease, tuberculosis, cancer, or certain other
diseases which to many people convey a stigma. For most purposes a death certificate
is required only to prove the fact of death, not the cause, and disclosure of the cause of
death to outside agencies is generally unwarranted.    The new certificate contains no DEPARTMENT OF HEALTH AND WELFARE,  1950 Y 71
mention of the cause of death, although the information is obtainable from the Division
of Vital Statistics when it is required for legitimate reasons.
Microfilming of Documents
All registrations of births, deaths, and marriages from the very earliest records
right up to the present date have now been microfilmed.
The project of microfilming Physicians' Notices of Birth from 1917 to 1948, inclusive, was completed during the year. In addition, almost all files relating to correction
declarations were placed on film and a project of photographing 2,600 files pertaining
to alteration of Christian name was concluded. The purpose of this undertaking is to
reduce the amount of filing space and filing equipment necessary to accommodate the
increasing volume of records in the custody of this Division.
Approximately 3,400 records of casualties of armed forces personnel who were
residents of British Columbia, and who died or were presumed dead during service in
World War II, were microfilmed in order to preserve these records and make them
available to the Dominion Bureau of Statistics.
At the request of the Dominion Bureau of Statistics, the entire numeric birth index
from 1925 to 1949 in use by the Family Allowance Division was microfilmed and the
film forwarded to Ottawa. This film is being used in connection with a revision of the
numeric index which is presently being carried out by the Dominion Bureau of Statistics.
CONCLUSION
While progress was made in many directions during the year, there were few spectacular changes. No new legislation affecting the collection of vital statistics was enacted
and no major policy revisions were made. The most significant developments related
to the improvement and expansion of the public health statistical services of the Division.
During the year the research staff was brought up to full strength and major emphasis
was given to in-service training of this section. Nevertheless, several major projects
for other divisions of the Health Branch were successfully concluded and the preparatory
work on several other assignments has begun. Included in this latter are the statistical
treatment of the epidemiological phases of the Health Branch's work, the statistical procedures for local health units, and the setting-up of cancer-treatment statistics in co-operation with the British Columbia Cancer Institute. Y 72 BRITISH COLUMBIA
REPORT OF THE DIVISION OF PUBLIC HEALTH EDUCATION
Kay Beard, Consultant
In reviewing the progress in public health education during 1950, the most outstanding development is the realization of a step which has been planned since before
this Division was organized in 1946. This was the placement of qualified health educators as members of local health units. The fall of this year saw two health educators
appointed in this capacity—Miss Joan List in the Central Vancouver Island Health Unit
and Keith MacDonald in the Victoria-Esquimalt Health Department and the Saanich
and South Vancouver Island Health Unit. Both these persons have completed a twelvemonth postgraduate course in public health education. This major advance in public
health education in British Columbia will be observed with great interest by many public
health workers. During next year it should be possible to clarify the functions of a local
public health educator and outline some of the ways in which this service can increase
the effectiveness of local public health education programmes.
CONSULTATIVE SERVICE
One of the major functions of this Division is to provide, on request, consultative
service on matters concerning public health education to local public health services, to
other divisions, and to other organizations.
In this connection, visits were made to three health units during the year to discuss
with the respective staffs their local programmes in health education and, in some cases,
to assist in planning specific projects. For example, during a visit to the South Okanagan
Health Unit a meeting was held with the executive of the Kelowna High School Junior
Red Cross Council to assist them in planning a dental health education programme.
Assistance was provided by correspondence in other projects, such as exhibits for fall
fairs, discussion groups, and talks to lay groups.
As in the past, requests from persons living in areas supplied with public health
service were referred to the local public health staff. Where the request was of an
unusual nature, the Division endeavoured to supply the local public health personnel
with the necessary information.
Consultative service to other divisions has been chiefly in the field of evaluation of
materials suggested for distribution to the public. At the request of the Department of
National Health and Welfare, draft copies of a number of pamphlets have been evaluated.
In each case the comments of persons representing various groups, both lay and professional, were obtained and summarized. A similar service has been provided for divisions
within the Provincial service.
MATERIALS
The .distribution of films and film-strips on loan has again increased rapidly during
this year. Although the film library now includes 108 films and 72 film-strips, the
demand for these materials still surpasses the supply. Attendance records indicate that
films from this library have been shown to as many as 8,500 persons per month during
the winter months. Films on child care and development and mental health are the
groups most frequently requested. These have been used extensively by public health
personnel in conjunction with talks to community groups, which shows an increasing
awareness of the importance of the preventive aspects of mental health. Films on
maternal and infant care have also been in great demand, particularly for use in classes
for expectant mothers.
During the year a completely revised film catalogue was prepared, which provided
detailed descriptions of all the films in the Division's library, with suggestions regarding
the audience for which each film would be suitable. DEPARTMENT OF HEALTH AND WELFARE,  1950 Y 73
The production of exhibits increased during 1949 as a result of an increased number
of requests. During the year about 100 photographs have been taken to be used for
exhibits, film-strips, or slides, and other purposes. The co-operation of the British
Columbia Government Travel Bureau in making available the services of a photographer
has made possible the collection of sufficient photographs to tell a fairly complete picture
story of the services of the Health Branch. A series of pictures on school health services
was obtained through the co-operation of the Division of Visual Education of the Department of Education. A number of these photographs were utilized in displays at the
Public Health Institute; the Convention of the Canadian Association for Health, Physical
Education, and Recreation; the Canadian Social Work Conference; and the biennial
meeting of the Canadian Nurses' Association. In addition, some sets were loaned to
local health units to be used in preparing displays for fall fairs.
Other exhibits prepared during the year included an exhibit on immunization for
loan to health units, an exhibit on the growth of public health services in British Columbia
for display at the Conference of the Canadian Institute of Sanitary Inspectors, and a display of library books for the field staff at the Public Health Institute.
One other major project in the preparation of materials was the work on a Manual
of Communicable Disease Control for Teachers. A comprehensive draft copy of this
booklet was prepared and submitted to a group of teachers for their comments. The
revision of this material to incorporate the suggestions received is still to be completed.
For many years this Department has distributed, on application, a series of twelve
monthly letters covering the first year of the baby's life. These are sent out to mothers
throughout the Province on request. During the past year such requests have been
received in this office from over 5,000 mothers. Since all other printed literature is
distributed through local health units, the long-range policy is to have these letters
distributed in the same manner. Three health units have already assumed this responsibility and are distributing an additional 4,000 sets of these letters. Five other units will
shortly assume this responsibility. From letters and comments received, this service is
a most popular one, particularly with new parents.
The meetings of the Local Health Services Council have provided opportunities for
reviewing a number of Departmental publications, including the above-mentioned letters.
Other publications reviewed at these meetings included the Health Bulletin and the staff
news-letter, Public Health News and Views. Following the discussions on news and
views, a questionnaire was prepared and distributed to all the recipients of the news-letter
to obtain their opinions and suggestions. Although many replies expressed satisfaction
with the present publication, a number of excellent suggestions have been received which
will be put into effect in the new year.
Following a review of the Health Bulletin, plans have been completed to have this
publication printed under a new name—B.C.'s Health—beginning with the first issue in
1951. This step will make it possible to double the circulation for approximately the
same total cost, and will provide a more attractive and more readable bulletin. It is
perhaps fitting that in its twenty-first year of publication this bulletin should assume
a new form.
