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

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 PROVINCE OF BRITISH COLUMBIA
Division of
Venereal Disease Control
Department of Health and Welfare
ANNUAL REPORT
For the Year 1950
VICTORIA, B.C.
Printed by Don McDiarmid, Printer to the King's Most Excellent Majesty
1951  TABLE OF CONTENTS
Page
1. List of Tables  4
2. List of Charts  4
3. Organization Chart  5
4. Introduction  7
5. Treatment  8
6. Epidemiology  8
7. Social Service  9
8. Education  10
9. General  11
10. Statistical Section :  13 STATISTICAL SECTION
LIST OF TABLES
Table Page
I. New Notifications of Venereal Infection and Rate per 100,000 Population,
1941 to 1950, Inclusive  14
II. New Notifications of Vener.eal Infection Compared with Reported Cases of
Certain Other Notifiable Diseases in Canada, British Columbia, and
Greater Vancouver, 1950  15
III. New Notifications of Venereal Infection Classified According to Diagnosis,
Sex, and Source of Reporting of Notifications, British Columbia, 1950.— 16
IV. New Notifications of Venereal Infection Classified According to Diagnosis,
Sex, and Age-groups, British Columbia, 1950  17
V. New Notifications of Syphilis by Age and Sex, British Columbia, 1950  19
VI. New Notifications of Gonorrhoea by Age and Sex, British Columbia, 1950.— 20
VII. Rate per 100,000 Population for Total Venereal Disease by Age-groups,
British Columbia, 1941 to 1950, Inclusive  21
VIII. New Cases of Syphilis Reported in British Columbia by Age-groups and
Marital Status, 1950  21
LX. Total Primary and Secondary Syphilis, British Columbia, 1949  22
X. Total Primary and Secondary Syphilis, British Columbia, 1950  22
XL New Notifications of Venereal Infection Classified According to Diagnosis
and Place of Residence, British Columbia, 1946 to 1950, Inclusive  23
XII. Patient-visits at All Clinics of the Division of Venereal Disease Control
Classified According to Diagnosis, for the Years 1941 to 1950, Inclusive 29
XIII. Report of Laboratory Work Done by the Division of Laboratories Relating
to the Diagnosis and Treatment of Venereal Disease for All Agencies
in British Columbia, 1946 to 1950, Inclusive  30
XIV. Free Medications Distributed to Private Physicians by the Provincial Depart
ment of Health and Welfare for the Treatment of Venereal Disease,
British Columbia, 1936 to 1950, Inclusive  32
XV. Places of Meeting Reported as Facilitating the Spread of Venereal Diseases,
1946 to 1950, Inclusive  33
XVI. Places of Exposure Reported as Facilitating the Spread of Venereal Diseases,
1946 to 1950, Inclusive  33
XVII. Contacts to Venereal Infection Classified According to Investigating Agency
and Result of Investigation, British Columbia, 1950  34
XVIII. Contacts to Venereal Infection Classified According to Investigating Agency
and Result of Examination, British Columbia, 1950  35
LIST OF CHARTS
Chart
I. New Notifications of Venereal Infection and Rate per 100,000 Population
by Diagnosis, Reported by All Agencies, British Columbia, 1941 to
1950, Inclusive  13
II. New Notifications of Syphilis by Age and Sex, British Columbia, 1950  19
III. New Notifications of Gonorrhoea by Age and Sex, British Columbia, 1950 ___ 20
IV. Patient-visits at All Clinics of the Division of Venereal Disease Control
Classified According to Diagnosis, for the Years 1941 to 1950, Inclusive 29
V. Free Medications Distributed to Private Physicians by the Provincial Department of Health and Welfare for the Treatment of Venereal Diseases,
British Columbia, 1936 to 1950, Inclusive  31 .1
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» S  DIVISION OF VENEREAL DISEASE CONTROL
ANNUAL REPORT FOR THE YEAR 1950
C. L. Hunt, M.D., Director
INTRODUCTION
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 sixty-one 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 over-liberal 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 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 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 NN 8 DEPARTMENT OF HEALTH AND WELFARE
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 syphilis and neurosyphilis.
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 incidence 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. VENEREAL DISEASE CONTROL REPORT,  1950 NN 9
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 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. NN  10 DEPARTMENT OF HEALTH AND WELFARE
