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PROVINCE OF BRITISH COLUMBIA Sixth Report of the DEPARTMENT OF HEALTH AND WELFARE (HEALTH BRANCH) (Fifty-fifth… British Columbia. Legislative Assembly 1952

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 PROVINCE OF BRITISH COLUMBIA
Sixth Report of the
DEPARTMENT OF HEALTH
AND WELFARE
(HEALTH BRANCH)
(Fifty-fifth Annual Report of Public Health Services)
YEAR ENDED DECEMBER 31st
1951
VICTORIA, B.C.
Printed by Don McDiarmid, Printer to the Queen's Most Excellent Majesty
1952  Office of the Minister of Health and Welfare,
Victoria, B.C., January 14th, 1952.
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, 1951.
A. D. TURNBULL,
Minister of Health and Welfare. Department of Health and Welfare (Health Branch),
Victoria, B.C., January 14th, 1952.
The Honourable A. D. Turnbull,
Minister of Health and Welfare, Victoria, B.C.
Sir,—I have the honour to submit the Sixth Report of the Department of Health
and Welfare (Health Branch) for the year ended December 31st, 1951.
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, B.A.Sc   - Minister of Health and Welfare.
SENIOR PUBLIC HEALTH ADMINISTRATIVE STAFF
G. F. Amyot, M.D., D.P.H.       -    ■-     -     •
J. A. Taylor, B.A., M.D., D.P.H.      ■
G. R. F. Elliot, M.D., CM., D.P.H.
A. H. Cameron, B.A., M.P.H.    -
G. F. Kincade, M.D., CM., L.M.C.C
Deputy Minister of Health and Provincial Health Officer.
Deputy Provincial Health Officer and
Director, Bureau of Local Health
Services.
Assistant Provincial Health Officer
and Director, Bureau of Special
Preventive and Treatment Services.
Director, Bureau of Administration.
Director, Division of Tuberculosis
Control.
C E. Dolman, M.B., B.S., D.P.H, Ph.D.
C. L. Hunt, M.D., M.R.C.S., L.R.C.P.
J. H. Doughty, B.Com., M.A.
N. J. Goode, B.A.Sc. (C.E.), M.S.S.E.
Miss M. Frith, R.N., B.A., B.A.Sc, M.P.H.
F. McCombie, L.D.S., R.C.S., D.D.P.H.    -
Mrs. K. Beard, B.Sc, M.S.P.H. - - -
Miss D. Noble, B.Sc(H.Ec), C.P.H. -
C. R. Stonehouse, CS.I.(C)     -
Director, Division of Laboratories.
Director, Division of Venereal Disease Control.
Director, Division of Vital Statistics.
Acting Director, Division of Public
Health Engineering.
T. H. Patterson, M.D., CM., D.P.H., M.P.H.      Director, Division of Environmental
Management.
Director, Division of Public Health
Nursing.
Director,   Division   of   Preventive
Dentistry.
Consultant, Public Health Education.
Consultant, Public Health Nutrition.
Senior Sanitary Inspector.  TABLE OF CONTENTS
General— Page
Local Health Services  11
Tuberculosis-control  12
Proposed Administration, Clinic, and Laboratory Building  12
Environmental Management  13
Public Health Institute  13
Red Cross Blood Transfusion Service  13
Accommodation, Victoria Offices  14
Population Characteristics  14
Longevity and Causes of Death in British Columbia  15
Administration of the Provincial Health Services—
Historical Development  18
Philosophy of Public Health at the Provincial Level  19
Administrative Organization of the Health Branch  19
Bureau of Administration  19
Bureau of Local Health Services  20
Bureau of Special Preventive and Treatment Services  22
Metropolitan Health Departments  23
Voluntary Health Agencies  24
Administrative Chart of the Health Branch  25
Report of the Health Branch Office, Vancouver Area—
Bureau of Special Preventive and Treatment Services  26
Faculty of Medicine, University of British Columbia  26
Voluntary Health Agencies  26
Civil Defence  28
National Health Grants..  28
Report of the Bureau of Local Health Services—
Administration .  36
Development and Expansion J 37
Personnel Changes  39
School Health Services  39
Home-care Programmes.  40
Community Health Centres  41
Disease Morbidity and Statistics  42
Table I.—Incidence of Notifiable Diseases in British Columbia (Including
Indians)  46
Table II.—Table Showing Cases of Notifiable Diseases in the Province of
British Columbia for the Year 1951 47, 48
Report of the Division of Public Health Nursing—
Table I.—Comparison of Provincial Public Health Nursing Staff Changes, 1950
and 1951  50
Public Health Nursing Training Programme  50
Public Health Nursing Supervision  51
Statistical Summary of Certain Public Health Nursing Services  53
Service Analysis  53
Table II.—Comparison of Percentage of Time Spent by Public Health Nurses
in Specified Activities as Indicated by Time Studies, 1949,1950, and 1951 54
Table III.—Analysis of Time Spent in Home-visits and Office by Percentage
of Total Time as Shown in Time Studies, 1949, 1950, and 1951  54
Civil Defence  54
Sickness Survey  55
Home Care  55 X 8 BRITISH COLUMBIA
Report of the Nutrition Service— Page
Consultant Service to Local Public Health Personnel  57
Consultant Service to Institutions  58
Consultant Service to Other Departments and Organizations  59
General Comments  60
Report of the Division of Preventive Dentistry—
Progress in 1951  61
British Columbia Dental Association  63
The Future  63
Report of the Division of Environmental Sanitation—
A. Public Health Engineering—
Water-supplies  65
Sewage-disposal  66
Stream-pollution  66
Shell-fish  67
Tourist Camps  68
General  68
B. Sanitary Inspection—
Milk  69
Eating-places  69
Locker Plants  70
Food-handling in Hospitals  70
Horse-meat  70
Meat Inspection  70
Slaughter-houses  71
Industrial Camps  71
Farm-labour Housing  72
Summer Camps  72
School Sanitation  72
Plumbing  72
Vermin-control  73
Rodent-control  73
Report of the Division of Vital Statistics—
Introduction  74
Registration of Births  74
Registration of Deaths __,  75
Registration of Marriages  75
Documentary Revision  76
Administration of the " Marriage Act"  76
Administration of Sections 34 to 40, Inclusive, of the " Wills Act"  76
Registration of Vital Statistics amongst Indians  76
Registration of Vital Statistics amongst Doukhobors  77
Effect of Old-age Security Legislation  78
General Office Procedures .  78
Microfilming of Documents  79
District Registrars' Offices and Inspections  79
Inspections  80
Statistical Services  80
Cancer Registry  81
Table I.—Number and Percentage of New Cancer Notifications by Sight and
Sex, British Columbia, 1951 (Excluding Indians)  82 DEPARTMENT OF HEALTH AND WELFARE,  1951 X 9
Page
Table II.—Number and Percentage of Reported Live Cancer Cases by Sight
and Sex, British Columbia, 1951 (Excluding Indians)     82
Table III.—Cancer Notifications by Sex and Age-group, British Columbia,
1951—Age Specific Rates per 100,000 Population (Excluding Indians)    82
Table IV.—Live Cancer Cases Reported by Sex and Age-group, British Columbia, 1951—Age Specific Rates per 100,000 Population (Excluding
Indians)     83
Report of the Division of Public Health Education—
Local Health Educators  84
In-service Training  85
Consultative Service  85
Publications and Publicity  86
Films  87
Staff Changes  87
Report of the Division of Laboratories—
Table I.—Statistical Report of Examinations Done during the Year 1951, Main
Laboratory ...   88
Table II.—Statistical Report of Examinations Done during the Year 1951,
Branch Laboratories  89
Total Laboratory Tests and Tests for Diagnosis of Venereal Disease, British
Columbia, 1932-51  90
Tests for Diagnosis and Control of Venereal Diseases  91
Tests Relating to Tuberculosis-control  91
Bacterial Food Poisoning and Gastro-intestinal Infections  93
Bacteriological Analyses of Milk and Water Samples  94
Other Types of Tests  94
Branch Laboratories  95
General Comments on Staff Activities  97
Report of the Division of Venereal Disease Control—
Treatment  99
Epidemiology  100
Social Service  101
Education .  102
General  102
Report of the Division of Tuberculosis Control—
X-ray Programme  104
Federal Health Grants  106
Staff  107
Nursing  107
New Cases  108
Clinics and Institutions  108
Social Service _-.  109
Conclusions  109  Sixth Report of the Department of Health and Welfare
(HEALTH BRANCH)
(Fifty-fifth Annual Report of Public Health Services)
YEAR ENDED DECEMBER 31st, 1951
G. F. Amyot, Deputy Minister of Health
At the outset, the Deputy Minister joins with other Health Branch officials in expressing appreciation of the continual and ever-increasing co-operation which has marked the
relationships with other departments of government, professional groups, and voluntary
agencies. The public health programme has derived very material benefits from the
assistance rendered by officials of these organizations.
In this Annual Report, the section entitled " General," immediately below, is
intended to summarize those activities, events, and trends which are considered to have
had the greatest impact upon the progress of public health in British Columbia during
1951.
Beginning on page 18, a description, entitled "Administration of the Provincial
Health Services," sets forth the historical development and the present administrative
plan. At the risk of some repetition of information found elsewhere in the Annual
Report, this material has been included to provide, in one section, a description which
may be conveniently reprinted for more general distribution.
Finally, the sections which begin on page 26 are presented by the heads of the
bureaux, divisions, and services which constitute the Health Branch. These contain
detailed information concerning the year's activities.
GENERAL
LOCAL HEALTH SERVICES
Experience in British Columbia and in most other parts of the continent has shown
that the most efficient administrative organization for the conduct of health services on
the local level is the health unit. In this Province, when present plans have been implemented, there will be eighteen such health units covering the populated areas outside the
boundaries of Greater Vancouver and Victoria-Esquimalt, which have their own large
city health departments.
During 1951, expansion of health unit service consisted of the extension of the
boundaries of certain units. Thus, although the number of health units officially and
completely organized remained at thirteen, the area of the Province covered and the
population served by this type of local organization was increased. Further, negotiations
with respect to the establishment of units in the Kamloops area and the Surrey-Delta area
were well advanced at the year's end. It is anticipated that organization of these two
units will be completed early in 1952. The following data reflect the improvement during
1951 and the status at the end of the year:—
Health units—
Officially organized and in operation  13
Organized but not in actual operation     2
Proposed      3
Total   18 X 12 BRITISH COLUMBIA
Percentage of population receiving service from— Per Cent
Provincial health units and city health departments of
Greater Vancouver and Victoria-Esquimalt  85.9
Non-health unit areas (public health nursing and sanitary
inspection districts)   13.0
Total   98.9
TUBERCULOSIS-CONTROL
The Annual Report of the Health Branch for 1950 stated that construction of the
new tuberculosis hospital at West Fifty-ninth Avenue and Heather Street, Vancouver,
had been undertaken. Now, one year later, it is gratifying to report that the first section
of 264 beds and the central and administrative facilities (for the complete 528-bed
hospital) are rapidly nearing completion. The institution has been named the Pearson
Tuberculosis Hospital in honour of George S. Pearson, M.L.A., who gave many years of
outstanding service in the Government of the Province in which he was Minister of
Labour, Provincial Secretary, and Minister of Health and Welfare. Personnel to staff
the new hospital are now being appointed, plans for the official opening are being made,
and it is anticipated that the first patients will be admitted early in 1952.
Although these 264 beds, shortly to be put into use, will do much to improve the
tuberculosis-control programme, they will by no means provide a solution to the problem
of bed-shortage. Because other accommodations, now housing beds on a temporary
basis, must be vacated and many of the patients must be transferred to the Pearson
Tuberculosis Hospital, the 264 new beds do not represent a net gain. There will still
remain a waiting list of tuberculous persons whose admission for care and treatment
must be delayed. For this reason, it is sincerely hoped that construction of the second
section of 264 beds may be undertaken immediately.
With the expansion of the tuberculosis-control programme, as exemplified by the
construction of the new hospital, it became evident to the Deputy Minister of Health and
the then part-time Director of the Division, Dr. W. H. Hatfield, that the Division required
a director who could serve on a full-time basis. Dr. Hatfield, a physician in private
practice in Vancouver, had, for many years, guided the Division's activities and had
been largely responsible for the high level of tuberculosis-control in British Columbia.
Unable himself, for personal reasons, to accept the full-time directorship, Dr. Hatfield
recommended that Dr. G. F. Kincade, then serving as Medical Superintendent of the
Willow Chest Centre, be appointed to this important post. When the change was effected
in August, Dr. Hatfield assumed the position of Adviser to the Deputy Minister of Health
on Tuberculosis and other Diseases of the Chest.
PROPOSED ADMINISTRATION, CLINIC, AND LABORATORY
BUILDING
It is extremely regrettable that this Report must state that construction of the
urgently needed administration, clinic, and laboratory building in Vancouver was not
undertaken, as anticipated, during 1951. Although many officials have devoted much
time in an effort to produce satisfactory plans and finalize administrative arrangements,
it has not been possible to surmount the financial obstacles resulting from rising costs
of labour and materials. The effect of this delay on important Health Branch services
located in Vancouver is most serious. The offices of the Assistant Provincial Health
Officer and the Division of Venereal Disease Control are located in old and quite unsatisfactory buildings which are the property of the Vancouver General Hospital. Although
these two Health Branch services might conceivably maintain efficient operation in these DEPARTMENT OF HEALTH AND WELFARE,  1951 X 13
quarters, the fact remains that the Vancouver General Hospital has given notice of its
intention to use the property for its own purposes. Notice to vacate the buildings will
undoubtedly be received in the near future. Because the proposed new building is not
available, there is presented the most difficult problem of locating reasonably suitable
temporary accommodations. However, the most serious aspect of the matter concerns
the Division of Laboratories. In the case of this Division, now located in four obsolete
wooden houses on Hornby Street, the problem is indeed grave. In addition to the more
ordinary difficulties associated with overcrowding and lack of proper facilities, there is
the very real danger of catastrophe resulting from fire or structural collapse. Such
a tragedy could mean not only the loss of much valuable equipment and materials and
the disruption of services, without which the entire public health programme would be
placed in jeopardy, but also injury and even death of highly skilled personnel.
ENVIRONMENTAL MANAGEMENT
The Health Branch has long been aware of the desirability of developing a programme which would meet more adequately the public health needs of the industrial
worker. Earlier planning had tended to confine this programme to the field of industrial
hygiene, but more recent thinking has revealed that the scope should be enlarged. With
this objective in view, an experienced public health physician was provided with postgraduate training at the School of Public Health, Ann Arbor, Mich., where he received
the Master of Public Health degree in June, 1951. His course of studies was specially
chosen to prepare him for leadership in the proposed programme in British Columbia.
On the return of this official to the Health Branch, he was appointed Director of the
newly established Division of Environmental Management. In addition to industrial
hygiene, this Division is concerned with medical-care problems, sanitation, and the
health aspects of civil defence. In the last-mentioned field, the Director serves as liaison
officer between the Health Branch and the Provincial Civil Defence Co-ordinator.
PUBLIC HEALTH INSTITUTE
The Public Health Institute is an annual educational conference attended by field-
staff personnel, senior Health Branch officials, and representatives of the city health
departments of Greater Vancouver and Victoria-Esquimalt. The 1951 meeting was held
in Victoria on March 26th to 29th, when Dr. Harry Mustard, former Dean of the School
of Public Health, Columbia University, was the chief speaker. Dr. Mustard has had
wide training and experience in important public health positions in the United States.
His contribution to the Institute was particularly valuable because of his deep knowledge
of local and rural health services, in which field he is the author of several widely used
texts. As in previous years, British Columbia public health staff, both from the field and
the central offices, played prominent parts in the programme.
RED CROSS BLOOD TRANSFUSION SERVICE
During 1951 the people of British Columbia continued to participate, both as donors
and recipients of blood, in this public health programme which means so much to the ill
or injured person in need of transfusion. Operated by the Canadian Red Cross Blood
Transfusion Service through its local chapters, the programme has received the active
support and co-operation of all personnel of the Health Branch. Since the inauguration
of the service, which makes blood transfusions available without cost to the recipients, the
Provincial Government has given financial support. This has helped the organization in
defraying general maintenance costs in clinics and offices and in meeting extraordinary
transportation charges in those cases in which special or emergency means of transportation must be adopted.   During the past year the Service has played an important role in X 14 BRITISH COLUMBIA
providing blood plasma to troops in Korea. Those British Columbians who have given
so willingly of their blood may well be proud of the fact that they have helped others,
both civilians and armed-force personnel, in times of grave need. However, all citizens
must realize that " withdrawals " from the " blood bank " can be made by themselves or
others only to the extent that " deposits " are maintained. A high percentage of blood
donors among the population is essential, particularly in view of possible emergency
conditions.
ACCOMMODATION, VICTORIA OFFICES
The opening of the Provincial Government's new Douglas Building provided much
needed office accommodation to departments in general. Although the Health Branch
itself was not allotted offices in the new building, the over-all increase in space will make
possible the consolidation of most of the Victoria Health Branch services in the extreme
west wing of the Parliament Buildings proper. During the latter half of the year the
Department of Public Works undertook necessary alterations and renovations in a portion
of the west wing vacated by personnel of another department. Unfortunately, certain
space has not yet been vacated, with the result that complete reorganization and consolidation cannot be made for some months to come. However, the now renovated and
available portions will be occupied by Health Branch personnel early in the new year.
The Deputy Minister and his staff are most grateful for the additional accommodation
and for the co-operation displayed by the Department of Public Works in carrying out
the necessary alterations as requested.
POPULATION CHARACTERISTICS
The Decennial Census of the Provinces of Canada was taken this year, providing an
accurate picture of the composition of the population in Canada for the first time since
1941. The results confirmed that the percentage increase in this Province's population
over the ten-year period considerably exceeds that for any other Province, being fully
twice that for Ontario, which had the next greatest percentage increase. In 1941 there
were 818,000 people in British Columbia, and by 1951 this figure had increased by
41 per cent to 1,153,000.    In 1941 the organized areas of the Province accounted for
74.6 per cent of the total population and the unorganized areas for 25.4 per cent. By
1951 the proportion of the population in the organized areas had increased to 77.7 per
cent and that in the unorganized areas had declined to 22.3 per cent. In 1941 there were
thirty-four cities in the Province containing altogether 439,119 people. In 1951 there
were thirty-five cities containing 565,801 people, a 28.8-per-cent increase. District
municipalities numbered twenty-seven in 1941 and twenty-eight in 1951, the population
in these areas having increased by 79.4 per cent from 160,801 to 288,421. Villages
showed the largest increase in number, having more than doubled from nineteen in 1941
to forty in 1951.   The population quadrupled, having risen from 10,052 to 42,155.
British Columbia is divided into ten census divisions, and a comparison of the proportionate population increase during the period 1941 to 1951 in these areas is interesting
in showing the pattern of growth in the Province. The greatest proportionate increase
occurred in Census Division 10. In this division, the Peace River area, the population
increased 67.2 per cent, from 8,481 in 1941 to 14,178.   The next greatest increase, of
57.7 per cent, occurred in the Cariboo area—Census Division 8. Census Division 3,
the Okanagan District, showed a population increase of almost 50 per cent over the ten-
year period. The Lower Mainland and Vancouver Island Districts, including Census
Divisions 4 and 5, each gained almost the same percentage from 1941 to 1951, slightly
over 40 per cent. The population in the area surrounding Kamloops, Census Division 6,
increased 34.7 per cent. Census Divisions 1 and 2, the East and West Kootenays^
increased 28.1 and 23.3 per cent respectively.   The population in the Ocean Falls area! DEPARTMENT OF HEALTH AND WELFARE,  1951 X 15
Census Division 7, increased by 26.4 per cent. The smallest population increase in the
Province during the 1941-51 period occurred in Census Division 9, comprising the
Queen Charlotte and northern coastal area. Here there was only a 14.4 per cent rise in
the number of people.
The birth rate this year, excluding Indians, showed an increase over that for 1950.
The rate in 1951 per 1,000 live births was 23.4, while in 1950 the rate was 23.0. The
excess of births over deaths in 1951 per 1,000 population was 13.9, an increase over the
1950 figure of 13.1. Marriages during the year also showed an increase from 9.9 per
1,000 population in 1950 to 10.4.
LONGEVITY AND CAUSES OF DEATH IN BRITISH COLUMBIA
A slight decrease occurred in the death rate per 1,000 population, excluding Indians,
this year to 9.5 from last year's rate of 9.7. As indicated in last year's Report, because
of the increasing number of older people in the Province, any improvement in the mortality rate is worthy of note. A consideration of the age-specific mortality rates reveals
that the mortality in the group from 0 to 19 years of age has remained unchanged at the
1950 rate of 2.6 per 1,000 population. There was also no change in the mortality rate
among the population from 20 to 39 years of age this year as compared to the rate of
1.6 for 1950. Improvements were registered in the mortality rates for both the 40-59
and the 60-and-over age-groups this year over 1950. In the 40-59 group, the rate this
year was 6.6 deaths per 1,000 population, while that for 1950 was 7.0. In the 60-and-
over age-group the rate was 42.8 in 1951 and 43.3 in 1950. Of the total deaths, 8.4 per
cent occurred in the 0-19 age-group, 5.4 per cent in the 20-39 age-group, 15.5 per cent
in the 40-59 age-group, and 70.7 per cent in the group 60 years and over.
The infant mortality rate among the population, excluding Indians, showed an
increase this year over that for the previous year. In 1950 the rate of infant deaths per
1,000 live births was 22.6, whereas this year the rate has risen to 23.4. Deaths from
prematurity, the leading cause of infant mortality, amounted to 20.6 per cent this year,
a slight increase over last year's figure of 18.4 per cent. An increase occurred in congenital malformations as a percentage of total infant mortality, this cause having accounted
for almost 20 per cent of all infant deaths in 1951 as compared to 14.5 per cent in 1950.
The percentage of infant deaths from asphyxia and atelectasis was 13.6 this year and
12.6 per cent in 1950. A substantial decline occurred in the deaths from birth injuries
this year to less than half the percentage of 13.6 arising from this cause in 1950.
The rate of maternal deaths per 1,000 live births continues to decline, and this year
reached a new low of 0.6 as compared to 0.9 in 1950. During the year there were only
17 maternal deaths. The improvement in maternal mortality during recent years has been
spectacular. The rate in 1940 was 2.8 per 1,000 live births; thus this year's rate is less
than one-quarter of the 1940 rate.
The new system of coding mortality has now been in use for two years, making
possible certain comparisons between 1950 and 1951. As was noted in the 1950 Annual
Report, with the introduction of the Sixth Revision of the International List of Causes of
Death comparisons are no longer completely accurate for all causes between deaths from
1950 onward and deaths in the preceding years. It is expected, however, that the
additional usefulness of the statistics now available will more than outweigh this loss of
comparability.
The number of deaths from heart-disease, the leading cause of mortality in the
population of the Province, excluding Indians, was slightly less than that for 1950. There
was a total of 3,951 deaths from this cause in 1951, while in 1950, 3,990 deaths occurred
as a result of heart ailments. The death rate declined from 359.8 per 100,000 population
in 1950 to 350.6 in 1951. Almost 37 per cent of all deaths were attributable to heart-
disease this year, a slight decrease from the 1950 figure of 37.3 per cent.    Deaths from X 16 BRITISH COLUMBIA
arteriosclerotic and degenerative heart-disease declined to 3,142 from the figure of 3,179
in 1950, while mortality from hypertensive heart-disease increased to 510 in 1951, compared to 497 in 1950. Rheumatic heart-disease caused 152 deaths this year, and other
heart conditions accounted for the remaining 147 deaths. In 1950 there were 194 deaths
from rheumatic disease and 120 from other heart conditions.
Cancer mortality remained substantially the same this year as for the previous year,
being 1,682 in 1950 and 1,675 in 1951. The mortality rate decreased from 151.7 to
148.6. Of the total deaths from cancer, 42 per cent or 699 were caused by malignancies
of the digestive tract, 18 per cent or 303 by malignancies of the genito-urinary system,
and 12 per cent and 10 per cent by malignancies of the respiratory system and breast
respectively.
The third leading cause of death, vascular lesions of the central nervous system, took
1,123 lives this year, a decrease of 5 per cent from the previous year's figure of 1,178.
The death rate from this cause declined from 106.2 in 1950 to 99.6 in 1951. Individual
causes under this heading were cerebral haemorrhage, which caused 698 deaths, and cerebral embolism and thrombosis, which caused 293 deaths. The remaining 132 deaths
in this classification were due to subarachnoid haemorrhage, spasm of cerebral arteries,
and other and ill-defined vascular lesions of the central nervous system.
The toll from accidents this year increased by 7 per cent to 815 deaths, and the
mortality rate rose accordingly from 68.7 per 100,000 population in 1950 to 72.3 in
1951. A total of 191 deaths arose as a result of motor-vehicle accidents in 1951, thus
placing this cause ahead of accidental injury by fall, the leading cause of death from
external causes in 1950. Motor-vehicle accident fatalities were up over 10 per cent
this year from the 1950 figure. Falls caused 157 deaths, 10 per cent less than the 1950
figure of 175. Drowning fatalities numbered 120 in 1951 and 116 in 1950, while deaths
from blows by falling objects numbered 80 this year, an increase of 26 over the 1950
figure. Nearly 70 per cent of all accidental deaths this year occurred as a result of these
four causes. Of the 547 non-transport deaths by accidents, 211 occurred in the home,
108 in industry, 24 in institutions, 13 in a public building, and 191 in other and
unspecified places.
The four leading causes of death, heart-disease, cancer, vascular lesions of the central
nervous system, and accidents accounted for 7,564 of the 10,701 deaths which occurred
in 1951, fully 70 per cent of the total mortality.
Pneumonia this year was the fifth leading cause of death, having taken 370 lives
as compared to 318 in 1950, an increase of 11.6 per cent. The death rate for this cause
rose from 28.8 in 1950 to 32.8 in 1951. Diseases of infancy, in sixth place as a cause
of death, killed 347 infants this year, 7 less than the previous year. Tuberculosis caused
the deaths of 219 people this year, placing it in seventh position. In 1950, 229 people
died from this disease. Diseases of the arteries, congenital malformations, and suicide
were in eighth, ninth, and tenth place this year, the mortality from these causes having
amounted to 184, 153, and 152 respectively.
The influenza epidemic experienced in the first few months of 1951 had a very
adverse effect on the mortality from this disease, more than trebling the deaths it caused.
In 1950 there were 31 influenza deaths, while in 1951, 98 people died from the disease.
When the causes of death by age-group are considered, the effect of each cause on
the population is revealed more clearly. In the younger age-groups, accidents are in the
forefront and cause a major proportion of the deaths, while as age progresses, the degenerative diseases, such as diseases of the heart, cancer, and vascular lesions of the central
nervous system, become of increasing importance. The following discussion of the
mortality in each age-group will be of value in demonstrating the effect of some of the
more important causes. DEPARTMENT OF HEALTH AND WELFARE,  1951 X.17
In the age-group from 1 to 19 years, accidents take a high toll of life. Almost one-
half of the 276 deaths at this period of life arise from external causes, and the importance
of other causes is dwarfed by this leading cause. Cancer, in second place, took 26 lives,
congenital malformations 22, and tuberculosis 15. A single cause of accidental death,
drowning, killed 40 people, almost as many as the next two leading causes of death just
mentioned.    Motor-vehicle accidents took 40 lives, fire 10 lives, and falls another 6.
In the age-group from 20 to 39 years, accidents exact an even higher toll than in
the previous group, 211 lives, but the proportion of total deaths this represents declines
to a little over one-third. Motor-vehicle accidents were responsible for one-third of
these accidental deaths, trailed by drownings (28 deaths) and blows by falling objects
(24 deaths). Heart-disease begins to make an appearance among the leading causes of
death in the 20-39 age-group. There were 62 deaths from this cause in 1951, and
following heart-disease, tuberculosis caused 60 deaths and cancer 58.
Heart-disease takes first place as a cause of mortality in the next age-group, from
40 to 59 years, a position it holds uncontested to the last age-group. Almost a third of
the deaths among the population aged 40 to 59 years arose as a result of this cause.
Cancer took 390 lives, nearly 25 per cent; accidents, which have now dropped to third
place, took 190 lives; and vascular lesions took 94 lives.
The 60-79 age-group presents a similar pattern of mortality, except that vascular
lesions have moved up to third place, ahead of accidents. The deaths in this age-group
from the major causes were heart-disease, 2,401; cancer, 1,029; vascular lesions, 687;
and accidents, 185.
In the last age-group, that from 80 to 99 years, heart-disease again leads, having
caused 948 deaths. Vascular lesions is in second place with 317 deaths, and cancer third
with 170. Accidental death no longer appears as one of the leading causes, having been
replaced by pneumonia.    One hundred and thirty people died from this cause.
The effects of the influenza epidemic were most marked on the older age-groups,
having accounted for 80 deaths among those over 60. In the population from 1-19,
this disease caused 1 death; in the 20-39 group, 5 deaths; and in the 40-59 group,
8 deaths.
During 1951 the staff of the Health Branch and personnel of related services have
again displayed keen interest and co-operation in planning and implementing British
Columbia's public health programme. Their loyalty to the service and their untiring
efforts to improve the health status of the people evoke the sincere gratitude of the
Deputy Minister. X 18 BRITISH COLUMBIA
ADMINISTRATION OF THE PROVINCIAL HEALTH SERVICES, 1951
Advances in medical and related sciences and the changing public health needs of
the people make necessary the constant modification of public health programmes and
procedures. In British Columbia, during World War II, modification of a truly progressive nature was difficult to achieve because of the serious shortage of trained
personnel. During the period since the war, however, the Province, aided materially
by the Federal Health Grants programme, has experienced a planned and controlled
expansion of its public health services. This has, of course, necessitated certain changes
in the administrative organization of the Health Branch.
Several years have elapsed since the last description of Provincial health services
was published in summary form. The revised description, presented in these pages,
summarizes the historical development and administrative organization and services
which are in effect in 1951.
HISTORICAL DEVELOPMENT
Public health services in British Columbia had their official beginning on February
23rd, 1869, following the passage of legislation entitled "An Ordinance for Promoting
the Public Health In The Colony In British Columbia." This ordinance marked the
first step in British Columbia's administration of public health. When British Columbia
became a Province of the Dominion of Canada on July 20th, 1871, the ordinance became
part of the Statutes.
At that time, service was provided primarily by a group of technical persons—
engineers, doctors, and others—who met from time to time whenever a special need
arose. Following the passage on April 12th, 1893, of a new act entitled "An Act
Respecting the Public Health," this group of technical persons became known as the
Provincial Board of Health. In a later development, policy-making responsibilities and
functions were more clearly distinguished from the provision of service. The Cabinet
became the Provincial Board of Health, under whose general direction the technical
group provided actual public health services.
Since the early days of government, there has been continual growth and expansion
through the addition of new services and the integration and co-ordination of others,
until in 1946 these services were given departmental rank through the passage by the
Legislature of the " Department of Health and Welfare Act." As provided under this
Act, the new Department, which came into operation in October of 1946, was composed
of a Health Branch and a Welfare Branch, each under the jurisdiction of a separate
Deputy Minister directly responsible to the Minister of Health and Welfare. The
Provincial Health Officer was appointed Deputy Minister of Health, retaining both titles,
since authority to administer existing health legislation was vested in the former.
In 1948 the Government passed the " Hospital Insurance Act" and a third branch
of the Department of Health and Welfare, the British Columbia Hospital Insurance
Service, was set up. The Department now consists of three branches, with three officers
holding the rank of Deputy Minister. They are the Deputy Minister of Health, the
Deputy Minister of Welfare, and the Commissioner of the Hospital Insurance Service.
The activities of the three branches are co-ordinated under the Minister of Health and
Welfare.
Health services for Indians are the responsibility of the Federal Government. In
certain areas, Indian health services are provided by the Provincial Health Branch, the
latter being reimbursed by the Indian Health Services, Department of National Health
and Welfare. DEPARTMENT OF HEALTH AND WELFARE,  1951 X 19
PHILOSOPHY OF PUBLIC HEALTH AT THE PROVINCIAL LEVEL
Under the " British North America Act," the responsibility for health matters not
of an interprovincial or international nature was delegated to the Provinces.
An important function of a Provincial Government is to organize a body to which
is entrusted the health of the people. The structure on which this responsibility rests
in British Columbia is the Provincial Health Branch. The purpose of this Branch, like
any Provincial department of health, is to develop a programme planned to meet the
public health problems of the Province, to control and prevent disease and premature
death, and to promote positive health.
The chief aims of the Health Branch are:—
(1) To promote the establishment and maintenance of adequate full-time local
health services rendered by public health trained personnel.
(2) To provide supervision of, and consultative service to, these local health
services.
(3) To provide, or assist in providing, special services which, for economic
or other reasons, are not feasible of development on the local level.
Included in this group are services for the diagnosis and treatment of
tuberculosis, venereal diseases, and cancer, and public health laboratory
services.
ADMINISTRATIVE ORGANIZATION OF THE HEALTH BRANCH
On page 25 will be found an administrative chart of the Provincial Health Branch
of British Columbia showing the chain of responsibility and the flow of services of
various bureaux and divisions to the local health services and through them to the people
of the Province. It should be noted here that the divisions are developed to simplify
administration and not to act as " water-tight" compartments. All health problems are
closely related because they all affect the health of the one group—the public.