The distribution of pamphlets to local public health personnel for use in their
districts has kept pace with the expansion of services during the year. Approximately
240,000 pieces of printed material, including pamphlets, posters, and mimeographed
information, have been distributed, exclusive of monthly publications. A revised system
of recording orders was put into effect early in the year and has been of great assistance
in estimating stock on hand and in ordering additional supplies.
PRE-SERVICE TRAINING
The orientation course for new members of the professional staff in the central
office, and for new health unit directors, has been continued during the year.    Courses Y 74 BRITISH COLUMBIA
were planned for three health unit directors, two health educators, and for several
members of related departments. In addition, a modified form of this course was
planned for several visitors from other countries who are studying Canadian public
health methods on fellowships from the United Nations. An article was prepared for
the magazine Canada's Health and Welfare describing the work being done in this Province in job training. As part of a plan to extend this programme to other personnel,
a draft copy of a booklet for new employees has been prepared. It includes information
on the services of the Department, as well as on personnel policies and Civil Service
regulations. The booklet has now been thoroughly reviewed and should be ready for
publication early in the new year.
IN-SERVICE TRAINING
The Annual Public Health Institute held in April featured a series of lectures by
Dr. Nathan Sinai, Professor of Public Health at the University of Michigan, an outstanding speaker and an authority in the field of public health economics. Other speakers
from within the Province discussed changes in policies and programmes in public health
and outlined plans for the future. These meetings provide an opportunity to give the
field staff a broader picture of what is happening in public health, as well as an opportunity to discuss their individual and collective problems with others and work toward
a solution.
Other in-service training procedures used throughout the year included staff meetings and information in the news-letter. An outstanding project in staff training this
year was the development by the Local Health Services Council of a manual for statistical clerks in local health units to assist in clarifying the duties and responsibilities of this
position.
CONFERENCES AND TALKS
Members of the Health Education Division attended conferences in a wide variety
of fields during the year, including those of the Canadian Association for Health, Physical
Education, and Recreation; the Canadian Nurses' Association; the Canadian Social
Workers; the Western Region of the National Film Board; and the Canadian Education
Association. Talks were given to student nurses at two Victoria hospitals, to public
health nursing students at the University of British Columbia, and to the teachers attending the Summer School course in effective living.
STAFF CHANGES
Two health educators were added to the staff during 1950. A. C. McKenzie, who
joined the staff in February, was granted leave of absence to undertake postgraduate
training in public health. R. H. Goodacre joined the staff in September to replace P. M.
Nerland, who transferred to another position within the Department. Miss Joan List,
as previously mentioned, returned from postgraduate training and accepted a position
as a local health educator. As in past years, it has been impossible to recruit suitable
persons with experience in fields related to public health education since the salaries are
not comparable with salaries for experienced persons in other fields, particularly teaching.
The development of long-range projects by the Division is seriously hampered by the
continual staff changes and the consequent time required to train new and inexperienced
persons. There is a definite need for at least one additional person, preferably with
experience in teaching, as a permanent member of the central office staff of the Division,
to specialize in materials in the field of school health.
The work of the Division during 1950 has been centred chiefly around the preparation and distribution of materials, especially exhibits, catalogues, and manuals, for the use
of local health services. A more stable personnel in the central office of the Division
would permit expansion of other functions of the Division, particularly consultative
services to local public health units. DEPARTMENT OF HEALTH AND WELFARE,  1950 Y 75
REPORT OF THE DIVISION OF LABORATORIES
C. E. Dolman, Director
In the annals of this Division the year 1950 will prove to have been notable for
the facts that, despite increasing difficulties of accommodation and a record number of
staff changes, there was again a slight increase in total tests performed; and, further, that
definite steps were at last taken during the year toward providing improved quarters
for the main laboratories in Vancouver. The year was also marked by the opening of
a new branch laboratory at Prince George, operating in close association with the
Cariboo Health Unit.
The total tests performed by the Division at large approached 400,000, of which
roughly 320,000 were carried out in the main laboratories in Vancouver. Table I shows
the classified totals of tests done during the years 1949 and 1950 in the central laboratories. It will be noted that approximately one-quarter of the tests carried out were
done on behalf of physicians and health officials operating outside the Greater Vancouver
area.
TESTS FOR DIAGNOSIS AND CONTROL OF VENEREAL DISEASES
As in previous years, tests relating to syphilis and gonorrhoea accounted for a very
high percentage of the total tests done. However, this proportion fell from around
75 per cent in 1949 to approximately 70 per cent in 1950. This drop may in part
reflect a somewhat diminished concern with these diseases, due to their undoubtedly
reduced incidence, but is also partly due to relative increases in the number of tests done
for the diagnosis of tuberculosis and enteric infections. The serological department itself
actually showed no evidence of a lessening demand for blood tests; indeed, nearly as
many blood specimens were examined during the first eleven months of 1950 as during
the whole of 1949. This may be attributed to the trend toward surveys of ostensibly
healthy people. Several surveys were again carried out in co-operation with the Division
of Venereal Disease Control.
During the year the policy was adopted of titrating out to the final dilution of serum
giving a positive reaction all those specimens which were positive by the standard
Kahn test. These quantitative reports were issued to all physicians, whether asked for
or not. It is hoped that supplying this additional information will eventually make for
better understanding of the control and treatment of syphilis.
The staff of the department performing these sero-diagnostic tests has noted an
apparent increase in the proportions of specimens giving a positive standard Kahn
reaction despite the complement-fixation reaction being negative or only doubtful.
In a rather high percentage of these cases there was no evidence of syphilis. The standard Kahn test would seem to have become particularly prone to give rise to the so-called
" biological false positive " reactions. This question has arisen before, notably at the
beginning of the last World War, and calls for careful reinvestigation. As a contribution
toward possibly helping to solve this problem, the Division received co-operation from
the Division of Venereal Disease Control in the collection of samples from patients
giving this type of false positive reaction. These specimens were forwarded to Ottawa
for distribution in the current year's sero-diagnostic survey. In the four previous surveys,
specimens of this category were not available for inclusion.
The general impression that the incidence of gonorrhoea has at least temporarily
undergone a decline, largely because of the efficacy and simplicity of penicillin treatment,
has been borne out by a definite decline in the numbers of microscopic and cultural
examinations for gonococcus. Y 76 BRITISH COLUMBIA
TESTS RELATING TO TUBERCULOSIS CONTROL
During the first part of the year it was decided to subject all sputum specimens to
cultural examinations for M. tuberculosis. Hitherto, this type of examination had been
reserved for specimens other than sputum from persons suspected of tuberculosis, and
for sputum specimens accompanied by a request for cultures. This policy accounts for
the fact that nearly double last year's number of examinations of this type was made.
By the end of the summer the arrangement was clearly becoming an intolerable burden
on the staff, from the standpoints of both the amount of work entailed and of the safety
of personnel in the present very overcrowded quarters. A compromise plan was therefore worked out, whereby cultures were done on all sputum specimens accompanied by
special requests, or which, because of the patient's history or for some other reason,
seemed to warrant this extra attention. The newer methods of treating sputum specimens prior to culture have been tried out carefully in the laboratories, and much useful
information obtained.
In the late summer the Tranquille unit of the Division of Tuberculosis Control
made it known that their guinea-pig colony was at last in a position to supply the laboratories' future needs of these animals. Shipments of guinea-pigs have now been arriving
twice monthly from Tranquille for the past several months.