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 out 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 or the Venereal
Disease Problem."
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 venereal 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 British
Columbia Hotels' Association at its 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. VENEREAL DISEASE CONTROL REPORT,  1950 NN  11
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 pther 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.
A supply of a pamphlet entitled " Some Practical Considerations in the Diagnosis
and treatment of Syphilis," by Pasquale J. Pesare, Dr.P.H., M.D., 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 our own teaching.
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 discussed, 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." NN 12 DEPARTMENT OF HEALTH AND WELFARE
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. His 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
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 new premises when—and if—new buildings can be provided. The need for
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. VENEREAL DISEASE CONTROL REPORT,  1950
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NN 15
The total number of venereal-disease cases notified in 1950 has again shown a small
but definite decline over previous years. This is particularly satisfactory in view of the
renewed efforts which have been made to detect new cases.
The rate per 100,000 population is the lowest recorded since 1941.
The incidence of gonorrhoea has shown a slight but probably insignificant decrease,
although the rate per 100,000 population has shown a definite decline to the lowest
figure since 1943. This is particularly gratifying in view of the policy of treating (and
diagnosing) an ever-increasing number of persons on purely epidemiological grounds
(that is, contact to infection), even though investigation may have failed to confirm the
diagnosis. This has been done primarily with a view to reducing the spread of infection
among promiscuous individuals.
The incidence of early infectious (primary and secondary) syphilis is the lowest
ever recorded in this Province. The same is true for other stages of syphilis, which are
largely discovered as a result of blood tests. Reference to Table XIII will show that
blood tests carried out by the Provincial Laboratories during 1950 exceeded those of any
previous year.
It would appear, therefore, that the " well of late syphilis " in this Province is slowly
but surely running dry.
TABLE IL—NEW NOTIFICATIONS OF VENEREAL INFECTION COMPARED
WITH REPORTED CASES OF CERTAIN OTHER NOTIFIABLE DISEASES
IN CANADA, BRITISH COLUMBIA, AND GREATER VANCOUVER, 1950.
Notifiable Disease
Canada
British
Columbia
Greater
Vancouver
Mumps -
Rubella	
Measles	
Chicken-pox	
Venereal disease...
Tuberculosis	
Whooping-cough-
Scarlet fever	
Diphtheria	
43,636
37,684
55,077
35,547
21,754
12,255
12,096
8,745
364
8,634
7,935
5,648
5,001
4,289
1,828
1,740
871
63
4,212
4,125
1,734
1,372
2,644
525
501
253
2 NN 16
DEPARTMENT OF HEALTH AND WELFARE
TABLE III.—NEW NOTIFICATIONS OF VENEREAL INFECTION CLASSIFIED
ACCORDING TO DIAGNOSIS, SEX, AND SOURCE OF REPORTING OF
NOTIFICATIONS, BRITISH COLUMBIA, 1950.
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T.
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T.
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4,289
2,860
1,429
2,431
1,523
908
2,119
1,384
735
97
66
31
41
22
19
114
28
86
33
19
14
27
4
23
1,594
1,168
426
40
24
16
223
144
79
1
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3,627
2,428
1,199
2,223
1,367
856
1,970
1,275
695
59
37
22
38
20
18
96
12
84
33
19
14
27
4
23
1,232
955
277
5
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3,626
2,428
1,198
2,223
1,367
856
1,970
1,275
695
59
37
22
38
20
18
96
12
84
33
19
14
27
4
23
1,231
955
276
5
602
376
226
173
125
48
126
90
36
26
17
9
3
2
1
18
16
2
354
205
149
35
24
11
40
22
18
42
35
7
13
11
2
9
8
1
2
1
1
19
13
6
8
6
2
3
4
1
3
2
1
69
33
36
26
21
5
16
13
3
3
2
1
266
156
110
55
32
23
40
23
17
9
4
5
1
1
41
36
.5
16
15
1
13
12
1
3
3
111
'74
37
42
32
10
33
25
8
3
2
1
2
1
1
4
4
53
3Z
21
12
8
4
4
2
2
19
14
5
3
3
3
3
13
9
4
2
1
1
1
1
22
10
12
9
4
5
6
1
5
3
3
11
5
6
2
1
1
13
5
8
1
1
1
1
12
4
8
11
7
4
10
6
4
10
6
4
1
1
49
49
75
25
13
13
17,
12
Oakalla 	
2
2
26
21
5
3
3
10
6
4
1
1
7
6
1
37
9
28
6
3
3
5
4
1
173
104
69
18
12
6
20
8
12
19
15
4
3
3
3
3
	