The Minister of Health and Welfare is responsible, through the Cabinet and the
Legislative Assembly, to the people for the programmes and services conducted by the
three branches of the Department.
The Deputy Minister of Health, who must be a duly qualified physician, is responsible
for carrying out the public health policy set by the Minister and the Cabinet.
For ease of administration, the Health Branch services are grouped under three
bureaux. With headquarters in Victoria, the Bureau of Local Health Services is directed
by the Deputy Provincial Health Officer, and the Bureau of Administration is directed
by the Administrative Assistant. With headquarters in Vancouver, the Bureau of
Special Preventive and Treatment Service has the Assistant Provincial Health Officer as
its director.
The Deputy Minister and the three bureau directors form the central policy-making
and planning group of the Health Branch. The bureaux are organized in such a manner
that most administrative problems can be solved by consultation among the bureau and
divisional directors concerned.
BUREAU OF ADMINISTRATION
The Bureau of Administration is concerned with all major phases of management.
Within this Bureau are the Central Office, the Division of Vital Statistics, and the
Division of Public Health Education. The latter two divisions are included in the
Bureau because, like the Central Office, they provide service to the entire Health Branch.
Central Office
Among the major responsibilities of the Central Office are personnel administration,
records, supplies, agreements with other Provinces and agencies, building projects, and
certain aspects of the Federal Health Grants programme. X 20 BRITISH COLUMBIA
Division of Vital Statistics
The Division of Vital Statistics has a dual function. It administers the various
Statutes concerning the registration of births, deaths, marriages, divorce orders, adoption
orders, and the like, and, in addition, it performs statistical analyses to aid in the planning
of health programmes. The consolidation of these functions in one Division gives a more
closely integrated service than is found in most other Provinces, States, and countries,
where the two functions are often separate.
The " Vital Statistics Act" requires that all births, deaths, and marriages be registered with a District Registrar, who then forwards the information to the central office
in Victoria. To facilitate registration, the Province is divided into seventy-two districts,
each having a District Registrar. Many of the District Registrars are Government
Agents or constables of the Royal Canadian Mounted Police.
In addition, the " Marriage Act," regulating the licensing of Marriage Commissioners and the registration of ministers, the " Change of Name Act," and the portion
of the " Wills Act" dealing with the registration of notice of filing of wills are administered by the Division of Vital Statistics.
As the statistical workshop of the Health Branch, the Division has two basic
responsibilities. It assists in determining the nature and extent of public health needs,
and it evaluates statistically the effectiveness of Health Branch services intended to meet
these needs.
Division of Public Health Education
The major responsibility of the Division of Public Health Education consists of
providing professional advice and assistance to local public health personnel and the
staffs of other divisions in the planning and conduct of health education programmes.
The Division also makes its services available to other Government departments and
voluntary agencies.
Most of the educational material distributed by the Health Branch is edited, and
often written, by staff of the Division. Included in such publications are the monthly
staff news-letter, " Public Health News and Views," and, for public consumption, the
monthly bulletin, " B.C.'s Health."
The Division maintains a central library of public health texts, journals, films, and
film-strips, which are used extensively by public health personnel in all parts of the
Province, and supervises the selection of materials for libraries in health units.
Pre-service and in-service training programmes for public health staff are arranged
and supervised by the Division. This programme is designed to acquaint new staff
members with Health Branch policies and procedures and to assist all personnel in
keeping abreast of the latest developments.
BUREAU OF LOCAL HEALTH SERVICES
The Bureau of Local Health Services includes the Divisions of Health Units, Public
Health Nursing, Public Health Engineering, Preventive Dentistry, and Environmental
Management. The Bureau is designed to co-ordinate and balance the services provided
to health units. A planning committee, or local health service council, meets weekly for
this purpose. Under the chairmanship of the Bureau Director, the council consists of
representatives of each of the Bureau's divisions and services.
Personnel of the Bureau, as well as other senior officers of the Health Branch,
participate actively in the bi-annual meetings of health unit directors and senior medical
health officers of metropolitan areas. Led by the Deputy Minister and the Bureau
Director, these meetings are conducted in an informal manner, permitting frank discussion
and comment. They provide opportunities for review, modification, and formulation of
policies and programmes.
Brief descriptions of the divisions and services within the Bureau follow. DEPARTMENT OF HEALTH AND WELFARE,  1951 X 21
Division of Health Units
The development of local public health programmes, through the formation of
health units to serve all populated areas of the Province, is the responsibility of this
Division. Under authority of the " Health Act," several organized municipal governments and School Boards may unite their local Boards of Health to form a Union Board
of Health which will provide all community and school health services through a health
unit.
British Columbia has an area of 366,255 square miles and a population of 1,153,000.
Approximately half the total population lives in and around Vancouver and Victoria,
with most of the remainder living along the main transportation routes or in the cultivated valleys and agricultural areas. The metropolitan areas of Greater Vancouver and
Victoria-Esquimalt have their own city health departments. The former is divided into
six health units, and the latter is comprised of one health unit. Although the activities
and programmes of these metropolitan services are closely co-ordinated with those of
the Provincial service, they do not come under the direct jurisdiction of the Health
Branch.
Outside the boundaries of Greater Vancouver and Victoria-Esquimalt, the Province
is served by eighteen health units, to which the Health Branch, through the Division of
Health Units, provides direct guidance and consultative service. Each of these eighteen
units is, in effect, a modern local health department staffed by full-time public-health-
trained personnel serving one or more population centres and the rural areas adjacent
to them. To simplify the collection of local financial contributions, the geographical
area covered by each health unit encompasses two or more school districts which serve
as the local " tax-collecting " agencies. However, it should be understood that school
health services are only a part of the total programme. A fixed annual assessment of
30 cents per capita is collected as the local contribution, and the difference between this
and the actual operating cost is borne by the Provincial Health Branch.
Each Union Board of Health, composed of representatives of the participating
municipalities and School Boards, meets quarterly. The director of the health unit, who
is the local medical health officer, acts as secretary of the Board.
Professional, technical, and clerical staff of the rural health units are employed as
Provincial Government Civil Servants in order that there may be uniform personnel
policies throughout the local health services. However, appointments and transfers are
subject to the approval of the Union Board of Health and, for all practical purposes of
day-to-da'y administration and operation, staff are considered as locally employed
personnel.
The direct administration of the local services is the responsibility of the director
of the health unit, who is assisted by several public health nurses, one or more Sanitary
Inspectors, one or more statistical clerks, and, in some units, a dentist and a dental nurse.
A public health educator has been added to the " teams " in two local areas, and consideration is being given to extending this service to other health units.
Division of Public Health Nursing
In the development of health services throughout the Province, public health nurses
have usually been the first full-time personnel to serve in any area. Introducing the
public health programme and informing the people of their districts with respect to the
possibilities of more complete services, they have been the pioneers building the foundations of health units. In all but a few areas of the Province, public health nursing
service is now a part of health unit service.
The Director of the Division and the staff of consultants at Provincial headquarters
are responsible for the recruitment and, through the health unit directors, the technical
supervision of the nursing staff of local health units. X 22 BRITISH COLUMBIA
Division of Preventive Dentistry
Full-time local dental health services have been made available in certain health
units. The local programmes are arranged by the health unit staff in co-operation with
the Division of Preventive Dentistry. Services consist of examination and treatment
of pre-school and Grade I children and, where possible, Grade II children. Specially
designed portable dental equipment, developed by the Division, is used. The programme includes the educational aspects of public health dentistry.
In some areas not yet provided with full-time dental health services, dentists in
private practice conduct part-time children's dentistry programmes under contract with
local committees. The dentist receives payment from the committee, which is then
partly reimbursed by the Provincial Health Branch.
Other part-time programmes are planned to meet the needs of remote areas. For
example, where there is no resident dentist in a particular area, portable equipment may
be placed on loan to a dentist in a neighbouring community if he agrees to make regular
visits and to devote a specified portion of his time to children's dentistry.
Division of Public Health Engineering
As its name indicates, this Division is responsible for all matters requiring public
health engineering knowledge and procedures. These include community water-supplies,
sewage disposal systems and treatment plants, stream-pollution, and sanitation of
swimming-pools, beaches, and shell-fish beds.
Under the " Health Act," communities which plan to install public water-supply or
sewage systems, or to extend or modify existing systems, must first obtain the approval
of the Deputy Minister of Health. Plans for such construction are reviewed by the
Division, of Public Health Engineering, which then advises the Deputy Minister with
respect to their acceptability.
Like the staffs of other divisions at the Provincial level, public health engineers
serve as consultants to health unit directors whenever their specialized training is required
to assist in solving local problems.
Division of Environmental Management
The programme of the Division of Environmental Management includes industrial
hygiene, rehabilitation, adult hygiene, nutrition, and environmental sanitation. The
public health aspects of the Provincial civil defence programme are co-ordinated by the
Director of the Division.
Nutrition services include the provision of advice and guidance to local public health
personnel and other divisions of the Health Branch. Consultative services are made
available, on request, to institutions and other departments of Government.
Supervisory and consultative services in sanitary inspection are provided on this
basis also.
BUREAU OF SPECIAL PREVENTIVE AND TREATMENT SERVICES
The Divisions of Laboratories, Tuberculosis Control, and Venereal Disease Control
conduct specialized, generally similar, and closely related programmes of prevention and
treatment. The headquarters and central service facilities of the three divisions are
located in Vancouver. For these reasons, they are grouped in the Bureau of Special
Preventive and Treatment Services, with the Assistant Provincial Health Officer as
Bureau Director. In addition to being responsible for co-ordinating the activities of the
three Divisions with those of other Health Branch services, the Assistant Provincial
Health Officer also serves as the Deputy Minister's representative in Vancouver and the
Lower Mainland. In this capacity, he is able to give advice and guidance to nongovernment agencies conducting health programmes which are officially recognized and DEPARTMENT OF HEALTH AND WELFARE,  1951 X 23
at least partially financed by the Provincial Government. Included among such agencies
are the British Columbia Cancer Institute, the British Columbia Division of the Canadian
Arthritis and Rheumatism Society, and the Western Society for Physical Rehabilitation.
Following are brief descriptions of the three Health Branch divisions which comprise
the Bureau of Special Preventive and Treatment Services.
Division of Laboratories
The main laboratory is located in Vancouver, and branch laboratories are situated
at strategic centres throughout the Province. The Division performs all types of public
health laboratory procedures, with the more complex tests and anlyses being undertaken
in the main laboratory. Biological products are distributed free of charge to the health
units and, through the health units, to private physicians.
Division of Tuberculosis Control
In its programme for the diagnosis, treatment, and control of tuberculosis, the
Division operates and maintains the following services:—
(a) Tuberculosis hospitals located at several centres throughout the Province.
(b) Diagnostic and treatment clinics, both stationary and mobile.
(c) Survey clinics, both stationary and mobile, using miniature-film equipment.
(d) Services for the chest X-rays of patients on admission to hospitals and
out-patients, using miniature-film equipment located in general hospitals
and some health unit centres.
The Division's programme is conducted in close co-operation with local health
services whose staff arrange the schedules of travelling clinics, receive reports of
diagnostic findings for residents of the local areas, and assist in making arrangements
for further care by private physicians.
Social workers of the Welfare Branch are assigned to the Division of Tuberculosis
Control to work in the various institutions. In their duties with respect to patients and
families of patients, they function through social service staffs located in the areas of
residence.
The British Columbia Tuberculosis Society, a voluntary organization, has always
operated in close co-operation with the Division of Tuberculosis Control. The society
accepts large responsibilities in undertaking much of the publicity and in producing
educational materials on tuberculosis. Through the " Christmas Seal" campaigns, it
raises funds which are donated to local areas and the Division of Tuberculosis Control
for special projects, including the purchase of equipment and the construction of buildings.
Division of Venereal Disease Control
The Division of Venereal Disease Control operates full-time clinics in Vancouver
and part-time clinics at other centres throughout the Province. These clinics provide
diagnostic and treatment services without cost to the patient. In areas where there are
no clinics, the Division makes payments to private physicians for the examination and
treatment of indigent patients. Through the director of the health unit in each area, the
Division provides drugs and consultative services to private physicians for the adequate
treatment of all patients. Laboratory procedures and tests for venereal diseases are
performed by the Division of Laboratories.
METROPOLITAN HEALTH DEPARTMENTS
As indicated in the earlier section dealing with local health services, Greater
Vancouver and Victoria-Esquimalt operate their own large-city health departments,
which do not come under the jurisdiction of the Provincial Health Branch.   Employment
PROVINCIAL LIBRARX,
VICTORIA, A C X 24 BRITISH COLUMBIA
of personnel and the appropriation of funds to finance the services are the direct
responsibility of the city authorities.
However, there is a very high degree of co-operation in planning and co-ordination
of services with the Provincial Health Branch, which makes annual grants to these two
health departments. The Provincial Health Branch also makes available consultative,
advisory, and other services, including those of the Division of Laboratories, Tuberculosis
Control, and Venereal Disease Control.
VOLUNTARY HEALTH AGENCIES
In the large field of public health endeavour, not all services are provided by the
Provincial or municipal authorities. Earlier reference has been made to the invaluable
programmes conducted by voluntary agencies for the benefit of cancer patients, severely
crippled persons, and those suffering from arthritis or rheumatism. In British Columbia
the important and well-established voluntary agencies have appointed Health Branch
representatives to their governing bodies. Such representation has done much to produce
balanced programmes and to eliminate duplication of services. Because of their important
place in the field of public health, the major voluntary agencies receive substantial grants
from the Health Branch.
In conclusion, it should be emphasized that a public health programme cannot
remain static and still continue to meet the needs of the people whom it is intended to
serve. As a result, any administrative plan, designed for the efficient conduct of the
services, must be flexible, and administrators must make continual changes in it. Thus,
although the foregoing description of Provincial Health services may continue to be
a reasonably accurate and complete summary for some time, it cannot be a final
statement. DEPARTMENT OF HEALTH AND WELFARE, 1951
X 25
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1 X 26 BRITISH COLUMBIA
REPORT OF THE HEALTH BRANCH OFFICE, VANCOUVER AREA
G. R. F. Elliot, Assistant Provincial Health Officer
BUREAU OF SPECIAL PREVENTIVE AND TREATMENT SERVICES
The Bureau of Special Preventive and Treatment Services includes the Divisions
of Laboratories, Tuberculosis Control, and Venereal Disease Control, all of which are
located in Vancouver. This Bureau assumes responsibility for co-ordination between
these services, as well as between them and the local health services. General administrative matters continue to be referred directly to the Deputy Minister of Health by these
three Divisions.
The Bureau is also actively associated with certain official voluntary health agencies,
which receive substantial grants from the Provincial Government, and which have
their Provincial headquarters in Vancouver. These organizations, such as the British
Columbia Cancer Foundation, British Columbia Division of the Canadian Arthritis and
Rheumatism Society, and the Western Society for Physical Rehabilitation, are making
a valuable contribution to the health of the people of the Province. It is advisable,
therefore, that the Government be aware of their activities, and that such specialized
services be co-ordinated with the general public health services available throughout
the Province.
FACULTY OF MEDICINE, UNIVERSITY OF BRITISH COLUMBIA
Close liaison has been maintained with the Dean and the Assistant to the Dean of
the Faculty of Medicine, University of British Columbia, and frequent discussions were
held with regard to the curriculum in the teaching of preventive medicine. Guidance
and advice were given by the Dean and the Assistant to the Dean regarding the
management of the National Health Grants as they affect the University of British
Columbia.
With the appointment of a full-time Professor of Pediatrics during the latter part
of the year, and the resultant effect of his ability, it would appear that further progress
will be made in the development of a more complete child health programme in this
Province. The time and advice of the Professor of Paediatrics have been sought on
many occasions, and they have been most freely given.
VOLUNTARY HEALTH AGENCIES
The voluntary health agencies located in the City of Vancouver, which receive
grants from the Provincial Government, continued to receive close supervision, and
once again it is felt that the programmes of these organizations are sound and the money
invested in them by the people of this Province, through the Provincial Government, is
well spent.
The activities of the British Columbia Cancer Foundation, the 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 existed. Budgets are reviewed
with great care, and its is felt that economy is being practised in a reasonably satisfactory
manner.
In addition to these organizations, limited time was given to the Vancouver
Preventorium, the Greater Vancouver Health League, and other similar organizations
related to health matters in the Province of British Columbia. During the year frequent
visits were made to all major hospitals in the Vancouver and Victoria areas on
Departmental matters, such as the co-ordination of the Provincial Biopsy Service and
the requests for assistance from the National Health Grants. DEPARTMENT OF HEALTH AND WELFARE,  1951 X 27
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. Funds are provided by the Cancer Control Grant of the National
Health Grants and by the Province of British Columbia on an equal basis to pay the
operating expenses of the main diagnostic and treatment centre, known as the " British
Columbia Cancer Institute," and the nursing home, both located in Vancouver, and of
the consultative and diagnostic clinics located throughout the Province. The consultative
clinics mentioned in the 1950 Annual Report continued operation at seven points in
the Interior. Additional clinics are planned for Prince George and Prince Rupert in the
near future.
During the latter part of the year a treatment centre of the British Columbia
Cancer Foundation was opened at the Royal Jubilee Hospital in Victoria. The opening
of the Victoria Cancer Clinic was delayed somewhat, due to the lengthy discussions
between the British Columbia Cancer Foundation, the Victoria Medical Association,
and the Royal Jubilee Hospital before satisfactory arrangements were finalized.
The building adjacent to the British Columbia Cancer Institute, which is being
constructed by the British Columbia Cancer Foundation, using private funds, is well
under way and should be in operation around the middle of 1952. The cost of this
building will approach $750,000. The operating costs of the expanded services made
possible by this building will also be borne by the matching Cancer Control Grant of
the National Health Grants. Purchase of equipment will be from the same source
of funds.
Provincial Biopsy Service
This service remains an integral part of the cancer-control programme and
continues to be most satisfactory to all concerned, as well as extremely popular with
the practising physician. To the biopsy service, which is chiefly concerned with the
diagnosis of solid tissues, a service for diagnosis of cells in fluids was added on the same
free basis to the patient. This service is known as the " Cytological Service " and is
carried out at the Vancouver General Hospital. It is interesting to note that this
cytology service was originally developed by a voluntary agency, but, when its usefulness
was proven, became an integral part of the Provincial Biopsy Service.
Western Society for Physical Rehabilitation
During 1951 the Western Society for Physical Rehabilitation has greatly expanded
the services and facilities of the Rehabilitation Centre. This expanded programme has
been made possible by the addition of a new wing to the centre, which was opened late
last year. Included in this wider programme was the engagement of a combined social
worker and vocational placement officer, and the commencement of an institutional
training programme for academic and vocational training.
The brace-shop established in the centre this year has been doing excellent work.
In order to keep up with the demand for orthopaedic appliances, the society is arranging
to train another brace-maker in the brace-shop.
This summer arrangements were made for the medical branch of the Canadian
Arthritis and Rheumatism Society to be housed in the Rehabilitation Centre. In addition,
space and facilities were allocated the medical branch for the treatment of arthritics on
an in-patient and out-patient basis.
Canadian Arthritis and Rheumatism Society (B.C. Division)
This organization continues to show satisfactory expansion, with an increasing
number of patients being served during the year.    Since the opening of the first clinic X 28 BRITISH COLUMBIA
in March, 1949, some 2,700 patients have received care.   The total number of patient-
visits made was 48,808, of which 22,678 were made this year.
An additional stationary clinic was established at the Royal Columbian Hospital,
New Westminster, during the year. This brings to a total of ten the number of units
in operation which combine stationary clinics and mobile services. The mobile service
operating out of Vernon was extended to Salmon Arm, and an additional mobile service
went into operation in the North Fraser Valley. This makes a total of six areas in the
Province receiving the mobile service only.
A total of thirty employees is now serving this agency, including a medical director,
sixteen physiotherapists, one orthopaedic nurse,, and one social service worker. A shortage
of qualified physiotherapists has delayed the opening of the mobile services to some
extent, but in general the expansion programme has been satisfactory.
It is interesting to note that this organization had a most successful drive for funds
in 1951, as compared to 1950, when the response from the public for financial assistance
was not marked.
CIVIL DEFENCE
Civil defence continues to demand a fair amount of time. A Civil Defence Forum
in Hull, Que., under the auspices of the Department of National Health and Welfare, was
attended by the Assistant Provincial Health Officer during the year. The annual meeting
in Toronto of the National Disaster Services of the Canadian Red Cross was also attended
during the year. Numerous lectures on atomic, biological, and chemical warfare, and
the medical implications, were given to both official and non-official agencies.
A physical survey related to actual hospital beds, accommodation suitable for
hospital beds, and accommodation for other purposes, such as evacuee accommodation,
was completed in co-operation with local health services for the Province. These findings
were tabulated on master sheets and placed in strategic centres throughout the Province.
A similar survey related to medical and allied medical personnel in the Province was also
carried out, tabulated, and decentralized in a similar manner. This office worked throughout the year in close co-operation with the Provincial Civil Defence Committee in matters
relating to the medical aspects of civil defence.
NATIONAL HEALTH GRANTS
General
Through the National Health Grants $2,923,150 has been made available to British
Columbia for the fiscal year 1951-52. The basis of allocation of these grants to the
Provinces remained unchanged for the fiscal year 1951-52 from that of the previous year,
with the exception of the General Public Health Grant, which increased again this year
from 45 cents per capita to 50 cents per capita, making an additional amount of $67,700
available to British Columbia. The total amount voted by the Federal Government also
remained unchanged, except the Public Health Research Grant, but due to the variable
factors included in the basis of allocation to the Provinces, there was a slight reduction
in the amount allocated to British Columbia under the grants for crippled children,
professional training, mental health, cancer, and hospital construction. The net increase
in total funds available this year was $63,809.
The regulations governing the National Health Grants this year made it possible
to request the Federal Treasury to transfer funds not allocated in one grant to the credit
of other grants to meet the costs of any special or expanded programme. An amount of
$89,330.53 was therefore transferred from the Cancer Control Grant, $76,953 being
credited to the General Public Health Grant and $12,377.53 to the Professional Training
Grant. As a result, new developments were possible which might otherwise have had
to be delayed due to lack of funds. DEPARTMENT OF HEALTH AND WELFARE,  1951
X 29
Administration
In view of the fact that over 75 per cent of the funds available this year, excluding
the Hospital Construction Grant, were allocated to continuing projects, it was decided
that some control should be exercised in future years in order to ensure that sufficient
funds would be available for new or extended services. Accordingly, steps have been
taken to reduce the amount required for continuing projects in 1952-53 by approximately 25 per cent from that required for the current year, in so far as it is practicable
to do so. This will mean the transfer to the regular budget of both Government and
non-government agencies of a portion of the expenditures now being charged to Health
Grants projects.
The Department of National Health and Welfare compiled and issued in October
a Reference Manual outlining the various policies and administrative procedures that
have been developed since the inception of the National Health Grants programme.
A draft copy of this Manual was reviewed with Dr. F. W. Jackson, Director, Health
Insurance Studies, in May of this year, when he visited this Province. This Manual
introduced some principles which are either new or which have not been followed in the
past, but it is intended that these will be brought into effect gradually in order not to
seriously affect any programme presently in operation. It is also noted that where the
regulations could not apply, or where strict adherence to these rules would not serve the
best interests of the programme, such a project may be referred to the Minister of
National Health and Welfare for special consideration.
Grants Received Year Ended March 31st, 1951
Total expenditures were $1,701,011 or 59 per cent of the total available, as
compared to $1,310,311 or 49 per cent of the total available for the year 1949-50.
This increased use of available funds was reflected generally in all of the grants. In
addition, the figures supplied by the Department of National Health and Welfare indicate
that the percentage of total funds available which was allocated for approved projects
or expended was higher for this Province than the average for all Provinces as a whole.
The amount available under each grant for the year ended March 31st, 1951, is
given in the following table, together with the amount allocated for approved projects
and the actual expenditures:—
Comparison of Amounts Approved and Actual Expenditures with Total Grants
for the Year Ended March 31st, 1951
Grant
Total Grant
Approved
Actual Expenditures
Amount
Per Cent
Amount       Per Cent
Total  	
$2,859,341
43,231
43,231
1,099,075
43,231
429,096
363,996
2,030
38,243
501,300
295,908
$2,086,778
31,485
42,889
646,374
43,231
368,035
361,920
2,030
14,500
457,115
119,199
73
73
99
59
100
86
99
100
38
91
40
$1,701,011
26,403
39,799
443,033
43,231
309,307
328,208
1,719
12,835
384,238
112,238
59
61
92
40
100
Mental Health ...	
72
90
85
34
77
38
Present Status
Plans are well advanced this year for the use of the National Health Grants, as
evidenced by the fact that by the end of the first six months of the current fiscal year
over 80 per cent of the total available, excluding the Hospital Construction Grant, had X 30 BRITISH COLUMBIA
been allocated for approved projects.    This includes continuation of the assistance given
to agencies outside the Provincial Government.
Expenditures should also exceed the total for previous years, due mainly to the large
amount approved for continuing projects, which in most cases have already been implemented completely. Some difficulty is still experienced in obtaining prompt submission
of accounts, which is important if full advantage is to be taken of approved funds.
General information regarding the distribution of each grant is given in the following
sections of this Report. Further information is also available in the annual report on
the National Health Grants to British Columbia, which is prepared for each fiscal year
and submitted to Ottawa.
Crippled Children's Grant
As a result of the survey of crippling diseases of children conducted in 1949-50
under this grant, the sub-committee of the Crippled Children's Grant recommended that
a registry of crippled children be set up, and that a panel of specialists on the various
aspects of crippling diseases of children be formed to advise on the implementation of
the recommendations of the survey report.
At the first meeting of this panel on May 9th, 1951, it was explained by the chairman, Dr. D. Paterson, that the function of the panel would be to advise as to the type
of cases to be registered and, after registration, to advise as to plans for treatment.
The registry is to be a voluntary one, cases being reported from the private physician,
hospital, and public health authorities.
The Registry of Crippled Children was formally established in August and is
located at 2670 Laurel Street, Vancouver. General supervision and assistance is given
to the registry by the Assistant Provincial Health Officer, although direction of the
programme is under the sub-committee appointed under the Crippled Children's Grant.
Dr. J. F. McCreary, Professor and Head of the Department of Paediatrics, Faculty
of Medicine, University of British Columbia, has been appointed a member of this
sub-committee.
Work is now proceeding in the more detailed follow-up of cases in the Trail and
district area, which were selected for a pilot study in the organization of the registry.
Close liaison is maintained with the local medical profession and public health services.
In addition to providing funds for the Registry of Crippled Children, this grant
has also assisted various agencies providing services for children.
A training course for orthoptic technicians was instituted early in the year at
the Health Centre for Children, Vancouver, in order to provide sufficient staff for the
treatment of the appreciable number of strabismus cases in the Province, as indicated
by the survey of crippling diseases of children. Personnel are not being trained at any
other centre in Canada. Four technicians who have been in training at the Health
Centre for Children are expected to become qualified by the American Orthoptic Council
this year.
Assistance to the Western Society for Physical Rehabilitation, Vancouver, was
continued for the retraining and rehabilitation of poliomyelitis patients, and this year
an essential service has been added in the establishment of a brace-shop where orthopaedic
appliances are manufactured and fitted for these patients. Through the Professional
Training Grant, it was possible for the brace-maker to spend four weeks in the Prosthetic
Services Department, Department of Veterans' Affairs, Sunnybrook Hospital, Toronto,
in order to give him advanced experience in the manufacture and fitting of braces.
Professional Training Grant
It would appear that the peak of the demand for postgraduate training has been
passed, and that the number of applicants for such assistance may now be expected to
become more or less stable over the next few years.    Evidence of this is seen in the DEPARTMENT OF HEALTH AND WELFARE,  1951 X 31
fact that the number of persons presently undergoing training has decreased over that
for previous years. The number of persons completing training during the calendar
year 1951 has also decreased over that for 1950, as will be seen by the following
table:—
Number of Persons Completed Training and Total Expenditures,
Years Ended December 31st, 1948 to 1951
Number of Persons       Total Expenditures
Year ended December 31st, 1951  38 $86,923.41
Year ended December 31st, 1950  51 91,358.36
Year ended December 31st, 1949  29 52,276.84
Year ended December 31 st, 1948  2 2,513.28
Totals   120 $233,071.89
The above table includes all persons trained under the National Health Grants. As
in former years, it was necessary to take advantage of that provision in the regulations
which enables other grants to be used for professional training in a particular field, such
as in mental health.
This year three projects provided in-service training, each of a distinctive type.
In April Dr. H. S. Mustard, Executive Director, State Charities Aid Association, New
York, conducted in Victoria a four-day institute for the local health personnel from all
parts of the Province. Assistance is being given for one year to the Registered Nurses'
Association of British Columbia toward the itinerant educational programme conducted
by them, whereby a well-qualified instructor lectures to all graduate nurses in the smaller
communities in the Province in order to keep them up to date on techniques, drugs, and
equipment.
The third type of in-service training was the course on food technology, given during
the winter of 1950-51 and arranged by the Canadian Institute of Sanitary Inspectors
(B.C. Branch), in co-operation with the University Extension Department and the Provincial Health Branch. Lecture notes were mimeographed and distributed to those
Sanitary Inspectors who were unable, on account of their location, to attend the weekly
lectures in Vancouver. A second course under the same auspices, entitled "Administration in the Public Health Programme," is being given during the winter of 1951-52.
The subjects for the lectures have been chosen to give the Sanitary Inspectors a wider
knowledge and better understanding of general public health principles and administration.
Hospital Construction Grant
Two important changes which were made in the regulations governing the Hospital
Construction Grant for the year 1951-52 widened considerably the basis of assistance
under this grant. Nurses' residence accommodation, combined laboratories, and community health centres are now eligible for assistance. A combined laboratory is defined
as one contained in or connected with a hospital which provides public health laboratory
services in conjunction with diagnostic laboratory service to both out-patients and
in-patients of a hospital. A community health centre means an institution or establishment providing health services, and includes approved out-patient departments or
additions thereto, and floor areas for diagnostic and treatment services which are
available to out-patients as well as in-patients.
Close co-operation is maintained with the British Columbia Hospital Insurance
Service. This is particularly important, in view of the direct interest which the Provincial
Health Branch has in the provision of public health laboratory services and community
health centres, including out-patient departments.
The rate of allocation of funds under this grant remains fairly steady, due largely to
the limitations imposed by the requirement that the Federal Grant portion must not exceed X 32 BRITISH COLUMBIA
one-third of the total cost of construction, that the Province must contribute an amount at
least equal to that allocated from the Federal Grant, with the remainder of the funds
coming from Provincial Government, municipal or other sources. However, there is
a definite increase this year in the amount claimed, indicating satisfactory completion of
the large number of construction projects initiated in 1948 and 1949.
Venereal Disease Control Grant
This grant is on a matching basis, and the total amount is therefore paid to the
Province as expenditures by the Province on the control of venereal disease are considerably in excess of the amount of the grant, and the standard and extent of service
given during the year 1948-49 is maintained. As all services for the control of venereal
disease in British Columbia are provided by the Provincial Government, the Annual
Report of this Division constitutes the report on the use made of this grant.
It should be pointed out, however, that the funds made available through this grant
are not automatically absorbed into the normal operating expenses of this Division.
A fairly large proportion of the grant is held, for the inception of new services. As a result,
this year it has been possible to expand the limited blood-testing service available in the
down-town area of Vancouver to one for both diagnosis and treatment. This clinic is
located in the same offices as one of the health units for Vancouver City, and is in the area
which is a central focus point for the spread of venereal disease infection. Particular
reference to the establishment of such a clinic was made by Dr. D. H. Williams in his
survey of the programme of venereal disease control in British Columbia.
Mental Health Grant
This grant is of benefit primarily to the British Columbia Mental Health Services,
Department of the Provincial Secretary. The majority of projects are initiated under the
Director of the Mental Health Services, who also reviews all proposed projects which will
be administered by other departments or agencies.
The most important new service is the Crease Clinic of Psychological Medicine,
which was officially opened to receive patients on January 1st, 1951. Through this grant,
technical staff is being provided, as well as a large amount of equipment, during this fiscal
year and the previous ones. A rehabilitation service to assist male patients to secure
suitable employment on discharge has also been inaugurated by the British Columbia
Mental Health Services.
All Provinces, through their share of this grant, contributed to the cost of producing
the film " Breakdown." This was filmed at the Provincial Mental Hospital, Essondale,
and released in the spring of this year.   A second film on " Old Age " is now being made.
Assistance is being continued to the University of British Columbia, the mental
hygiene programme in the Cities of Vancouver and Victoria, the psychiatric services in
the Vancouver General Hospital, and to the training of additional public-school teachers
as mental health co-ordinators.
Tuberculosis Control Grant
The Tuberculosis Control Grant is similar to those for Mental Health and Venereal
Disease Control, in that the majority of the services for tuberculosis are provided by the
Provincial Government, and the largest proportion of this grant therefore is allocated to
these services. Detailed information regarding these services is given in the Annual
Report of the Division of Tuberculosis Control, and reference is made here only to new
developments or expansion of services.