FOOD-POISONING AND GASTRO-INTESTINAL INFECTIONS
As usual, there was a large number of staphylococcus food-poisoning outbreaks,
none of them, fortunately, involving large numbers of individuals. This year there is
no instance of botulism to report. But a wide variety of Salmonella infections were
identified, the strains isolated being forwarded to the Laboratory of Hygiene, Ottawa,
for final typing. Salmonella micro-organisms were isolated during the year from approximately 140 different individuals, a figure only slightly below that of last year. At least
twelve types were represented, the most prevalent organisms being the same four types
which have been dominant in this Province for the past many years—namely, S. typhi
(13), S. paratyphi B. (17), S. typhimurium (62), and S. newport (30).
The largest food-borne outbreak of Salmonella infection occurred during September,
when several dozen people became ill, some quite seriously, after a picnic. Epidemiological evidence appeared to incriminate a turkey, and success was met in isolating
S. newport from a sample of the turkey-meat as well as from the fasces of twenty-two
victims. The turkey had been kept in cold storage and was inadequately cooked. The
Laboratories carried out some experimental work which emphasized the necessity of
thorough cooking of large turkeys, especially after being held in the deep-freeze and
only partially thawed out before being put in the oven.
In last year's report a comment was made on the apparent slow decline in the
incidence of shigellosis (bacterial dysentery) in this Province during the past five years.
An abrupt reversal of this trend occurred during 1950, chiefly because of the prevalence
of Shigella sonnei. There were no fewer than 158 separate persons from whom this
organism was isolated during the first eleven months of the year, a figure larger than the
total number of Salmonella isolations during the same period, and almost double the
total number of individuals yielding Shigella sonnei throughout the past six years.
Fortunately, the incidence of Shigella flexneri, which generally causes a more severe
type of infection, showed a slight decline from the average annual number of isolations.
Well over half the total cases of Shigella sonnei infections encountered were directly
or indirectly related to an outbreak of gastro-intestinal infection which occurred at the
end of July and early in August at a girls' summer camp in Howe Sound. Positive stool
cultures were isolated from no fewer than seventy-seven persons there, and the camp
had to be closed. Laboratory examinations of the camp water-supplies indicated heavy
pollution.   An epidemiological inquiry carried out by Dr. John Nelson, of the Division DEPARTMENT OF HEALTH AND WELFARE,  1950 Y 77
of Venereal Disease Control, substantiated that a contaminated water-supply was the
probable cause of the outbreak. The Division has reason to believe that sanitation
arrangements, particularly as regards water-supply, of many of these summer camps
leave much to be desired. Mild cases and carriers leaving this camp no doubt contributed
to the subsequent outbreaks of the infection which have occurred sporadically during
the latter part of the year.
BACTERIOLOGICAL ANALYSES OF MILK AND WATER SAMPLES
Examinations of water-supplies showed a slight but definite increase during the
year, while examinations of milk-supplies have more than doubled in the main laboratories. It is gratifying to record the generally good co-operation received from sanitary
inspectors throughout the Province in shipping samples on ice in specially constructed
boxes. Most inspectors are considerate in making arrangements as regards days on
which their shipments should reach the Laboratories, thus enabling us to plan a schedule
permitting the maximum possible turnover of examinations. The very pronounced
increase in these laboratory examinations of milk samples shown in the past two years
must eventually have favourable effects on the incidence of milk-borne infections throughout the Province. Intelligent action by the inspector sending in the specimen, when he
in due course receives the Division's report, affords a gratifying example of the way in
which the findings of the laboratory can be applied to best advantage in the improvement
of milk-supplies through the interpretations of a trained intermediary.
OTHER TYPES OF TESTS
Examinations of swabs for C. diphtheria; amounted to over 17,000, which represents
an appreciable increase over last year's total. Although there was no extensive outbreak
of diphtheria during the year in this Province, isolated cases and small outbreaks occurred.
Most of this very large number of throat swabs examined were taken as part of hospital
routine.
The Paul-Bunnell test for infectious mononucleosis was performed more than twice
as many times as last year.    It appears that this condition may be on the increase locally.
The numbers of examinations for intestinal parasites also underwent a substantial
increase of nearly 50 per cent. On the whole, the numbers of such examinations which
prove positive are fewer than might have been expected in view of the peculiar location
of Vancouver and of its heterogeneous population. It is curious, for instance, that for
some years now no definite case of amoebic dysentery has been diagnosed in the main
laboratories. It is not felt that these or other intestinal parasites are being missed,
because at least two senior members of the staff have had special training in parasitology.
Moreover, the Laboratory of Hygiene at Ottawa has kindly sent to each of the Provincial laboratories during the past few months a series of typical specimens from the
field of parasitology for identification. A week or so after these specimens have been
scrutinized in the laboratories, their identity is revealed in a communication from the
Laboratory of Hygiene. This useful checking system has provided a sort of minor
refresher course.
BRANCH LABORATORIES
A. R. Shearer, Senior Bacteriologist and Supervisor of Branch Laboratories, managed to visit each of the laboratories at least once during the year. Representatives of
several branch laboratories visited the main laboratories, in some cases staying for a week
or longer in order to study out latest methods. The Victoria and Nelson branch laboratories, for instance, sent technicians to Vancouver for a period of two weeks during
the summer. Again, an assistant bacteriologist from the main laboratories spent a couple
of days in the Victoria Branch Laboratory at Jubilee Hospital to help elucidate some Y 78 BRITISH COLUMBIA
difficulties experienced in their serology department. Such direct interchange of staff
as this is much more satisfactory than correspondence, and would be arranged more
frequently if staff shortages were not so acute.
The shortages of trained personnel which handicap the work of the main laboratories
so badly are of even more serious import to the branch laboratories. A poorly trained
technician in a branch laboratory is not only of no help, but may be a positive danger.
The absence of a suitable pool of well-qualified technicians from which to draw has
prevented the reopening the Prince Rupert Branch Laboratory, and has seriously handicapped the work at the Nelson and Kamloops branches. The same difficulty led to
postponement until July of the opening of the Prince George Branch Laboratory.
However, this venture got under way as soon as a temporary employee could be obtained,
after Mr. Shearer had paid a visit to Prince George to help install equipment in the newly
built extension to the headquarters of the Cariboo Health Unit, in which the branch
laboratory is housed. After about two and a half months the temporary employee was
replaced by Miss G. E. Hill, who had formerly been on the staff of the main laboratories
in Vancouver.
After five months of operation it is clear that the work done in the Prince George
Laboratory has been of great value to the programmme of the health unit, particularly
as regards improvement of the milk and water supplies over the very large territory served
by the unit. Excellent relations have been built up between the technician and the
sanitary inspectors. There is every hope that a limited number of additional tests—
for example, smear examinations for gonococcus—can eventually be carried out also as
part of the programme. The experiment will provide a valuable guide in the estimation
of the costs of operating such a laboratory, about which only meagre data have hitherto
been available. The total cost per test seems likely to be of the order of 70 to 85 cents,
which does not seem an excessive figure for a small laboratory in an isolated area engaged
primarily in the bacteriological analyses of milk and water samples.
GENERAL COMMENTS
Conferences and Publications
The Assistant Director, Miss D. E. Kerr, attended a series of four weekly refresher
courses on several special aspects of public health laboratory work given by the Communicable Disease Centre at Atlanta, Ga., which operates under the United States Public
Health Service. The expenses involved in attendance at these courses were met by
a Federal Public Health Grant. The experience gained from this visit, and especially the
interchange of views it afforded with visitors from all over North America and abroad,
was most beneficial to Miss Kerr herself and to the Division as a whole.