Girls' Industrial School and Juvenile
7
7
Other                        -	
5
166
105
61
1
1
—
5
166
105
61
1
1
17
17
Source: Notifications of Venereal Infection, Form N. 1.
The figures for gonorrhoea cases notified by the various agencies in 1950 bear a
striking resemblance to those for 1949. This applies not only to the number of cases
notified by the various agencies, but also to the proportion of males to females reported.
One case of gonorrhoea! ophthalmia neonatorum was reported during the year.
This baby was rapidly cured by penicillin.
The figures relating to prenatal syphilis remain unchanged—an indication that the
blood-testing of women during pregnancy is still not being carried out as widely as could
be desired.
There has been a slight decrease in the reported cases of cardiovascular syphilis
and neurosyphilis, which is in accordance with the general decline of syphilis as a whole. VENEREAL DISEASE CONTROL REPORT,  1950
NN 17
TABLE IV.—NEW NOTIFICATIONS OF VENEREAL INFECTION CLASSIFIED ACCORDING TO DIAGNOSIS, SEX, AND AGE-GROUPS, BRITISH
COLUMBIA, 1950.
Age-groups
Gonorrhoea
Syphilis
Acquired
Totals..
Under 1 year..
1- 4 years ...
5- 9 years	
10-14 years.—
15-19 years.	
20-24 years...
25-29 years..
30-34 years...
35-39 years...
40-44 years..
45-49 years ..
50-54 years...
55-59 years...
60-64 years...
65-69 years ...
70-74 years...
75-79 years...
80 and over..
Not stated-
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
T.
M.
F.
4,289
2,860
1,429
4
2
2
8
3
5
9
3,627
2,428
1,199
25
1
24
360
144
216
1,161
736
425
886
602
284
491
354
137
365
264
101
228
171
57
178
145
33
130
100
30
96
85
11
67
50
17
54
47
7
28
25
3
9
9
5
3
182
117
65
23
1
22
343
137
206
1,087
688
399
823
570
253
439
326
113
303
231
72
172
135
37
134
117
17
63
52
11
43
39
4
20
19
1
13
12
1
5
5
1
1
144
95
49
3,626
2,428
1,198
23
1
22
343
137
206
1,087
688
399
823
570
253
439
326
113
303
231
72
172
135
37
134
117
17
63
52
11
43
39
4
20
19
1
13
12
1
5
5
144
95
49
11    1
1     1
14
9
5
6
5
1
3
3
1
1
-I    2|
..     1|
-I    II
4V
49
15
10
10
10
Source:   Notifications of Venerea! Infect'on, Form N. 1. NN 18 DEPARTMENT OF HEALTH AND WELFARE
Reference to Table IV reveals a startling increase in venereal disease occurring in
the 10-14 age-group—only seven cases having been notified in 1949, whereas twenty-
five (of which twenty-three were gonorrhoea) were notified in 1950. It will be noted,
moreover, that twenty-four of these cases occurred in girls, suggesting an early drift of
school-age girls into promiscuous sexual relationship, if not into frank prostitution.
Is this the effect of a declining home and parental influence and the advocating of a
greater freedom for the self-expression of youth?
It is also noted that there has been a 7-per-cent increase in the number of cases
reported in the 15-19 age-group.
Although the age of highest incidence remains in the 20-29 age-group, this preponderance is slightly less marked than in previous years.
There is a very marked preponderance of female cases up to the age of 20, after
which males outnumber females in gradually increasing proportions over the ensuing
years.
The infectious stages of syphilis (primary, secondary, and possibly early latent)
follow much the same age distribution as gonorrhoea, which is to be expected. Later
stages of syphilitic infection, however, have a more even distribution throughout the
later years of life.    The present figures bring out these facts in a striking manner.
The additional fact that male patients are more liable to develop cardiovascular
syphilis and neurosyphilis than females is fairly well illustrated in this table. VENEREAL DISEASE CONTROL REPORT,  1950
NN 19
CHART IL—NEW NOTIFICATIONS OF SYPHILIS BY AGE AND SEX,
BRITISH COLUMBIA, 1950
LEGEND
MALES
FEMALES                 ET.;:::::]
•
l
Hrrri        rrm        fTHl    Bill
10-14 15-19 20-24        25-29        30-34 35-39        40-44
AGE-GROUPS
45-49       50-54
60-64       65-69        70  &
Over
TABLE V.—NEW NOTIFICATIONS OF SYPHILIS BY AGE AND SEX,
BRITISH COLUMBIA, 1950
Age-group
Male
Female
Age-group
Male
Female
Totals-
376
226
Under 1 year~
1- 4 years.	
5- 9 years	
10-14 years—
15-19 years	
20-24 years	
25-29 years.....
30-34 years	
2
1
3
	