A Medical Records Section has been established in the Division of Tuberculosis
Control. A qualified medical records librarian, who recently completed training under
the Professional Training Grant, was appointed in September to organize the section. DEPARTMENT OF HEALTH AND WELFARE,  1951 X 33
Co-ordination and supervision of all medical records of the various services of the
Division will be the responsibility of this Section. Although in effect only a few months,
present indications are that the usefulness of this Section will be evident in a comparatively
short time.
Services have been expanded at the Willow Chest Centre, as the Vancouver unit of
the Division is now known, by the establishment of a pneumothorax clinic in the health
unit office of the Metropolitan Health Committee of Greater Vancouver, which serves the
down-town area. It was decided to decentralize this service, which has previously been
given only at the Willow Chest Centre, in order to make it available to the large number
of tuberculous patients who live or work in this district. In addition, the clinic at Willow
Chest Centre had reached its capacity, an average of fifty patients attending each afternoon, and there was no space here for a second clinic. As previously mentioned, under
the Venereal Disease Control Grant, this brings together generalized public health services
and specialized treatment services for venereal disease and tuberculosis.
By means of pulmonary function investigation, it is now possible to predict to what
extent a surgical procedure may affect the functioning of the lungs and to ascertain that
a patient will not become a " pulmonary cripple " as a result of lung surgery. In order
to carry out such investigation at the Willow Chest Centre, a Department of Respiratory
Physiology has been set up. This work will be under the direction of a well-trained
physician on the staff who has been carrying on similar work for the past two years at the
McGill University clinic.
Further improvement in the care of surgical patients in this institution will result
from the employment of a physiotherapist. There is now wide acceptance in chest
centres of physiotherapy as a necessary adjunct to chest surgery both in the pre-operative
preparation of the patient and in the post-operative period of recovery.
As part of the programme of hospital-admission X-rays, the Student University
Hospital in the recently completed Wesbrook Building is being equipped with diagnostic
X-ray equipment to be operated under the jurisdiction of the Faculty of Medicine. In
addition to being used for hospital-admission X-rays, this equipment, in co-operation
with the Metropolitan Health Services of Greater Vancouver, will be used for chest
X-ray surveys of faculty, students, and other residents of this area. This service will
supplement and wisely decentralize such chest X-ray services now in operation in
Vancouver, and will establish a new diagnostic service and association with the preventive medicine programme of the University of British Columbia.
Public Health Research Grant
The project approved in 1949 under this grant for a study of the evaluation of
the antigenicity of cholera vaccine in fluid media was completed this year. The detailed
report is not yet finalized, but a summary of the work done during the past year is
included here.
Following upon the work published in the Canadian Journal of Research, E, 28:
257-261, by Ranta and McLeod, cholera vaccines prepared in a synthetic fluid medium
were examined for protective activity by a 50-per-cent end-point mouse musin test. The
results of these experiments will be offered for publication by Ranta and McCreary. It is
apparent cholera (fluid) vaccine is not as stable as cholera (standard) vaccine. Moreover, in identical concentrations, the protective activity of cholera (fluid) vaccine is
slightly less than that of cholera (standard) vaccine. The significance of the difference
remains to be statistically analysed.
Two research projects have been initiated this year in widely separated fields of
public health.
Under the direction of Dr. J. R. Adams, Department of Zoology, University of
British Columbia, an investigation of the cause of schistosome dermatitis has been
2 X 34 BRITISH COLUMBIA
undertaken. It is known that bathers in lakes in various parts of British Columbia
have been troubled with " swimmers' itch," presumably schistosome dermatitis, and
the purpose of this investigation is to examine these and other reports to determine if they
are of cercarial origin. With this point demonstrated, it will be possible to determine
the snails which harbour the infected cercariae and to identify the cercariae. Such
information is required as a basis for possible control measures or public information
on the means to eliminate or avoid this nuisance.
Intensive studies were made during the past summer at Cultus Lake, and sufficient
information obtained to enable laboratory investigations to be carried out during the
winter on possible chemical means of control. Very satisfactory progress has been made
in this research study.
The purpose of the second project approved under this grant is to endeavour to
obtain the best means of controlling skin infections in the new-born. Under the
Department of Obstetrics and Gynaecology of the Vancouver General Hospital, the
comparative value of present control measures in the hospital nurseries is being studied
with other recognized methods used to control pyoderma neonatorum in order to establish
the efficiency of a simple technique of skin-care for use in the smaller isolated hospitals
as well as in the larger ones. This research was not undertaken until September of this
year, but progress has been made in the collection of basic information.
Health Survey Grant
Funds were provided under this grant to enable each Province to survey existing
health services and facilities and to study ways and means of improving same. The survey
in British Columbia has been completed, and the report is in the final stages of preparation.
At the 1951 spring session of the Legislature, the "Psychiatric Nurses Act" and
the " Practical Nurses Act" were passed. This legislation, which was drafted by the
Committee on Nursing Services in British Columbia, provides for the licensing of these
two groups. The " Psychiatric Nurses Act," which provides for mandatory licensing
as from September 1st, 1951, is administered by the Department of the Provincial
Secretary. Due to circumstances, it was considered advisable to make provision only for
voluntary licensing in the " Practical Nurses Act," the administration of which is under
the Department of Health and Welfare.
General Public Health Grant
An additional amount of $144,653 is available under this grant during the current
fiscal year owing to the increase in the per capita basis of the allocation between Provinces
and the transfer of funds from the Cancer Control Grant. Due primarily to the large
expansion of local health services in previous years, practically the full amount of the
original grant of $569,000 was required for continuing projects. The transfer of funds
from the Cancer Control Grant, therefore, made possible certain new developments.
Provision was made for the appointment of a Director, Division of Environmental
Management, and this Division was set up under the Bureau of Local Health Services in
July of this year. Funds were also provided for the appointment of a Director, Division
of Health Units, but this appointment has not yet been made.
A convalescent nursing service has recently been established by the North Okanagan
Health Unit to make possible earlier discharge of patients from hospital. This is to be
a pilot study in order that information will be available as to whether or not further
consideration of such a service throughout the Province is warranted. It was therefore
considered advisable to limit the service to the Vernon City area.
Detailed information in regard to these new services, as well as to the assistance
provided the local health services, is given in the section of this Report on the Bureau of
Local Health Services. DEPARTMENT OF HEALTH AND WELFARE,  1951 X 35
One of the most important new developments, and one which will have widespread
benefit, is the project to enable the University of British Columbia to implement its plans
for the expansion of the Department of Bacteriology. These plans, which have been put
into effect during the current academic year, will permit students to begin the study of
bacteriology in their first year at the University, will prescribe a course in technique in
their second year, and will offer a wider choice of specialized studies in their last two
years. The Department also anticipates being able to double at least the output of
graduates with a degree in bacteriology.
The Department of Bacteriology and Preventive Medicine of the University of
British Columbia is the main source of qualified bacteriologists in this Province. Although
making every effort to do so, it has been unable to supply sufficient graduates to fill all
the vacancies in public health, hospital, and private laboratories, as well as in the Canadian Red Cross Blood Transfusion Service. The project is designed primarily to ensure
a greater supply of senior technicians, both men and women, with a real understanding
of scientific principles. Within a few years, benefits of widespread significance to public
health in Canada may well result, while substantial advantages in terms of quantity and
quality of graduates should become apparent by the end of the academic session of
1951-52.
Cancer Control Grant
The amount of the grant received from the Federal Government is substantially the
same as in the previous year, but as this is a matching grant and an increased amount has
been provided by the Province, a total of $400,000 is available for the year 1951-52.
Approximately one-half the amount available is required for the operating expenses
of the services provided by the British Columbia Cancer Foundation, which has been
named as the agent of the Province of British Columbia in the provision of cancer-control
services. The volume of work has increased in all branches—namely, the British
Columbia Cancer Institute and the Boarding Home, Vancouver, and the consultative
clinics held periodically in seven cities in the Interior of the Province.
Services were expanded by the establishment of the Victoria Cancer Clinic, which
will function as a unit of the British Columbia Cancer Foundation, and which is located
in the Royal Jubilee Hospital. This clinic will provide cancer services for the residents
of. Lower Vancouver Island which were not previously available to them. The services
will conform to the high standard already set by the British Columbia Cancer Foundation
and will be integrated with other services being developed by the Foundation throughout
the Province. As the Victoria Cancer Clinic is actually an expansion of the former
weekly diagnostic clinic, utilization of the present qualified staff and existing suitable
facilities at the Royal Jubilee Hospital will forestall any duplication of these services.
An important addition to treatment facilities in this Province is the purchase of a
cobalt 60 beam therapy unit, funds for which are being provided from this grant. The
unit will be located in a new out-patient diagnostic and treatment centre presently under
construction adjacent to the present quarters of the British Columbia Cancer Institute.
Acknowledgment
In conclusion, one must pay tribute to the valuable assistance and co-operation
received from officials of the Department of National Health and Welfare, the Provincial
Health Branch, the Department of the Provincial Secretary, particularly the Provincial
Mental Hospitals staff, and the Commissioner and staff of the British Columbia Hospital
Insurance Service.
Harmonious working relationships exist with the city health departments of Vancouver and Victoria, the voluntary health organizations, and general and specialized
hospitals, with all of whom this office has been in contact during the year. X 36 BRITISH COLUMBIA
REPORT OF THE BUREAU OF LOCAL HEALTH SERVICES
J. A. Taylor, Director
ADMINISTRATION
As the society in which public health functions is constantly changing, so the scope
and content of those public health services must be subject to some change, sometimes
slowly, other times rapidly. In this Province the public health service has experienced
those changes in function and in pace, brought about in an endeavour to meet the health
needs and demands of the municipalities and school districts in which local health services
function.
One major administrative change that took place within the Bureau of Local Health
Services during the year was the development of the Division of Environmental Management, which had its origin in the need and desire for the development of some public
health programme within the field of industry. Initially, this Division was planned to
promote a programme of industrial hygiene, but this has become enlarged in scope to
deal with the larger field of environmental conditions, as exemplified in civilian defence,
medical-care problems, and- sanitation. With this development there has been reorganization of existing Divisions, with the transfer of sanitary inspection services from the
Division of Environmental Sanitation to the Division of Envronmental Management,
while nutrition services come definitely within a division for the first time. The Division
of Environmental Sanitation, as such, becomes renamed the Division of Public Health
Engineering.
The Local Health Services Council, which was established a year ago, composed of
representatives of the separate divisions under the Bureau of Local Health Services, has
continued to function throughout the year, and is proving its value in the proposal and
recommendation of policies and programmes which will prevail in the field. It has
assumed as its major task for the moment the compilation of a Local Health Services
Policy Manual, which will outline and enumerate the various functions and responsibilities of the official agencies and personnel within local health services, so that a definite
reference manual will be available for the future. This is a time-consuming task which
may require several years to bring to fruition.
The bi-annual meeting of the full-time Medical Health Officers has been continued,
held again in March and September. The first meeting, as usual, convened during the
annual Public Health Institute, when an opportunity presented itself to have Dr. Harry
Mustard, former Dean of the School of Public Health at Columbia University, review the
local administrative problems and offer his comments on the handling of them. During
the fall conference the group discussed administrative problems as related to the field
service, aired the various points, and made recommendations for the guidance of the
Department in framing programmes, policies, and legislation. The meeting was extremely successful in providing all parties with an opportunity to present their comments
and suggestions toward improvement in the administration and development of the local
health services.
This year, Dr. L. Ranta, Assistant to the Dean of Medicine, University of British
Columbia, attended as an interested observer, anxious to gain as much information as
possible in relation to the public health problems and services, to serve as a guide in his
organization of the subject in the curriculum taught to the medical students in the Faculty
of Medicine. For the reason that he is so intimately associated in the teaching of the
subject, and since he is qualified to speak on many technical aspects of public health, a
motion of the conference was unanimously approved appointing him as a future active
member of the Health Officers' group to sit in on all future conferences as a participating
representative. DEPARTMENT OF HEALTH AND WELFARE,  1951 X 37
DEVELOPMENT AND EXPANSION
Although no new health units were formally organized during the year, consolidation
of the existing units with expansion of their boundaries did take place, while negotiations
toward the establishment of the formation of a unit for the Kamloops area and one for
the Surrey-Delta area were advanced with the recruitment of qualified public health
physicians. It would now seem very definite that these latter two units will come into
being early in January, 1952, thereby providing fifteen of the planned eighteen health
units. It was particularly gratifying to inform the Surrey Public Health Advisory Committee that its desires of the past ten years could now be finalized in the establishment of
its unit. As a commencement it is suggested that this unit embody the Municipalities of
Surrey and Delta to include School Districts Nos. 36 and 37. The headquarters will
become centred in Cloverdale, in the public health centre which was built by the far-
sighted Gyro Club of that area some years ago.
The recruitment of a physician for the Kamloops area is well along in the negotiation
stage, and it is proposed that plans will now be laid before the Councils and School Boards
in the planned unit area, outlining the steps which they should undertake toward the legal
establishment of their unit.
In the original planning of health units, division of the Province into potential health
units areas was designed on the basis of such factors as population distribution, school
district boundaries, geographical contours, distances of travel, and road conditions. With
these factors in mind the units were organized around at least one main centre of population, but including a number of communities or municipalities and a number of school
districts for which it was felt efficient service could be provided by a staff localized and
resident throughout the area. In the beginning it was not always possible to commence
the unit with the provision of service to the entire area, and often the unit in its initial
stages included only a part of the proposed area, on the principle that expansion to include
the ultimate area could take place as the organization became consolidated. It has been
possible during the past year to propose certain expansions to the various Union Boards
of Health, who, in co-operation with the unit staff, have brought about the expansion of
the health units to their ultimate boundaries. The first of these to occur was in relation
to the Upper Island Health Unit, which, following approximately two years of operation,
was able to expand to include Powell River, Cranberry Lake, and Westview, and School
District No. 47 (Powell River). This forward step provides for consolidation of local
health services in the Upper Island and Powell River areas under one Union Board of
Health, the service administered by the one Medical Health Officer.
The plans for the Upper Fraser Valley Health Unit, with headquarters at Chilliwack,
had originally included the Village of Hope, School District No. 32 (Hope), Municipalities
of Sumas and Matsqui, the Village of Abbotsford, and School District No. 34. At the
last reporting, mention was made that this had been a unit which had suffered a shrinkage
in size with the transfer of services to its counterpart on the opposite side of the Fraser
River. During this year, however, some of the originally planned expansion became
possible when the Village of Hope and School District No. 32 (Hope) passed the necessary by-law and resolution joining their community and school health services with the
Upper Fraser Valley Union Board of Health. There remains the further possibility of
expansion of this health unit westward to incorporate the other proposed municipalities
and school districts within its boundaries.
For some time there has been indecision in respect to placement of the Village of
Burns Lake and School District No. 55 (Burns Lake) either in the Prince Rupert Health
Unit or the Cariboo Health Unit. From the point of view of travel, it has been deemed
that the area might more efficiently be administered through the Cariboo Unit, which
already encompasses a considerable area.    It was questioned whether that unit could X 38 BRITISH COLUMBIA
feasibly assume a greater load. With this in mind, the situation was reviewed with the
Prince Rupert Union Board of Health, which pointed out the extreme difficulties that
often prevail in so far as travel to and from the main headquarters at Prince Rupert to
Burns Lake would be concerned. Following further negotiations, a decision to accede
to the request of the Burns Lake officials was made to include the area in the Cariboo
Health Unit, which became definite early in the fall with the passage of the necessary
local legislation. The Cariboo Health Unit now becomes the largest health unit in point
of area served, including School Districts Nos. 55, 56, 57, 28, and 27, and the communities of Burns Lake, Vanderhoof, Prince George, Quesnel, and Williams Lake.
In its boundaries is looming one of the largest industrial developments in British
Columbia, and it is likely that additional staff will become necessary as this development
progresses. Already an additional nurse has been placed to deal with public health
nursing in that area, and it is proposed that an additional Sanitary Inspector should be
added as quickly as possible.
The East Kootenay Health Unit, which has been operating for the past five years,
was at last able to consider expansion of its boundaries to include the newly organized
Village of Invermere, the community of Golden, and School Districts Nos. 4 and 18. As
in so many other units within the Province, there is a long travel distance between headquarters and the main northern boundary of the unit, but it is felt most practical and
logical to have the health services of that Golden-Invermere area supervised by the staff
of the East Kootenay Health Unit under the guidance of that Union Board of Health.
New communities and new school districts will receive representation on that Union Board
of Health with this consolidation.
Finally, the newest-established health unit, the West Kootenay Health Unit, which
commenced operation a year ago with its nucleus in the communities of Tadanac, Rossland, Trail, Kinnaird, and Castlegar, together with School Districts No. 9 (Castlegar) and
No. 11 (Trail-Tadanac), was able to promote its expansion to its fully planned boundaries to include the City of Grand Forks, the City of Greenwood, and School Districts Nos.
12 and 13. Actually, the latter areas would have preferred the administration of their
local health services through the South Okanagan Health Unit, which seems to be their
most logical outlet, but it was recognized that the South Okanagan Health Unit was already
of such a size that it could not effectively administer service to additional territory. As
the milkshed for the Rossland-Trail area, the Kettle Valley area very effectively fits into
the West Kootenay Unit. Consequently, the expansion was made on the proviso that
transfer of the Grand Forks-Greenwood area to the South Okanagan Health Unit be
considered at a later date, when revision of health unit boundaries are under review.
It must be recognized that unit boundaries should be subject to some review, as
changing populations and development of newer communities promote the need for
changing administration within local health services. It is proposed that such a review
should occur at least following census years, and the 1951 Census, just completed, will
present an opportunity for a population review, the limits of the unit boundaries will be
reassessed early next year, as the census figures become available. Census findings may
be a major factor influencing the expansion or contraction of the existing units and
proposals for development of others.
The health services within metropolitan areas of Greater Vancouver and Victoria-
Esquimalt are administered more or less independently by the Health Boards for each
area, but a very fine spirit of co-operation exists between those departments and the
Bureau of Local Health Services. This close liaison has been continued during the past
years, and opportunities have presented themselves for numerous consultations in respect
to health needs and services, while the senior Medical Health Officers in each case have
attended the bi-annual Health Officers' conferences to participate intimately in those
discussions. DEPARTMENT OF HEALTH AND WELFARE,  1951 X 39
PERSONNEL CHANGES
Resignation of four of the incumbent public health physicians created a serious
void in the ranks of public health physicians about the middle of the year, leading to
the question as to whether existing health units maintain operation under part-time
direction. Fortunately, the available supply of physicians improved shortly thereafter,
and it was possible to recommend replacements to the Union Boards of Health concerned
to maintain all units at full strength. It did, however, forestall the earlier planned new
units in which these new physicians could have been utilized. The Director of the East
Kootenay Health Unit, who had been on leave of absence for one year on postgraduate
study, returned to his post with that unit, thereby filling one of the vacancies. New
appointments were made to the South Okanagan Health Unit, the North Fraser Valley
Health Unit, and the Peace River Health Unit.
Leave of absence has been granted to the present Directors of the Cariboo Health
Unit and the North Fraser Valley Health Unit, effective September 1st, to permit them
to take postgraduate study toward a diploma in public health at the University of
Toronto under a Federal Health Training Grant, both of whom will return to their original
posts early in 1952. Both of these physicians have served for a period of a year or more
in the capacity of Medical Health Officer, have proved their capabilities, and were offered
bursaries for this postgraduate training in line with the policy established at the time
of their recruitment.
As has been the established Departmental policy for many years, the Director
of the newly formed Division of Environmental Management is a former health unit
director, who had served in local health services as Director of the Cariboo Health
Unit for two years, prior to his leave of absence for postgraduate study at the University
of Michigan during the past year. On his return to the Province he was immediately
promoted to the rank of director, in keeping with the policy of appointing senior officials
from personnel with field experience who are acquainted with the problems of the local
health services.
SCHOOL HEALTH SERVICES
In recent Annual Reports, repeated mention has been made of the studies that
have been going on to determine the most efficient method of providing the maximum
service to the maximum number of pupils in the matter of school medical examinations.
The study has beeen prompted mainly by a desire for reorganization of the school
medical inspections to deal with the nutritional, mental, and emotional, as well as the
physical, aspects of the pupil's health.
For the past two years the investigation has been under way in co-operation with
the Department of National Health and Welfare into the Wetzel Grid method of assessing
the physical status of children on the basis of height and weight measurements related
to chronological age, plotted on a special graphical chart. As the heights are plotted
against the weights, the child is automatically categorized into one of nine physical
types of specific body build, and he is expected to maintain that with fidelity throughout
his growing years. If, as a result of subsequent measurements, the plottings show a
deviation from this preferred channel of growth, it is argued that something must be
wrong, physically, nutritionally, or emotionally, and the child should be thoroughly
investigated.
A report on this study was prepared initially by the field director and presented
to the Department of National Health and Welfare and the Health Branch, Provincial
Department of Health. Both Departments have been giving the matter thorough consideration. Early in the year officials of the Department of National Health and Welfare
visited the Province to confer with Department officials in a study and citical analysis
of the report, resulting in a recommendation for a redrafting of the report to permit a
public release on the findings.   As a result of this review, a final report was drafted, to X 40 BRITISH COLUMBIA
be released under the title "Report of the British Columbia Wetzel Grid Study."
Essentially, the report summarized the study, recommending the continued use of the
grid in school health services as an ancillary to the physical examination by public health
nurses and School Medical Inspectors.
Arising from that work, it is proposed that grids would be made available for other
health unit areas in the future, and during the year an extension of the programme was
undertaken in the North Okanagan Health Unit, where the grids were adopted for use
in the school medical services for Grade I pupils only. Gradual expansion would
be undertaken as grids were added for the incoming Grade I classes in future years, so
that ultimately, the entire school programme would be on a grid basis. Proposals are
that a similar programme be introduced in other health unit areas in future years.
An inquiry was made during the year into the question of visual testing in schools,
in an endeavour to ascertain if the present Snellen Chart method could be improved.
This inquiry complemented a study made two years ago, when reliable information
indicated that the adequately lighted Snellen Chart was the most satisfactory method.
It was most gratifying to learn that the enquiries this year again substantiated the
properly lighted Snellen Chart as a very efficient vision-screening technique. It was
borne out that adequate illumination to approximate 10 foot-candles can be obtained
by placing a goose-neck lamp reflector on each side of the. chart 3 feet away, each lamp
containing a 100-watt daylight bulb. With this method it was definitely borne out
that few additional defects of serious import are likely to be detected through specialist
examination, and that the extra time and expense of examining every school-child along
those lines would be unnecessary and wasteful of public funds. After careful consideration of all the facts, the effectiveness of the programme, the personnel, time, and money
involved, it was recommended to continue the present Snellen Chart screening method,
coupled with parent-teacher, public health nurse referral as 'constituting the most ideal
vision-testing method for all practical purposes.
HOME-CARE PROGRAMMES
Mention has been made of the changing concepts in public health practice prompted
by the demands of a changing society. One of these departures is the development toward
a visiting-nurse programme to provide for home care of convalescent and chronically ill
patients. During the past year considerable interest has been created in this possibility
as a result of hospital-bed shortages and the need for ancillary service to both the convalescent and chronically ill patient. There have been requests from a number of communities for inclusion of this type of programme in the public health nursing field,
particularly from Parksville, Nanaimo, New Westminster, and Vernon. As it became
evident that there was need for study of this service as a practical method to augment and
supplement medical and hospital care, it was proposed that pilot studies on three different
levels be developed within local community health services, financed by Federal Health
Grants. Initially, plans were prepared toward pilot studies in the Vernon, New Westminster, and Parksville areas. Progress was most rapid in the Vernon area, where a
committee consisting of representatives from the Hospital Board, the District Medical
Society, the Union Board of Health, the City Council, and social welfare agencies, was
organized. They were all extremely interested in such a study and willing to pool their
opinions in the evolution of an acceptable plan.
The draft proposals submitted by this Committee were presented to the North Okanagan Union Board of Health and provided that:—
(a) A plan would be tried, commencing September, 1951, to assist the hospital
during its peak load from September to April. The hospital is actually
faced with a surplus demand during that period, but operated with empty
beds during the April to September summer period. DEPARTMENT OF HEALTH AND WELFARE,  1951 X 41
(b) The service would be provided to the maximum of ten patients for a stated
time-limit of about fourteen days each.
(c) The service would be confined to the City of Vernon and its immediate
environs for the present.
(d) Patients would be admitted to the service only from hospitals at first, since
the purpose of the pilot study was to determine whether the service could
lessen the load from the hospital.
(e) One public health nurse was to be added to the staff, and two or three
housekeepers to provide housekeeping service as required.
(/•)  The senior nurse of the health unit would become part-time administrator
of the home-care service, and an office would be maintained in the hospital
in which records would be kept for ready access by the doctors, where
orders could be left by the doctors for the guidance of the nurse administering service to the patients.   All charts would be kept in a special filing-
box in that office.
(g)  Early in the spring the programme would be reviewed to determine if the
hospital had benefited, if the community had obtained service, and whether
a saving had occurred by releasing patients from the hospital earlier in the
convalescent stage to carry on their convalescence at home under the
visiting nurses.
The plan was ratified by the North Okanagan Union Board of Health, which supported the view that a complete review of the total plan should be undertaken after
approximately six months' operation, when it was felt sufficient data would be available
from the charts and reports to determine whether the proposal was practical, economical,
and effective.
Discussions were also held in the New Westminster area with municipal officials and
representatives of the Union Board of Health to review the problem of nursing home-care
in that city, where already some modicum of service is provided through the Red Cross
nursing programme. As funds were becoming depleted and as proposals were being
made for changes in the service, it was felt desirable that the whole situation should be
reviewed by the health unit personnel and that the unit director submit a plan to the
Deputy Minister of Health for the development of a pilot study in which both municipal
and Provincial departments might co-operate.
Subsequently, a meeting was held in Parksville with the Village Commissioners,
Chamber of Commerce, medical profession, and others to discuss the whole gamut of
medical and hospital care in that area. A very thorough discussion on all proposals concerning the possibility of a small community hospital, an emergency-treatment centre, or
a visiting-nurse programme were reviewed. Following the meeting a report on these
various services was prepared for submission to the Village Commissioners, detailed in
respect to advantages and disadvantages of each proposal, together with submission of the
proposed costs. It was felt that the next move should be for the citizens to determine
community participation in financing the particular recommendation, being the development of the visiting-nurse programme as the most practical initial phase. This is awaiting
further representation from the community before negotiations proceed further.
COMMUNITY HEALTH CENTRES
Some encouragement toward the development of more suitably appointed office accommodation for local health services has been undertaken to provide not only administrative offices, but also suitable space for clinics in community health centres. Funds for
such purposes are available on both Federal and Provincial levels, and it is proposed that
community participation to the extent of at least one-third of the cost should be considered.   Under the plan the community health centre would be deemed to be an institu- X 42 BRITISH COLUMBIA
tion or establishment providing health services, and should include out-patient departments or additions thereto, and floor areas for diagnostic and treatment services which are
available to out-patients as well as in-patients. A health centre may be contained in, or
connect to, a hospital or may be completely detached, operating as a separate unit, providing the services, as outlined, are in effect. The building shall be designed primarily to
provide adequate accommodation for the staff of the health unit in that area and for the
operation of the health services necessary to meet the health needs of the area. Additional
accommodation for welfare services and voluntary health agencies may be desirable and
practical, and construction designed to include their accommodation would be approved,
but the additional floor-space thus required may be outside the terms under which the
grant is provided. The building, upon completion, would become the property of the local
area, the municipality or city, to be operated directly by the Council, the Union Board of
Health, or the Board of Trustees organized specifically for that purpose.
Some activity has been expressed on the part of the West Kootenay Health Unit to
provide some such centre at Trail, the North Fraser Valley Health Unit to provide a sub-
centre at Haney, the Simon Fraser Health Unit to enlarge its present community health
centre at New Westminster and to provide improved quarters at Coquitlam, and the Cariboo Health Unit to provide a sub-centre at Quesnel, while the Central Vancouver Island
Health Unit proposes to provide a community health centre at Nanaimo.
The proposals originally advanced were that the provision of a community health
centre should be originated in the community either by the municipal authorities or by
some service club to spark-plug a drive to raise community funds for that purpose. Following this, an appeal might be made to this Department, which would investigate the
possibility of obtaining joint Provincial and Federal funds to assist in the construction of
such a centre.
The greatest progress is being displayed in the Central Vancouver Island Health
Unit, where a definite proposal to build a two-story structure to house the civil defence
headquarters in the basement, the health unit staff on the ground floor, and the voluntary
organizations on the second floor is making headway. The city authorities have approved
and agreed to set aside city property on which suitably designed, adequately planned
accommodation would be constructed. Blue-prints of the building have been prepared
for study in preliminary stages, being acceptable to all parties concerned. It is hoped
further progress will permit construction during 1952.
As the year ended, definite action was being taken toward the renovation of a school
building in Coquitlam to provide well-appointed quarters for the sub-office of the Simon
Fraser Health Unit at that location. It will provide, for the first time, an opportunity for
the administrative and the clinical offices to be housed under one roof, while also adding
the additional feature of space for the newly organized dental services in that unit.
DISEASE MORBIDITY AND STATISTICS
The completed revision of the Communicable Disease Regulations came into effect
formally in January of 1951. This revision was the result of the combined opinions of
full-time Health Officers, as the proposals were discussed the previous fall during the
Health Officers' fall conference. It provides for a number of major changes in the
Communicable Disease Regulations, decreasing the quarantine period of the minor communicable infections, while promoting considerable change in the poliomyelitis and
scarlet fever isolation and quarantine periods.
A morbidity study or sickness survey, mentioned in the last Annual Report, which
got under way October, 1950, was carried to completion in October, 1951. That the
survey on the whole operated so smoothly can be credited to the public health nurses who
were assigned the task of visiting the homes to check on the accurate preparation of the
data.   The material will now be correlated and analysed by the Department of National DEPARTMENT OF HEALTH AND WELFARE,  1951 X 43
Health and Welfare, which organized the study on a National basis in each Province in
Canada. It is understood that the individual Provincial figures will be returned for the
use of Provincial departments and should be of major significance in future planning of
medical and nursing-care needs, while at the same time guiding the planning in public
health development.
In the field of communicable disease control, some mention should be made of the
studies that are going on toward the development of a practical method of oral immunization, as contrasted to the present parenteral method. Toward the latter part of the
year the Department of National Health and Welfare proposed that local health services
in this Province participate in a study of the practicability of caramel lozenges, containing
diphtheria toxin, as an effective method of reinforcing diphtheria immunization of schoolchildren and young adults. This method of approach has been under study at the
Laboratory of Hygiene in Ottawa for the past two or three years, utilizing college students
as research material. These studies indicate that it may be a practical method of reinforcing the immunity status, but it is desirable to conduct tests among certain younger
age-groups. After some negotiation, it was proposed that two series of studies be carried
on in British Columbia—one in Vancouver and one in Victoria—among two groups of
200 to 300 children in each centre. The materials and laboratory analysis will be supplied by the Laboratory of Hygiene, while the organization of the groups and the blood
collection will be the task of the health services in Vancouver and Victoria. By utilizing
one elementary school, one high school, and the Normal School or University, it is anticipated that a sufficient group of children will be collected, with parental approval, to
participate in the study.
This method of oral immunization offers very definite advantages over the present
parenteral injection method, and would be much more practical toward maintaining the
immunity status of the population. At present so few return for reinforcement immunization after the preliminary series is completed. Actually, immunity titres decrease after
three to five years, which requires that one reinforcing injection be provided. This can
be handled in the school-children, but becomes less and less practical in the high-school
groups and younger adults. Oral administration may promote more widespread participation by the population as a whole, and thereby improve the total immunity status of
the community.
Early in the year, health officials on this continent became disturbed about the
epidemic of virus influenza sweeping European countries, and immediate preparations
were made throughout Canada to provide diagnostic facilities and arrangements to deal
with any influenza outbreak that might occur in any part of the country. Instructions
were forwarded from the Department of National Health and Welfare to arrange for each
Provincial laboratory to prepare for collection of specimens from suspected cases of
influenza. The Bureau of Local Health Services, in co-operation with the Division of
Laboratories, undertook to keep each of the Medical Health Officers in British Columbia
informed on the subject, detailing the manner in which they would investigate even minor
outbreaks of influenza in their area, report them weekly to the Provincial Department of
Health, while arranging for collection of specimens to be forwarded to the Laboratory of
Hygiene in Ottawa for complete virology study. Thus a link was provided between the
local health service on the one hand through the Provincial service to the National service,
which was maintaining an active liaison with the World Health Organization and the
virus research centres in the United States.
Explosive outbreaks of this illness developed in February in the East Kootenay,
South Okanagan, and North Okanagan Health Unit areas. The major incidence was in
the Penticton, Kelowna, and Vernon areas, where the explosive outbreaks occurred,
affecting large groups of people within twenty-four hours. X 44 BRITISH COLUMBIA
The impact of the increased incidence, approaching epidemic proportions, is reflected
in the notifiable disease statistics, in which the volume of cases reported produced a rate
of 956.8 per 100,000 population, as compared to the rate of 40.4 for 1950 and 4.2 for
1949. These figures for comparison over the past three years are available in Table I,
page 46. Fortunately, the severity of the disease remained mild, resulting in recovery for
the vast majority of patients in a short period, and, consequently, there was not the same
comparative increase in mortality from influenza, there being comparatively few deaths,
confined for the most part to the aged, in whom associated complicated factors were
responsible.