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,
December 14th to 16th, inclusive, under the auspices of the Laboratory of Hygiene,
Department of National Health and Welfare. A great variety of technical questions was
discussed at these meetings, as well as the part to be played by Provincial laboratories
throughout Canada in problems of national defence. Following this conference, the
Director attended the annual meeting of the Laboratory Section, Canadian Public Health
Association, which was also held this year in Ottawa, where he presented, in conjunction with colleagues, two papers on rat-bite fever and on Streptobacillus moniliformis
respectively.
A paper entitled " Fish-borne and Type E Botulism: Two Cases due to Home-
pickled Herring in Vancouver " appeared in the June issue of the Canadian Journal of
Public Health under the joint authorship of Dr. Dolman, Miss Chang, Miss Kerr, and
Mr. Shearer. DEPARTMENT OF HEALTH AND WELFARE,  1950 Y 79
In August the Director attended the annual meeting of the International Northwest
Pacific Conference on Diseases of Nature Communicable to Man, and by invitation read
a paper on rat-bite fever, which will be printed in the Proceedings of the Conference.
Dr. Dolman represented the Provincial Department of Health on this occasion.
Staff
When the present Director assumed his duties at the Provincial Laboratories in Vancouver just over fifteen years ago, the staff numbered eleven, including himself, and the
annual turnover of tests performed was around 40,000. By the year under review the
staff has more than quadrupled, while the annual turnover of tests is eightfold greater.
The whole operation of the Divsion has become greatly more complex. Far more
varieties of tests are performed now than before, while entirely new responsibilities,
such as the maintenance of branch laboratories and the distribution of biological products,
have been assumed. The devoted enthusiasm and fine personalities of key senior members of the staff have alone made it possible to carry on during years of increasing difficulty in most discouraging circumstances.
One of the more baffling problems, which is shared by public health laboratories
everywhere, is the very rapid turnover of technical staff. Young women carry out this
type of work with deftness and accuracy, and their generally high level of conscientiousness has fitted them admirably for this occupational field. However, there can be no
escaping the fact that the ambition of most young women is to marry, and no sensible
person would seek to dissuade them from this endeavour. The marriage rate happens to
be particularly high among young women graduates of the University, or among laboratory assistants who may lack a university degree but probably have in most instances
a comparable level of intelligence; and the consequence is that the average number of
years of service put in by these people barely exceeds one year. The magnitude of staff
problems may perhaps be revealed by the fact that in 1950 thirty newcomers had to be
absorbed into the staff, the great majority of these being technical employees, and most
of them replacements of persons who had resigned, in many instances, to be married.
The attention given to the careful training of so large a number by comparatively few
senior staff members, who meanwhile had to carry on with their ordinarily heavy duties,
reflects great credit on them. It is to be hoped that another year in which more than
half the staff are newcomers will not be experienced.
If emoluments were at a higher level, the policy would naturally be to recruit young
men into these positions, in the hope that they would look upon this field as a possible
life work and, at any rate, would not abandon their position so promptly on marriage.
One male assistant bacteriologist was taken on the staff toward the end of the year, more
or less as an experiment. The nature of the accommodation and the salary limitations
do not warrant any attempt to extend this policy at present, but it will be interesting to
see whether the two technically qualified men added to the staff within the past two years
will find this type of work satisfying. It must be emphasized, however, that until the
importance of the work is recognized by provision of generally higher salary scales,
opportunities for recruitment of men will be few.
Accommodation
In successive Annual Reports for the past fifteen years the Director has regularly
drawn attention to the unsuitable and inadequate nature of the accommodation in the
main laboratories at Vancouver. The situation reached a climax at last year-end, when
the laboratories had to close for several days because it was impossible to operate in the
extreme cold, which froze up pipes, plugged drains, and kept the temperature in several
unheated laboratories at unendurable levels. The patience and good humour of the staff
on this occasion was taxed to the limit and beyond. Several resignations occurred which
must be regarded as directly or indirectly due to the difficulties of accommodation. Y 80
BRITISH COLUMBIA
It is gratifying to report that detailed floor plans have now been drawn up for
a building which it is proposed to erect near the Vancouver General Hospital, three floors
to be occupied by the Provincial Laboratories. The urgent necessity of replacing the
present quarters by more adequate and worthy accommodations cannot be too strongly
stressed. In the event of any emergency, local or national, it would be impossible to
contribute any proper measure of effort and technical skill to alleviating the disaster
because the absolute limit of capacity to improvise in the handling of additional burdens
has already been reached.
Finally, the Director wishes to record his appreciation of the fine co-operation shown
by all members of the staff under exceptionally trying conditions.
Table I.—Statistical Report of Examinations Done during the Year 1950
Out of
Town
Metropolitan
Health Area
Total in
1950
Total in
1949
259
2,957
1,503
390
22
4,277
1,341
2,003
592
312
9,013
5,052
1,384
28
5,179
3,989
17,051
2,306
9,179
823
26,333
3,481
3,157
356
286
491
96,525
16,391
3,752
15,853
2,283
206
969
1,806
2,261
2,062
2,062     ■
1,767
905
2,442
225
225
225
267
1,192
571
11,970
6,555
1,774
50
9,456
5,330
19,054
2,898
9,179
1,328
30,710
9,404
4,499
378
321
673
126,722
21,873
4,952
21,571
2,998
259
1,207
2,353
2,962
3,156
3,156
2,486
965
6,504
225
225
225
347
2,924
586
Blood serum agglutination tests—
11,410
6,621
1,028
23
Cultures—
3,727
Typhoid-Salmonella-dysentery group   	
4,158
19,788
3,819
10,508
505
4,377
5,923
1,342
22
35
182
30,197
5,482
1,200
5,718
715
53
238
547
701
1,094
1,094
719
60
4,062
1,326
Direct microscopic examination—
33,851
8,939
3,727
454
373
561
Serological tests for syphilis—
Blood—
119,905
22,341
5,610
21,730
Cerebrospinal fluid—
3,184
322
Cerebrospinal fluid—
1,523
2,579
3,143
Milk—
2,235
Coli-aerogenes... _ 	
2,234
1,712
Water-
910
7,942
Ice-cream—
—
80
1,732
536
4,610
79,422
239,838
1
319,260
311,415
* After June 1st, 1950, included under " Cultures—M. tuberculosis.* DEPARTMENT OF HEALTH AND WELFARE, 1950 Y 81
REPORT OF THE DIVISION OF VENEREAL DISEASE CONTROL
C. L. Hunt, Director
There has been very little change in the over-all picture of venereal disease during
the year 1950, although the number of cases of early infectious (primary and secondary)
syphilis has fallen to the lowest figure ever recorded. This latter figure has shown
a reduction of over 55 per cent over that for 1949. This figure of 62 cases for the year,
in a Province where almost half of the total population lives in or around a major seaport,
must now have fallen almost to its absolute minimum.
This reduction is particularly interesting in view of the deliberate policy of the
Division of recommending that all cases of gonorrhoea be overtreated, with a view to
eliminating any concomitantly acquired syphilis.
Since a high proportion of sexually promiscuous persons will ultimately require
treatment for gonorrhoea, this seemed—as has indeed been shown—to be a feasible
method of attacking the spread of syphilis.
In carrying out this vigorous campaign against the more dangerous syphilitic
infections, there has been a somewhat overliberal tendency to treat many patients merely
on clinically suggestive evidence of gonorrhoea, even though the diagnosis could not be
confirmed by the laboratory. This policy explains to some extent the insignificant
reduction in the number of gonorrhoea cases notified in 1950 as compared with 1949.