i
	
2
4
9
30
26
22
29
20
23
35-39 years-
40-44 years.-
45-49 years-
50-54 years-
55-59 years .
60-64 years_
65-69 years..
70 and over~
Not stated—
28
32
27
45
45
31
35
33
19
29
20
16
19
7
16
6
6
16
There is again a preponderance of males over females notified as suffering from
syphilis during the year. This preponderance is due largely to the greater number of
men in the later age-groups who were found to be suffering from the late complications
of untreated or inadequately treated syphilis.
In the early and early-middle age-groups it will be observed that infections are
fairly evenly distributed between the sexes. NN 20
DEPARTMENT OF HEALTH AND WELFARE
CHART III.—NEW NOTIFICATIONS OF GONORRH(EA BY AGE
AND SEX, BRITISH COLUMBIA, 1950
15-19       20-24
35-39        40-44      45-49        50-54       55-59      60-64
AGE-GROUPS
TABLE VI.—NEW NOTIFICATIONS OF GONORRHOEA BY AGE AND
SEX, BRITISH COLUMBIA, 1950
Age-group
Male
Female
2,428
1,199
1
5
8
1
22
137
206
688
399
570
253
326
113
Age-group
Male
Female
Totals.
Under 1 year_
1- 4 years	
5- 9 years	
10-14 years	
15-19 years.....
20-24 years	
25-29 years	
30-34 years	
35-39 years...
40-44 years..
45-49 years-
50-54 years...
55-59 years._
60-64 years...
65-69 years-
70 and over..
Not stated...
231
72
135
37
117
17
52
11
39
4
19
1
12
1
6
95
49
The preponderance of females infected with gonorrhoea before the age of 20 is
probably due, in part, to the earlier maturing age of women. After this age the relative
proportion of males infected becomes progressively larger through the years. VENEREAL DISEASE CONTROL REPORT,  1950
NN 21
TABLE VII.—RATE PER 100,000 POPULATION FOR TOTAL VENEREAL
DISEASE BY AGE-GROUPS, BRITISH COLUMBIA, 1941 TO 1950,
INCLUSIVE.
Age-group
0- 4 years...
5- 9 years ..
10-14 years ...
15-19 years.—
20-24 years....
25-29 years...
30-34 years....
35-39 years....
40-44 years....
45-49 years...
50-54 years...
55-59 years...
60-64 years...
65-69 years...
70 and over....
All ages	
1941
25
24
35
231
821
690
552
499
412
271
246
184
149
166
73
1942
24
19
23
326
1,046
770
619
518
375
249
265
133
188
113
83
1943
21
26
24
385
1,133
843
598
543
474
272
218
193
141
80
74
1944
1945
23
17
43
616
1,383
953
619
534
573
337
309
196
183
106
61
336 ]  392 |  415
508
29
23
19
637
1,525
1,039
751
699
586
446
307
211
188
169
53
~553~
1946
1947
1948
35
24
33
709
2,069
1,547
986
737
565
457
292
232
215
157
83
25
20
9
697
1,921
1,306
689
607
474
438
325
234
208
172
81
16
10
12
523
1,413
1,036
555
495
361
308
238
141
119
100
62
1949
10
459
1,451
1,012
542
454
379
307
230
148
162
111
64
1950
10
10
34
489
1,342
957
535
446
315
279
219
163
118
113
62
677
575 |  419 |  406 |  378
The venereal-disease infection rate during 1950 has shown a general decrease in
all ages, with the exception mainly of the 10-19 age-groups. There appears to have
been a marked increase in the number of infections occurring in young people.
Experience in the armed services during the Second World War indicated that one
of the most important factors responsible for limiting the spread of venereal disease was
the maintenance of high morale, by means of discipline, education, and an active programme for the stimulation of spare-time interest, activity, and entertainment.
Where these were lacking, delinquency and the venereal-disease rate became distressingly high.
There would seem to be an urgent need in the homes, in the schools, in the church,
and in the communities for the organization of a programme on similar fines for the
youth of our country to-day.
TABLE VIIL—NEW CASES OF SYPHILIS REPORTED IN BRITISH
COLUMBIA BY AGE-GROUPS AND MARITAL STATUS, 1950
Single
Unmarried*
Married
Age-group
Male
Female
Male
Female
Male
Female
No.   1 Rate
1
No.   1 Rate
No.
Rate
I
No.   1 Rate
1
No.
Rate
No.
Rate
4
11.0
7    |    20.3
2
83.3
25
71.8
12    |    48.4
13
62.2
5
67.6
13
68.8
25-29 years    	
16
8
76.2
46.5
7    |    53.4
5         64.9
17
8
79.1
59.3
8
7
55.9
72.9
5
10
23.3
74.1
21
15
146.9
156.3
30-34 years —	
35-39 years  	
15
157.8
3    |    61.2
16
150.9
8
106.7
12
113.2
20
266.7
40-44 years 	
6
80.0
10
111.1
7
112.9
20
222.2
13
209.7
10
14
169.5
269.2
12
17
160.0
236.1
2
4
33.3
63.4
14
24
186.7
333.3
13
14
216.7
222.2
55-59 years... 	
13
240.7
|
18
225.0
2
27.4
26
325.0
5
68.5
60-64 years _ 	
8
142.9
12
134.8
5
58.8
16
179.8
11
129.4
65-69 years	
9
180.0
14
153.8
2
2.3
18
197.8
4
46.0
* Includes single, widowed, divorced, and separated.
Note.—Rates shown per 100,000 population in each marital group.
It will be noted that the highest infection rate for notified syphilis occurs in the
later age-groups—ages 50 to 60 in males and 35 to 45 or 50 in females.    This is due
to the comparatively large number of old infections discovered in later life by means of
blood tests, as well as to the development at that age of the late degenerative lesions of
syphilis. NN 22
DEPARTMENT OF HEALTH AND WELFARE
TABLE IX.—TOTAL PRIMARY AND SECONDARY SYPHILIS,
BRITISH COLUMBIA, 1949
(Age specific rates per 100,000 population.)
Age-group
Male
Number
Rate
Female
Number
Rate
0- 4 years...
5- 9 years	
10-14 years.—
15-19 years	
20-24 years....
25-29 years...
30-34 years....
35-39 years..
40-44 years..
45-49 years..
50-54 years..
55-59 years.
60-64 years.
65-69 years..
70 years and over~
3
19
19
23
4
6
4
4
1
3
8.1
44.4
41.7
50.9
10.0
16.2
12.2
12.9
3.1
9.5
11
11
7
3
2
2
1
1
1
1
30.1
24.2
14.7
6.6
5.1
6.0
3.5
3.7
3.7
4.0
TABLE X.—TOTAL PRIMARY AND SECONDARY SYPHILIS,
BRITISH COLUMBIA, 1950
(Age specific rates per 100,000 population.)
Age-group
Male
Number Rate
Female
Number
Rate
0- 4 years	
5- 9 years	
10-14 years ...
15-19 years	
20-24 years....
25-29 years—
30-34 years..
35-39 years _
40-44 years-
45-49 years-	
50-54 years	
55-59 years	
60-64 years	
65-69 years	
70 years and over..
1
2.7
17
40.2
7
15.6
4
8.8
7
17.0
3
7.9
1
2.9
6
19.0
1
3.0
—
	