The total volume of notifiable diseases was increased to a new rate of 4,100.5, as
compared with the rate of 3,569.1 for the previous year. In many respects this volume
was increased partly due to the marked upward trend in influenza, but also by increases in
the minor communicable diseases—namely, chicken-pox (578.5 per 100,000 population)
and measles (543.7 per 100,000 population). There was a significant decrease in the
incidence of mumps, from a rate of 758.7 per 100,000 population for 1950 to a rate of
506.0 per 100,000 for 1951. The epidemic of rubella which was evident in 1950 (697.3
per 100,000 population) showed a downward trend (198.4 per 100,000 population).
The upward trend in the number of cases of whooping-cough, noted last year (152.9
per 100,000 population) as being the highest recorded in the past five years, dropped
considerably (98.3 per 100,000 population), but is still somewhat higher than is deemed
necessary if preventive measures were more widely adopted. This disease is most serious
in the first two years of life, when mortality from its effects are more common, and
definite protection can be provided through early and repeated immunization. Fortunately, this group of the population seems to be relatively well protected, since the incidence in infancy was not too marked, the majority of cases occurring in later pre-school
children and early school-age groups.
For the first time in the past five years no cases of tetanus were recorded. While
ground is being made toward increasing the immunity status of the population to this
infection, the results this year cannot be credited to that entirely, and it is felt that continued efforts toward increased immunization are justified, particularly in the interests of
preventive civil defence measures.
Poliomyelitis showed a slight upward trend (8.0 cases per 100,000 population) from
that experienced in 1950 (6.4 per 100,000 population), which is gratifyingly low as
compared with the previous two years' experience. Actually, British Columbia escaped
fairly lightly in so far as this disease is concerned, as viewed in the light of the incidence in
neighbouring States and Provinces.
For the first time in the past four years no cases of botulism were recorded, but there
were significant numbers of other gastro-intestinal conditions in the form of shigellosis
and salmonellosis. Shigellosis showed an upward tendency to the rate of 21.9, as compared with a rate of 16.6 for 1950 and very materially lower rates in the previous two
years. Trends in this regard are discussed briefly in the report of the Division of Laboratories, which predicts the possibility of future increases as a result of the dissemination of
the infection over wide areas of the Province.
In respect to salmonellosis, the paratyphoid type was significantly lower (0.6 per
100,000 population) as compared to 1950 (3.1 per 100,000 population), while the
other types showed approximately the same incidence (12.9 per 100,000 population as
related to 13.4 during 1950). It must again be recorded, however, that this incidence
only indicates a trend, since it is questionable if all the cases occurring will ever be
definitely recorded, as many cases with gastro-intestinal symptoms never seek medical
care, and even all those who do so are never investigated bacteriologically to establish
a scientific diagnosis. Nevertheless, the incidence bespeaks the need for continued vigilance on the part of Health Officers and a thorough training of all food-handlers in the DEPARTMENT OF HEALTH AND WELFARE,  1951 X 45
principles of proper food preparation and handling. In this, the service club picnic,
the church supper, and the children's summer camps should receive particular attention
to ensure that preventive measures are followed, since so many of the outbreaks follow
one or other of these gatherings.
One disease which has shown a gradual upward swing over the past three years, with
a very definite peak during 1951, was in relation to the streptococcal infections, with
a rate of 385.6, as compared with 92.6 in 1950, 93.3 in 1949, and 49.9 in 1948. For the
most part the increase was resultant from an epidemic in the East Kootenay and Cariboo
areas, although there are concomitant upper trends in most areas of the Province. This
has been studied with definite interest, since the new Communicable Disease Regulations
significantly lowered the isolation period for scarlet fever and septic sore throat patients,
and it was questioned whether the increased incidence might be resultant from that.
However, very few secondary infections traceable to these isolated primary cases could be
located, and it was felt that the increase was in no way related to the changed isolation
and quarantine regulations. As the year ended, publicity xwas stepped up to warn residents
in affected areas of the increased incidence and the protective measures that should be
adopted while immunization measures were being offered as an additional precaution.
It is not recommended that scarlet fever immunization be carried on on a routine basis,
except where imminent epidemics seem likely.
The reported cases of rheumatic fever were doubled in 1951 (5.4 cases per 100,000
population as compared to 2.9 cases for 1950), which was as many cases in a single year
as the total for the previous three years. The reasons for this are not particularly apparent,
but it warrants some study, especially as it is realized that the reporting of rheumatic fever
is not as efficient as might be desired. Although it is a notifiable disease, it is a well-
known fact that only a minor number of the cases are ever actually reported.
In passing, some mention must be made of the slightly decreased incidence in the
number of cancer cases reported, less than in the two previous years.
Comments on the venereal disease and tuberculosis incidence will be found in the
reports of those separate Divisions.
A complete list of notifiable diseases as reported from the various areas of British
Columbia by the Medical Health Officers is recorded in Table II, pages 47 and 48. X 46
BRITISH COLUMBIA
Table I.—Incidence of Notifiable Diseases in British Columbia
(Including Indians)
Notifiable Disease
Actinomycosis... 	
Anthrax	
Botulism 	
Cancer.. _ 	
Cerebrospinal meningitis.
Chicken-pox	
Conjunctivitis (acute)	
Diphtheria   	
Dysentery—
Amoebic _ 	
Bacillary—  	
Encephalitis _. _
Epidemic hepatitis-.	
Erysipelas _
Gonorrhoea	
Infant diarrhoea	
Infectious diarrhoea	
Influenza   	
Leprosy..   _
Malaria 	
Measles  	
Mumps  -	
Poliomyelitis	
Puerperal septicaemia	
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	
1949
Number
of
Cases
Rate per
100,000
Population
1950
Number
of
Cases
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
35,066
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
963.3
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
3,147.8
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
40,616
Rate per
100,000
Population
1951
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
0.4
160.6
1.0
1.9
0.5
152.9
3,569.1
Number
of
Cases
38
3,301
30
11,033
2
6,269
5,835
92
62
2,288
7
149
4,146
300
568
1,662
18
18
48
1,134
Rate per
100,000
Population
47,281
2,850
247.2
30
2.6
6,671
578.5
374
32.4
5
0.4
253
21.9
90
7.8
3.3
286.3
2.6
956.8
0.2
543.7
506.0
8.0
5.4
198.4
0.6
12.9
359.6
26.0
49.3
0.7
144.1
1.6
1.6
4.2
98.3
4,100.4 DEPARTMENT OF HEALTH AND WELFARE,  1951
X 47 X 48
BRITISH COLUMBIA
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C
h DEPARTMENT OF HEALTH AND WELFARE,  1951 X 49
REPORT OF THE DIVISION OF PUBLIC HEALTH NURSING
Monica M. Frith, Director
Public health nursing, like any other public health service, grows out of the social,
economic, and technical media of the world about it.
Nursing in the home developed quite naturally in the early Christian era as a religious
outlet based on the concept of service to others. The settlement houses and visiting-nurse
organizations which sprang up in the nineteenth century grew out of the poverty, crowding, disease, and filth which characterized the industrial expansion and the struggle to
make the social adjustments which were necessary for the successful transition from hand
to machine production.
Now in the mid-twentieth century, public health nursing must be seen as it is related
to our present way of living and working. The preceding years have been rich in scientific discovery and technical advance. The public to-day is better informed. The gap
between scientific discovery and the application of results has been decreasing. As a
result of economic, social, and medical developments, the emphasis in health-care has
been broadened to include a larger component of supervision of illness, health guidance,
and mental hygiene. Changes in disease incidence and medical care have placed new
demands on public health nurses for more intensive and individualized service. A few
years ago, hundreds of children needed to be immunized against diphtheria, smallpox, or
tetanus. Families needed to learn the importance of such protection and to be motivated
to secure it for their children. While some individualized attention was necessary, a mass
approach to health problems was often used. Now the incidence of childhood diseases
has decreased as immunization has been more widely accepted; the nurse must teach and
guide with individual consideration to specific problems.
Public health nursing in British Columbia has been evolving gradually in an attempt
to bring the most needed of nursing services to the people in the most economical manner.
During the past year the objective of basic Public Health Nursing services available to all
persons in British Columbia has come closer to realization.
During the past year it has been possible to open two new areas and augment existing
services. Service in the Grand Forks area, comprising School District No. 12, was instituted in September and became part of the West Kootenay Health Unit. An additional
nurse was placed at Vernon in the North Okanagan Health Unit and at Kimberley in the
East Kootenay Health Unit. Nechako community was given Public Health Nursing service as part of the Cariboo Health Unit, as the result of a special financial arrangement
with the Mannix Construction Company. A part-time nurse was added to the staff of the
Saanich and South Vancouver Island Health Unit.
During the year it was possible to reopen two nursing districts, Lillooet and
Invermere-Golden, which had been closed temporarily because of lack of qualified Public
Health Nursing staff.
At the close of the year 1951 there were 124 positions for public health nurses. This
includes two vacancies, which, it is hoped, may be filled soon. The Public Health Nursing
staff include positions for ninety-four public health nurses (Grade 1), twenty-one public
health nurses (Grade 2), five supervisors, two consultants, the Assistant Director, and
Director.
There were forty-five appointments to the staff during the year. In spite of the fact
that there were only three more new positions, it was necessary to employ twelve more
nurses than last year to fill the vacancies. This figure includes eight nurses who returned
following additional training as part of the educational training project under Federal
Health Grants. Sixteen were public health nurses trained in British Columbia, five received training elsewhere, while seventeen were registered nurses without public health
training. Eighty-six per cent of the Public Health Nursing staff are fully qualified as
public health nurses. X 50 BRITISH COLUMBIA
Although exact figures are not available for each year, it is known that over fifty of
the Public Health Nursing staff replacements in 1948 were public health nurses trained
outside this Province. In 1951 only five or 11 per cent were obtained from this source.
This points out the fact that British Columbia will have to depend more and more on its
own resources for supplying staff replacements.
Thirty-one nurses left the service. Oi this group, nine went to university for further
education; five married nurses returned to their homes; ten were married and left the
service, while eight joined health services elsewhere in Canada, United States, and Britain;
and two left for other reasons.
Sixteen nurses changed their nursing districts, while one field nurse exchanged with
a public health nurse in the Division of Venereal Disease Control. The total staff turnover was 79 per cent, which is 12 per cent higher than last year and 9 per cent higher
than the average for the last ten years. This figure includes transfers, new appointments,
and resignations.   The volume of nursing administration has increased accordingly.
Table I.—Comparison of Provincial Public Health Nursing Staff Changes,
1950 AND 1951 1950 1951
Positions available  121 124
Total staff changes ,     81 98
Percentage of staff changes     67 79
New appointments     331 451
Resignations     312 362
Transfers      17s 173
i Returning from university included.
2 To university included.
3 One exchange included.
PUBLIC HEALTH NURSING TRAINING PROGRAMME
The Division has been fortunate in obtaining bursaries for seven registered nurses
to assist them financially to obtain the necessary academic training for permanent
appointments as public health nurses. This training programme has made it possible to
fill key positions with qualified staff who have had experience in the Provincial Public
Health Nursing field. Thus these newly qualified public health nurses could be placed
at centres which would not ordinarily be filled by nurses who had just completed the
University Public Health Nursing Course.
The heavy programme of in-service training for registered nurses has of necessity
been continued, since 38 per cent of new staff do not have their formal public health
training. Although this has created a good deal of additional work for the public health
nurse in charge of the district during the orientation period, the registered nurses have
proved very satisfactory in providing continuity of Public Health Nursing service. The
experience has given them an excellent background for the University course, and has
resulted in very well-trained public health nurses returning to the staff.
During the year, field-work facilities were provided for twenty students from the
University of British Columbia and for one student from McGill University, Montreal.
Saanich and South Vancouver Island Health Unit continues to offer introductory experience in public health nursing to undergraduate nursing students from St. Joseph's
Hospital, Victoria. Public Health Nursing staff have assisted with public health nursing
lectures at schools of nursing at Royal Jubilee Hospital and St. Joseph's Hospital in
Victoria, Royal Columbian Hospital in New Westminster, and the Royal Inland Hospital
in Kamloops.
Public health nurses have continued to meet regionally in their study groups and
have been able to study a number of pertinent subjects on a group basis.    Subjects DEPARTMENT OF HEALTH AND WELFARE,  1951 X 51
included the Baillie-Creelman Report, the new course in Effective Living, Prenatal Care,
Civilian Defence, etc. Subject material has been related to the particular need of each
group. As the study groups are an integral part of the Public Health Nursing Council
of the Division of Public Health Nursing, they provide a method of making known the
wishes of the staff, as a group. The Public Health Nursing Council meets annually at
the Institute to consider the wishes of the individual groups and to vote on any recommendations which would have application on a Provincial basis.
This year at the Public Health Institute a full day was devoted to public health
nursing. This innovation proved a great success and has been a stimulus to the development of certain programmes. Special mention is made of the panel on prenatal or
mothers' classes, which was presented by members of the Public Health Nursing field
staff and a member of the Victorian Order of Nurses' staff from Victoria, and the paper
presented by Miss Giovando on consideration of certain mental-hygiene factors as related
to the expectant mother. This project stimulated the establishment of mothers' classes
on a wider basis and is contributing to a more comprehensive prenatal-care programme
on a Provincial basis. The volume of service given expectant mothers was four times
greater than last year.
PUBLIC HEALTH NURSING SUPERVISION
The fact that good supervision is one of the most important factors in an effective
public health nursing programme was pointed out in the Report of the Study Committee
of Public Health Practice in Canada, by Baillie and Creelman (1950). With this objective in view, a constant effort is being made to improve the supervisory programme.
From a staff recruitment point of view, it is recognized that public health nurses
tend to accept employment in areas' where good supervision is available. However, the
reason and justification for supervision lies in the improvement of the generalized service.
To fulfil this purpose the quality of the nursing service must be constantly assessed
in order to bring about the necessary changes in programme. This is accomplished not
only by personal observation of services as rendered, but also by the objective study of
statistical reports—for example, local birth, death, morbidity statistics—and by the study
of time as allocated to service and case-load analysis. In this way the strengths and
weaknesses of services may be determined.
The Public Health Nursing senior or supervisor is in a position to take a broad
impersonal view of the service and to direct attention to the proper balance of service—
for example, certain nurses more interested in the school service might give too much
time to this service, thereby neglecting the tuberculosis programme. As the Public Health
Nursing service becomes increasingly complex, it becomes necessary to stimulate and
guide the staff nurse in order that she develop the required skills and keep up to date
with new advances. The supervisor or senior nurse is in a position to encourage staff
education, to meet the needs of the individual nurse, and to help her meet the problems
which arise in the district. With the variety of work in public health there is a need to
have one individual of the nursing service available to relate the work of the other staff
members and to work with other agencies. The senior or supervisor makes the administration of the nursing service easier for the director of the health unit.
The plan for Public Health Nursing supervision is flexible enough to fit into the plan
for health unit development in British Columbia, and to provide supervisory assistance
to nurses not yet receiving the full benefit of health unit coverage.
Senior and supervisory nurses, too, require assistance in setting up supervisory programmes and in evaluating their effectiveness. Central Office Public Health Nursing
personnel have been able to orient newly appointed senior nurses to their new responsibilities and to assist those members of the supervisory and senior-nurse staff in meeting
local problems through field visits, conferences, correspondence, and interviews. X 52 BRITISH COLUMBIA
In December it was possible to have the majority of senior nurses attend a two-day
conference at the Kinsmen Health Centre at Cloverdale. Considerable time was spent
on discussion of programmes being carried by Public Health Nursing staff, and on discussion of the duties and responsibilities of a senior or supervisory nurse. These responsibilities have now been set down on paper and will be incorporated into the general policy
manual.
During the year, consultant services have been increased. Miss Lucille Giovando
returned to the staff after completing the M.P.H. degree, with extensive training in Mental
Hygiene, at the University of Minnesota, and is initiating a more comprehensive mental-
hygiene programme for the field staff. The purpose of the mental-hygiene programme
is to promote mental well-being in all age-groups and to help prevent mental disorders and
emotional disturbances. A programme which will assist the Public Health staff to incorporate mental-hygiene principles into their daily routine is being developed. Miss
Giovando has met with Public Health Nursing staff at study-group meetings, with health
unit staff at staff meetings, and has spoken to special groups on request. To assist the
staff to utilize the services of the Child Guidance Clinic more effectively, Miss Giovando
completed three and one-half months with the clinic. During this time she travelled out
to areas where the Child Guidance Clinic was meeting with the health unit staff and
assisted in the interpretation of the services and necessary procedures. It is expected that
Miss Giovando will give special assistance with mental-hygiene problems and, at the same
time, be able to give assistance to Public Health Nursing supervisors and seniors with
other health problems because of her experience as a staff and supervising public health
nurse.
Miss Margaret Cammaert returned in September following completion of the M.P.H.
course at Johns Hopkins University, majoring in Maternal and Child Health. Miss
Cammaert has been appointed consultant public health nurse and is located in the Trail
office of the West Kootenay Health Unit. The Kootenay region has been selected as a
pilot area to work out methods of improving and developing additional services in relation
to the field of maternal and child health. Miss Cammaert is providing consultant service
Provincially from this centre and retains responsibility for generalized Public Health Nursing supervision in the West Kootenays.
Miss Fern Primeau completed a year of service as the public health nurse assigned
to the Division of Tuberculosis Control. It has been her purpose to assist the Public
Health Nursing staff in carrying out the tuberculosis-control programme as planned and
approved jointly by the Division of Tuberculosis Control and the Bureau of Local Health
Services. The duties of the nurse assigned to this position have changed with the development of more complete local health services. The field staff have assumed responsibility
for the tuberculosis programme on a local level, and thereby reduced the need for direct
contact with local areas. However, certain unorganized areas continue to present problems in tuberculosis-control which have to be cleared by Miss Primeau. Although the use
of the mobile unit has decreased, a good deal of time was spent in advising health personnel on the best use of this unit. Public health staff are advised of new procedures, changes
in treatment, care and progress of patients. Miss Primeau has been able to visit a number
of centres to assist with specific problems related to the tuberculosis programme and is
available to assist with staff education.
The Division of Venereal Disease Control has continued to assist public health staff
with the local venereal disease programme. Since the volume of work has decreased considerably, the rural epidemiology worker position has been discontinued. However, Public Health Nursing staff continue to receive help and guidance with problems from the
Division. The policy manual dealing with all aspects of the programme as it relates to
the Public Health Nursing field was completed and is now ready for printing.
The following statistical summary shows the volume of work in certain Public Health
Nursing services during the year:— ■ ■■
DEPARTMENT OF HEALTH AND WELFARE, 1951 X 53
Statistical Summary of Certain Public Health Nursing Services
Home services—
28,043 infants.
30,953 pre-school children.
31,078 school-children.
20,622 adults.
16,607 tuberculosis cases and contacts.
970 venereal disease cases and contacts.
2,502 expectant mothers.
10,602 mothers within six weeks after the birth of their babies.
School services—
74,390 school pupils were examined by the public health
nurse.
30,779 school pupils were examined by the School Health
Inspector assisted by the public health nurse.
43,101 conferences were held with teachers.
40,254 conferences were held with pupils.
8,495 conferences were held with parents.
31,126 home-visits made regarding school pupils.
Clinic attendance—
Prenatal clinics or classes showed attendance of     2,502
Child health conferences were used to advantage of—
Infants   43,344
Pre-school children  36,420
(See home service for additional prenatal, infant, and pre-school
service statistics.)
Immunizations—
9,049 individuals received complete series of innoculations
for protection against whooping-cough.
12,210 for diphtheria.
13,238 for tetanus.
3,185 for typhoid.
600 for scarlet fever.
24,018 for smallpox vaccination.
257 were vaccinated with B.C.G.
240,437 innoculations in all were given.
SERVICE ANALYSIS
As a supervisory method of assessing the volume of service being rendered by each
public health nurse, and the time being devoted to each aspect of the health programme,
a time study was completed by 100 staff nurses in May. One of the main advantages of
a time study to the staff nurse is to assist her to utilize her time to the best advantage. For
example, if a nurse in a densely populated district shows a higher than average amount of
travel-time, it would indicate that an investigation should be made into the plan for covering the area in order to reduce the travel-time and leave more time for actual service. The
composite results of the studies give valuable information about the extent and volume of
service being rendered and show trends in the development of new services. The percentage of time spent on each service is shown in Table II, which also shows the results
of similar studies done in 1949 and 1950. Table II gives a breakdown of the time spent
on home-visits and in the office by percentage of the total time. From these tables it is
possible to compute the average amount of time spent in certain activities. X 54
BRITISH COLUMBIA
Table II.—Comparison of Percentage of Time Spent by Public Health Nurses
in Specified Activities as Indicated by Time Studies in 1949, 1950, and 1951
NOV., 1949
MAY, 1950
MAY, 1951
Total-
Visits to schools	
Child health conferences-
Home-visits, total	
Office total  	
Conferences _
Travel  	
Meetings-
Other activities.
Overtime .
100.0
17.4
7.3
18.1
28.5
6.1
18.3
3.7
1.7
4.2
100.0
17.2
7.1
17.3
24.4
5.2
17.6
4.4
6.8
9.8
100.0
16.1
7.8
20.1
23.3
6.1
17.4
6.1
3.1
6.4
Table III.—Analysis of Time Spent in Home-visits and Office by Percentage
of Total Time as Shown in Time Studies, 1949, 1950, and 1951
Year
1949
1950
1951
Total home-visits              	
18.1
0.5
3.2
1.0
3.0
3.1
1.9
1.7
0.3
2.4
17.3
0.5
3.4
1.1
3.0
4.2
1.9
1.7
0.2
1.3
20 1
Prenatal                    ...
0 5
Infant  	
3 7
Postnatal              	
3.0
42
School.             . 	
Nursing care             	
Tuberculosis...  	
20
Venereal disease. _  _ 	
02
Other 	
3 4
Total office      .
28.5
15.1
4.8
8.6
24.4
13.5
5.8
5.1
Clerical-professional.   	
School recording  _	
Tuberculosis -	
2 1
Other -    - _
7.4
Non-professional 	
Other office _
5 1
Although the total amount of home-visiting has increased this year, as seen in Table
III, after it is shown that 2.3 per cent of the total time was spent on the sickness survey,
the amount of other home-visiting would be about the same as the figures shown in the
studies completed in 1949 and 1950.
A case-load analysis was completed by all public health nurses carrying districts.
The information taken from this analysis assists central office in assessing the service
loads carried by each nurse. From this report the need for additional Public Health Nursing or clerical staff may be shown, as indicated by an increased service load. Evidence
of the population distribution is shown in these reports.
CIVIL DEFENCE
The Public Health Nursing Division has taken an active part in the preparation and
organization of the educational programme dealing with the nursing aspects of civil
defence and A.B.C. warfare. Miss Margaret Campbell, Assistant Director of Public
Health Nursing, attended a five-day course dealing with the Nursing Aspects of Atomic
Warfare in San Francisco, along with three other nurses from British Columbia—Miss
Mary Henderson, representing Metropolitan Health Committee, Vancouver; Miss Fern
Trout, Registered Nurses' Association of British Columbia; and Miss Joyce Collison,
representing the Department of Veterans' Affairs.    This group of nurses initiated an DEPARTMENT OF HEALTH AND WELFARE,  1951 X 55
educational programme consisting of a two-hour orientation lecture on this subject for
the nurses of British Columbia. Miss Trout and Miss Campbell spoke to the nurses in
the Provincial areas (including Victoria), while Miss Henderson and Miss Collison gave
their lectures in Vancouver. This group of nurses attended a special meeting in Ottawa
in June on A.B.C. warfare, when the proposed teaching manual for Canadian nurses was
presented for suggestions and approval.
The Division was active in arranging for the four-day course on the Nursing Aspects
of A.B.C. Warfare, presented by a team of experts from the staff of the Department of
National Health and Welfare in December. Seventy-five nurse instructors selected from
all regions of British Columbia attended the course in Vancouver, which was sponsored
by the office of the Provincial Civil Defence Co-ordinator, which provided financial
assistance to nurses from outlying districts, and the British Columbia Registered Nurses'
Association and the Department of Health, who assisted in planning for the course. It is
expected that this nucleus of trained instructors will return to their own communities to
teach nurses about this subject and their role in civil defence.
SICKNESS SURVEY
The sickness survey was completed in October, and the results are not yet available.
The Assistant Director, Public Health Nursing, spent a considerable amount of time in
the early part of the year interpreting the various requirements of the survey to the staff.
HOME CARE
A pilot-study home-care programme was established in the North Okanagan Health
Unit in October. This study has been undertaken with the assistance of Federal Health
Grant funds in an effort to determine whether it is possible to release hospital beds to
relieve hospital overcrowding and at the same time give the patient necessary care at
home. Home-care services have been successful in large metropolitan areas, and it
remains to be seen whether this type of service can be carried out satisfactorily in smaller
centres.
The programme was established with the active support of the Vernon Medical
Society, the Vernon Jubilee Hospital Board, the Union Board of Health of the North
Okanagan Health Unit, and local welfare services. An advisory committee was set up to
assist with the organization and development of the service. It is necessary for a patient
to be admitted from hospital to this service by the attending physician, and thus the
home-care service can be considered an extension of hospital care to the home. The
health unit staff is prepared to give nursing care in the home on an hourly basis. Housekeeping service is also available to patients requiring home help. A small daily charge is
made for both nursing and housekeeping service. One nurse has been added to the staff
of the North Okanagan Health Unit to assist in meeting increased demands for nursing
care. Housekeepers have been given appropriate lectures to assist them with their work
in the home. The senior nurse of the health unit acts as administrator of the home-care
service and supervises the care given the patient in the home by the housekeeper and the
nurse.   To date it is too soon to evaluate the result of this service.
As the demand for nursing treatments and injections increased in the Saanich and
South Vancouver Island Health Unit, it was felt advisable to add a registered nurse to
the staff to take over part of this programme. The public health nurse visits all patients
initially to determine whether the case should be taken over by the registered nurse. The
patient continues under the supervision of the public health nurse.
These two new programmes are indicative of a teamwork approach to bringing
needed care to the patient in the home.
PROVINCIAL LIBRARY,
VICTORIA, B. C. X 56 BRITISH COLUMBIA
Public Health Nursing Central Office staff have continued to act on a number of
nursing committees. These include the Red Cross Nursing Committee, the Junior Red
Cross Crippled and Handicapped Committee, the Public Health Nursing Curriculum, and
Educational Policy Committees of the Registered Nurses' Association of British Columbia, the Provincial Nursing Services Committee, the Advisory Committee to the University of British Columbia School of Nursing.
Visitors to the Department included Dr. Pauline Jewett, who is completing a structure study on nursing for the Canadian Nurses' Association; Miss Ruby Tinkiss, Division
of Child and Maternal Health, Ottawa; and Miss Evelyn Pepper, Nursing Consultant to
the Civil Defence Health Planning Group, Department of National Health and Welfare,
Ottawa.
The variety and scope of the Public Health Nursing programme has continued to
increase as the need for new services becomes evident. Tribute should be paid to the
public health nurses, who have adapted themselves to changing conditions and accepted
and expedited new programmes promptly and efficiently. DEPARTMENT OF HEALTH AND WELFARE,  1951 X 57
REPORT OF THE NUTRITION SERVICE
Doris L. Noble, Consultant
The year 1951 shows considerable development and achievement in the programme
of the Nutrition Service. Studies of the foods eaten by school-children in sixteen districts
have clearly indicated that many families in British Columbia are not eating enough of the
foods they require, even though these foods are readily available and comparatively inexpensive. The year's programme has been concentrated on developing those methods of
education which to date have proven most effective in encouraging the people of this
Province to enjoy a more adequate diet.
CONSULTANT SERVICE TO LOCAL PUBLIC HEALTH PERSONNEL
An important responsibility of public health personnel is that of counselling and
advising individuals and families regarding the selection and preparation of appetizing,
nourishing meals. The service of the Nutrition Consultants in providing technical
information and advice, assistance in studying food habits, and developing effective
methods of nutrition education is available to public health personnel throughout the
Province.
During the year the Nutritionists have visited twelve health units in order to provide
the most practical assistance to the health unit staff. In each area a regular staff meeting
has been attended to review the latest nutrition information and discuss local activities
and problems. Further time has been spent in health unit areas this year in order to
include additional meetings and visits arranged by health unit directors and senior nurses.
For example, in many areas visits have been made to cafeterias, and meetings of School
Lunch Committees, Parent-Teacher Associations, and similar groups have been attended
to consider nutrition problems. At the request of the Welfare Branch, the Nutritionist
has also met with the social workers in each area to discuss advice that may be offered
to families on low-cost meal planning.
An important activity of the Nutrition Service this year has been to assist public
health personnel in studying the foods eaten by children and families in various areas.
This type of study has proven valuable both in providing information concerning what
people eat and as an effective method of nutrition education in the community. The
studies are planned co-operatively by public health personnel and teachers as a school
health project. During the past two years, food studies have been conducted in sixteen
districts of the Province. The major portion of this work has been completed during
1951, when over 4,000 three-day food records from school-children were analysed by the
staff of the Nutrition Service.
A brief summary of the results of the food studies may be of interest. As mentioned
previously, it was noted from the over-all results that many families in British Columbia
are not eating enough of the foods they require, even though these foods are readily available and comparatively inexpensive. In every area the three chief deficiencies in children's
diets were found to be milk, a Vitamin D preparation, and foods rich in Vitamin C. Less
than 40 per cent of the children studied were receiving a pint of milk or more each
day, only 10 per cent were receiving a Vitamin D supplement such as fish-liver oil, and
only 40 per cent were eating daily a food that is rich in Vitamin C such as tomatoes,
vitaminized apple-juice, or citrus fruits. These are important foods, since they are
essential for best growth and development and good health. The survey results also
revealed that many children ate liberal quantities of sweet foods such as candy, soft drinks,
cake, bread and jam. Such items not only contain little food value, but also dull the
appetite for more nourishing foods and help promote tooth decay.
The Nutrition Service has co-operated with the Division of Health Education in
publicizing the results of the food studies through articles prepared for magazines of the X 58 BRITISH COLUMBIA
Parent-Teacher Association, Women's Institute, and Department of Education. In these
articles and during discussions with public health and other community workers, four
specific objectives have been stressed, namely: For each child every day (1) at least
1 pint of milk, (2) a Vitamin D preparation, (3) a serving of some food rich in Vitamin
C, and (4) a decreased consumption of sweet foods. A pamphlet stressing these four
objectives was prepared by the Nutrition Service and printed early in 1951. This
pamphlet has, been widely circulated to parents and children in many areas of the Province.
Public health personnel and teachers have stressed these four points and methods of
improving family meals with children, parents, and community groups.
The interest aroused by the food studies has been followed up in numerous areas
with rat-feeding experiments. The experiment illustrates vividly the importance of food
to growth, appearance, and disposition, and is effective in encouraging improved food
habits. One group of rats is fed on a diet including foods recommended in Canada's
Food Rules, and the second group is fed on a poor diet rich in sweet foods. The rats are
fed and cared for by school-children in the classroom. Over a period of several weeks
the children are able to observe the effect of the two contrasting diets on the weight,
appearance, and activity of the rats. During 1951, rat-feeding experiments were conducted in thirty-four schools outside of Vancouver. Each project was planned co-operatively by public health nurses and teachers, and additional assistance provided from the
Nutrition Service. From the reports received from teachers and public health personnel,
it is obvious that the rat-feeding project is one of the most effective methods of arousing
children's and parents' interest in improving their daily meals for their own well-being.
White laboratory rats for all experiments have been provided from the animal nutrition
laboratory at the University of British Columbia, and their excellent co-operation throughout the year has been appreciated.
The volume of requests from local public health personnel for technical services and
information has been considerably greater during 1951 than in the past. Since 1951 has
been a year of increased food prices, one of the chief requests has been for up-to-date
information on low-cost meal planning. The current prices of essential food items have
been studied each month, and a series of articles have been prepared for health and
welfare personnel to offer suggestions on stretching the food dollar.
Considerable service has been requested and provided to local public health personnel relative to various types of school-lunch programmes. The construction of new
schools with lunchroom and kitchen facilities has increased the need for such information
as minimum equipment requirements for supplementary or complete meal programmes,
plans for efficient kitchen layout, quick and economical methods of preparing foods at
school, menus, and large-quantity recipes. This type of information has been compiled for the public health staff and school administrators in various areas of the Province
this year. It has been possible, also, to offer additional information during visits to various
schools while in a health unit area.
It should be noted that the provision of nutrition information and advice on materials
for nutrition education to local public health personnel is a constant and growing activity
of the Nutrition Service.
CONSULTANT SERVICE TO INSTITUTIONS
Consultant service has been extended to other institutions during the past year and
continued to those from whom information and assistance was requested previously.
Assistance is provided on all phases of food service, including food selection, preparation,
choice, and arrangement of equipment and organization of staff.