Penicillin has indeed proved to be the wonder drug for the treatment of both syphilis
and gonorrhoea, and is steadily and surely replacing all the older forms of therapy. It is
highly effective, relatively harmless, and more rapid in action than any other known form
of therapy. In spite of this, however, large numbers of venereal infections (chiefly
gonorrhoea) continue to occur. This serves to illustrate very forcibly that effective
treatment alone is not in itself sufficient to combat the spread of venereal disease.
Epidemiology has an extremely important part to play in any effective programme, and
it is becoming increasingly evident that it is in this field that our future energies must
be primarily directed.
Penicillin continues to be issued free of charge to private physicians for the treatment
of notified cases of venereal infection. The recommendation that all cases of gonorrhoea
be treated with 1.2 to 1.5 million units of penicillin has resulted in a considerable increase
in the amount of penicillin distributed.
Consultative service to private physicians is also being given to an ever-increasing
extent. The fact that such services are being requested is a measure of the confidence
in which this Division is held by the medical profession as a whole.
The Division employs consulting physicians in many of the major specialties. These
consultants are all of the highest calibre and are recognized as outstanding in their own
fields of medicine.
It is of interest to note that although a comparatively small number of Divisional
clinics is operating in the Province, these clinics are responsible for reporting 57.5 per
cent of all venereal disease cases. The main Vancouver clinic alone was responsible
for notifying approximately 50 per cent of all reported cases. This serves to illustrate
the important part being played by these clinics in the over-all venereal disease control
programme of this Province.
TREATMENT
The general treatment schedule for syphilis was fully revised in February, 1950, and
copies of the new schedule were distributed to every practising physician in the Province,
as well as to hospitals and public health personnel.
Minor changes have since been made in the recommendations for the treatment of
cardiovascular and neuro syphilis. Y 82 BRITISH COLUMBIA
As has already been indicated, penicillin is now being recommended almost
exclusively for most stages of syphilis, though a short course of bismuth is still being
employed in some instances as a preparatory procedure before commencing penicillin
treatment.   Arsenic has been almost entirely superseded in the treatment of syphilis.
Aureomycin has proved to be an effective agent for the treatment of all types of
venereal disease, though its use is likely to be strictly limited as long as its cost remains
at the present high level. Furthermore, penicillin appears still to be slightly superior
to aureomycin in the treatment of syphilis and gonorrhoea.
Streptomycin and the sulpha drugs are being used in the treatment of chancroid, and
in certain cases of gonorrhoea and non-specific urethritis of venereal origin which have
not responded to treatment with penicillin. It has been shown in a recent study of clinic
cases, however, that approximately 96 per cent of all patients with gonorrhoea are cured
by a single injection of penicillin.
The clinics of the Division continue to be used very extensively by the public,
approximately 32,000 patient-visits to all clinics being made during 1950, of which
23,000 were made to the main Vancouver clinic alone.
In September, 1950, extensive investigation into the follow-up requirements of
persons treated for gonorrhoea resulted in a change of policy in this regard. In view of
the acknowledged effectiveness of penicillin in the treatment of gonorrhoea, one negative
test of cure is now considered to be adequate in these instances, thereby diminishing very
considerably the amount of time and work involved.
EPIDEMIOLOGY
The past year's experience with a highly effective treatment agent such as penicillin
has served to throw into still greater relief the importance of epidemiology in controlling
the spread of venereal disease.   Effective treatment alone is not enough.
It was with this in mind that increased efforts have been made to improve and
strengthen the Divisional epidemiological programme during the past year.
The workers in epidemiology are constantly alert to improved methods of case-
finding and case-holding. Greater emphasis is being placed on the interview, both as
a means of giving information about the venereal diseases to persons attending the clinics
and as an exhaustive search for every contact. A patient who gives an incomplete contact
history is reinterviewed on his second visit. The results obtained from the reinterview
have been most gratifying. An increasing number of patients are being asked to bring
their own contacts to the clinic for examination.
The diagnostic centre at the Vancouver City Gaol continues to be a valuable asset
to the epidemiology programme. The incidences of infection found in this group of
persons has remained at approximately the same high level since the inauguration of
this examination centre during 1947. In this regard it is of interest to note that, during
1950, examinations carried out at the Vancouver City Gaol numbered approximately
2,800, of which 5.5 per cent were found to have previously undiscovered venereal disease
infections.
The above centre has proved to be so helpful in our Vancouver programme that
it was felt it would be a definite advantage to extend the service to include gaols in other
city centres in British Columbia for the purpose of examining those groups of anti-social
personalities who have been shown to present the greatest problem in spreading venereal
disease.
The Prince Rupert City Gaol diagnostic centre commenced operation in November,
1949. This was closely followed by the opening of a similar centre at Prince George
in July, 1950. The Provincial health unit in each area provides the staff who are responsible for the examination of the inmates. Persons found to be infected are referred to
a local physician for treatment.    In each instance the success of these centres is in large DEPARTMENT OF HEALTH AND WELFARE,  1950 Y 83
part due to the extremely high degree of co-operation that exists between the local health
department and the local police detachment.
Health units have been brought more into the picture from the point of view of
case-finding, case-holding, and contact-tracing. Health Unit No. 1 in the Vancouver
Metropolitan Area has instituted a full-time blood-testing service, which is operated by
a member of the nursing staff of this Division. The number of blood tests taken at the
health unit has increased steadily each month. Not only does this centre provide a
method of case-finding in an industrial area of Vancouver, but it also provides a conveniently located centre in the down-town area where clinic patients may report for
follow-up tests.
In addition to this, arrangements have been made for penicillin injections to be
given at that health unit, as well as at the New Westminster Health Unit, for the convenience of certain patients whose treatment has been previously outlined at the Divisional
clinics.    It remains to be seen how far this service can be extended in the future.
A blood-testing survey among Indians employed in canneries in the Prince Rupert
area was completed in August. This was accomplished in co-operation with the Indian
Department and the local health unit. The number of persons brought to treatment as
a result of the survey proves that this method of case-finding among selected groups of
the population is well worth the time and effort spent.
Facilitation processes have continued to be explored and observed from every possible angle, and in this respect special mention should be made of the great co-operation
and assistance given to the Division by the Provincial and Vancouver City Police Forces,
the British Columbia Hotels' Association, the Liquor Control Board, and, indeed, by
every group of public citizens which has been approached.
SOCIAL SERVICE
Much excellent work has been done by the social service workers in the Division
over the past year. All patients with new infections are interviewed at least once, when
the social service worker, besides giving help in personal problems, often finds it possible
to discover further information which may prove helpful epidemiologically.
Because of the relationship between promiscuity and the acquisition of a venereal
disease, the Social Service Section has continued to focus its attention on the behaviour
problems behind the venereal disease incidence in British Columbia. In an effort to
treat some of the basic personality disorders that are manifested by the people who are
acquiring venereal disease, personal counselling of each patient individually is an integral
part of the treatment process at the Vancouver clinic. The effectiveness of this individual
approach, to control the spread of venereal disease by means of the self-control of the
infected person, is dependent on the capacity of the individual to change. Among the
venereal disease population, this capacity varies widely.
Patients whose problems appear to be beyond the scope of the social worker are
referred to the consulting psychiatrist for further attention.
Many instances of psychological " rehabilitation " have occurred as a result of this
system. In addition, much interesting and valuable information has been obtained with
regard to the social habits and behaviour patterns of those reporting with repeated
venereal infections. A recent study carried out by the Social Service Section of the
Division has shown, among other things, that one of every three new patients treated
at the Vancouver clinic had suffered from more than one infection.