3.6
2.7
5.4
9.0
6.3
2.2
Reference to these tables demonstrates the marked decline in infectious (primary
and secondary) syphilis throughout all age-groups in this Province during 1950. VENEREAL DISEASE CONTROL REPORT,  1950
NN 23
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z NN 28 DEPARTMENT OF HEALTH AND WELFARE
It will be observed on reference to the foregoing table that Greater Vancouver
(Area 4b) is still responsible for the notification of over 62 per cent of venereal disease
occurring in the Province. This is largely accounted for by the high proportion of
gonorrhoea notified in this area (65.2 per cent of all gonorrhoea cases notified).
On the other hand, the figures for syphilis (49 per cent) are more in accordance
with the population distribution of the Province.
The high proportion of venereal disease in the infectious form (gonorrhoea) located
in the Vancouver area is probably due, in part, to the very active epidemiological
programme being carried out in that area, particularly as regards case-finding and
contact-tracing. This area is also the most important centre in the Province for shipping
and many other industries, as well as being the off-duty playground for many who are
employed in industries elsewhere, such as loggers, fishermen, etc. VENEREAL DISEASE CONTROL REPORT,  1950
NN 29
CHART IV.—PATIENT-VISITS AT ALL CLINICS OF THE DIVISION OF
VENEREAL DISEASE CONTROL CLASSIFIED ACCORDING TO DIAGNOSIS, FOR THE YEARS 1941 TO 1950, INCLUSIVE.
100,000
80,000
60,000
40,000
20,000
10,000
8,000
6,000
4,000
2,000
1,000
-
—
—
—
—
TOTAL
—
----.
wmm mmm
	