Food-cost accounting continues to have an important place in control of food costs.
The method which was developed and proved satisfactory in one of the larger institutions
is being adapted in other institutions where service has been requested. DEPARTMENT OF HEALTH AND WELFARE, 1951 X 59
Yearly studies comprising analysis of per capita food consumption are completed
for Oakalla Prison Farm and New Haven. In addition, assistance has been provided
to the Women's Gaol at Prince George, hospitals under the Division of Tuberculosis
Control, the British Columbia Cancer Institute, the Queen Alexandra Solarium, the
Vancouver Preventorium, and the Western Society for Physical Rehabilitation.
A special study was made of the meat purchases at the Jericho unit of the Division
of Tuberculosis Control. It was found that a considerable saving is made by purchase
of wholesale cuts rather than carcass beef. This more economical method of purchasing
may also be applicable to other food-service departments.
A study was made of the number of staff and duties of the dietary department of
the Tranquille unit of the Division of Tuberculosis Control. It is clearly recognized that
the place of the dietitian as an administrator and supervisor of food-service departments
is important in institutions of this type. However, the purpose of this study was to
ascertain the number of dietitians required to give efficient service and yet to use these
specially trained persons for those administrative and supervisory duties suitable to their
training.
Food-service procedures of several large hospitals have been studied during the year.
From this study, considerable information has been obtained relative to the particular
type of food service which will be initiated in the new Pearson Tuberculosis Hospital.
Consultant service has been provided to personnel in the Hospital Services Division
of the British Columbia Hospital Insurance Service, in relation to such problems as
kitchen planning, dietary staff, equipment, and food-cost accounting.
CONSULTANT SERVICE TO OTHER DEPARTMENTS
AND ORGANIZATIONS
It is recognized that the programmes of other Government departments and Provincial organizations are often related or closely allied to the broad field of nutrition
education. In view of this, consultant service is offered to other departments and organizations, and whenever possible meetings are held with those in related fields to discuss
mutual problems and plans.
Considerable time has been spent in the preparation of a School Lunch Manual for
teachers, which was requested by the Department of Education. The manual includes
considerable detail on the necessary features to be considered in planning and operating
lunch-supplement and complete-meal programmes. The final draft was forwarded to
the Department of Education in August and has been approved for printing and circulation to teachers and others concerned with this subject.
Throughout the year the Nutrition Consultant has attended the monthly meetings of
a group of nutritionists representing various fields in British Columbia. Through these
meetings it has been possible to gain a keener appreciation of the programmes and activities of others working in the field of nutrition education. A group project this year has
been the completion of a list of low-cost weekly food allowances for various age-groups.
These data have been requested by the Bureau of Economics and Statistics for guidance
in compiling the Cost of Food Index. The list will also be of assistance to personnel in
the Welfare Branch who are interested in developing low-cost food budgets for families.
A continuing project of the nutrition group has been the revision of the first edition
of the booklet Family Meals, which was circulated to public health personnel, social
workers, and groups of parents during 1950. This year the group has worked on the
final revision of the booklet, with the objective of completing this material for printing
and circulation in the coming year. It is obvious from requests of parents and community
workers that this booklet will fill a very useful purpose. X 60 BRITISH COLUMBIA
The programme and objectives of the Nutrition Service have been described in talks
to key groups, such as student nurses, Home Economics teachers, dietitians, and public
health nursing students at the University.
GENERAL COMMENTS
Miss Yvonne Love, who has served as Nutrition Consultant with this Department
since 1945, resigned in December to accept a position in Vancouver. During her time
with this Department, Miss Love has been a most enthusiastic and capable member of
the Nutrition Service and has contributed a great deal to the nutrition education programme in this Province. DEPARTMENT OF HEALTH AND WELFARE,  1951 X 61
REPORT OF THE DIVISION OF PREVENTIVE DENTISTRY
F. McCombie, Director
In a recently published book, Modern Trends in Public Health, appears the statement "Concentration of attention on the teeth of the youngest (children) has lessened
the need for treatment as they grow older, and with what inestimable benefit to the health
of the children! Freedom from pain allows them to eat their food with enjoyment; they
can run about without the otherwise unfortunate result of violent toothache caused by
increased circulation of the blood; their sleep is not interrupted by pain; their systems
are not poisoned by dental sepsis, and a foundation is laid for lifelong health."
This could easily describe the first objective of the Division of Preventive Dentistry
of the Health Branch of the Department of Health and Welfare. While very considerable
progress toward this goal has been achieved during 1951, it cannot yet be claimed that
this desirable state of affairs has been accomplished in British Columbia. Furthermore,
it is suggested that our responsibility does not end there. Not only must we ensure that
a foundation has been laid for a lifelong health, but we must do all within our power to
ensure that this foundation is not destroyed.
To obtain this ideal, there are three requirements. Firstly, it is necessary to ensure
that every child is restored to dental health at the earliest possible opportunity. Secondly,
it is hoped that the possibilities of the prevention of the vast majority of dental disease
may become known to all members of the medical and dental professions, the teaching
profession, the parents, and the children—the future citizens of this Province. Thirdly,
for the dental disease which is not prevented, satisfactory arrangements for its necessary
treatment should be available to all, irrespective of locality, race, colour, creed, or any
other barrier. To meet either the first or the third of these requirements is not yet
possible, due to insufficient dental man-power within this Province.
A Departmental committee of another Government convened in 1919 to review the
" Dentistry Act" recorded, " We wish to state very strongly that in our opinion the State
cannot afford to allow the health of the workers of the nation to be continuously undermined by dental neglect. Steps should be taken without delay to recognize dentistry as
one of the chief, if not the chief, means of preventing ill-health. The dental profession
should be regarded as one of the outposts of preventive medicine and as such should be
encouraged and assisted by the State."
PROGRESS IN 1951
In the endeavour to help improve the dental health of the people of this Province, it
has been the Division's thought in the past, and remains so to-day, that the keystone of
the preventive dental programme rests in the inclusion within each local health department of at least one full-time dentist especially qualified and trained in children's and preventive dentistry. This year seven such appointments have been made to local health
units. These appointments have been made with the Cariboo, North Okanagan, South
Okanagan, Upper Fraser Valley, North Fraser Valley, Simon Fraser, and Central Vancouver Island Health Units. The dental divisions of the metropolitan areas have all
appointments presently filled. In total, there are now in this Province twenty-four dentists
employed full time in the practice of preventive dentistry. At the close of 1950 only
fourteen such appointments were recorded. In all, twenty-six school districts now have
dental services provided by full-time personnel, and a further school district is served by
a dentist providing half-time services. In addition, in a further fourteen school districts
dental clinics are now organized in which private dental practitioners provide regular
sessions in their own offices for the younger children of the community. X 62 BRITISH COLUMBIA
• In an endeavour to provide this latter type of service to additional communities, this
summer sets of transportable dental equipment, especially designed by this Division, were
loaned to dental practitioners willing to carry out this type of programme in communities
where there is no resident dentist. By this means such programmes were carried out
at Port Alice, Port Hardy, Bella Coola, Golden, and the more remote parts of the
Seechelt Peninsula and adjacent islands. In addition, through the loan of this equipment
other dentists have made their services available to such isolated communities as those
along Alaska Highway and communities along the west coast of Vancouver Island and
to Alert Bay.
To increase the effective dental man-power of this Province, at the spring session
of the Legislative Assembly the " Dentistry Act" of this Province was amended to
provide facilities whereby dental hygienists might be licensed. To date the necessary
regulations to make this possible, which are to be submitted by the Council of the College
of Dental Surgeons of British Columbia, have not been received. It is hoped that these
may be forthcoming at an early date. It is further hoped that the regulations will be
such that the dental hygienists will be able to make a significant contribution to the dental
care of the people of this Province.
As an additional and possibly more effective means of increasing the dental
man-power of this Province, the Division was informed that two committees have
been established during the present year to investigate the need, the desirability, and
practicability of establishing a dental faculty within this Province. One committee has
been established by the Council of the College of Dental Surgeons of British Columbia
and a further committee by the Senate of the University of British Columbia. To have
two such responsible bodies appreciate the need for increased dental man-power and
take at least such investigatory action is indeed most heartening.. It is hoped that in
due course the findings of these two committees will be made public.
To maintain the people of this Province in dental health, the ratio of dentists to
population during 1951 improved slightly, and is now estimated at 1 dentist to about
2,000 people. However, the disparity between the ratio of dentists within the large
metropolitan areas and in the rural areas of the Province is still a subject of serious
concern. The metropolitan areas of Greater Vancouver, Greater Victoria, and New
Westminster, we estimate, now have a ratio of 1 dentist to 1,640 population, virtually
identical to the 1950 estimate. However, for the remaining population of the Province,
approximately 44 per cent of the total, the ratio is 1 dentist to approximately 3,000
people. This is some slight improvement over the 1950 estimate. This change is due
mostly to the fact that this summer eleven new graduates located outside the metropolitan
areas. This may indicate that the letters sent out for the past three years by the Dental
Public Health Committee of the British Columbia Dental Association are attaining
results. These letters were sent to senior dental students from this Province studying
in the various dental faculties of Canada and the United States.
However, while some improvement in this regard can be recorded during 1951, it
must be remembered that in 1952 the number of graduates from Canadian dental schools
will, it is reported, drop by approximately 33 per cent to an estimated 205 for the
whole of Canada, and in the following year to 175. The year 1951 was the last year
of graduation of courses grossly expanded to accommodate veterans of the armed
services.
Therefore, with the rapidly expanding economy and population of the Province,
it is extremely likely that unless increased facilities for the training of dental students in
Canada, and possibly within this Province, are made available within the very near
future, the ratio of dentists to population will rapidly become worse as the years progress.
In an endeavour to decrease the need of dental care of large sections of the
population of this Province by decreasing the incidence of dental decay, at least amongst
the children, the health authorities in the two largest cities of this Province have given DEPARTMENT OF HEALTH AND WELFARE,  1951 X 63
very active consideration to the artificial fluoridation of their respective water-supplies.
The Metropolitan Health Committee of Greater Vancouver signified its approval of
such a procedure to the Greater Vancouver Water District, and the Union Board of
Health of Greater Victoria and Esquimalt has recommended study relative to the
fluoridation of the Greater Victoria water-supply. The Council of the College of Dental
Surgeons of British Columbia and the Vancouver and District Dental Society have given
their endorsement to such a measure. In view of the fact that in no case has any
experiment been concluded whereby the value of artificial fluoridation has been completely
assessed, the Victoria and District Dental Society suggests that concurrently experimental
data be acquired to provide further information, and also rightly point out that fluoridation
must be considered an adjunct and not a replacement to other preventive measures.
As a further effort to decrease the amount of dental disease presently occurring, the
Division has continued, with the co-operation of the Division of Health Education,
the Nutrition Consultants, and the Public Relations Committee of the British Columbia
Dental Association, to assess available dental-health educational material and assist in
its distribution. As an example, it is noted that no less than 10,000 persons viewed
dental-health films made available through the Division of Health Education. Toward
the end of the year a new project was initiated—namely, the construction, by auxiliary
groups, of toys which will teach a lesson in dental health for use in waiting-rooms of
clinics and private practitioners. It is hoped that it will be possible to report some
results in this new field in the coming year.
In order to improve the correlation between the various dental-health programmes
now operating throughout the Province, for the first time a Dental Health Conference
was convened this fall, at which were present the Dental Directors with local health
units, the Director of the Dental Health Division of the Metropolitan Health Committee
of Greater Vancouver, and the Director of School Dental Services of the Greater Victoria
School Board. At this two-day meeting many topics were discussed, including an
evaluation of dental-health education material presently made available by this Department, correlation with nutrition education, fluoridation of water-supplies, education
techniques, and the possible role of the dental profession in a programme of civil defence.
BRITISH COLUMBIA DENTAL ASSOCIATION
Throughout the year it is most pleasing and gratifying to report that the co-operation
of the executive of the British Columbia Dental Association and its various committees,
especially the Dental Public Health and Public Relations Committees, has been of
material assistance to the furtherance and success of the activities of this Division.
THE FUTURE
What now remains to be accomplished? Firstly, there remains the appointment
of at least eleven additional full-time dentists with local health departments. Two such
appointments are planned during the coming year to the Upper Vancouver Island Health
Unit and West Kootenay Health Unit. Concurrently, due to the expansion of Grade I
enrolment in the Vancouver area, it is likely that further full-time appointments will
be necessary there. It is hoped that these appointments will assist in the restoration
to dental health of the younger children.
The teaching of dental health within the schools of this Province requires some
revision. It is hoped that by greater co-operation with the Department of Education
at the Provincial level, and by the activities of Dental Directors with health units, in
co-operation with School Inspectors and school principals at the local level, that the
teaching of dental health will improve in the years to come.
It is hoped that in the future the private dental practitioners of the Province will
provide ever-increased assistance in meeting the wishes of the people by maintaining X 64 BRITISH COLUMBIA
in dental health all the children after they are so restored. For those parents who are in
receipt of social assistance, it is hoped that arrangements can be made whereby their
children may be similarly cared for. Lastly, remains the large group who find it difficult
to make adequate financial arrangements for dental care for their children. To make
suitable arrangements for this group will not be easy, but unless some satisfactory
arrangements are made, there will be many, many parents who fully realize the value of
dental service, but who may be forced to watch their children grow into dental cripples.
To meet these demands, an increased number of dentists in this Province will be
necessary. To provide these dentists, it is right that increasing attention be paid to the
desirability of establishing training facilities in this Province at the earliest practical
opportunity. DEPARTMENT OF HEALTH AND WELFARE,  1951 X 65
REPORT OF THE DIVISION OF ENVIRONMENTAL SANITATION
A. PUBLIC HEALTH ENGINEERING
N. J. Goode, Acting Director
Public health engineering is concerned with the engineering aspects of the physical
world that can affect the public health. This involves a wide range of activity, as engineering methods can be useful in solving such diverse problems as determining the extent
of pollution on a shell-fish lease or the most efficient means of disposing of garbage.
In fact, engineering methods can be employed profitably in adjusting all parts of our
surroundings so that communicable diseases and accidents can be prevented. The
Division of Public Health Engineering functions within the framework of the Health
Branch to assist in and advise on the need for and the best means of instituting desirable
changes of this nature.
In this Province the need for public health engineering advice has not been too
evident in the past because of the widely scattered population and the relatively small
amount of industrialization. As the Province has grown in population and industry, the
problems have increased in number and complexity. These problems have also become
more evident as the increased numbers of public health personnel have brought a lot of
matters to light that previously were not recognized. This growth in the volume of
problems has been evident in 1951, and a review of and the steps taken to deal with the
most important phases of them is noted in the following report.
Water-supplies
Numerous improvements were made to the public water-supply systems in the
Province during the year. Although there are no statistics available on the subject,
experience would indicate that the steps taken were only sufficient to balance the adverse
effects due to normal deterioration and the increased population and industrialization.
The two main reasons for this apparent lack of progress would appear to be the public's
lack of information about the potential dangers to water-supplies and their faith in the
natural purity of most water found in the Province. Therefore, if more adequate improvements are to be made in the future, it will be necessary to supply factual information to
the public so that they will be better able to assess the needs of their supplies. With this
in mind, an attempt was made to assist the local health units to interpret information
about water-supplies so that it could be more readily understood and appreciated by the
people responsible. This consisted of drawing up an inspection form, making a standard
graph for illustrating bacteriological results, and drafting two articles. The first one is
designed for distribution to the general public and will describe the usual ways water-
supplies are contaminated and how it can be prevented. The other article will be distributed to waterworks operators and superintendents, and it will describe the benefits
to be obtained from planning the orderly development and improvement of their systems.
Improvements under this type of programme will most likely take years to become
evident, but at present this would seem to be the best method of approach. Quicker
results could most likely be obtained by more numerous visits by engineers, as direct
consultative advice could be given to the operators. However, it seems unlikely that
any great increase in visits can be made with the present staff.
Advice on and approval of a number of water-supply systems was given by members
of this Division. Recommendations were made regarding plans for the improvement
or future development for twelve systems, and approvals were given for the construction
of three new systems and the improvement or extensions to thirteen systems.
One of the two emergency chlorinators was loaned to the City of Mission for a short
period while water from an auxiliary source was being used to augment the regular supply. X 66 BRITISH COLUMBIA
Fluoridation—the process which involves adding a minute amount of the fluoride
ion to water as a means of control of dental caries—was publicized widely by other
authorities in the United States and Canada. As it might be adopted by some communities in this Province, information was gathered on the engineering aspects of this
process. Some of this was obtained at a Conference on Fluoridation sponsored by the
Washington State Department of Health in Seattle, and other material was obtained from
current literature. A digest of this data was presented at a meeting of the dentists in the
Health Branch.
Sewage-disposal
There was an increased interest and activity in the construction of municipal sewage-
disposal systems during the year. Two municipalities added appreciable extensions, two
completed new systems, and four started planning for future systems. Although these
figures seem small, the estimated cost of these changes involves approximately $3,000,000.
All of these improvements were initiated by the municipalities which made the
changes; they were not the result of complaints from neighbouring municipalities which
might have been affected by improper disposal practices. Usually, planning for the
changes was started because nuisances were created by septic-tank effluents. However,
the City of Vancouver did institute an investigation into a more suitable means of disposal
because of the pollution of bathing-beaches.
Through action initiated by this Division, plans were started for sewage-disposal
facilities for Essondale. This was done because the untreated sewage is contaminating
the receiving body of water. It seems apparent that difficulties of a similar nature will
arise in other parts of the Province in the near future, and some planning will have to be
done to control such pollution and maintain the streams at a reasonable quality level.
Visits were made to nine sewage-disposal plants. The operation of each was
reviewed and discussed with the operators.
A short school for operators of treatment plants was conducted in Idaho, and invitations to attend were forwarded through this Division to operators in this Province.
This school is operated each year by the States in the Pacific Northwest area, and they
have been kind enough to open them to persons engaged in this work in British Columbia.
A comprehensive article on septic tanks was prepared and mimeographed for distribution to the public, as numerous requests for this type of information are received
from persons living in unsewered communities. The article covered the construction,
operation, and maintenance of septic tanks and tile disposal-fields. A leaflet on the
percolation test for tile disposal-fields was also prepared.
A paper was prepared on the construction and maintenance of septic tanks. Those
phases of the subject which are of interest to engineers were dealt with as it was presented
at the annual convention of the municipal engineers.
Stream-pollution
There are relatively few instances where improved treatment facilities are indicated
at present, but it is anticipated that these problems will increase and become more acute
within a few years if the population and the industries continue to increase. The " Health
Act" makes some provision for the control of stream-pollution, but for a number of
reasons remedial action is often very difficult to obtain. The main reason for this is that
separate solutions must be found for each problem because there are an infinite number of
waste compounds which will create varying degrees of pollution, depending on the type,
amount, and strength of the waste, the flow of the stream, and the type, amount, and
strength of other wastes being discharged at other points into the stream. Despite the
complexity of the problems and the time needed to deal with them, an effort was made
in a number of instances to advise on adequate treatment procedures. DEPARTMENT OF HEALTH AND WELFARE, 1951 X 67
A report was made of pollution problems in the vicinity of Kelowna, and general
recommendations were made regarding possible corrective measures.
Pollution problems as they affect the Fraser River were discussed at various times
with the executive secretary of the Dominion-Provincial Fraser Basin Board. In addition, the best means of furthering the pollution study of the Fraser River were discussed
at a meeting which was convened by the Board.
Two meetings of the Pacific Northwest Pollution Control Council were attended.
During the year this informal group continued its work on water-quality objectives,
sewage-works design standards, air pollution, and related subjects. It is anticipated that
the results of the work being carried on by this organization will be of great assistance
when regulations of this nature are to be implemented in this Province, as members of
the Committee are some of the best-informed persons on this subject in the Pacific Northwest region.
Shell-fish
The administrative procedures for enforcing the Shell-fish Regulations became fairly
well established during the year. During the previous year it had been difficult to obtain
uniform enforcement as the responsibility for administration was handled by two persons
during different periods, and there were a number of details about the recently adopted
regulations which required clarification. During the current year an amendment to the
regulations was passed, giving jurisdiction over shell-fish plants and handling procedures
to the local health units. Following this, the Sanitary Inspectors were acquainted with
the shucking plants in their areas and a system of reporting devised so that the Department
of National Health and Welfare could be kept advised. From present indications this
system has given satisfactory control.
A number of new shell-fish leases were forwarded to this Division for approval.
All of them were recommended, as they were located in unpolluted areas.
A representative of the Division attended a three-day Shell-fish Sanitation Seminar in
Seattle. This meeting of members of the shell-fish industry and officials of the regulatory
agencies on the Pacific Coast was arranged by the Washington State Department of Health.
During the first day regulatory officials only were present, when control procedures were
discussed. On the following two days the meetings were directed toward those aspects
of shell-fish production which are of interest to the industry. They included sanitation,
biology, pollution of shell-fish beds, and shell-fish toxicity. The meetings were well
worth while and provided an excellent opportunity to keep the industry advised of current
findings and approved methods of operation and to keep regulatory officials aware of
difficulties being encountered by the operators.
Three members of the United States Public Health Service, who are employed in
shell-fish work, were taken on a tour of the shell-fish research establishments in the
Province.
Matters relating to shell-fish toxicity were dealt with at some length. A chart was
made of the laboratory findings to date, a narrative review was made of the toxicity
problem as it exists in the Province, and a meeting of the Pacific Coast Shellfish Committee was convened to consider future plans for dealing with the problem. As it had
not been possible to find any correlation between the seasons and the amount of toxicity,
the chart was made to show the number of samples obtained and the intensity of toxicity
at each sampling point. The review was compiled to bring members of the Shellfish
Committee up to date on the subject and to form a basis for discussion at the meeting.
It is hoped that more can be determined about this subject so that a control programme
can be based on well-established facts. x 68 british columbia
Tourist Camps
Assistance in the enforcement of the Regulations Governing Tourist Accommodation
continued throughout the year. This work consisted of acting as a member of the Licensing Authority and of co-ordinating the findings of Sanitary Inspectors in the field.
An amendment was made to the regulations, which gave municipalities power to
enforce the regulations when tourist camps are within their boundaries. To clarify the
administrative changes required by this amendment, a detailed memorandum was
compiled for the use of the field personnel.
General
Further steps were taken to try to improve the enforcement of sanitary procedures
in unorganized territory. A meeting of the Interdepartmental Committee on Sanitation
was arranged, and its recommedations forwarded to the Cabinet. Further consideration
of this important problem is indicated for the coming year.
A review was made of the role of public health personnel in town planning. A digest
of this material was presented to a meeting of the Medical Health Officers.
Work was done on two matters relating to the qualification of Sanitary Inspectors.
The position of Chairman of the Examining Board for Sanitary Inspectors' examinations
was filled by the writer. It involved organizing two days of examinations and marking
some of the papers. Valuable assistance was given in this work by members of the
Metropolitan Health Committee in Vancouver. This Division was also represented on
two Screening Committees for Sanitary Inspectors. These Committees have been formed
in Vancouver and Victoria to review the qualifications of persons wishing to become
Sanitary Inspectors, and each Committee meets once or twice a year to interview
prospective candidates.
The work of the Division was reviewed in detail on three separate occasions.
An article was prepared for publication in the British Columbia Professional Engineer,
a publication of the British Columbia Engineering Society. Those phases of the work
which are of interest to consulting engineers were especially noted. A talk on the
Division was given to the student nurses at the University of British Columbia to acquaint
them with its function in the Department of Health and Welfare. In addition, a review
was made of the Division's work as an appraisal of past accomplishments and as a means
of planning for the future. This was done so that a clear picture could be obtained of
the Division and its relation to the rest of the Health Branch, the local health units, other
Governmental departments, and consulting engineers.
Matters concerning the general functions of the Division were discussed at a meeting
of representatives of all the public health engineering divisions from other Provincial
departments of health in Canada. This meeting was quite useful and informative, as it
provided an opportunity to compare procedures and accomplishments with the other
organizations of a similar nature in Canada and thus to evaluate the present programme
and to plan future ones.
In the administration of the Division itself a number of things occurred which are
worthy of note. Mr. R. Bowering, the Director of the Division, remained on leave of
absence for the entire year in order to continue the work which he was doing in Korea.
He was a member of a team doing public health work under the jurisdiction of the World
Health Organization of the United Nations.
In order to improve the efficiency of the work of the Division, a number of new
devices were used and some old systems were changed. A number of form letters were
compiled and mimeographed to speed up replies to some of the routine inquiries received.
In addition, a number of inspection report forms were devised so that information
received would be more uniform. It is intended that these should be given a fairly
extensive trial period before they are distributed to the local health units.   The filing ^^^^^^^^^^^^^^^^^^^^^^^^ff
DEPARTMENT OF HEALTH AND WELFARE,  1951 X 69
system was reviewed, and a number of changes made which proved effective in making
desired information more readily accessible. These changes were made not only because
of the need for more efficient files, but also because of a planned change in the administration of the subjects involving environmental sanitation.
Plans were drawn up for the changes to be made in new office space which will be
assigned to this Division. This space is in the basement of the Parliament Buildings
and will apparently be available during the coming year.
In conclusion, this Province appears to be entering on a period of great industrial
expansion. This will inevitably bring an influx of population and provide an ever-
increasing number of public health engineering problems. If these problems are foreseen,
and if plans are made to provide reasonable controls, there is no reason why the environment during this expansion period should not be improved rather than become a greater
hazard to the public health. It is the intention of this Division to try to anticipate these
requirements and the controls needed for the future so that recommendations can be
made for their adoption as required.
B. SANITARY INSPECTION
C. R. Stonehouse, Chief Inspector
Milk
The Division continues to act as the liaison between the local authorities who enforce
local milk by-laws and the Provincial Department of Agriculture, which is responsible
for the inspection and grading of farm premises.
Two municipal by-laws were reviewed prior to submission for approval by the
Lieutenant-Governor in Council.
With the continual improvement in the bacteriological quality of the milk throughout
the Province, it is evident local authorities are investigating the ways and means of
establishing a method of measuring such improvement. The Division assisted in this
progressive step by supplying information on evaluation methods.
An exploratory survey and review of laboratory reports on fifty-six pasteurizing
plants throughout the Province indicated the average plate counts to be 22,000 per cc,
well within the accepted limit of 50,000 per cc. The study indicates the majority of the
plants included in the survey are exceptionally well operated and produce a bacterio-
logically good-quality milk.
An outbreak of salmonellosis was attributed to contaminated milk. The carrier of
the organism causing the outbreak was traced to an Ungraded supplier. The vendor who
distributed the Ungraded milk experienced a breakdown in the pasteurizing process due
to a temporary power shut-off, which meant that normally pasteurized milk from a reliable
vendor reached the consumer without the safeguard of pasteurization.
Eating-places
Public eating-places, usually a target of public criticism, provided less than the
normal number of complaints this year. The decrease may be credited to the food-
handlers' training courses carried out by Local Health Services. In the Nelson and East
Kootenay Districts the courses were sponsored by the Health Services. In the Cariboo,
the Restaurant Association sponsored the course, assisted by the Health Services.
Certificates of attendance were awarded the employees attending the courses.
With the expansion of the armed services, the various hygiene sections have solicited
assistance and advice on water-supplies, sewage-disposal, and dairy products. In
particular, the naval services consulted the Division on proposed changes in food-catering
measures. The Saanich and South Vancouver Island Health Unit assisted in training
naval hygiene personnel. X 70 BRITISH COLUMBIA
With the Royal visit, particular attention was given to all premises and the sources
of all foods to be served the Royal party. It was a co-ordinated effort, contributed to by
Dominion, Provincial, and local health departments. Inspections were made of all
supplies and catering methods on the Royal train, stopping-places, and holiday retreats.
Locker Plants
A thorough review of Departmental records of 105 plants was made pursuant to
a submission of the Frozen Food Locker Association requesting amendments to the
Regulations Governing the Construction and Operations of Frozen Food Locker Plants.
A summary was prepared of comments solicited from Medical Health Officers on the
proposed changes. The information and data were presented to the association. In lieu
of the changes they proposed, it was decided that an inspection of the plants on completion of construction, followed by routine quarterly inspections of operations, and the
enforcement of compulsory cutting and wrapping of meats by the plant operator would
materially overcome the alleged deficiencies in the application of the regulations.
Food-handling in Hospitals
A preliminary step has been taken toward co-ordinating the routine activities of the
local services, as they apply to hospital sanitation, with those of the Consultation and
Inspection Division of the Hospital Insurance Service. A survey is in progress on food-
handling techniques, catering measures, and other sanitation matters, in which information from past and current inspections is being utilized. All of which is to prevent
overlapping and duplication of services.
Horse-meat
The availability of horse-meat as food for human consumption was given much
newspaper publicity in July. Inquiries were received from many cities and communities
throughout the Province which led to a review of control measures on the Federal, Provincial, and municipal levels. In most municipalities its sale is restricted to premises
solely for the sale of the product. When the product was first available, it originated
in an abattoir under Federal inspection beyond our Provincial borders. It is now also
available from horses slaughtered within the Province, in which case no inspection is
required.
The evil, if any, attached to the sale of horse-meat is the possibility of the unscrupulous vendor substituting horse-meat for beef. This practice is contrary to the " Food
and Drugs Act," which requires that products containing horse-meat shall be conspicuously labelled. Although horse-meat has not, to our knowledge, presented any health
problems, we were interested in nutritional factors that may have been ascertained in
other quarters. From the Nutrition Services, Department of National Health and
Welfare, we were avised that an analysis from Belgium was obtained. Compared to
beef, horse-meat is slightly lower in fat and therefore slightly lower in caloric value.
In nutrient values, to all intents and purposes, the protein quality and Vitamin B content
are so close they may be considered identical. With the drop in exports of horse-meat
and resultant use in Canada, the Federal "Department plans to arrange an analysis to
compare its findings with those of Belgium.
Meat Inspection
Several inquiries were received from local Health Services for information as to
the future prospects for meat inspection. There is a passive, yet insistent, demand for
such inspections on a Provincial level which has been relayed to the Department of
Agriculture.    In the past, two measures of meat inspection have been applied in the DEPARTMENT OF HEALTH AND WELFARE, 1951 X 71
Province. Large abattoirs primarily interested in the export of its products have
inspection under Federal authority. The City of Vancouver has a by-law requiring that
inspected meats only may be offered for sale in that city and, in connection therewith,
have a municipal inspection service. During the year a Fraser Valley slaughter-house
operator instituted meat inspection on a voluntary basis. In the remainder of the
Province there is no requirement that meat be examined and inspected.
Slaughter-houses
Slaughter-houses are licensed under the " Stock-brands Act" in the interest of
preventing the slaughter of stolen cattle. The inspection under the regulations pursuant
to the " Health Act" was primarily designed to prevent nuisances arising upon the
potential offensiveness of such a trade.
In 1950 an arrangement was made with the Department of Agriculture whereby
an applicant for the slaughter-house licence or for the renewal of the annual licence
was requested to submit with the application an inspection certificate signed by the
Medical Health Officer. This arrangement was made at the request of several local
Medical Health Officers and has proven of immense value to the local health services.
The value of the arrangement is reflected by the increased number of premises approved
during the past year, by the improved standards of construction of slaughter-houses,
and by the replacement of unsatisfactory or dilapidated structures with new premises.
Seventy-three premises were licensed during the year.
The Division has acted in the capacity of a liaison between the Department of
Agriculture and the local health services, and this liaison will be furthered during the
coming year in an endeavour to bring about the desired improvements in those premises
below the standards set forth in the regulations pursuant to the " Health Act."
Industrial Camps
In the Sanitary Inspectors' activities, industrial-camp inspections are possibly more
numerous, aside from eating-places, than any other phase of environmental sanitation.
Camps are more widely distributed and difficult to inspect due to the remoteness of the
operations. Again, there being no registration or licensing involved, records of the
inspections are, with the exception of complaints, frequently directed to this Department
and requests for technical advice and information retained within the health unit.
Complaints in this field have outnumbered those of any other phase of sanitation
despite the apparent improvement in recent years. Yet the instances are infrequent
when compared to the number of camps throughout the Province. The majority of
the complaints are channelled by unions in the form of requests for inspection.
It might be reported that the International Woodworkers of America Union is contemplating expansion of the safety-first programme, in which the director of the programme would act as a liaison between the union and camp management in matters
relating to camp environment in the lumbering industry.
The use of mobile camp accommodation was introduced in the construction
industry during the year. In order to permit the use of well-constructed, nicely finished,
and well-appointed trailer bunk-house accommodation, the regulations governing the
sanitary control of industrial camps were amended to permit their use, particularly to
permit the use of double-tier bunks and to reduce the area and cubic-space requirements
per person.
With the activity in connection with the Aluminum Company project, several visits
have been made to the general contractors for the project in connection with the
temporary and, later, the permanent camps, water-supplies, and sewage-disposal. The
load of camp inspections in this area plus the community growth of Burns Lake and X 72 BRITISH COLUMBIA
Vanderhoof has fallen upon the Cariboo Health Unit.    It is proposed to establish
a branch of the health unit and a Sanitary Inspector at Burns Lake in the near future.