A sociological analysis was made of 150 consecutive patients in the younger age-
group attending the Vancouver clinic, and the results recorded by Miss Joan Morris and
Miss E. A. Johnson in a paper entitled "A Sociological Measurement of the Venereal
Disease Problem."
. Y 84 BRITISH. COLUMBIA
A further investigation was made of the female patient group examined by this
Division at the Vancouver City Gaol in 1949. In this analysis, it was shown that two-
thirds of these women had a previous venereal disease history or a police record.
During the year the Social Service Section has directed some attention to the problem
of homosexuality and the spread of venereal disease. For the first eleven months of
1950, 15 per cent of the total early syphilis diagnosed at the Vancouver clinic was
acquired as the result of homosexual behaviour. Every effort has been made to give
these patients the benefit of psychiatric consultation.
Special attention has been given to the problem of juveniles (under 18) who become
infected with a veneral disease. A meeting was held with the Youth Detail of the Vancouver Police Department, when a policy of close co-operation was evolved for the
handling of these cases and of the circumstances giving rise to them.
EDUCATION
The policy governing general public health education on venereal diseases dictates
that prime responsibility for this field lies with the Division of Public Health Education.
There is, however, a close liaison between the aforementioned Division and the Division
of Venereal Disease Control, the latter carrying the greater portion of responsibility in
the programme for the Vancouver area.
Lay education has consisted in lectures to small groups, such as young peoples'
societies and university students. A talk was also given to the members of the B.C.
Hotels' Association at their annual conference in Vancouver in September.
A booklet " Decent Living—The Story of Your Personal Problems," by Albert H.
Crombie (published by Youth Problems, Inc., Columbus, Ohio), has been approved by
the Department of Education for use in schools as a reference in the new Effective Living
programme. A copy of the booklet is being placed at the disposal of each teacher in
junior-senior high schools.
Arrangements have been made for talks on venereal disease to be given from time
to time by members of this Division, or by other members of the Health Department,
to P.-T.A. groups, both in Vancouver and throughout the Province. It is felt that the
new course for schools on Effective Living is likely to be more effective if some supplementary instruction is given to the parents.
Further lay education is directed at specific groups of employees. With the
co-operation of the Barbers' Association of British Columbia, specific literature is being
sent to each barber in the Province with a twofold purpose in mind: that of giving
information to the barber himself, and of making available to him such information as
he may be asked for in his line of duty.
Considerably greater distribution of literature pertaining to the venereal diseases
has been made possible through the medium of stationary and travelling display stands,
a service of the British Columbia Tuberculosis Society, in Vancouver.
Professional education has been maintained and to some extent augmented during
the past year.
Regular venereal disease instruction courses for student nurses have now been
extended to cover all schools of nursing in British Columbia, and plans are being made
to include a period of practical experience at one of the clinics for all nurses in training.
In addition to these regular courses of lectures and those presented to lay students and
to social workers, lectures and films have been given to the practical-nursing students
at the Vancouver Vocational Institute, and plans are being made to include other groups
of this school in the same lecture-film service.
Complete revision has been made of the manual " Venereal Disease Information for
Nurses," incorporating new policies, current treatment of infections, and extension of
services; for example, more attention is given to the emotional reactions of venereal
disease patients through social service treatment. DEPARTMENT OF HEALTH AND WELFARE,  1950 Y 85
A supply of a pamphlet entitled " Some Practical Considerations in the Diagnosis
and Treatment of Syphilis," by Pasquale J. Pesare, M.D., Dr.P.H., and Mario Mollari,
M.D., Dr.L.M., has been obtained by this Division for use in the professional education
programme. This is an excellent publication, wherein the subject is discussed in a manner
closely following the teaching of this Division.
During the year, visits were made by Dr. Charles Gould, consulting neurologist to
the Division, and by the Director to various large teaching centres in the Eastern United
States for the purpose of discussing and observing latest methods and developments in
the management and control of venereal disease. These visits proved highly stimulating
and instructive, and resulted in a few minor changes in policy in this Division.
In December Dr. Ben Kanee, consulting syphilologist to the Division, attended the
Conference of the American Academy of Dermatology and Syphilology at Chicago for
the purpose of studying recent developments in the diagnosis and management of syphilis.
Talks have been given to groups of practising physicians and to interns, while, at the
fortnightly physicians' conferences at the Divisional headquarters, regular lectures have
been given by members of the consulting staff on various medical and epidemiological
aspects of venereal disease control.
Some members of the nursing staff attended work conferences held at the annual
convention of the Canadian Nurses' Association, reports of which were presented at
epidemiology meetings held at the Vancouver clinic.
GENERAL
The Fifth Western Regional Conference of Directors of Venereal Disease Control
was held in Vancouver in February, 1950. Dr. G. F. Amyot, Deputy Minister of Health
for the Province of British Columbia, welcomed the members of the conference and gave
the opening address. Besides representatives from the four Western Provinces, the
meeting was attended by Dr. Layton and Dr. Laroche, from the Division of Venereal
Disease Control, Department of National Health and Welfare, Ottawa, and by Dr.
Hatfield, Director of the Division of Venereal Disease Control, New Brunswick.
The conference, at which many outstanding problems relating to venereal disease
control were diagnosed, was a pronounced success.
The following medical papers were published during the year by members on the
staff of the Division: " The Treatment of Syphilis," by Dr. Ben Kanee, in the Journal
of the Canadian Medical Association, and " Interpretations of Serology in the Diagnosis
of Syphilis," by Dr. C. L. Hunt, in the Vancouver Medical Bulletin.
Papers were also given by Dr. C. L. Hunt before a meeting of the British Columbia
Society of Internal Medicine in September on " The Primitive in Medicine," and before
the Canadian Public Health Association at its annual meeting, in June at Toronto, on
" The Role of Epidemiology in Venereal Disease Control." A paper was read by Dr.
C. L. Hunt before the British Columbia Public Health Institute in April, entitled " Local
Health Services in the Arthritis Programme."
Owing to the steadily diminishing numbers of cardiovascular and neuro syphilis
cases reported in the Vancouver clinic, there has been a diminishing demand for beds
for the treatment of these cases in the Vancouver General Hospital. Two beds only are
now available to this Division for the treatment of such cases.
Changes in personnel continue to occur. Dr. A. J. Nelson, physician in charge of
clinics, has left the Division to take up the duties of Assistant Director of Venereal
Disease Control for New York State. FLis loss will be felt keenly by the Division, where
his pleasing personality was much appreciated and his work of a very high order.
It is also announced with regret that Miss A. Beattie, who successfully completed
a postgraduate course at the Washington State University during the summer of 1950,
has left the Division to take up field service as supervisor of the West Kootenay Health Y 86 BRITISH COLUMBIA
Unit. A further loss was sustained when Miss E. A. Johnson, a social service worker
with the Division, was transferred to the Vancouver Child Guidance Clinic.
The present premises of the Division continue to deteriorate. Little has been done
in the way of repairs beyond what is necessary for bare safety, since there is a nebulous
promise of a new public health building. The need for these new premises continues
to become ever more urgent.
Federal Health Grants have afforded many opportunities to our medical and nursing
personnel for acquiring special postgraduate training.
The British Columbia Medical Centre Library continues to receive certain funds
from this Division toward its operation. All up-to-date literature on venereal disease is
available to medical graduates and those in training. The Director of the Division
is a member of the committee in charge of its management.
Special appreciation is expressed to the Division of Laboratories for its great and
unstinted co-operation with this Division at all times, and also to the Division of Vital
Statistics, whose assistance and advice have always been so helpful and so readily given.