■--
^
• ... mmm
s
YPHILIS
^^^^■-*
"■■■■■■■■
""***■.
■ ■ ■   HW
— GONORR
HOEA     —
*
* ^^
"
—             ■
*
—
—•»«,           NOT YET
—      *•» ^lACNOSED
y
—
-
—
1941
42
43
44
45
4 7
48
49
1950
TABLE XII.—PATIENT-VISITS AT ALL CLINICS OF THE DIVISION OF
VENEREAL DISEASE CONTROL CLASSIFIED ACCORDING TO DIAGNOSIS, FOR THE YEARS 1941 TO 1950, INCLUSIVE.
Total
Syphilis
Gonorrhoea
Not Yet Diagnosed
Year
All
Clinics
Vancouver
Clinic
All
Clinics
Vancouver
Clinic
All
Clinics
Vancouver
Clinic
All
Clinics
Vancouver
Clinic
1941	
1942	
42,863
36,410
36,170
46,961
46,898
56,385
51,129
43,871
36,551
31,150
32,357
28,046
28,929
36,069
35,657
41,856
38,180
32,480
27,934
22,000
28,712
24,173
22,389
24,766
26,297
30,047
28,291
24,894
16,335
11,685
21,636
18,686
18,573
19,468
20,084
23,158
21,986
19,166
13,139
9,301
8,107
7,584
9,331
13,021
9,692
11,382
9,799
8,480
9,102
8,548
6,406
5,927
7,366
10,580
8,065
9,297
8,051
7,014
7,858
7,418
6,044
4,653
4,450
9,174
10,909
14,956
13,039
10,517
11,114
10,831
4,315
3,433
1943	
1944	
1945	
1946
2,990
6,021
7,508
9,401
8,143
1947.   .
1948
6,292
1949	
6,937
1950	
5,226
The number of patient-visits to all clinics operated by the Division is showing a
steady annual decrease. This is due not only to the diminishing incidence of venereal
disease, but also to the shorter treatment requirements in syphilis and the decreased
number of tests of cure required after treatment for gonorrhoea. NN 30
DEPARTMENT OF HEALTH AND WELFARE
TABLE XIIL—REPORT OF LABORATORY WORK DONE BY THE DIVISION
OF LABORATORIES RELATING TO THE DIAGNOSIS AND TREATMENT
OF VENEREAL DISEASE FOR ALL AGENCIES IN BRITISH COLUMBIA,
1946 TO 1950, INCLUSIVE.
Examination
1946
1947
1948
1949
1950
12,664
34,743
1,093
177,908
11,219
34,589
854
152,437
10,322
33,990
605
167,816
10,508
33,851
454
173,092
9,179
30,710
Treponema pallidum microscopic examinations...
378
•    178,375
The work carried out by the Division of Laboratories in relation to the diagnosis
of disease in British Columbia continues to show a steady increase as regards blood-testing,
the figure for 1950 representing a weekly average of approximately 3,430 blood tests.
Miscroscopic examinations and gonococcus cultures have shown a slight decline in
1950, possibly due, in part, to the diminished number of tests of cure now required after
treatment of patients for gonorrhoea. Since this policy was in operation for only six
months during the year 1950, it is hoped that these figures will show a still further
decline in 1951. VENEREAL DISEASE CONTROL REPORT, 1950
NN 31
CHART V.—FREE MEDICATIONS DISTRIBUTED TO PRIVATE PHYSICIANS
BY THE PROVINCIAL DEPARTMENT OF HEALTH AND WELFARE
FOR THE TREATMENT OF VENEREAL DISEASES, BRITISH COLUMBIA,
1936 TO 1950, INCLUSIVE.
37,500
30,000
2Z500
15,000
7,500
LEGEND
ARSENICAL   (AMPOULES)  	
BISMUTH         (IN CCS)— ——
SULPHONAMIDE (100 GRSJ — - —
PENICILLIN   (1,000,000 UNITS)---
/
Tl
\
\
/
/
t
^-*
\
N
4
/
/
/
f
\
\
\
/
/
/
^»
0 ^^"
>
\
\
\
1
1
[
• •»•"■■"
1
\
i
t
\
V
A   i
//
1
1
» *«
«.--'
^
*
/
*
s
*
V
%
\
Tl—J
f
I
/
*
1
1
V
1936
37
39
45
46
47
48
49 1950 NN 32
DEPARTMENT OF HEALTH AND WELFARE
TABLE XIV.—FREE MEDICATIONS DISTRIBUTED TO PRIVATE PHYSICIANS
BY THE PROVINCIAL DEPARTMENT OF HEALTH AND WELFARE FOR
THE TREATMENT OF VENEREAL DISEASE, BRITISH COLUMBIA, 1936
TO 1950, INCLUSIVE.
Year
Arsenicals
Bismuth
Sulphonamide
Penicillin
Penicillin
O. &W.
(100,000 Units)
Streptomycin
(Ampoules)
(CC.)
(Grains)
(100,000 Units)
(Grams)
1936              	
6,456
1,397
1937 	
12,192
15,539
55,485
1938     	
12,666
16,125
281,745
	