Farm-labour Housing
Seasonal labour for the Fraser and Okanagan Valleys is recruited as a service by
the Department of Agriculture. In 1947 certain improvements were instituted within
the Fraser Valley due to co-operation of the Small-fruit Growers' Association and the
Departments of Agriculture and Health.
In 1950, due to complaints from labour imported to the Fraser Valley, a joint
cursory evaluation of the lower standard of housing, provided by a minority of employers,
was made by the local placement officer, the local health service, and the Growers'
Association, at which time it was proposed that there be a review of the standards toward
improvement in general. Pursuant to that meeting the Matsqui-Sumas-Abbotsford
Public Health Service submitted a report with recommended standards. The report
has been reviewed and endorsed by the Emergency Farm Labour Advisory Committee,
and it is the desire of the Advisory Board that the Division of Land Clearing and Extension, the Department of Agriculture, and the Division of Environmental Sanitation plan
a further meeting with the Growers' Association early in the coming year and work
toward implementing the revised standards before the 1952 harvest.
Summer Camps
Licensed under the " Welfare Institutions Licensing Act," these camps are operated
by church organizations, welfare agencies, service clubs, fraternal organizations,
Y.M.C.A., Y.W.C.A., and, to a limited extent, by private enterprise. Most camps are
of a benevolent nature and provide summer outings for children who, to a large degree,
might be unable to afford such an outing. The majority of the operators are members
of the British Columbia Branch of the Canadian Camping Association, whose objectives
are to stimulate citizenship and leadership training and other worthy ideals. There
are approximately sixty-five camps operating in the Province on permanent camping-
sites, the majority of which are outside the boundary of any health unit, which leads to
difficulty of inspecting. Four camps were inspected toward recommendations for a licence
in 1950. In 1951 a full-scale inspection with complete reports was made on forty-nine
camps. In the evaluation of the report, twenty-eight camps were classified as good,
twelve as fair, seven as poor, and two as unsatisfactory.
School Sanitation
Pursuant to the annual inspection of schools by School Medical Inspectors, copies
of 364 complete reports as prepared for School Boards were submitted to this office.
In addition, copies of ninety-two supplementary reports were received, fifty-nine of which
were from the Central Vancouver Island Health Unit. With particular reference to the
latter, an evaluation of the reports was made to ascertain the outstanding problems in
that area.
This Division and the Division of School Planning in the Department of Education
propose, as a joint effort, to prepare a manual on school planning and environmental
needs for the information of school planners, School Boards, and School Medical
Inspectors.
Plumbing
A Technical Committee on Plumbing Services appointed by the National Research
Council, met in August and again in November on the revision of a recommended
standard plumbing by-law used by the National Research Council.    A further meeting mm
DEPARTMENT OF HEALTH AND WELFARE, 1951 X 73
to complete the revision will be held early in the year. The Committee consists of
representatives from each Provincial department of health and from the plumbing
industry.
On invitation from the City of Victoria, the Department was represented on a joint
Advisory Committee on a new plumbing by-law. The Committee consisted of representatives of the Plumbing Contractors' Association and Journeymen Plumbers.
At the request of the Upper Fraser Valley Health Unit, a model by-law was prepared
for a village in that health unit area. A by-law was prepared from the latest information on plumbing requirements, and might be said to be of less restrictive nature than
most plumbing by-laws that have been established from empirical standards.
Vermin-control
Several inquiries were received during the year for advice and even monetary
assistance on mosquito-control. This activity has been conducted entirely on the local
level as an advisory service of the local health unit to the municipal and community
bodies undertaking control and elimination measures. The species of mosquito found
in this Province is not a transmitter of disease and is therefore not of public health
significance.
Rodent-control
The Department has co-operated with the research on rodents conducted by the
Department of National Health and Welfare in the study of Rocky Mountain spotted
fever, pseudotuberculosis, tularemia, lepto-spirosis, and plague.
Since 1950 the field officer collecting the specimens for the study has been a Sanitary
Inspector from the Division, whose duties have been to collect the rodents and its ectoparasites and submit tissue specimens to the laboratory. In addition, this field officer
has functioned as a consultant to local health services on rodent-control measures.
It has now been established that the diseases associated with rodents and their
ecto-parasites are comparable to those found in other States and Provinces. It is therefore proposed that the collection of the domestic rodent (rat), if possible, be confined
to the metropolitan areas of Vancouver and Victoria, and that the funds now expended
on the Province-wide survey be spent on a more intensive survey in that part of the
Province in which plague bacillus among animals was found in 1950. X 74 BRITISH COLUMBIA
REPORT OF THE DIVISION OF VITAL STATISTICS
J. H. Doughty, Director
INTRODUCTION
The Division of Vital Statistics performs two functions in the public service, one
statutory and the other statistical. The former comprises the administration of the
" Vital Statistics Act," the " Marriage Act," the " Change of Name Act," and certain
sections of the " Wills Act." The latter consists 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.
In line with the increase in population of the Province, there has been an increasing
number of vital statistics registrations filed. The year 1951 saw the highest number
of registrations yet filed in any one year with the Division. It was encouraging to note
that while the number of live births increased over the previous year, the number of stillbirths declined appreciably.
There was also an appreciable increase in the number of certificates issued by the
Division, the number of searches carried out, and in the total revenue received by the
Victoria office. The number of birth certificates issued by the Victoria office was
26,566, a 31-per-cent increase over the 20,271 issued in 1950. Marriage certificates
issued by this office increased by 62 per cent to a total of 3,492. The number of death
certificates issued declined slightly to 5,056. Revenue-producing searches increased
from 24,512 in 1950 to 28,495 in 1951. In addition, there were 14,120 non-revenue
searches conducted, plus 4,650 searches carried out without charge for other Governmental departments. Total revenue received by the Victoria office increased by 18 per
cent to a total of $45,101.07.
REGISTRATION OF BIRTHS
Current Registrations
Birth registration in the Province is virtually complete, except for Indians and
Doukhobors, and in the former group particularly, encouraging improvements have been
noted.
The few births which occur at home in isolated localities cause problems in obtaining
satisfactory records, as do those situations where mothers enter hospitals under assumed
names for the births of illegitimate children and then disappear before filing registrations.
In most of these cases, however, the omission is corrected indirectly within several months
by the need for proof of the birth for Family Allowance purposes.
Investigation of the small number of fraudulent and improper birth registrations
discovered during the year has again shown that the action of the informant in each
case was motivated by a mistaken belief that the child's interests were being protected,
rather than from an intent to defraud for financial or other reasons.
The appreciation of the Division is expressed to the medical profession and hospital
staffs for their part in assisting to attain the high percentage of registration which presently
exists.
Gratitude is also expressed to the Regional Director, Family Allowances Division
of the Department of National Health and Welfare, for assistance rendered in cases
involving investigations.
Delayed Registration of Birth
Again this year the bulk of the delayed registrations accepted referred to events
which occurred before the year 1920.    The announcement of the payment of old-age DEPARTMENT OF HEALTH AND WELFARE,  1951 X 75
pensions to all persons 70 years of age and over led to many persons seeking a delayed
registration of their birth.
The Division continued an active campaign to obtain material which will assist the
public in procuring delayed registrations of birth, even though the onus of obtaining
such evidence actually rests with the applicant. The action by the Division in this regard
facilitates the acceptance of applications for delayed registrations and also helps to maintain a high quality of supporting evidence. The verification library comprises copies of
hospital reports of births, physicians' notices of birth, school returns of particulars of
birth, baptismal records, diaries from deceased medical practitioners, case records from
hospitals which are no longer in operation, etc. Efforts are continuing to be made to
expand this service by the addition of more material as it becomes available. During
the year the Division was able to obtain several large groups of church baptismal records
to add to this verification library. Such records are microfilmed and are returned to the
church authorities. Appreciation is expressed for the kind co-operation which the
various denominations have extended to us in this regard.
REGISTRATION OF DEATHS
The registration of deaths is likewise virtually complete, except in isolated localities
of the Province. As with the other series of registrations, a system of cross-checking is
used as a means of ensuring against loss of records during the period between their
original preparation and the time of processing in the Division.
One gap in the recording of deaths stems from the inability of the Division to
register deaths when bodies are not recovered. Particularly does this apply to drownings, although other circumstances may cause destruction or loss of bodies. In such
cases, proof of the fact of death is generally obtained by Orders of Presumption of Death
issued by the Court, but a death registration cannot be made for such cases. While
this procedure satisfies various requirements for proof of death, it does not provide for
statistical information on the cause of death.
REGISTRATION OF MARRIAGES
The responsibility for registering a marriage rests with the person solemnizing the
event—namely, the officiating clergyman or Marriage Commissioner. This method of
obtaining marriage registrations has proven very satisfactory over a period of many years
and is the method generally used in other Provinces and countries.
Marriage registers are provided free of charge to clergy and Marriage Commissioners. These are returned to the Division periodically in order that they may be
checked against the indexes of registrations filed with the Division. If it is thus
ascertained that an event has been unrecorded, steps are promptly taken to obtain
a registration.
DOCUMENTARY REVISION
It has long been recognized that, unlike other types of records, vital statistics records
seldom become inactive. Reference is frequently made to registrations filed fifty years
or more ago, and certificates are constantly being issued from such documents. As a
result, errors or omissions made by the informant at the time of recording the events are
constantly being discovered, and it becomes necessary to make corrections in order to
have the registrations reflect the true facts. In addition, alterations of given names are
made, adoptions are ordered by the Courts, legitimations take place, and changes in
surname are authorized. Changes must also be made on marriage registrations so that
the records indicate changes brought about by divorce, nullity, change of name, and
correction. Amendments to death registrations usually consist of corrections made by
the informant to details originally furnished at the time of death. X 76 BRITISH COLUMBIA
All registrations which have been amended are immediately remicrofilmed and the
indexes amended accordingly.
ADMINISTRATION OF THE "MARRIAGE ACT"
One new denomination was granted recognition in 1951, thus enabling its ministers
to solemnize marriage within the Province. In addition, applications for registration
of six other denominations were under consideration as at December 31st, 1951, and
one other application was refused. Each application is carefully investigated according
to the requirements set out in the " Marriage Act " in order to ensure that the provisions
of the Statute are fulfilled.
As a protection to the public, all registrations of marriage are checked to ensure
that the officiating clergyman has been duly registered pursuant to the provisions of the
" Marriage Act." In two instances it was discovered that the clergyman had not been
authorized to solemnize marriage, and appropriate action was therefore taken by the
Division to validate the ceremonies.
Applications for an order of remarriage pursuant to section 47 of the " Marriage
Act " were approved in twenty-two cases.
Form M. 5, Notice of Transfer or Disqualification, was revised in order to facilitate
the maintenance of the register of authorized ministers and clergymen.
ADMINISTRATION OF SECTIONS 34 TO 40, INCLUSIVE,
OF THE " WILLS ACT "
Over 10,000 notices showing the location of the last will of the respective testators
h&d been filed as at December 31st, 1951. The provision whereby the Director is
required to accept such notices was enacted in 1945. Since that time there has been
an increasing use made of this service by the public. In 1949, 1,500 notices were filed,
in 1950 the number rose to 2,200, while in 1951 over 2,700 were received.
A revised index, consolidating the information received during the period 1945 to
1950, was prepared during the year. In addition, the current year's notices were indexed
as rapidly as they were received in order to provide a speedy means of searching.
REGISTRATION OF VITAL STATISTICS AMONGST THE INDIANS
Current Registrations
It is probably not surprising that more difficulty is encountered in obtaining vital
statistics registrations for the Indian population than for the white. Because of his
different way of life and different background, the Indian has had little reason to become
conscious of the value of records. Nevertheless, official records of the vital events of the
Indian's life are now as important as are those of the white population, and such records
are required for a multitude of purposes. Efforts are continually being made to educate
Indians to the value of accurate recording of vital statistics, and the results gained during
the last several years have been quite gratifying.
There has also been a noticeable improvement in the interest taken by the Indian
Superintendents in the last several years toward gaining complete and accurate registration within each agency. This interest has been stimulated not only by the evergrowing need for certification and statistical data, but also by personal contacts between
the Superintendents and senior members of the staff of this Division.
The offices of nine Indian Agencies were visited during the year for the purpose of
providing instruction in obtaining and maintaining registrations Indications are that
registration of births and marriages is reasonably complete, but much remains to be
accomplished with regard to the satisfactory recording of deaths. This deficiency is
largely due to deaths occurring in remote areas, where knowledge of these events does not DEPARTMENT OF HEALTH AND WELFARE,  1951 X 77
reach the Indian Superintendent for weeks or even months afterwards. It is a situation
which is difficult to correct, but efforts are being made to encourage the Indians to register
deaths of their band members before disposal of the bodies, if at all possible.
The Indian Commissioner for British Columbia has been kept advised periodically
as to progress made, and he has given valuable support to the efforts of the Division.
Documentary Revision
The project of checking, revising, and reindexing Indian registrations filed during
the period 1917 to 1946, inclusive, was continued throughout the year.
During the year all the registrations of the births and deaths of the Stewart Lake
Agency and the birth records of the Babine and Fort St. John Agencies were revised.
Where errors in existing registrations were discovered, steps were taken to obtain sufficient
information with which to make corrections. In those instances where births had not
been previously registered, efforts were concentrated on having the Indian offices submit
the required registrations.
One hundred and fifty-five schools submitted reports for the 1950-51 term, of which
twenty indicated that no Indian children had been newly enrolled during the term.
It was ascertained that 2,166 Indian pupils attended school for the first time, and for
these children there was a high percentage of disagreement between particulars shown on
the school records, the Agency nominal roll, and the birth registrations. Where necessary, the latter were amended, while information necessary for correcting the school
record or the Agency nominal roll was referred to the schools and/or the Agency offices
for attention.
Delayed Registrations
Further additions were made in 1951 to the collection of baptismal records, thus
assisting in the large task of processing applications for delayed registration of births of
Indians. The problem of locating verification which is sufficient to justify the acceptance
of a delayed registration is a very real one, and every available means of obtaining proof
of the date, place of birth, and parentage must be employed.
Although the registration of vital events for Indians was introduced on a voluntary
basis in 1917, it was not until 1943 that such action was made mandatory. There is, as
a result, a large back-log of unregistered Indian births for this period. The combined
efforts of the Indian Commissioner for British Columbia, the Indian Superintendents,
and the Division of Vital Statistics have resulted in the recording of many such events
during 1951, while many more were being processed at the close of the year.
Deputy District Registrars in Indian Agency Offices
The number of appointments of Deputy District Registrars in Agency offices was
increased so that all except four agencies in British Columbia now have staff members
holding such authority. This action has proven to be extremely advantageous, as it
allows the Agency staffs to expedite delivery of registrations to the Division at times
when the Superintendents are carrying out their field duties. The service is particularly
valuable in facilitating the completion of delayed registrations. It is hoped that similar
appointments may be made in the remaining Agencies as soon as the clerks become
sufficiently trained to carry out the responsibilities involved.
REGISTRATION OF VITAL STATISTICS AMONGST THE DOUKHOBORS
Current Registrations
Comparatively little difficulty is now encountered with regard to the attitude of the
so-called orthodox Doukhobors toward registration of births. The field representative
of the Division working amongst Doukhobors continued to carry on his activities in X 78 BRITISH COLUMBIA
attempting to secure registration in cases where other methods had failed. His efforts
have included an educational programme aimed at informing the Doukhobors of the true
purpose and value of vital statistics registration. It is believed that a project of this
nature must be planned with a long-range view, since it is difficult to dislodge suspicion
and overcome the fears and convictions of many generations' standing.
Little change was noted in the past year concerning the registration of deaths.
It appears that complete and accurate reporting of deaths will not be achieved until these
people are further educated to comply with the statutory requirements and until the bodies
of all deceased persons are disposed of by professional undertakers. In many Doukhobor
villages a neighbour of the deceased person prepares a coffin, and the burial is conducted
as a family affair.. Through ignorance, and sometimes through disregard of the law,
some bodies are thus buried without notification of any kind to the appropriate authorities.
There has likewise been little change in reaction toward marriages being solemnized
in a legal manner. However, some Doukhobor couples have been married by Marriage
Commissioners, thus indicating an acceptance of the civil form of marriage.
Sons of Freedom remain adamant in their refusal to accept the principles of
registration of vital statistics, but it is hoped that continued efforts to bring about a change
in their thinking will eventually be successful.
EFFECT OF OLD-AGE SECURITY LEGISLATION
In January, 1951, registration of applicants for the old-age security benefits payable
in 1952 was commenced by the Department of National Health and Welfare. The full
impact of the demand for certification to prove age for eligibility was felt during August,
when the revenue-producing business conducted by the Central Office was approximately
15 per cent greater than that for the previous all-time high established only the month
before. While there was a levelling-off during subsequent months, this new legislation
has created a distinct additional need for proof of age, which will result in the continuation
of a noticeably higher volume of business than has been experienced heretofore.
GENERAL OFFICE PROCEDURES
Since January 1st, 1949, a multipart Speediset form (V.S. 30) has been the basis
of processing all cash mail received at the Division. This is a combined form which acts
as (a) the cash-register receipt, (b) the reply to the applicant, (c) the working copy of
the application for internal office use, (d) cross-index file, (e) suspense cash ledger, and
(/) file copy recording all steps in the transaction. As a result of experience gained in
the use of these forms, several minor changes were made in the reprint which was placed
in use late in the year, the alterations being confined to adjustment of location of certain
items in order to gain the greatest speed and accuracy in production.
An experiment was made early in the year in the preparation of these forms by the
use of an electric typewriter. The results obtained were very satisfactory from the viewpoint of quality, quantity, and relief from undue fatigue on the part of the operator.
Later events proved the advisability of this action, for, despite a great increase in the
volume of business, it was unnecessary to increase staff, although an increase would have
been necessary under the previous arrangement.
There was a considerable change in the staff during the year, which necessitated
changes of duties on the part of the remaining staff.
Steps were taken to make available a duplicate birth index which could be taken
into use on short notice. The basic information for this duplicate index had been
prepared several years ago, but considerable work is required by reason of changes made
to the original registrations to make the index fully operative. This project is being
completed as and when time allows and will be continued during the next year. The
index is considered important for two reasons—firstly, as a replacement for the copy
presently in use and, secondly, as a security measure. DEPARTMENT OF HEALTH AND WELFARE,  1951 X 79
The matter of supplying free verification and/or certification to other Government
departments is one which receives constant attention, for it has been found that unless
a close control is maintained, the volume of such work becomes unduly onerous.
Approximately 10 per cent of all searches are made for other departments and are
non-revenue-producing.
It has been necessary to adopt a strict rule that only in cases of extreme urgency
will searches be conducted on the basis of a telephoned request. Searches hurriedly
made in response to a telephone call cannot be as reliable as those which are processed
in the regular manner, and, in addition, the telephoned information is much more subject
to misinterpretation. It is felt that in view of the legal implications of information
appearing on vital statistics registrations, this is a very reasonable and necessary rule
to enforce.
MICROFILMING OF DOCUMENTS
All current registrations of births, deaths, marriages, and stillbirths were photographed on a weekly basis, the records for all earlier years in these series having been
placed on film previously. Likewise, amendments to registrations brought about by
name changes, adoptions, divorces, etc., were photographed, and the amended images
spliced into the appropriate rolls of film.
Several miscellaneous microfilming projects were completed during the year,
including the following:—
(a) Physicians' Notices of Birth for the calendar year 1949.
(b) 1,700 legitimation-of-birth files.
(c) 2,500 change-of-name files.
(d) 8,500 notices of the filing of a will.
(e) Miscellaneous baptismal records contained in books loaned temporarily
by various churches.
Some improvements in darkroom facilities were made during the year, including
an improved ventilating system and the replacement of a machine for washing prints.
DISTRICT REGISTRARS' OFFICES AND INSPECTIONS
Changes in Registration Districts
At the request of the Royal Canadian Mounted Police headquarters, the police were
relieved of vital statistics duties at six district offices in the Province. In these districts
the police had found it difficult to perform the functions of a District Registrar of Births,
Deaths, and Marriages in addition to carrying out their regular police duties. Consequently, at Mission, Murrayville, and Terrace the appointments of District Registrar or
Deputy District Registrar were transferred to the local Municipal Clerk. At Dawson
Creek and at Vanderhoof the appointments were transferred to private businessmen,
while at Kimberley it was transferred to the Stipendiary Magistrate.
The office of the Deputy District Registrar of Births, Deaths, and Marriages at Keremeos was closed and the services consolidated under the District Registrar at Penticton.
This move was taken in view of the small volume of business which had been handled
at the Keremeos office.
With the closing of the Government Agency at Stewart, the appointment of District
Registrar was transferred from the Government Agent to the Sub-Mining Recorder.
Upon the resignation of the District Registrar at Ganges, the appointment was transferred to the Provincial Assessor of the Department of Finance.
Arrangements were made with the municipal authorities of the City of North Vancouver to transfer the District Registrar's office from Lonsdale Avenue to the City Hall.
The new office is ideally located for the convenience of the public and offers much better
working facilities than did the former premises. X 80 BRITISH COLUMBIA
INSPECTIONS
Twenty-five offices and sub-offices covering the Queen Charlotte Islands, the northern
part of the Province extending from Prince Rupert to Prince George, the Peace River
District, and the Central Cariboo District from Quesnel to Lillooet were visited by the
Inspector of Vital Statistics during the year.
In addition, brief instructional visits were made to nine Indian Agencies. Visits were
also made to the Vancouver office, as well as those of New Westminster and North Vancouver. The purpose of these visits was 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 ninety-two offices and sub-offices in seventy-two
registration districts. In addition, there is a special Deputy District Registrar working
amongst the Doukhobors, a Marine Registrar, and eighteen Indian Superintendents who
are ex officio District Registrars of Vital Statistics for Indians only. Thirty-seven of the
offices are Government Agencies or Sub-Agenciest. while twenty-eight of the offices are
staffed with Royal Canadian Mounted Police personnel. Nine offices are staffed by
other Government employees, while fourteen offices are operated by private individuals.
STATISTICAL SERVICES
The Division continued to carry out its function as the statistical workshop for the
Health Branch and, in addition, maintained complete statistical analyses of all births,
deaths, marriages, stillbirths, adoptions, divorces, changes of name, and of other services
provided by the Division. A considerable increase has occurred in the assistance which
the Division has been able to give to the various divisions of the Health Branch and to
other agencies. This has taken the form of analyses of record systems, consultative
service on statistical matters, provision of statistical analyses, and other special studies.
The illness of the director of the sickness survey during part of the year necessitated
sending a member of the Victoria statistical section to Vancouver in order that the sickness
survey might be continued. As a result, there was a reallocation of certain duties within
the statistical section. Supervision of the sickness survey, the purpose and scope of
which was outlined in the 1950 Report, constituted one of the major tasks of the Division
during the year.
The usual demographic functions of the Division were carried out by the statistical
section. These consist of the maintenance of monthly summaries of vital statistics data,
the preparation of a quarterly and annual report, the provision to the Metropolitan Health
Committee of Vancouver and to the Victoria-Esquimalt Union Board of Health of special
tabulations, and the provision of estimates of population in the Province. Various
requests from within the Department of Health and from other Government departments,
from industries, from organizations, and from private individuals were received and dealt
with as required. Detailed statistical information on marriages was supplied to several
religious denominations who required these data for their work. During the year a
request was received from the Lower Mainland Regional Planning Board for extensive
data on births, deaths, and population in the organized areas of the Lower Mainland.
Frequent requests for data were received from students doing research work or special
assignments.
During the first part of the year when a nation-wide influenza epidemic existed, the
Department of National Health and Welfare was kept advised of the number of influenza
deaths occurring each week and of the number of cases reported. This procedure was
carried on throughout the Dominion, so that it was possible at all times to have a check
on the progress of the epidemic. DEPARTMENT OF HEALTH AND WELFARE,  1951 X 81
As noted in the Annual Report of the Department of Health for 1950, population
estimating has become increasingly hazardous during the last few years because of the
increasingly long interval since the last census, which was taken in 1941. The Ninth
Decennial Census, however, was taken during 1951, and the results will provide the first
accurate population counts available within the last ten years. Already the population
counts of the organized areas of the Province have been made available, as well as those
in the various census areas. It is expected that breakdowns of the population by age,
race, religion, marital status, and other factors will be available in the near future. The
speed with which the Census Division of the Dominion Bureau of Statistics has been able
to provide results of its enumerations has proved to be very helpful.
The Divisions of Tuberculosis Control and Venereal Disease Control were again
supplied with the statistical tabulations of their case-loads. A number of requests for
special tabulations were also received, and the necessary information was derived from
the punch-card records on file in the Division. A revised form for the reporting of
tuberculosis was drawn up, and it is expected that this will be put into use at the beginning
of the year. This revision should mrke possible the provision of improved statistics on
tuberculosis.
Considerable assistance was rendered to the British Columbia Cancer Institute in
the setting-up of a system of cancer-treatment statistics. A summary of each cancer case
will be forwarded to the Division and will be placed on punch-cards. Statistical tabulations from these cards will provide the first extensive medical statistics available on cancer
treatment in this Province.
Analyses of the diet in certain institutions were completed for the Nutrition Service
during the year.
The report on the Wetzel Grid as an adjunct to school medical services was completed in 1951. This report contains statistical analyses of the procedures followed in
carrying out the study and of the results obtained.
A completely revised form for the reporting of a live birth or stillbirth by the physicians was put into operation in February of the year. The new form was drafted with
the advice and co-operation of a special medical committee of practising physicians. The
information which is contained on the new Physician's Notice of a Live Birth or Stillbirth
is being coded and placed on punch-cards for subsequent statistical analyses. The implementation of this programme constituted an important addition to the statistical work
of the Division.
CANCER REGISTRY
Cancer is a notifiable disease in this Province, and consequently physicians are
required to report all cases to the Department of Health. The purpose of this reporting is
to make possible the provision of up-to-date data on the cancer problem in the Province.
The operation of this cancer registration system is a responsibility of the Division of
Vital Statistics. For several years the Division has been concentrating on efforts to
ensure complete reporting of cancer in order that the statistics to be derived might be as
accurate as possible.
The following tables show the cancer cases reported during 1951 classified according
to site, age-group, and sex. It will be noted from these tables that a total of 2,798 new
cases of cancer were reported during the year, of which 1,928 cases were reported alive
and 870 cases reported for the first time upon death. X 82
BRITISH COLUMBIA
Table I.—Number and Percentage of New Cancer Notifications1
by Site and Sex, British Columbia, 1951 (Excluding Indians)
Site
Male
Female
Total
Number
Per Cent
Number
Per Cent
Number
Per Cent
461
188
261
7
176
106
121
30
27
16
94
31.0
12.6
17.6
0.5
11.8
7.1
8.2
2.0
1.8
1.1
6.3
318
266
167
24.3
20.3
12.7
779
454
428
325
219
156
150
51
41
19
176
27.8
16.2
Skin  	
15.3
318      I       24.3
43                3.3
11.6
7.8
Urinary system   	
50
29
21
14
3
82
3.8
2.1
1.6
1.1
0.2
6.3
5.6
5.4
1.8
Lymphosarcoma ' _	
1.5
0.7
6.3
Totals —  	
1,487
100.0
1,311
100.0
2,798
100.0
1 Includes 870 cases reported for the first time at death.
Table II.—Number and Percentage of Reported Live Cancer Cases
by Site and Sex, British Columbia, 1951 (Excluding Indians)
Site
Male
Number      Per Cent
Female
Number      Per Cent
Total
Number      Per Cent
Skin	
Genital system	
Digestive system-
Breast	
Buccal cavity	
Respiratory system..
Urinary system	
Lymphosarcoma	
Bone...  	
Brain and central nervous system..
Other and not stated	
Totals..
253
129
193
5
116
96
72
20
10
4
48
26.7
13.6
20.4
0.5
12.3
10.2
7.6
2.1
1.1
0.4
5.1
175
229
159
280
29
19
31
11
3
4
42
17.8
23.3
16.2
28.5
3.0
1.9
3.2
1.1
0.3
0.4
4.3
428
358
352
285
145
115
103
31
13
8
90
946
100.0
982
100.0
1,928
22.2
18.6
18.3
14.8
7.5
6.0
5.3
1.6
0.7
0.4
4.6
100.0
Table III.—Cancer Notifications1 by Sex and Age-group, British Columbia,
1951 (Excluding Indians)
(Age specific rates per 100,000 population.)
Male
Female
Total
Age-group
Number
Age
Specific
Rate
Number
Age
Specific
Rate
Number
Age
Specific
Rate
0- 9	
10-19	
12
5
11
33
97
232
439
448
154
56
11.7
7.0
12.9
38.9
137.8
371.6
746.9
2,119.2
1,767.0
16
8
27
93
170
292
305
263
98
39
16.6
11.3
30.1
108.5
269.0
542.8
674.5
1,138.3
1,328.8
28
13
38
126
267
524
744
711
252
95
14.1
9.2
21.7
73.9
199.9
450.8
715.4
1,310.7
1,561.3
20-29                   _            .          	
30-39    _	
40-49                                    	
50-59	
60-69     	
70-79   _	
Totals    	
1,487
259.1
1,311
245.0
2,798
252.3
1 Includes 870 cases reported for the first time at death. DEPARTMENT OF HEALTH AND WELFARE,  1951
X 83
Table IV.—Live Cancer Cases Reported by Sex and Age-group,
British Columbia, 1951 (Excluding Indians)
(Age specific rates per 100,000 population.)
Male
Female
Total
Age-group
Number
Age
Specific
Rate
Number
Age
Specific
Rate
Number
Age
Specific
Rate
0- 9 	
1
4
8
29
67
165
278
260
88
46
1.0
5.6
9.4
34.2
95.2
264.3
473.0
1,229.9
1,004.0
8
5
22
84
142
234
222
167
56
42
8.3
7.1
24.5
98.0
224.7
434.9
490.9
722.8
759.3
9
9
30
113
209
399
500
427
144
88
4.5
10-19	
6.4
20-29.                        	
17.2
30-39...  	
40-49              	
66.3
156.6
50-59 	
60-69     ..	
70-79	
343.3
480.8
787.2
892.2
Totals   	
946
164.8
982
183.6
1,928
173.9 X 84 BRITISH COLUMBIA
REPORT OF THE DIVISION OF PUBLIC HEALTH EDUCATION
Kay Beard, Consultant
LOCAL HEALTH EDUCATORS
During the fall of 1950 two trained health educators were appointed to the staffs
of local health services—one to serve the Victoria-Esquimalt Health Department and the
Saanich and South Vancouver Island Health Unit, and the other to serve the Central
Vancouver Island Health Unit.
In November of this year the two local health educators completed their first year
of work in health units. During the year much time and thought has been given to
clarifying the functions of persons working in this capacity. In this connection an outline
of the duties and responsibilities of local health educators was prepared with the assistance
of the two local health educators. Although the programme in each unit must vary
according to the needs of the community, the outline is a useful guide in planning the
work of a health educator in a health unit.   The functions are outlined as follows:—
Under the general direction of a health unit director, to plan and carry out a
comprehensive programme of health education in a local health unit, including such
responsibilities as:—
(1) To provide consultative service to the staff and to other agencies in
education techniques, methods, and materials. To assist the staff in
improving the effectiveness of their individual and group teaching.
(2) To assist public health staff to organize and co-ordinate the health-
education aspects of such projects as child-health conferences, pre-school
and school examinations, and food-handlers' schools; to assist in guiding
community agencies (voluntary and official—for example, Parent-Teacher
Associations, Women's Institutes, service clubs, schools) in selecting and
developing health-education projects for which there is a need in British
Columbia to develop, and maintain interagency co-ordination in community health projects.
(3) To assist in determining and clarifying staff policy as it concerns health
education; to represent the Health Branch on committees concerned with
activities related to health education, and to interpret Health Branch policy
to these committees.
(4) Through interviews, questionnaires, and other survey methods, to determine where emphasis should be placed to improve the effectiveness of
health-education programmes, and to give guidance in evaluating health-
education projects, services, and materials.
(5) To provide leadership in the improvement of staff-training procedures
and practices within the local unit, including planning of orientation
courses, staff meetings, study-group meetings, and to assist other community groups in developing or improving staff-training methods; to
assist in interpreting and clarifying the policies of other agencies for the
staff.
(6) To organize and assist in administering the public relations and publicity
programme for the health unit; to establish favourable relations with
press and radio, prepare news releases, arrange for selection and distribution of health-education materials; to provide leadership in improving the
public-relations practices of the staff; to arrange programmes and speakers
for meetings of community groups; to prepare, in co-operation with the
staff, special materials for particular needs, such as annual reports, posters,
leaflets, and displays; to develop methods of increasing community
understanding of the services provided by local health units. DEPARTMENT OF HEALTH AND WELFARE,  1951 X 85
Since much of the work of a health educator may take months or years to show
results which can be evaluated, it is too early to estimate with any degree of accuracy the
success of the local programmes to date. There is, however, one point in connection
with such programmes which bears emphasizing at this time. This is that the success
of the health-education programme depends on the whole-hearted co-operation of the
health unit staff. The health educator cannot and does not carry out the health-education
programme, but is responsible for planning, co-ordination, guidance, and leadership to
the staff and the community in matters concerning health education. It is therefore most
important that the health unit staff have a good understanding of the functions of a local
health educator and an earnest desire to work with a specialist in this field if a successful
programme is to be developed.