Acknowledgments are due to Dr. Amyot, Deputy Minister of Health, and to Dr.
G. R. F. Elliot for their constant help and encouragement, and also to all the other
branches and divisions of the Health Department, to health unit directors and their staffs,
and to public health nurses in rural areas for their generous co-operation with this
Division at all times. DEPARTMENT OF HEALTH AND WELFARE,  1950 Y 87
REPORT OF THE DIVISION OF TUBERCULOSIS CONTROL
W. H. Hatfield, Director
The year 1950 shows further advance in the tuberculosis-control programme, and
it is now possible to see toward the end of the original planning and the rounding-out
of a complete tuberculosis organization in this Province.
The biggest development during the year was letting the contract for a new sanatorium. The original contract is for central facilities for 528 beds and for construction
of 264 beds. It is hoped that, as soon as finances permit, the institution will be fully
developed to its total bed capacity. This has been the major need of the Division for
a number of years, and it is gratifying to see this need now being met. When these
facilities are available, it is planned to eliminate some of the present beds occupied by
tuberculous patients in the Vancouver area, such as those occupied in the City of Vancouver Isolation Hospital, St. Joseph's Oriental Hospital; the temporary beds attached
to the Vancouver unit;  and, eventually, Jericho Beach Hospital.
Further developments in bed facilities that have been recommended are the complete modernization of Tranquille Sanatorium and construction of a central unit of
approximately 150 beds and clinic for Victoria.
There has been a marked drop in the tuberculosis death rate throughout the Province
this year. The percentage drop in mortality has been greater during this year than in
any year since the inception of the Division. Along with the drop in death rate there
has been a considerable drop in the number of new cases of tuberculosis that have
developed during the year. The lowered morbidity and mortality rates obtain through
the white, Indian, and Oriental populations.
Relative to case-finding, considerable changes have been made in the programme
during the year. X-ray units to take miniature films have now been installed in the
following thirty-four centres: Metropolitan Health Unit No. 1, Vancouver; Metropolitan Health Unit No. 4, Vancouver; Oakalla Prison; Vancouver General Hospital, Vancouver; St. Vincent's Hospital, Vancouver; Grace Hospital, Vancouver; Mount St.
Joseph's Hospital, Vancouver; North Vancouver General Hospital; St. George's Hospital, Alert Bay; Ocean Falls General Hospital; Powell River General Hospital; Prince
Rupert General Hospital; Royal Jubilee Hospital, Victoria; St. Joseph's Hospital,
Victoria; Nanaimo General Hospital; Lourdes Hospital, Campbell River; St. Joseph's
Hospital, Comox; King's Daughters' Hospital, Duncan; West Coast General Hospital,
Port Alberni; Royal Columbian Hospital, New Westminster; St. Mary's Hospital, New
Westminster; Chilliwack General Hospital; St. Eugene Hospital, Cranbrook; Creston
General Hospital; Fernie General Hospital; Kimberley General Hospital; Kootenay
Lake Hospital, Nelson; Mater Miseracordiae, Rossland; Trail-Tadanac, Trail; Prince
George General Hospital; Royal Inland Hospital, Kamloops; Kelowna General Hospital;
Penticton General Hospital; and Jubilee Hospital, Vernon. Thus, it is now possible in
these centres to X-ray all hospital admissions and permit out-patients to be X-rayed on
a year-round basis. In addition, one mobile unit has been turned over to the Metropolitan Health Committee for use in the City of Vancouver and another knock-down
type of equipment with a panel truck is available for areas not served by the thirty-five
units. Thus, now the responsibility for case-finding is in the hands of the local health
services. All films, however, are interpreted by the Division of Tuberculosis Control,
and the results returned to the local health service for follow-up. Cases that are considered suspicious in this general survey programme are re-X-rayed and referred to the
diagnostic facilities of the Division of Tuberculosis Control for final diagnosis.
As has been previously reported, the problem of obtaining properly trained medical
personnel still remains, and the recommendation that there should be some adjustment
in salaries paid is still under consideration. Y 88 BRITISH COLUMBIA
With the advent of an adequate number of beds for the treatment of patients, it is
apparent that the work of the Division will be mainly of a clinical nature. With the
large volume of in-patient care and the advances in scientific treatment of tuberculosis
and the work of the diagnostic clinics and out-patient treatment, a well rounded out
staff of clinicians is essential.
With more beds there will be fewer patients having to be cared for in the home,
which will lessen the public health problems confronting the local health services. It is
hoped that as time goes on it will be possible to give all the consulting service to the
local health services that is necessary through travelling clinics. Physicians carrying out
this service should be of consultant status and attached to one or another of the institutions. The Province in this regard would be divided into four areas, with four consultants travelling from time to time.
In our general preventive programme, B.C.G has been introduced and its use is
steadily increasing. Contact children who have negative tuberculin reactions and any
particular group where the tuberculosis rate has tended to be higher than the average,
such as hospital employees, have been offered B.C.G. It is planned to concentrate
particularly on the contact group over the next year, and the gradual extension of this
vaccination programme is visualized.
Federal Health Grants materially assisted the Division's work during the year, and
the following projects, divided into continuing and new, were approved:—
Continuing Projects
Occupational therapy for out-patients.
X-ray pool—purchase of survey X-ray equipment.
Medical library.
Home-care service.
Dark-room equipment for health units.
Nursemaids for Vancouver Preventorium.
Rehabilitation.
Senior intern, Vancouver unit.
Payment for admission X-rays.
Administration of streptomycin to patients in their homes.
Postgraduate training (short-term courses).
Postgraduate training—nursing, medical, laboratory.
Assistant instructor, T.B. nursing.
Clinical research in electrocardiography.
Equipment for community survey work.
Photographic equipment, Tranquille.
Pathology Department, Tranquille.
Nursing personnel for surgical unit, Vancouver.
Two additional physicians.
New Projects
Bacteriologist, Vancouver unit.
P.A.S. and streptomycin.
Additional nurse for New Westminster clinic.
Occupational therapy equipment for in-patients.
Additional stenographers.
Sterilizer, Tranquille.
Postgraduate training in hospital administration.
Postgraduate training, X-ray technician.
Expansion of educational programme, tuberculosis nursing.
Additional equipment for Victoria unit.
Art therapy. ^—^—
DEPARTMENT OF HEALTH AND WELFARE,  1950 Y 89
With the help of Federal Health Grants the postgraduate training programme continues in effect. This year, for example, several physicians have returned after completing their training in internal medicine. The following have taken postgraduate
training during the year, including short courses: Physicians, 7; nurses, 6 (including
1 from the Preventorium); laboratory technicians, 4; X-ray technicians, 1.
During the year the Director was privileged to represent Canada at the meeting of
the International Union against Tuberculosis in Copenhagen, and an opportunity was
provided for visits to Sweden and England.
The annual meeting of the Canadian Tuberculosis Association was held in Vancouver
during the year, with every Province in Canada being represented. This was a very
successful meeting. The Director of the Division was honoured by being made president
of the association for the year 1950-51.
There have been further advances in the treatment of patients, with a marked
increase in the use of para amino salicylic acid. This, combined with streptomycin, has
allowed many more patients to come to surgery than heretofore. Over the past five years
there has been an increase of approximately 400 per cent in the volume of surgery done
by the Division.