	
1939        -	
10,933
21,270
252,930
	
1940.   _	
10,212
22,029
336,825
..
	
1941 - _ -
10,955
22,566
469,998
	
	
'94?,
12,636
27,024
772,301
1943    .... 	
11,162
26,300
583,786
	
1944       .. _    .
12,005
23,350
883,986
	
	
1945  -	
17,147
27,580
950,719
678
	
	
1946	
20,586
33,375
308,565
1,498
	
1947 	
18,328
35,325
213,829
1,415
	
	
1948      -	
15,601
26,625
165,195
1,580
7,059
	
1949* 	
6,675
14,100
83,300
4,611
	
233
1950  ,.	
2,796
6,250
95,985
5,676
155
* The figures originally appearing in our 1949 Report represented total drugs used during the year.    The figures in
the present Report have been corrected and refer only to free medications distributed to private physicians.
These figures not only illustrate the very large quantity of penicillin now being freely
distributed to private physicians, but also depict the change that has occurred in the uses
of arsenic and bismuth over the past two years.
In the light of experience gained at all large venereal-disease treatment centres, it
has now been decided to discontinue the use of arsenic in all Divisional clinics, and also
to recommend that its use be abandoned by private physicians. VENEREAL DISEASE CONTROL REPORT,  1950
NN 33
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#    4-CO NN 34
DEPARTMENT OF HEALTH AND WELFARE
The figures given in these tables represent places of meeting and places of exposure
of patients reporting with a venereal infection. These figures remain essentially similar
for 1950 to those for 1949.
Places of meeting are naturally difficult to control. Hotels and rooming-houses
still constitute the outstanding problem as places of exposure, and much remains yet to
be done in tightening the control of certain of the more constant offenders.
TABLE XVII. — CONTACTS TO VENEREAL INFECTION CLASSIFIED
ACCORDING TO INVESTIGATING AGENCY AND RESULT OF INVESTIGATION, BRITISH COLUMBIA, 1950.
Investigated by—
£j
a
o
Ih
0
Result of Investigation
3
o
H
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eg
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843
623
83
37
17
5
17
21
40
445
97
26
73
26
125
91
2
4
1
.   71
57
5
4
2
2
1
Investigated, already diagnosed or
under care 	
31
3
1
2
4
21
538
261
15
100
39
1
27
5
88
2
118
56
1
13
15
2
24
2
5
Found to be ex-Province  	
Investigation not indicated	
2,096
3
850
221
1,022
237
	
	
	
235
1
	
1
	
	
Totals	
4,379
1,100
125
228
102
368
164
32
142
874
221
1,023
Note.—The above figures cover the period of October, 1949, to September, 1950. VENEREAL DISEASE CONTROL REPORT,  1950
NN 35
TABLE XVIII. — CONTACTS TO VENEREAL INFECTION CLASSIFIED
ACCORDING TO INVESTIGATING AGENCY AND RESULT OF EXAMINATION, BRITISH COLUMBIA, 1950.
0
H
Investigated by-
Result of Examination and
Whether or Not Previously
Diagnosed
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Infected with primary syphilis—
6
2
i
1
—
6
Not previously diagnosed.
Not stated 	
— 1   -—
Totals 	
8
i
......
1
...... 1 ...... 1 ...... 1 ...._
...... |       6
-
	