Throughout the year increased attention has been given to interpreting the functions
of a local health educator to health unit personnel. Two health unit directors have
recently requested that a health educator be attached to the staffs of their units. It may
be possible to meet one of these requests during the coming year.
IN-SERVICE TRAINING
It has been said that " To stand still is to slip backward "—a statement which is
certainly true of public health personnel. New developments in medicine and in public
health and changing social problems necessitate constant study on the part of all those
engaged in public health work to keep abreast of modern thinking. The main feature
of the in-service training programme of the Health Branch is the four-day Annual
Institute. This year, with an outstanding guest speaker, Dr. H. S. Mustard, to highlight
the programme, the Institute was most successful. A member of this Division was on
the Institute Planning Committee, and all the staff of the Division assisted in preparation
of displays and publicity. For the first time an attempt was made to evaluate the
programme through the use of a questionnaire. Although some of the replies were
difficult to tabulate, the results provided useful information on the effectiveness of the
Institute as well as suggestions to be considered in next year's planning.
In order to assist local health educators in programme planning and provide an
opportunity for exchange of ideas on projects being developed, five meetings of the local
health educators and the staff of this Division were held during the year.
Other in-service training projects in which this Division participated included the
fall meeting of the health unit directors, the fall meeting of the dental directors, and the
Sanitary Inspectors' course in Public Health Administration.
A successful administrator must be familiar with the broad policies governing his
field of administration and with the philosophy behind these policies. The health unit
director, who is responsible for local administration and policy in his health unit, needs
to have a clear understanding of the Provincial policies within which he is to plan.
In addition, he needs to know the services available to him from Provincial sources.
In order to provide new health unit directors with this information, an orientation course
is arranged through this Division for new health unit directors and other key personnel in
health units or divisions of the Branch. During the year four health officers, seven dental
directors, and two health educators completed orientation courses. In addition, an
intensive ten-day orientation was arranged for Dr. L. E. Ranta, Assistant to the Dean,
Faculty of Medicine at the University of British Columbia, at his request, in order that
he might become more conversant with the policies and programmes of the Health
Branch. A one-week course was also arranged for a field worker on the staff of the
Junior Red Cross.
CONSULTATIVE SERVICE
During the year, visits were made to four health unit centres to attend staff meetings.
The main topic of discussion in each case was the Effective Living Course for junior and X 86 BRITISH COLUMBIA
senior high schools and the part the public health staff could play in its successful
implementation. Other matters concerning school health were discussed, including the
use of the pamphlet order forms for teachers prepared by this Division during the summer.
Throughout the year, advice has been given by correspondence to local public health
staff on other phases of health education, such as annual reports, planning speeches, and
materials for co-operative play groups and discussion groups.
In order to provide a satisfactory consultative service to local public health staff, it
will be necessary to increase the number of field-trips so that each unit is visited at least
once a year. To date the shortage of staff has made this impossible, but the addition
of a second health educator with postgraduate training, in October of this year, should
help considerably in expanding consultative services during the coming year.
PUBLICATIONS AND PUBLICITY
The close of 1951 marked the end of the first year of publication of B.C.'s Health,
the new printed form of the Health Bulletin. During the year the mailing list was revised
and enlarged to increase the circulation from 2,500 to 5,000 copies per month. Groups
of persons added to the mailing list included dentists, pharmacists, secretaries of Parent-
Teacher Associations, and elementary-school principals. From April until October an
extra 2,000 copies were printed for distribution through public health staff to families
participating in the sickness survey.
During the year, articles have been prepared for such publications as B.C. Schools,
B.C. Teacher, and Your Health. Plans are being completed for the preparation of a page
entitled " Mental Health and Public Health News " as a regular feature of the Vancouver
Medical Bulletin. The purpose of this page will be to provide to practising physicians
throughout the Province information on policy changes and new developments in these
services which are of interest to practising physicians.
As in past years, the Division has co-operated with other divisions in the preparation
of special materials, such as pamphlets, manuals, and reports, and has accepted the
responsibility for planning the layout and arranging for production.
Two special publications prepared during 1951 will be ready for distribution early
in 1952. At the request of the College of Physicians and Surgeons, a Manual for
Physicians on Mental Health and Public Health Services has been completed and is
being printed for distribution to all doctors in the Province. Copies will be supplied to
the College for distribution to physicians coming to British Columbia to practise. The
Manual is intended to present briefly the services available to physicians through Mental
Health Services and the Health Branch, together with the physician's legal responsibilities
to these services. The second publication, entitled "Administration of Provincial Health
Services, 1951," is included elsewhere in this Report and will be available also in
pamphlet form. It has been prepared for distribution to persons requesting information
about the services provided by the Health Branch.
In the field of exhibits, good use was made of the photographic display prepared
during 1949. The display consisted of eighty enlarged and mounted photographs
illustrating the more important services of each division of the Health Branch and of
Local Public Health Services. It was exhibited first in the lobby of the Parliament
Buildings during the opening week of the legislative session, and later at the Public Health
Institute and the Provincial Normal School in Victoria. Sections of the display have
been used by local public health staff in community and school exhibits. The photographs
have been useful also in illustrating articles in B.C.'s Health and other publications.
During the year, assistance was given to various health units in planning twenty
displays, and additional basic materials have been prepared for loan to health units
producing exhibits.
One of the most widely used educational materials distributed by the Division is the
series of mothers' advisory letters (postnatal letters).   About 10,000 sets of these letters DEPARTMENT OF HEALTH AND WELFARE, 1951 X 87
are produced yearly. To date, it has been possible for ten of the health units to accept
the responsibility for the distribution of these letters locally as a part of their health-
education programme. Other units plan to assume this responsibility as soon as the
clerical staff can handle the additional work involved. Throughout the year, assistance
has been given to health units in setting up systems for the distribution of these letters.
FILMS
The film library has been expanded to include 117 films and 85 film-strips. Request
for films continue to increase, with, as in 1950, the greatest demand for films on mental
health, particularly in the field of child behaviour. An average of 100 films has been
distributed each month, with a monthly audience varying from 500 to 10,000 and
averaging about 4,900. An encouraging trend has been noted in the increasing number
of films being requested as part of a discussion group or a special series of classes, such
as parent-craft classes. This is but one of many evidences that public health workers
are becoming more interested in using films effectively.
A revised edition of the film catalogue was prepared during the year to include
the latest additions to the library. A similar revision of the film-strip catalogue is under
way at the year's end and should be completed early in the new year.
STAFF CHANGES
On August 1 st a university graduate with teaching experience joined the staff of the
Division to take up the duties of another staff member who was granted leave of absence
to undertake postgraduate study in public health education at the University of Toronto
on Federal Health Grant funds. On October 1st another staff member returned from
postgraduate training at the University of Michigan and resumed duties in the central
office. X 88                                                      BRITISH COLUMBIA
REPORT OF THE DIVISION OF LABORATORIES
C. E. Dolman, Director
The year under review completes the second decade of the Provincial Laboratories'
existence within the Department of Health of British Columbia.    During the whole of
this period the main laboratories have been housed in entirely unsuitable and now disintegrating " temporary quarters," which will be the subject of further comment at the end
of this report.    Notable features of the year were the continuing upward trend in numbers
and complexity of tests performed and the successful establishment of a full-time branch
laboratory at Nelson.
The total tests performed by the Division exceeded 410,000, a fixture equivalent
to about one test for every three inhabitants of the Province.   Nearly 350,000 of these
were carried out in the central laboratories, an increase of around 10 per cent over 1950,
and over 60,000 in the branch laboratories at Victoria, Nelson, Prince George, and
Kamloops.    Table I shows the classified totals of tests done in Vancouver during 1951,
with the comparative figures for 1950.    In Table II the total tests carried out in the
four branch laboratories during 1951 have been set forth.
Table I.—Statistical Report of Examinations Done During the
Year 1951, Main Laboratory
Out of Town
Metropolitan
Health Area
Total in 1951
Total in 1950
1
265      !              333
598
12,204
6,203
2,208
69
13,631
6,426
26,433
4,516
6,352
1,661
26,837
14,694
3,862
351
267
756
135,740
25,517
4,064
26,271
2,769
176
1,084
2,155
2,774
3,231
3,231
2,474
894
7,041
191
191
191
176
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
Blood serum agglutination tests—
3,540
1.666
528
38
7,053
2,097
7,636
1,017
566
4,554
9,171
1.208
46
41
172
36,566
7,414
1,289
7,902
846
39
300
672
841
1,106
1,106
749
2
5,040
41
8,664
4,537
1,680
31
6,578
4,329
18,797
3,499
6,352
1,095
22,283
5,523
2,654
305
226
584
99,174
18,103
2,775
18,369
1,923
137
784
1,483
1,933
2,125
2,125
1,725
892
2,001
191
191
191
1 .5
Paul Bunnell                                                                	
Cultures—
M. tuberculosis ■•  —  	
Direct microscopic examination—
N. gnnnrrhffip
Serological tests for syphilis—
Blood—
Cerebrospinal fluid—
Cerebrospinal fluid—
Milk-
Standard plate count   _
Phosphatase.   	
Water-
Standard plate count  	
Ice-cream—
-       I       	
Totals
103,5-1             241,727             345,238      |      319,260
1 After June 1st, 1950, included under " Cultures—M. tub
erculosis." DEPARTMENT OF HEALTH AND WELFARE, 1951
X 89
Table II.—Statistical Report of Examinations Done During the
Year 1951, Branch Laboratories
Kamloops
Nelson
Prince
George
Victoria
78
112
1
2
72
93
73
315
8
148
234
20
8
38
65
2,194
34
33
118
118
96
200
321
71
209
347
349
82
228
390
3
6
9
3,996
75
4
32
46
876
879
263
28
761
605
807
836
85
29
562
19
117
Blood serum agglutination tests—
102
Brucella group  _	
178
103
Cultures—
1,651
348
C. diphtherias   ____-.  ,	
2,654
2,654
445
Direct microscopic examination—
692
M. tuberculosis (sputum)	
4,244
602
19
Vincent's spirillum _ .„._	
15
149
Serological tests for syphilis—
Blood—
23,246
1,423
374
2,072
565
Cerebrospinal fluid—
Cell count  _ _ __ _	
Protein- _ _  _______
413
401
491
Milk-
1,036
1,036
1,036
Water—
1,419
1,179
Totals         	
4,060
8,975
2,943
48,664
Roughly 30 per cent of the main laboratories' activities related to specimens from
outside the Greater Vancouver area. Until a few years ago this proportion was only
10 per cent. The disproportionately heavy increase in demand for public health laboratory work from the Province at large reflects mainly the establishment of several new
full-time health units, with consequent greater awareness in less populated areas of the
important contributions this Division can make to the general public health. Improved
transportation schedules and facilities have also encouraged the shipment of specimens
which formerly could not have reached Vancouver in time to yield reliable results.
The following chart shows the steady upward trend in the total numbers of tests
performed annually in the main laboratories. The corresponding totals for tests relating
to the diagnosis and control of venereal diseases are likewise displayed. The graph
illustrates the inexorable tendency of public health laboratory work to increase—in our
own case to a tenfold extent during the twenty-year period covered. It also emphasizes
the high but slowly diminishing percentage of the Division's work which is concerned
with venereal diseases. X 90
BRITISH COLUMBIA
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TESTS FOR DIAGNOSIS AND CONTROL OF VENEREAL DISEASES
Approximately two-thirds of all tests done in the Division had to do with syphilis
and gonorrhoea. Only two years previously the proportion reached as high as three-
quarters. There is little likelihood that in the foreseeable future laboratory tests for
venereal diseases will represent less than half the total turnover. It may be anticipated
that eventually many strains of spirochetes and of gonococci will acquire resistance to
the antibiotics which are currently so effective against these micro-organisms. Since
exposure rates are meanwhile likely to have risen rather than otherwise, the need to
conduct sero-diagnostic surveys for syphilis and routine laboratory examinations for
gonococcal infection among selected groups of ostensibly healthy persons will not have
diminished.
The total number of blood specimens received in 1951 in the main laboratories for
sero-diagnostic tests for syphilis was little changed from the previous year. Over 150,000
such blood specimens were sent in to the Division as a whole. The numbers of the more
time-consuming standard Kahn and Kolmer complement-fixation tests increased by about
10 per cent each.
By contrast, significant declines were again noted in the numbers of cultural and
microscopic examinations for gonococci. The former showed a reduction of from nearly
9,200 to about 6,000 (roughly 35 per cent), and the latter fell from 30,700 to about
25,000 (roughly 20 per cent). These declines were even more marked than in the previous year, and undoubtedly reflect an appreciable reduction in the incidence of acute
gonorrhoea.
Toward the end of May we received the results of the fifth sero-diagnostic survey
conducted under the auspices of the Laboratory of Hygiene, Department of National
Health and Welfare, and in which all Provincial laboratories in Canada participate
annually. The tabulated summaries of results clearly showed the value of these surveys.
Much more uniform standards of accomplishment were apparent among the laboratories
participating in the 1950-51 survey than were revealed in some of the earlier surveys.
This improvement is the more significant since two newer tests—the Mazzini and
V.D.R.L. tests—were carried out on many of the specimens, in addition to the officially
approved presumptive Kahn, standard Kahn, and Kolmer complement-fixation tests.
Moreover, a proportion of difficult specimens, whose reactions fell in the doubtful category, were deliberately included in this survey. This Division, with the co-operation of
the Division of Venereal Disease Control, contributed more than its share of such specimens for redistribution by the Laboratory of Hygiene. It is gratifying to record that our
own main laboratories' performance in respect of both specificity and sensitivity could be
classed as excellent, and was not bettered by any other Provincial laboratory. It would
be very desirable in future to include our branch laboratories in such surveys.
TESTS RELATING TO TUBERCULOSIS-CONTROL
The increased load of microscopic and cultural examinations for M. tuberculosis
was especially heavy. Over 40 per cent more cultures were performed, and nearly
50 per cent more microscopic examinations.
About 45 per cent of specimens for culture and over 60 per cent of those submitted
to direct microscopic examination came from outside the Greater Vancouver area. This
unusual distribution results from such factors as increased activity of the travelling and
stationary clinics of the Division of Tuberculosis Control and diversion to us of many
specimens from hospitals (for example, Miller Bay Hospital) operating under the Indian
Medical Services Branch of the Department of National Health and Welfare.
The desirability of culturing all non-sputum specimens, and also most sputa, is now
generally accepted, but few persons outside the Division of Laboratories realize the heavy X 92 BRITISH COLUMBIA
additional work entailed by this policy. Moreover, the infection hazards are multiplied
for those handling and preparing specimens for cultural examination. Only by the exercise of strict laboratory discipline and ingenuity has it proved possible, in the appallingly
inadequate space available, to maintain to date the unblemished record of freedom from
accidentally acquired tuberculosis among the staff of this Division. The extra work and
risk arising from broad recognition of the greater sensitivity of cultural methods over
direct microscopy in the laboratory diagnosis of tuberculosis represent one of the most
troublesome of our current dilemmas. In the public interest we should struggle to furnish
the best possible diagnostic methods, but from the standpoint of the staff's health and
safety, we dare not accept any additional load.
A good culture medium is believed able to detect the presence of between 30 and
300 tubercle bacilli, according to the size of the inoculum. On the other hand, estimates
of the numbers of bacilli which must be present for assured detection by direct microscopy
have been as high as 100,000. To illustrate this disparity, reference may be made to
a series of 589 specimens reaching the Vancouver laboratories, of which 28 or 4.8 per
cent were positive for M. tuberculosis by both microscopic and cultural methods, whereas
72 or 12.2 per cent gave positive cultures but negative smears. Other public health
laboratories could doubtless quote comparable figures.
The belief still persists that guinea-pig inoculation is much more sensitive than
cultural methods for detecting M. tuberculosis. Actually, when the best available culture
media are used, there is little difference in sensitivity between the two methods, although,
of course, guinea-pig inoculation is essential for determining whether atypical strains are
virulent or not. In practice, the guinea-pig method is expensive and inconvenient, and
entails a delay of six to eight weeks before results are available, as compared with an
average of three to four weeks for reports on cultures. Hence we have performed animal
inoculations only upon special request and as a test for virulence. During the last few
weeks of 1951, guinea-pig inoculations had to cease altogether, owing to the outbreak of
an epizootic among the Tranquille colony, which had only so recently developed into
a satisfactory source of supply of these animals. Several months must elapse before this
infection can be eradicated and regular shipments of healthy guinea-pigs from Tranquille
resumed. Meanwhile, the quarters available at the main laboratories for laboratory
animals must be renovated.
Over the last few years the Division has had to cope with increasingly elaborate
requests for multiple reports on specimens from tuberculosis suspects. When these
requests began to reach unmanageable proportions, the Director brought the matter before
the meeting of divisional and health unit directors held in Victoria in mid-September.
At this meeting it was resolved that every effort should be made to curb the tendency—
by no means confined to the field of tuberculosis—to saddle the laboratories with the
responsibility for notifying all persons and agencies having a possible interest in their
findings. Following several discussions with the Director of the Division of Tuberculosis
Control, an agreement was reached whereby that Division would undertake to relay our
reports to its own field representatives and to health unit directors. Confusion and costs
in our office operations should thus be reduced, while the Division of Tuberculosis Control
stands to gain from more complete centralization of its records.
The Director was invited to participate in one session of the annual meeting of the
staff of the Division of Tuberculosis Control. The New Westminster clinic had noted
several instances of positive cultural findings in persons showing no clinical or radiological
evidence of tuberculosis. In every case the virulence of these cultures had been demonstrated by guinea-pig inoculation. We were satisfied that laboratory errors in technique
could be eliminated as a possible explanation. The attention of the meeting was therefore
focused upon the general principle, of which this series of cases was but another example,
that as laboratory procedures become more sensitive and specific, they tend to outstrip —mm
DEPARTMENT OF HEALTH AND WELFARE,  1951 X 93
clinical and other diagnostic methods in proficiency.    Further, there is always the possibility that M. tuberculosis may be isolated from apparently healthy human carriers.
BACTERIAL FOOD POISONING AND GASTRO-INTESTINAL INFECTIONS
There were no apparent cases of botulism in British Columbia during 1951. As
usual, many episodes came to our attention in which the epidemiological circumstances
pointed to staphylococcal food poisoning. In several of these instances we were able to
furnish confirmatory bacteriological data. A rather unusual example of this type of food
poisoning came to light in June, when a series of small outbreaks of acute gastro-intestinal
disturbances in Vancouver were traced to "Australian chicken " (imported frozen rabbit),
bottled by a local firm under obviously unhygienic conditions. Large numbers of
staphylococci were demonstrated present in a sample of the suspected meat, the probable
source of these micro-organisms being one of the employees handling the product, who
was reported by a Sanitary Inspector to have multiple spots and boils around the face.
Salmonella-Shigella infections proved unduly prevalent during the year, and in many
instances were no doubt food-borne. However, the great majority of these episodes
were confined to family contacts, or even to single individuals, so that the route and
vehicle of conveyance was impossible to trace. One outbreak, involving a party of
distinguished visitors to this Province, was identified in the main laboratories, in co-operation with the Victoria branch laboratory, as due to Salmonella typhi-murium infection of
turkey. The bird may have acquired this infection spontaneously during life, rather than
as a result of post-mortem contamination of human origin, for turkeys are notoriously
liable to many varieties of Salmonella infection. This occurrence, coupled with the
outbreak due to Salmonella newport mentioned in last year's Report, should serve to
underline the need for thorough cooking of turkeys, particularly when they have been
deep-frozen.
In June, Salmonella typhi was isolated in Vancouver from a Water Board employee
in the course of the routine stool-culture examinations to which such persons are subjected. This is the second such instance of a typhoid-carrier having been identified by
the laboratories among Water Board employees.
In all, Salmonella organisms were isolated from about 160 different individuals
during the year, a total exceeded only during 1946. By far the most prevalent organism
was 5. typhi-murium, isolated from more than 90 persons, followed by 5. newport,
S. typhi, and S. oranienburg. There was a wider than usual variety of types, including
representatives of types seldom or never encountered before in British Columbia—for
example, S. Cambridge, S. derby, S. bredeney, S. worthington, S. montevideo, S. St. paul,
and S. maleagridis. Two cases of infection by S. sandiego represented the first known
isolations of this organism in Canada.
The reversal of the trend noted in last year's Report, which brought the incidence
of Shigella infections ahead of Salmonella infections for the first time in this Province,
was accentuated during 1951. Over 320 cases and carriers of shigellosis were detected
in the main laboratories, around 290 of which yielded Sh. sonnei and the remainder
various types of Sh. flexneri (mostly 2a and 3). In fact, altogether there were twice as
many isolations of Shigella, as of Salmonella.. This emergence of Sh. sonnei as the major
source of specific gastro-intestinal infection dates from the epidemic of dysentery at
a girls' camp in Howe Sound during the summer of 1950, mentioned in. the preceding
Report. Starting from that focus of heavy, acute infection, these dysentery bacilli have
been carried throughout most travelled parts of the Province. Until there is a drastic
improvement in prevailing standards of community sanitation and personal hygiene, it is
difficult to foresee any appreciable decline in the incidence of Sonnei dysentery, to which
infants and young children are particularly susceptible. X 94 BRITISH COLUMBIA
Nearly 6,500 stool specimens were submitted to complex and time-consuming
cultural examinations during the year, an increase of around 12 per cent over the
corresponding total for 1950 and more than 55 per cent above the figure for 1949.
If this trend should continue into 1952, as anticipated, the main laboratories will face an
exceedingly critical situation. Accommodation in the stool-culture department was taxed
to the utmost in 1951, and any additional turnover in the present quarters can be handled
only at the grave risk of laboratory infection and under the certainty of excessive nervous
strain upon all those carrying the responsibility for this work.
We are glad to acknowledge here the assistance received from Dr. E. T. Bynoe and
his associates of the Laboratory of Hygiene, Ottawa, in the final typing of these
Salmonella-Shigella organisms. This was the first year in which the Laboratory of
Hygiene offered its facilities for typing the Shigella.. While these typing procedures are
technically well within our compass in the main laboratories, much time and trouble is
saved by this activity of the National Salmonella Typing Centre, and we feel it proper
that such functions should be discharged by an institution within the framework of the
Department of National Health and Welfare. Thus the whole picture of the Salmonella-
Shigella incidence across Canada can be secured and made available to each Province.
BACTERIOLOGICAL ANALYSES OF MILK AND WATER SAMPLES
Slight increases were inexperienced in the numbers of milk and water samples
examined. There is still great need for further improvement in the bacteriological
quality of milk and water supplies. The Division has done its best to provide some
facilities for milk and water testing to quite remote parts of the Province. A number
of specially constructed wooden boxes are available for shipping to Vancouver six milk
or water specimens at a time, packed in ice. The branch laboratories, especially those
at Prince George and Nelson, are similarly serving territories far beyond their own
immediate vicinity. Many polluted streams and wells remain in use as sources of
drinking-water, and it is impossible, and perhaps undesirable, to attempt to provide
testing facilities to cover these under the present pattern of organization of the Division.
Apart from the futility of testing specimens which have been overlong in transit, misleading impressions can be conveyed by the results of tests on isolated samples, especially
when unsupported by sanitary surveys of the sources in question. Unfortunately, a few
Sanitary Inspectors and other public health officials are rather prone to saddle the
laboratories with such irrelevant specimens. But on the whole, very good co-operative
relationships obtain between this Division and the health units throughout the Province,
most of whom recognize their primary responsibility for detecting the grosser errors of
sanitation with their own eyes. Individual citizens still confront us with requests for
examination of their domestic well-water supplies, and it is sometimes difficult to follow
consistently the only scientific policy—to reject such requests unless a competent sanitary
survey has first been conducted. After the unusually dry summer, many wells throughout
the Province showed signs of heavy pollution when the autumn rains began. Clear-cut
evidence of sporadic water-borne infection is hard to uncover, though among the record
number of intestinal infections experienced this year, there were several instances in
which water was suspected as the vehicle. For example, we isolated a strain of Salmonella
from a travelling salesman who suffered a severe attack of gastro-enteritis, which he
ascribed to diluting a drink of whisky with water from a creek.
OTHER TYPES OF TESTS
Examinations of swabs for C. diphtheria increased from roughly 19,000 in 1950 to
some 23,500 in 1951, or by about 24 per cent. A large part of this substantial increase
is accounted for by the surveys for diphtheria-carriers at the Provincial Mental Hospital,
Essondale, and at its No. 9 Unit, New Westminster, which we began during the last half DEPARTMENT OF HEALTH AND WELFARE,  1951 X 95
of December, 1950, and continued during January and February of 1951. This survey
was launched when two or three mild cases of diphtheria occurred in these institutions.
During the three months' period of the survey, approximately 5,000 nose and throat
swabs were examined. Among these, forty-one positive swabs, representing twenty-one
individual carriers, were identified. Their discovery posed serious problems in public
health administration to the officials concerned.
Efforts are being made in the United States and Canada to gather information
bearing on the incidence and distribution of diphtheria-carriers in various age-groups of
different communities, as a preliminary to assessing the significance of such carriers in
a partially immunized population. In response to a request from Dr. Donald T. Fraser,
of Connaught Medical Research Laboratories, University of Toronto, and in co-operation
with the staff of the Metropolitan Health Service of Greater Vancouver, nose and throat
swabs taken from every member of certain classes in Vancouver schools have been
examined bacteriologically in the main laboratories for C. diphtheria; and for hemolytic
streptococci. This undertaking also accounted for much of the increase in cultural
examinations for diphtheria bacilli. The actual incidence of the disease remained low
during the year.
The incidence of scarlet fever, on the other hand, was abnormally high, especially
during the last months of the year. This situation and the throat-swab survey alluded
to in the foregoing paragraph account for cultural examinations for haemolytic staphylococci and streptococci increasing from 2,900 in 1950 to around 4,500 in 1951—that is,
by 55 per cent.
Last year's Report mentioned a substantial increase in the number of Paul-Bunnell
tests for infectious mononucleosis. In the year now under review a further substantial
increase occurred. Over 2,200 such tests were carried out, as compared with less than
1,800 in 1950 and only just over 1,000 in 1949. The fact that a fairly high percentage
of the specimens show significant titres of sheep-cell agglutinins suggests that this doubling
in the number of requisitions does not represent a mere fad, but a wider recognition
of an established endemic infection.
Microscopic examinations for intestinal parasites also showed a further substantial
increase. The percentage of such specimens found positive remained surprisingly low.
E. histolytica, for example, was not observed, although some local physicians with
experience of amoebic dysentery, and knowing the results of surveys in other parts of
North America, point to the likelihood that both cases and carriers exist in our community. Nevertheless, it is improbable that we are failing to detect positive specimens.
At least two of our senior staff members have had special training in parasitology. In
addition, we were kept up to date by receiving at regular intervals during the year a series
of mounted specimens of various types of parasites, prepared and kindly distributed to
all Provincial laboratories by Mr. J. B. Poole, parasitologist at the Laboratory of
Hygiene, Department of National Health and Welfare, Ottawa.
BRANCH LABORATORIES
Last year's Report referred to the establishment of a small branch laboratory at
Prince George, in space set aside for this purpose within the building which serves as
headquarters for the Cariboo Health Unit. One full-time assistant bacteriologist,
seconded to Prince George from the staff of this Division, performs the duties of bottle-
washer, media-maker, stenographer, and technician. Admittedly, one-person laboratories
are vulnerable to staff changes and are bound to exhibit fluctuating efficiency, but there
is not yet a sufficient volume of variety of tests to justify employment of more than one
person at Prince George. We managed to keep the laboratory going throughout the
year, despite three changes of appointees, and it is gratifying to record an average turnover of around 250 specimens examined monthly.   Moreover, there is a growing local X 96 .   BRITISH COLUMBIA
appreciation of the laboratory's efforts, especially in the field which it was particularly
intended to cultivate—namely, the bacteriological analyses of milk and water. Incidentally, some fifty specimens monthly, taken from newly admitted inmates of the Prince
George Gaol, were examined microscopically for evidence of gonococcal infection.
The laboratory's services are by no means confined to the immediate vicinity of
Prince George, or even to the Cariboo Health Unit, but are available to any territory
within convenient access. For example, milk and water specimens are received by train
on several days each week from Prince Rupert. The per specimen cost is relatively high,
but otherwise these northern communities would be entirely dependent for milk- and
water-testing facilities upon the even more costly and uncertain shipments by air to
Vancouver.
The branch laboratory at Nelson was reorganized during the year. For the past
fifteen years or more the Kootenay Lake General Hospital had carried out public health
laboratory work for the Nelson area under subsidy from the Provincial Department of
Health, through the Division of Laboratories. When both technicians resigned, negotiations were begun With the board of directors of the hospital with a view to this Division
taking over full responsibility for the public health laboratory work. Eventually, a very
satisfactory agreement was made, under which the Kootenay Lake General Hospital
Society leased rent-free quarters to us in the former isolation hospital. We undertook
to maintain the necessary full-time staff and to provide all supplies and equipment. An
assistant bacteriologist, Miss Mary Yeardye, and a laboratory assistant, Miss Lorainne
Handlen, were transferred from the central laboratories as of April 1st, and from the
beginning have fully justified the confidence placed in them. Within three months of
their arrival the monthly turnover of tests was around 1,000, a figure not reached under
the former system. The monthly average for the first nine months of operation is about
1,100 tests, and toward the year-end appeared to be headed for a level of nearly 1,500
monthly, the maximum figure which two technicians can be expected to handle. Indeed,
as the monthly totals mounted above the 1,000 mark, it became necessary to arrange
with the Hospital Society for the half-time services of a ward-maid, who acts as cleaner
and general help.
The salaries of the two full-time and one half-time employees at the Nelson branch
laboratory, and of the one at Prince George, were covered by a Federal Public Health
Grant for " Improvement and Extension of Branch Laboratory Services." Both projects
can be regarded as very successful to date. Not only are the areas concerned receiving
better public health laboratory service than ever before, but, also, useful information
is afforded by comparing the costs and convenience of operation of the two branches at
Nelson and Prince George respectively.
The Kamloops laboratory, operating under a subsidy arrangement with the Royal
Inland Hospital, again experienced difficulties due to periodic shortages of trained
technicians. Most of the public health laboratory work had to be diverted to Vancouver
for several weeks during the late summer. These recurrent problems at Kamloops point
to the desirability of reforming the system in operation there. The Victoria branch
laboratory likewise operates under subsidy, in the Royal Jubilee Hospital. During the
year, under the direction of Dr. R. G. D. McNeely, it maintained proficiently a steady
average of some 4,000 tests monthly.
The Nanaimo branch, housed for many years at the Nanaimo General Hospital,
under the direction of Mr. George Darling, ceased operations at the end of 1950. When
the hospital authorities demanded a substantial increase in the subsidy, we recommended
instead, in view of improved transportation arrangements between the Central Island
area and Vancouver, that this branch be abolished. No steps were taken to restore the
branch laboratory formerly maintained under subsidy at the Prince Rupert General
Hospital. We are opposed to restoration of the subsidy system in any centre, and at
present it would be too difficult to persuade our own staff members to consider a period of DEPARTMENT OF HEALTH AND WELFARE,  1951 X 97
duty at Prince Rupert. By shipping some specimens to Prince George and others by
air mail to Vancouver, reasonably adequate facilities can be secured. In summary,
during 1951 the Division maintained full-time branch laboratories at Nelson and Prince
George and subsidized public health laboratory services at Kamloops and Victoria.
Mr. A. R. Shearer, in his capacity as Travelling Supervisor of Branch Laboratories,
visited each branch at least once during the year. He helped both to plan the necessary
installations and renovations in the quarters assigned to us at Nelson and to inaugurate
the service, as he did the year before, at Prince George. The Director also paid a short
visit to the Nelson and Kamloops branches at the end of August, and was much impressed
with the efficiency and happy atmosphere of the former.
GENERAL COMMENTS ON STAFF ACTIVITIES
The Director was one of two representatives of the Provincial Laboratory Directors
invited to attend a meeting of a Working Party on Laboratory Services Relating to Civil
Defence. This was held at Ottawa under the auspices of the Department of National
Health and Welfare during the last week in March. From the standpoint of this Division,
one of the most notable resolutions of the conference was that which recognized the
critical shortages of trained bacteriologists throughout Canada and the consequent
necessity for providing increased training facilities in appropriate university departments.
Another important feature was the general agreement that a travelling laboratory should
be available in each Province.
The Director pressed home these recommendations, and is happy to acknowledge
here an exceedingly helpful Federal Public Health Grant of $25,000, made to the
Department of Bacteriology and Immunology at the University of British Columbia, for
improved training of bacteriologists and other senior laboratory personnel. This grant,
together with the splendid new quarters available to the Department on the campus,
should ensure that future employees of this Division will have graduated with an academic
background in bacteriology as good as is obtainable anywhere in North America. As for
the travelling laboratory, the emergency and peace-time uses of this amenity were
outlined by the Director in a brief presented to the Conference of Health Unit and
Divisional Directors, held in Victoria in September. The conference unanimously
adopted a resolution favouring the proposal that a travelling laboratory be attached to
this Division.