During the year a survey was made of the records of the Division, with some
recommendations for simplification. In general, the survey revealed that the records of
the Division are good, and only minor alterations are essential to bring them completely
up to date. It was further recommended that one or more medical-record librarians be
employed to endeavour to generally improve the use of the records. Various other
surveys were made during the year, such as a survey of dietary problems.
The number of new cases discovered during the year amounts to 1,713, which is
a decrease over last year. This, broken down into racial groups, shows the following:
Indians, 374; other than Indians, 1,339; and into age-groups:—
Indians— Other than Indians—
0- 4  38 0- 4     36
5- 9  53 5- 9     54
10-14. :  48 10-14     30
15-19  41 15-19     49
20-24  45 20-24  123
25-29  31 25-29  155
30-39  29 30-39  233
40-49  33 40-49  217
50-59  25 50-59  155
60-69  14 60-69  172
70-79  12 70-79     78
80 and over     2 80 and over     14
Not stated     3 Not stated     23
CLINICS
There has been no increase in the number of clinics operated by the Division. The
number of people attending the clinics remains approximately the same, but the amount
of diagnostic work per patient has shown a tendency to increase.
The clinic at Nelson has been notified that it will have to vacate its present quarters
at the Nelson General Hospital, and new accommodation is being sought for this clinic,
which needed more space than it was able to obtain previously.
The New Westminster clinic continues to be crowded. Either more facilities should
be developed in the present building or new facilities be built in conjunction with a general
health building in that area. Y 90 BRITISH COLUMBIA
During 1950, 179,126 people were X-rayed in the survey clinics. This shows some
reduction, as the new programme for providing X-ray facilities for local areas has been
developing on a gradual basis and is only beginning to get into proper operation toward
the end of the year. Of the total number of people X-rayed in clinics of the Division,
1,950 were referred to diagnostic clinics.
The sources of reporting of new cases during the year were as follows:—
Stationary clinics:   Tranquille, 2;   Vancouver, 519;   Victoria, 77;   and New
Westminster, 133.
Travelling clinics:   Interior, 62;   Coast, 96;   Island, 29;   and Kootenay, 83.
Reported from outside the Division of Tuberculosis Control, 712.
It is noted that in those cases that are reported to, and not found by, the Division
there is a very high percentage of far advanced active cases, whereas those found by the
Division show a very low percentage of far advanced cases, the majority being in the
minimal stage.
The total number of examinations throughout the Province, including survey and
diagnostic clinics and films referred to the Division for interpretation, was 229,789.
INSTITUTIONS
All our institutions have worked at full capacity during the year, and our central
admitting office has felt very heavy pressure from the need of new beds, there still being
a long delay between diagnosis and admission. Every endeavour has been made to
discharge patients from hospital as early as possible, creating in many instances problems
for the social service department.
There has been some increase in rehabilitative work during the year, with more
patients receiving training than heretofore.
In the Vancouver unit a special study has been carried out on the treatment of
tuberculous meningitis. With the long waiting list for admission, the Vancouver unit
has carried out quite extensive out-patient therapy, 108 out-patients having received
streptomycin, and 197 para amino salicylic acid. There has been a continuous increase
in the number of patients attending the out-patient clinic, with an average at the present
time of 250 patients receiving pneumothorax, with approximately 40 patients per day
attending the pneumothorax clinic.
At Tranquille there was a great number of changes in the medical staff during the
year. Two physicians have been away on postgraduate work, and another physician
was given leave of absence to assist in the development of survey work in Newfoundland.
Relief doctors were obtained to fill the vacancies. A new pathological department is
being developed and also a photographic department.
A new guinea-pig house was built at Tranquille, and this institution is now supplying guinea-pigs for all the tuberculosis institutions, the Provincial Laboratories, and the
Royal Jubilee Hospital and St. Joseph's Hospital in Victoria.
The Interior Travelling Clinic work has been moved from Kamloops to Tranquille.
The modernization of the old buildings is continuing, and extensive work has been done
in the Infirmary Building, giving much more modern wards and providing some extra
rooms.
Certain improvements were made at Jericho Beach Hospital during the year, such
as subdividing the large wards. It is planned, however, in the future to do only maintenance work at this unit, as the hospital will probably be discontinued when the new
sanatorium has its full bed complement.
There have been few changes in Victoria, this unit's problem being mainly one of
shortage of medical staff.
, DEPARTMENT OF HEALTH AND WELFARE,  1950 Y 91
NURSING
Expansion in the nursing department has been made possible through assistance
from the Federal Health Grants during the past year. Projects have included postgraduate training for four senior nursing positions. Three of these nurses have returned
to new or former positions, and one is currently enrolled at the University of Toronto
for a course in clinical supervision.
Other projects included the appointment of a second instructor for the affiliation
course in tuberculosis nursing at the Vancouver unit and a second nurse in the New
Westminster Stationary Clinic, thus providing for increased student enrolment and
practice facilities.
During the year 254 student nurses were enrolled in the tuberculosis affiliation
course at Vancouver, and 90 at the Victoria section. Two graduate nurses completed
the eight-week postgraduate course offered at the Vancouver unit and 27 graduate nurses
received field-work experience, including six who completed the affiliation course to
qualify for university entrance or reciprocal registration. Special programmes of observation were arranged for nine persons in allied services. Thirty-six practical-nurse
students from the Vocational Institute received a one-month period of supervised practical training.
A study was made of the institutional nursing service to determine the adequacy
of prevailing staff quotas and standards in relation to desired standards. The findings
were compiled in separate reports for each institution and a comparative statement prepared. The information will be a useful guide in the development of our programme
for the future.
SOCIAL SERVICE
The staff situation in the Social Service Department was more disturbed in 1950
than it has been for some time, there being five changes among the social workers and
two among the stenographers. The social service staff has been reduced by one, as one
of the workers was not replaced when she resigned.
The case-loads for the social workers showed a slight over-all decrease, but the
average case-load per worker for Vancouver and Victoria has increased to 96, and for
Tranquille to 152.
The social worker at the Jericho Beach unit started an intensive research project
during the year, doing detailed case-studies of selected patients. There are no findings
to report yet, but some of the information which has come to light about the difficulties
faced by patients when they have tuberculosis has been most interesting. It has reinforced the feeling that the patient who is apparently calm on the surface may have things
troubling him with which he needs help.
The Division has been interested in the success of the Tuberculosis Home-maker
Service, administered jointly by the Metropolitan Health Committee and the Family
Welfare Bureau. A great deal of time has been spent in setting up standards for the
people who are to receive the service and in screening the applicants. At the end of
the year twenty-two families were receiving service, seven with a full-time home-maker
and fifteen with part-time help.
CONCLUSIONS
As has been mentioned, the major need of the Division—an increased number of
beds—is now going to be met. It should be recognized, however, that these facilities
will not be available during the ensuing year, and the problems relative to shortage of
beds will continue until the new institution is completed. The reduction in death rate
and morbidity rate is encouraging, and it is hoped that this will continue. Y 92 BRITISH COLUMBIA
The British Columbia Tuberculosis Society, the voluntary agency in the tuberculosis activities, continues to play an important part in the programme. The assistance
that has been received from this source has been most valuable.
The Vancouver Preventorium continues to treat children with tuberculosis, with
certain services rendered by the Division of Tuberculosis Control. Excellent work is
being carried out under the direction of the board of directors of that institution.
It is expected that the postgraduate training that has been instituted will begin to
bear fruit during the next year, strengthening business administration, medical, nursing,
and other technical services.
VICTORIA, B.C.
Printed by Don McDiarmid, Printer to the King's Most Excellent Majesty
1951
745-151-4404

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