Infected with secondary syphilis—
6
4
3
—
	
—
1
	
—
	
6
—
......
Not previously diagnosed	
Not stated 	
......
......
Totals    	
10
3
_
__
 -1   11 - -1
-- 1       6 |     |  |   	
Infected with other syphilis—
93
72
2
4
14
1
—
4
2
6
1
...... |   ......
6 j     15
1  1   -	
1
25
88
Not previously diagnosed
Not stated  	
Totals       	
167
19
...... |       4
2
6
7 |     15
26 |     88
-- 1     1   -----
Infected with gonorrhoea—
670
606
1
1
389
74
1
35
19
45
3
44
......
1
664
1
Not previously diagnosed
Not stated	
	
Totals 	
1,277
390
75
35
19
45
47 1       1
-  |   664 |	
1 1   —
Infected with chancroid—
4
4
4
	
	
1           1
  1   ----- 1   —-
-..- |   ...... |   ......
...... i   ...... |   ......
3
1
Not previously diagnosed
Not stated  	
Totals	
8
4
  |   	
  1   ----- 1   — 1   --
3 1       1  1   -  1   -- 1   —
Infected with lymphogranuloma
venereum  or granuloma
inguinale—
1
	
	
—
	
1
—
Not previously diagnosed
Not stated.: 	
—
Totals	
1 |   ...... |   ...... |   ...._
--    I     |  |   ......
----- |       1  |   ...... |   ......
Incomplete examination—
2
7
7
__
	
-- 1   	
  1   -	
	
2
	
—
Not previously diagnosed..	
Not stated .
—
Totals	
9
7
......
— 1     1
--. |       2
......
......
Negative—
65
587
5
300
1
34
67
3
23
78
	
56
	
7
19
65
3
1
Not previously diagnosed
Not stated 	
Totals 	
657
301
34
70
23
78
56
7
19
69 |   ...... |   ...... |   ......
Investigation not indicated—
2
2
1,252
 .
	
2
1
11
221
1
1   ......
1
1,020
Not previously diagnosed
Not stated	
Totals...	
1,256 |   ...... 1   	
----- 1   ------ 1     1   	
14
221
1,021.
Not stated—
2
2
982
1
374
[     16
|   118
58
1
237
54
9
93
2
21
1
Not previously diagnosed
Not stated  	
1
Totals 	
986
|   375
1     -6
1   118
58
238
|     54 |       9
93
23
......
[       1
|       1
Totals—
850
1,279
2,250
5
712
383
108
17
107
121
44
58
|   131
1   237
1           1
3 |       1
|   106 j     22
|     55 |       9
4
44
93
836
[       4
1      34
|   221
|       1
1       1
[1,021
Not previously diagnosed	
|       1
Totals   _  	
4,379
|1,100
|   125
|   228
102
|   368
1    164  I      32
141   1    874
|   221
11,023
1
Note.—The above figures cover the period of October, 1949, to September, 1950. NN 36 DEPARTMENT OF HEALTH AND WELFARE
Efficacy of contact-tracing as a case-finding method depends to a great extent on
the adequacy of information obtained from the patient.
In 1950 the information given regarding 78 per cent of the named contacts was
adequate for further investigation of the contact. During the past three years there
has been a steady increase in the adequacy of information obtained. This might be
explained by the fact that more cases are bringing their own contacts for examination,
and cases where contact information is inadequate are being reinterviewed for further
contact information. Also the adequacy of contact information received from the
private physician is improving.
It will be seen from the above table that investigation was indicated on 2,261 of
the 4,379 named contacts. The public-health personnel in British Columbia investigated 77 per cent of these contacts, the remainder being investigated by private physicians or agencies outside our Province. Of those investigated by the public-health
personnel, 68 per cent were located, and 93 per cent of those located were examined.
Of those examined, 56 per cent were found to be infected. The number of contacts
located has increased by approximately 10 per cent over the past three-year period.
VICTORIA, B.C.
Printed by Don McDiarmid, Printer to the King's Most Excellent Majesty
1951
1,295-351-5480

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