In August the Director attended the annual meeting at Banff of the International
North-west Conference on Diseases in Nature Communicable to Man, where he read a
paper, by invitation, on botulism. In December he attended the annual conference in
Ottawa of the Technical Advisory Committee on Public Health Laboratory Services to the
Dominion Council of Health. These conferences provide an invaluable opportunity
for exchange of technical information between the participating laboratory directors,
and for discussions of policy of mutual concern to the Provincial laboratories and to the
Laboratory of Hygiene, under whose sponsorship these meetings are held. Following
this conference, the Director attended the annual meeting in Toronto of the Laboratory
Section, Canadian Public Health Association, where he presented a paper on Clostridium
botulinum, Type E.
During May Miss D. E. Kerr, Assistant Director, enjoyed a ten days' course in
virus diagnostic procedures arranged by the Laboratory of Hygiene at Ottawa, through
Dr. F. P. Nagler, who is in charge of the Virus Section of that institution. Our main
laboratories are now equipped to carry out certain of the viral complement-fixation and
other tests—for example, for smallpox, mumps, Types A and B influenza, and Q fever.
The expenses incurred in taking this course were covered by a Federal Public Health
Grant.
In September arrangements were made for Mr. Shearer to enroll for a three-day
refresher course in Hsematology, offered to physicians by the Department of Pathology X 98 BRITISH COLUMBIA
of the University of Washington Medical School at Seattle. Such occasional opportunities
for senior staff members to travel to meetings and refresher courses are greatly appreciated
by the individuals concerned, and time lost from duty is more than amply repaid.
Miss Kerr was able to make particularly effective use of an intensive course in
mycology, which she had attended in Atlanta in 1950, by giving a short course of
lectures and laboratory work in pathogenic fungi to a group of final-year students in
the Department of Bacteriology and Immunology at the University. Several other
seniors on our technical staff contributed in various capacities to the expanded curriculum
in bacteriology. The very small number of hours entailed off duty were fully made up,
both as regards time actually spent and, more intangibly, as a result of personality-growth
from challenges successfully met. In addition, long-term benefits will accrue to the-
Division through the better calibre of future graduates recruited to the staff. DEPARTMENT OF HEALTH AND WELFARE,  1951 X 99
REPORT OF THE DIVISION OF VENEREAL DISEASE CONTROL
C. L. Hunt, Director
There has been a slight decrease in the total number of venereal disease cases
reported during the year 1951. Early infectious (primary and secondary) syphilis has
now become a comparative rarity in British Columbia, only thirty-two cases having been
reported during the year. Indeed, the infection rate per 100,000 population in this
Province is now the lowest in Canada. The number of syphilis cases reported in the
later stages has also decreased markedly in spite of sustained efforts at case-finding.
The policy of overtreating all cases of gonorrhoea with massive doses of penicillin
to eliminate any possible concomitantly acquired syphilis has been maintained. This
appears to have been justified if the extremely low incidence of early infectious syphilis
can be used as a measure of its success. Private physicians throughout the Province
have given their whole-hearted support to this policy.
There has been a slight but definite increase in the number of cases of chancroid
among mariners and in service personnel returning from the Far East, but most, if not
all, cases have been detected on arrival, and there has been no evidence of increased
spread of this infection among the general population.
The incidence of reported cases of gonorrhoea has shown a small decrease in spite
of better co-operation on the part of private physicians in notifying their cases. Divisional
clinics still continue to play a major part in notification and treatment of venereal disease,
though the proportion of cases notified by private physicians has markedly increased
during the past year. This increased reporting by private physicians is apparent in all
parts of the Province and is not limited to the metropolitan areas.
Highly qualified consultants in various fields of medicine continue to be employed
by the Division, and consultative service on problems relating to venereal disease is given
extensively to private physicians throughout the Province.
Free drugs are made available to physicians for the treatment of any notified case
of venereal disease. In order to make these drugs more readily available to those
physicians practising in outlying areas, stocks are held by all health unit directors and
by some of the more remote hospitals for local distribution.
Besides the convenience afforded to physicians, this policy enables health unit
directors to maintain a closer association with the health problems in their own spheres
of activity.
It is becoming increasingly evident in this Division that non-specific urethritis of
venereal origin is presenting a problem of growing importance. The actual cases notified
are few, but this is due in some measure to the comparatively large number of cases which
are diagnosed as gonorrhoea on clinical grounds but in whom smears and cultures are
negative. Most of these patients show a notable lack of response to normal methods of
treatment for gonorrhoea. These cases represent approximately 11 per cent of those
treated for gonorrhoea at the Vancouver clinic.
Investigations into the causes of non-specific urethritis have not tended to clarify the
problem, for the causes are many and varied, with no single type of treatment being
universally successful.
Further consideration is being given to this problem, which appears to be causing
concern in many other centres of venereal disease control throughout North America.
TREATMENT
Treatment schedules for the various stages of syphilis and for gonorrhoea were
reviewed periodically through the year, with the object of maintaining the highest standards available in the light of current knowledge. X 100 BRITISH COLUMBIA
The use of arsenic in the treatment of syphilis has been entirely discontinued, and
bismuth is being used in only a few specially selected cases as a preparatory form of
treatment before commencing penicillin.
Penicillin is the treatment of choice in all stages of syphilis and in gonorrhoea.
Non-specific urethritis of venereal origin still presents many problems in treatment
by virtue of the multiplicity of underlying causes. Streptomycin, sulphadiazine, and
aureomycin have their uses in the treatment of this condition, though none of these
materials is universally successful.
Aureomycin is used infrequently, and only on certain specially selected cases or when
other methods of treatment have failed to produce the desired effect. The high price of
aureomycin still precludes its use on a wide scale.
Seamen and service personnel returning from overseas with venereal infections have
presented a special problem within recent months. Diagnosis has frequently been obscured by previous unstated or inadequate treatment. Occasionally, seamen are due to
leave for foreign ports within a few hours. Such problems have called for bold and urgent
treatment, with detailed instructions regarding follow-up examinations at future ports of
call.
There has been a marked decrease in the total number of patient-visits to the Divisional clinics during 1951, the figure being approximately 25,000, as compared with
32,000 in 1950. This appears to be due partly to a decrease of approximately 350 reported cases of venereal disease attending the clinics, but also to the marked decrease in
follow-up examinations required with modern methods of treatment.
EPIDEMIOLOGY
The prevalence of venereal disease is steadily decreasing, but the seeds of epidemic
still exist in the community.
It is for this reason that there can be no relaxing of effort on the part of this Division
in endeavouring to trace contacts and in using every available means to bring venereal
disease to light wherever it may exist.
Information regarding contacts is frequently inadequate and reluctantly given. In
order to overcome this defect, tact and understanding are essential in the armamentarium
of the epidemiologist. Moreover, since much of the epidemiological investigation must
be carried out in more remote regions of the Province, the policy and methods of the
Division must be made known to public health personnel in the field.
Bearing all these points in mind, this Division has maintained a staff of well-trained
public health nurses, whose duty it is not only to interview patients reporting to the clinic,
but also to give guidance to those persons employed in tracking down venereal disease in
outlying areas. Close liaison is therefore maintained with public health personnel in the
field, on whom much of the contact-tracing and follow-up investigations fall. In order to
facilitate this co-ordination, a manual has been completed for the use of the public health
field staff, British Columbia Department of Health, and relates to venereal disease control
procedures and policy in areas outside Vancouver and Victoria. An epidemiology worker
is available on request to give guidance and assistance to the local health services.
A second male epidemiological worker has been employed by the Division for the
purpose of interviewing male patients. It was felt that certain male patients would probably be more willing to divulge information to a male questioner than to a female one.
New methods and tools for obtaining contact information are continuously being
sought and reviewed. The interview is now recognized by the worker as the established
centre from which to work. The results obtained by reinterviewing the patient, where
indicated, for a more complete contact history have been so successful that this procedure
has become the rule.   Many more patients are bringing their own contacts to treatment.
A closer working relationship between the private physician and the Epidemiology
Section has been attempted during the past year.   In each instance where inadequate con- DEPARTMENT OF HEALTH AND WELFARE,  1951 X 101
tact information is received, the physician is telephoned and is offered the service of an
epidemiology worker to reinterview his patient. Greatest emphasis is placed on contacts
to primary and secondary syphilis.
Case-finding and case-holding facilities have been further extended by the opening
of a venereal disease clinic, primarily for diagnostic purposes, at Health Unit I in downtown Vancouver. This clinic is being operated under the joint direction of the Vancouver
City Health Department and the Division of Venereal Disease Control, Provincial Department of Health and Welfare. The number of blood tests done at that clinic has already
reached almost 900 per month.
Arrangements have been made with the Victorian Order of Nurses to provide treatment in the home for certain non-infectious patients. These cases are previously carefully
selected and there must be a definite reason for home treatment.
The Vancouver City Gaol examination centre, which has proved so successful in the
past, continues to show excellent results regarding case-finding and case-holding. In
February, 1950, it was decided to extend treatment on epidemiological grounds to all
women who are brought in to the Vancouver City Gaol on morals charges and to certain
others who are known or believed to be actively carrying on promiscuous sexual relationships. Such treatment is not compulsory but is strongly recommended. In this way it
is hoped to limit still further the spread of gonorrhoea in that community which presents
the greatest problem in venereal disease control.
Several meetings have been held with the Regional Superintendent, Indian Health
Services, to determine better methods of case-finding and follow-up of the British Columbia Indians. A survey to be carried out in a different part of the Province each year
seemed perhaps the best answer to the problem. In August a blood-testing survey was
completed on persons employed at the fish-canneries in New Westminster and Steveston.
Reports on any activities of the Division of Venereal Disease Control that are of
particular interest to the health unit personnel have been submitted at regular intervals
to the staff bulletin of both the Provincial Department of Health and Vancouver City
Health Department.
SOCIAL SERVICE
During the year the Social Service Section continued to focus its attention on the basic
personality disorders at the root of the venereal disease problem. All newly diagnosed
patients treated at the Vancouver clinic were interviewed by the social service staff. This
personal counselling, geared to the specific needs of the individual patient, was an integral
part of the treatment for venereal disease.
To gain some knowledge about the kind of people who were being treated at the
Vancouver clinic, the Social Service Section devised a rating scale to measure the capacity
of the individual to utilize this kind of counselling service.
Of 515 patients who were interviewed in a period from July, 1951, to November
30th, 1951, over 50 per cent were in the groups in which it was considered that personal
counselling could probably be effective.
In 1950 there were forty-six cases of venereal disease reported in children of 14 years
and under. As this was a marked increase in incidence in this young age-group, the social
worker reviewed the information available in the Division regarding each of the forty-six
cases. It was found that this did not represent a real increase in the incidence of venereal
disease among children, but that many of these children were being treated on suspicion
as a precautionary measure rather than on laboratory or clinical evidence of venereal
disease.
The study also revealed that seventeen of the forty-six children reported were Indians.
To determine whether or not this indicated a deficiency in the public health services in
any specific area, these particular cases were again reviewed. It was found that except in
one area where eight of the children were treated on epidemiological grounds as part of X 102 BRITISH COLUMBIA
an intensive public health survey, the other nine cases occurred in widely scattered areas.
It was felt that in the Indian-patient group the problem was one of education to modify
the Indian way of life rather than a lack of public health facilities.
The social service worker has maintained a close liaison with the psychiatric consultant, to whom those patients presenting unusual personality problems have been
referred.
Excellent work has also been done by the psychiatrist, not only in helping those
patients presenting acute behaviour problems, but also in endeavouring to evaluate some
of the underlying factors responsible for promiscuous sexual behaviour resulting in the
spread of venereal disease.
EDUCATION
The prime responsibility of all health education in this Province rests with the
Division of Public Health Education. However, in view of the specialized nature of
education relating to venereal disease, a close liaison is necessarily maintained between
that Division and the Division of Venereal Disease Control.
The responsibility for lay education is shared by both Divisions, but education
directed to professional groups and student nurses remains the prime responsibility of the
Division of Venereal Disease Control.
Lectures on the venereal diseases and methods of control have been given to student
nurses at all the main training-schools in the Province. In addition to this, practical
experience is provided at the Vancouver clinic for student nurses in training at the Vancouver General Hospital.
Lectures have also been given to students in various other fields, including the
medical students at the University of British Columbia.
Every possible opportunity has been taken to promote professional education in the
venereal diseases, including the occasional publication of material in the Journal of the
Canadian Medical Association. Published articles include " Homosexuality as a Source
of Venereal Disease," written by Dr. B. Kanee, consultant in syphilology at this Division,
and Dr. C. L. Hunt, Director of this Division; " Effectiveness of Modern Treatment for
Gonorrhoea in Women "; and " The Role of Epidemiology in Venereal Disease Control,"
by Dr. C. L. Hunt.
Fortnightly meetings are held in the Divisional headquarters for all attending
physicians, when lectures are given by members of the consulting staff on various aspects
of venereal disease.
The manual Venereal Disease Information for Nurses has been revised and reprinted.
This manual is distributed, free of charge, to all student nurses in the Province during the
course of their training.
Other manuals which have been revised and brought up to date include Procedures
and Services in Venereal Disease Control and the Treatment Manual for Clinic Physicians.
The Venereal Disease Manual for Public Health Nurses has been rewritten and
enlarged. It is proposed to supply copies to all public health units and to individual
public health nurses in outlying areas for their use as reference manuals.
GENERAL
Deterioration of the premises occupied by the Divisional headquarters proceeds
apace, and it is fervently hoped that new quarters will be made available before the
urgency becomes too acute.
Mrs. Anna Grant, who has been with the Division for approximately eight years as
senior clinic nurse and staff nursing instructor, has resigned to take up residence with her
husband at Campbell River.   Her loss will be felt keenly by the Division.
The Epidemiology Section of the Division has temporarily lost the services of Miss
Muriel Scott, who was selected by the World Health Organization to serve on a team of DEPARTMENT OF HEALTH AND WELFARE,  1951 X 103
public health advisers in venereal disease control to the Burmese Government. This
Division takes considerable pride in Miss Scott's selection, which should prove a source
of considerable interest and experience to her.
An additional loss to the Division has been the promotion of Miss Enid Wyness,
senior social service worker, to a higher position, in which her services are available only
in an advisory capacity. Miss Dora Porter now carries the entire patient-load in the
Social Service Section.
Dr. C. L. Hunt has resigned from his full-time appointment as Director, but continues to be employed in that capacity on a part-time basis.
Federal Health Grants continue to prove extremely useful in assisting the Division
in maintaining its ever-expanding services, as well as in affording opportunities for postgraduate training of medical and nursing personnel.
Funds from this grant have been made available toward the operation of the British
Columbia Medical Centre Library, where up-to-date literature on the venereal diseases
is maintained. The Divisional Director is an active member of the management committee of this library.
Much appreciation is felt toward the various community groups, the Vancouver City
Police, the Royal Canadian Mounted Police, the British Columbia Hotels Association,
the Liquor Control Board, the Department of Indian Affairs, and the various other groups
who, by their co-operation and help, have contributed so much to the success of the
venereal disease control programme of the Province.
In addition, special appreciation is expressed to the Division of Laboratories, without
whose ever-willing services and co-operation this Division would find it difficult to function, and also to the Division of Vital Statistics for its helpful advice and assistance so
freely given at all times. X 104 BRITISH COLUMBIA
REPORT OF THE DIVISION OF TUBERCULOSIS CONTROL
G. F. Kincade, Director
In 1951 a significant change in the administration of the Division of Tuberculosis
Control was the appointment of a full-time Director. Dr. W. H. Hatfield, who had been
part-time Director for sixteen years, resigned, and Dr. G. F. Kincade, formerly Medical
Superintendent, Willow Chest Centre, became full-time Director of the Division. Dr.
Hatfield will continue to act on a part-time basis in an advisory capacity to the Deputy
Minister on matters relating to tuberculosis and other diseases of the chest.
Another major advance has been the construction of the new sanatorium in Vancouver. This has been named the Pearson Tuberculosis Hospital, in honour of Mr. G. S.
Pearson, M.L.A., formerly Minister of Health and Welfare, Minister of Labour, and
Provincial Secretary.
Started early in the spring of 1951, excellent progress has been made, and this institution, housing 264 beds, will be opened within a year from the beginning of construction. This will provide modern sanatorium facilities for the treatment of tuberculosis
cases, and, being situated in the Lower Mainland of British Columbia, it will provide beds
in this rapidly growing area where they are most needed.
Although the opening of these 264 beds will meet the present situation, it is apparent
that the construction of the total complement of 528 beds for this institution should be
continued as soon as possible. The present plan is that, after the Pearson Hospital is
opened, the tuberculosis patients housed in the Infectious Disease Hospital and St.
Joseph's Oriental Hospital will be transferred there. These patients, plus the present
Provincial waiting list, will almost completely fill the 264 beds. With the construction
programme of the Vancouver General Hospital proceeding toward the erection of a large
acute hospital, this Division's tenure of the temporary building at the Willow Chest Centre
is seriously threatened, and it may be necessary to move from this building before next
summer. Recent alterations at Tranquille should compensate for the loss of these beds.
However, it will not be possible to occupy the extra beds at Tranquille until such time as
the proposed tunnel, elevator, and laundry have been completed.
At present we visualize the eventual bed facilities of the Division of Tuberculosis
Control as being 528 beds at the Pearson Tuberculosis Hospital, 400 beds at Tranquille
Sanatorium, the Willow Chest Centre reduced to approximately 115 beds for surgical and
diagnostic cases, and the facilities in Victoria providing approximately the same number
of beds as at present.
It was with considerable satisfaction that in 1950 we attained the lowest death rate
yet recorded in British Columbia. This rate of 21.7 for the other-than-Indian population
and 27.2 for the total population followed the trend of decline in other parts of the
country. Whatever its cause, it represents a reduction of approximately 50 per cent in
a five-year period and, in actual numbers, a reduction from 576 deaths to 310—this in
spite of an increase in population.
We are pleased to report that this low rate has been maintained in 1951 with 228
deaths in the total population, which gives a rate of 25.0 per 100,000. There were 224
deaths in the other-than-Indian population or 19.9 deaths per 100,000.
X-RAY PROGRAMME
During the past year we have been very much interested in the development of the
miniature X-ray programme throughout the Province, and have been endeavouring to
concentrate on hospital-admission X-rays as a case-finding method so that the programme
could be applied effectively. 	
DEPARTMENT OF HEALTH AND WELFARE,  1951 X 105
In the reorganization of the X-ray programme utilizing miniature X-ray equipment
in hospitals, a very definite endeavour has been made to co-ordinate it entirely within
the community health services provided through the local health units. Thus the appointments and organization of the time schedules are the responsibility of local health services
which have co-ordinated the programme with each local hospital. All patients are referred
through the health unit, which assumes some responsibility for continuity of referral and
follow-up where necessary. In addition to the admission X-ray of all hospital patients,
arrangements are provided whereby some out-patients referred by the practising physicians or the public health staff can be accommodated.
It has been disappointing to note that some hospitals are falling down very badly in
carrying out this programme, whereas others are most energetic in trying to obtain complete coverage of the patients admitted. In spite of the poor showing in some hospitals,
the work done has represented 40 per cent of the admissions X-rayed in the hospitals
where installations have been made, and it does represent 71,410 examinations in 1951.
While this does not reach the goal set and eventually hoped for in this work, it does
represent a good contribution to the case-finding programme. It also shows a changing
emphasis in that fewer examinations will be done by the travelling clinics, while in the
geographical areas covered by these clinics there will be a greater number of people
X-rayed. This is the result desired, and the clinics will be freed from a great deal of
routine contact examinations, which were screened in the past, and will devote more time
to the important work of examining and advising known cases of tuberculosis or cases
who are referred because of suspicious X-rays. For example, in 1951 the Kootenay
Travelling Clinic took 2,525 X-rays, as compared with 3,427 in 1950. During 1951
there were 17,377 miniature films taken in general hospitals in the Kootenay area, making
a total of 19,902 films.
During 1950 there were 179,126 X-ray examinations in the clinics of the Division,
general hospitals, and health units.   During 1951 this increased to 271,381 films taken.
With thirty-four miniature X-ray machines operating in hospitals and health units
outside the Division during the past year, there have been no new installations of photo-
roentgen equipment. At the present time we are preparing to install this type of equipment in the new Burnaby Hospital, in the University of British Columbia Health Service,
and at Mission Memorial Hospital. We are also considering withdrawal of the equipment
from one hospital, where it is not being used satisfactorily, and in another community the
transfer of the equipment from the hospital to the health unit, where it will serve the
needs of the community to greater advantage. Installations for other areas will be considered as the communities expand and local conditions appear to justify its placement.
In the development of the hospital-admission X-ray programme, we have been
actively supported by the British Columbia Hospital Association and the British Columbia Registered Nurses' Association.
During the past six months our mobile photoroentgen unit has been travelling
throughout the Interior of the Province and on Vancouver Island, visiting smaller communities where X-ray services were not available. This has been a difficult and costly
enterprise, and at the present time we are not certain that the results warrant the continuation of this work in subsequent years. The 1951 schedule was completed early in
December, and the results of the work will be critically analysed to see if it is justified.
The Division is watching with interest an experiment that is being carried out in
Chilliwack at the present time. Realizing that the mere presence of an X-ray machine in
a local community to provide free X-rays does not necessarily assure a good case-finding
programme in that community, the British Columbia Tuberculosis Society has gone
forward with a plan to promote an educational campaign in Chilliwack as an experiment.
The idea behind this was that a properly qualified person would visit the community to X 106 BRITISH COLUMBIA
publicize the services that were available and to organize local groups to canvass citizens
so that a continuing community survey might be carried out. If successful at Chilliwack,
this could be applied throughout the Province, using local facilities.
FEDERAL HEALTH GRANTS
From the projects already submitted it appears that the Tuberculosis Control Grant
will be totally expended for the present year if delivery of equipment is obtained before
the expiry date of the grant. The total tuberculosis grant for British Columbia in
1951-52 was $368,315, and this has all been allocated.
Certain new projects and extensions of previous projects have been set up during
the year. For example, the art-therapy project has been extended to the Victoria unit, a
pneumothorax clinic has been approved for Metropolitan Health Unit No. 1, a physiotherapist has been obtained for the Willow Chest Centre, a Department of Respiratory
Physiology is being set up in Vancouver, and a large amount of equipment has been obtained for the Pearson Tuberculosis Hospital. Three nurses, one laboratory technician,
one hospital administrator, and four physicians are receiving training under the grants.
The Medical Records Section has also been made possible from Federal Health Grants.
The following is the list of projects in the tuberculosis-control field for the present
year:—
Continuing Projects
Occupational therapy.
X-ray pool—
Photoroentgen equipment for University of British Columbia Health
Service.
Burnaby Hospital.
Mission Memorial Hospital.    .
Medical library.
Home-care service.
Nursemaids for Vancouver Preventorium.
Rehabilitation.
Payment for admission X-rays.
Administration of streptomycin in homes.
Postgraduate training (short courses).
Nursing personnel—
Three nurses at University of British Columbia.
Equipment for community survey work.
Staff and equipment—
Tranquille Sanatorium—
Two physicians.
Undelivered equipment from 1950-51.
Willow Chest Centre—
Bacteriologist.
Senior interne.
Assistant instructor of nursing.
Executive nurse, surgical.
Physician.
Art therapy.
Planigraph.
Physiotherapist.
Out-patient Pneumothorax Clinic, Metropolitan Health Committee.
Department of Respiratory Physiology.
P.A.S. and streptomycin. DEPARTMENT OF HEALTH AND WELFARE,  1951 X 107
Additional graduate nurse, New Westminster.
Postgraduate training for two physicians.
Training in surgical nursing and techniques.
Additional stenographers—
New Westminster Clinic.
Kootenay Travelling Clinic.
Interior Travelling Clinic.
Postgraduate training for laboratory technician.
Hospital-administration training.
Expansion of education programme, T.B. nursing.
Art therapy, Victoria.
Equipment for new sanatorium.
New Projects
Postgraduate training for one physician.
Medical Records Section, T.B. Control.
STAFF
In reviewing the staffing of our clinics and institutions, it is pleasing to report that
at the present time the Division appears to be in a very good position. The medical staff
throughout the Division is at full strength, and it is a source of satisfaction to report that
well-trained medical men are being attached to the service. At the present time there are
five physicians under training leading to specialists' certification. It should be pointed out
that a pathology service is being developed at Tranquille, and in the Willow Chest Centre
a well-trained pulmonary physiologist is proving most valuable in the carrying-out of
respiratory function tests, mostly in connection with pre- and post-operative cases. However, it is hoped that some attention can be paid to research in this field. It is possible,
in the future, that the Division may be able to add others to the staff with special interests,
such as bacteriology.
NURSING
The nursing service gives a great deal of pride to the Division because it is recognized
that throughout the Division the nursing standards are of the highest order. Having
assembled an able group of nursing administrators, a sound programme of student and
graduate teaching is the basis of the nursing services in our clinics and institutions. As a
result of this, tuberculosis nursing has been elevated to the status of a specialty, and the
nurse takes an important place in the education and physical rehabilitation of the patient.
Although the stage has not yet been reached where there is an abundance of nurses available, the Division is attracting a fair share of an excellent type of well-trained nurses into
the service.
During.1951 the nursing service was maintained to provide for a full complement of
patients in all of the institutions during the past year, and the staff in the stationary clinics
was stable.
Increased student quotas and expanded activities were evident in all sections of the
educational programme, for example:—
(1) Affiliation Course for Student Nurses.—(a) Three hundred and twenty-
five students affiliated at the Vancouver centre, an increase of seventy over
1950. The Jericho Beach unit and New Westminster Stationary Clinic
were used for placement of students in addition to the Willow Chest Centre.
(b) Seventy-four students affiliated in Victoria. Students from the
two Victoria schools started in November to come to Vancouver for the
lecture series in the first week of the course, thus providing a uniform content of instruction for all students prior to placement on the wards. X 108 BRITISH COLUMBIA
(2) Supervised Experience for Practical Nurse Students from the Vocational
School.—Fifty-five students completed one month each of ward experience
at the Jericho Beach unit, an increase of fifteen over last year.
Indications are favourable that progress will be made this coming year toward
implementation of the objectives outlined in the study on staff quotas and nursing-care
requirements, completed for the three main institutions more than a year ago.   Organization of the ward routine to the team nursing plan is suggested as a basic factor in
providing more personalized care for the patients.
Two objectives urged for the coming year in both the service and educational fields
are directed toward the same target—better nursing care for the patient through implementation of a team nursing plan on the wards and better experience in nursing practice
for the students.
NEW CASES
The number of new cases discovered during the year amounted to 1,691, which is a
slight decrease from last year's figure. This, broken down into racial groups, shows the
following: Indians, 329; other than Indians, 1,362; and into age-groups:—
Indians—
Other than Indians—
0- 4	
_______ 51
0- 4	
_    55
5- 9	
  61
5- 9	
..    28
10-14	
  44
10-14	
__    28
15-19	
  41
15-19	
._    43
20-24	
  26
20-24	
__ 104
25-29	
  29
25-29	
_ 127
30-39	
  20
30-39	
_. 276
40-49	
  13
40-49	
_ 208
50-59	
  21
50-59	
- 190
60-69	
     9
60-69	
__ 192
70-79	
  12
70-79	
__    87
80 and over	
     2
80 and over	
__    16
Not stated	
Not stated	
__      8
The sources of reporting of new cases during the year were as follows:—
Stationary clinics:  Tranquille, 13; Vancouver, 514; Victoria, 81; and New
Westminster, 117.
Travelling Clinics:  Interior, 64; Coast, 75; Island, 33; and Kootenay, 119.
Reported from outside the Division of Tuberculosis Control, 675.
CLINICS AND INSTITUTIONS
With the major efforts being the construction of the Pearson Tuberculosis Hospital
in Vancouver and the renovation of the Tranquille Sanatorium, there have been few
physical changes other than those within the institutions. The Kootenay Travelling Clinic
in Nelson found it necessary to change its location from the Kootenay Lake General
Hospital to a down-town location in that city, and new quarters have been obtained. This
is proving to be a more satisfactory situation than before.
The staff situation has been relatively stable over the year, but it is anticipated there
will be a great many transfers in all units within the Division in staffing the new sanatorium. In making the key appointments, the Medical Superintendent of Tranquille is
being transferred to the Pearson Tuberculosis Hospital, while he is being replaced at
Tranquille by the transfer of the Medical Superintendent of the Victoria unit. To facilitate the handling of the problem of transfers and new appointments, a personnel assistant
has been appointed to the Central Office of the Division.   This should provide a more DEPARTMENT OF HEALTH AND WELFARE,  1951 X 109
direct line of communication to the Civil Service Commission and expedite the handling
of personnel problems.
Aside from the Kootenay Travelling Clinic in Nelson, which is becoming more and
more a stationary clinic, and the work in the Fraser Valley, which is carried out by the
New Westminster Stationary Clinic, all the travelling clinics are being operated from the
sanatoria, with headquarters in the Victoria unit, Willow Chest Centre, and Tranquille
Sanatorium. Various members of the medical staff of these institutions take responsibility
for covering the medical services provided by these clinics.
There have been no significant changes in the medical or surgical treatment in the
institutions during the year.
In the preventive programme, B.C.G. vaccination is being carried out in selected
groups. This vaccination is urged for hospital employees and for contacts of known
cases of tuberculosis. However, it has not been considered advisable to extend the
programme to other groups, such as young adults, until such time as the programme is
considered to be effectively applied in the contact group.
SOCIAL SERVICE
Staff changes continued to hamper the work of the Social Service Section during the
year. At the Willow Chest Centre the situation was relieved by two former social workers
returning to the staff, but at Tranquille the social-work programme had to be curtailed
because no replacement could be found for the social worker who resigned in July. With
the exception of Tranquille, case-loads for the workers have remained about the same as
the previous year, with an average case-load of ninety-five per worker in the Willow Chest
Centre, ninety-nine in the Jericho Beach unit, and ninety-six in the Victoria unit. At
Tranquille the case-load averaged 165 per month. In September the Provincial supervisor joined the Royal Canadian Air Force as senior administrative officer in the welfare
field, and the case-work supervisor at the Division of Venereal Disease Control was
transferred to the Division of Tuberculosis Control. As part of the reorganization of the
Tuberculosis Social Service Section at this time, the senior case-worker at the Willow
Chest Centre was promoted to case-work supervisor for the Vancouver area.
The programme for providing home-maker service on a selective basis to tuberculous
patients and their families in the Vancouver metropolitan area has continued during the
year under the joint administration of the Metropolitan Health Committee and the Family
Welfare Bureau of Vancouver. At the end of the year ten families were in receipt of full-
time supervised home-maker service and fourteen families were receiving part-time help
from this source. Because the programme was inaugurated as a demonstration project,
financed from Federal Health Grants,'the evaluation of the service should yield some
significant information about the specific contribution which a properly organized home-
maker service can make to the tuberculosis-control programme.
Although the basic Social Allowance rate was increased in 1951 by $5 a month, the
problem of convalescent care for the tuberculous patient without resources remains
chronic. Even with the dietary extras which may be added to the basic Social Allowance
granted to a person who is unable to support himself because of tuberculosis, the Social
Allowance budget falls below requirements.
CONCLUSIONS
Having been faced for many years by an acute shortage of beds for the treatment of
tuberculosis, the day is rapidly approaching when this problem will be met and eventually
overcome. Having then provided for those cases which have pulmonary tuberculosis, the
problem of the non-pulmonary tuberculosis cases will require serious consideration, when
sanatorium facilities are adequate to permit their acceptance.   It is generally agreed that X 110 BRITISH COLUMBIA
all forms of tuberculosis, including idiopathic pleurisy with effusion, should be treated in
a sanatorium, and this practice is followed in most centres throughout the country.
Effective legislation to control recalcitrant patients would be of considerable benefit
to the tuberculosis programme in British Columbia. Under present regulations an infectious case of tuberculosis may be placed in sanatorium, but there are no regulations that
will force him to remain there. The lack of adequate authority to deal with the careless
and unco-operative case is a real handicap in preventing the dissemination of tuberculosis.
The care of the child with tuberculosis is a problem still being met by services outside
the Division of Tuberculosis Control. Acute phases of the disease in children are being
taken care of in general hospitals, while the Vancouver Preventorium is meeting a most
essential need in caring for the sub-acute and chronic cases amongst children. This
voluntary group is presently considering plans for the expansion of its facilities that will
approximately double the present capacity of the Preventorium so as to provide modern
medical and nursing care for the more active forms of the disease in children. These
services are urgently needed, and the board of directors of the Preventorium deserve great
credit for their continued assistance to the campaign against tuberculosis in this Province.
The British Columbia Tuberculosis Society, which has long played a leading part in
tuberculosis work, continues to contribute greatly to augment the services provided
through official agencies. Taking a leading part in educational activities and creating
interest in tuberculosis work in a large number of communities in the Province through
Christmas Seal Committees, the society has also made large monetary contributions to
the Christmas Seal Auditorium in Vancouver and in providing a new radio installation for
the patients at Tranquille Sanatorium. This assistance has been much appreciated and
most valuable.
The work of the Division has been greatly facilitated by the close co-operation and
cordial relations with other agencies of the Government.
victoria, B.C.
Printed by Don McDiarmid, Printer to the Queen's Most Excellent Majesty
1952
845-152-2848    

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