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Seventh Report of the DEPARTMENT OF HEALTH AND WELFARE (HEALTH BRANCH) (Fifty-sixth Annual Report of… British Columbia. Legislative Assembly [1953]

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 PROVINCE OF BRITISH COLUMBIA
Seventh Report of the
DEPARTMENT OF HEALTH
AND WELFARE
(HEALTH BRANCH)
(Fifty-sixth Annual Report of Public Health Services)
YEAR ENDED DECEMBER 3 1st
1952
VICTORIA, B.C.
Printed by Don McDiarmid, Printer to the Queen's Most Excellent Majesty
1953  Office of the Minister of Health and Welfare,
Victoria, B.C., January 14th, 1953.
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, 1952.
ERIC MARTIN,
Minister of Health and Welfare. Department of Health and Welfare (Health Branch) ,
Victoria, B.C., January 14th, 1953.
The Honourable Eric Martin,
Minister of Health and Welfare, Victoria, B.C.
Sir,—I have the honour to submit the Seventh Report of the Department of Health
and Welfare (Health Branch) for the year ended December 31st, 1952.
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. Eric Martin -------      Minister of Health and Welfare.
SENIOR PUBLIC HEALTH ADMINISTRATIVE STAFF
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.
G. F. Amyot, M.D. -      -      -      -
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.   -----      Director, Division of Tuberculosis
Control.
C. E. Dolman, M.B., D.P.H., Ph.D., F.R.C.P.
A. J. Nelson, M.B., Ch.B., D.P.H.      -     -
J. H. Doughty, B.Com., M.A.      -
R. Bowering, B.Sc.(CE.), M.A.Sc   -
Director, Division of Laboratories.
Director, Division of Venereal Disease Control.
Director, Division of Vital Statistics.
Director, Division of Public Health
Engineering.
T. H. Patterson, M.D., CM., D.P.H., M.P.H. -     Director, Division of Environmental
Management.
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.    -
R. H. Goodacre, M.A., C.P.H. - - -
Miss D. Noble, B.Sc(H.Ec), C.P.H. - -
C. R. Stonehouse, CS.I.(C)
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
The Population and Its General Composition  11
The Health of the People  11
Public Health Services and Their General Organization  12
Local Health Services_
Tuberculosis-control
  13
  13
  14
  14
  16
  16
  17
  18
Problems of Alcoholism and Narcotics Addiction  19
Venereal-disease Control	
Environmental Management..
Health Education	
Vital Statistics	
Laboratory Services	
Public Health Engineering..
National Health Grants	
Provincial Health Building	
Voluntary Health Agencies	
Red Cross Blood Transfusion Service	
Report of the Bureau of Local Health Services-
Administration	
19
20
20
21
23
25
27
Community Health Centres     27
Home-care Programmes     28
Resident Physicians' Grants     29
School Health Services     3 0
Disease Morbidity and Statistics     31
Table I.—Incidence of Notifiable Diseases in British Columbia  (Including
Indians)	
Table II.—Table Showing Cases of Notifiable Diseases in British Columbia
Expansion and Development-
Personnel Changes
36
by Health Units and Specified Areas for the Year 1952  37
Report of the Division of Public Health Nursing—
Present Status of Service  38
Table I.—Comparison of Provincial Public Health Nursing Staff Changes
during the Period 1943-52  39
Public Health Nursing Training  39
Records Committee  40
Public Health Nursing Consultant Service  41
Local Public Health Nursing Service  41
Service Analysis  43
Table II.—Comparison of Time Spent by Public Health Nurses in Specified
Activities as Indicated by Time Studies in 1949, 1950, 1951, and 1952____ 43
Table III.—Breakdown of Amount of Time Spent in Home-visits and Office
by Percentage of Total Time on Duty as Shown in Time Studies, 1949,
1950, 1951, and 1952  44
Civil Defence  44
General  44
Report of the Division of Environmental Management  46
A. Report of the Nutrition Service—
Consultant Service to Local Public Health Personnel  48
Consultant Service to Hospitals and Institutions  49
Co-operative Activities with Other Departments and Organizations  50 BB 8
BRITISH COLUMBIA
Report of the Division of Environmental Management-
B. Sanitary Inspection Services—
Food-control	
-Continued
Page
  51
  51
  52
  52
  53
  5 3
Sanitary Inspection of Hospitals  53
Eating and Drinking Places_
Frozen-food Locker Plants__
Slaughter-houses	
Meat Inspection	
Horse-meat	
Housing..
Farm-labour Housing-
Summer Camps	
School Sanitation-
Plumbing-
C.
D.
  53
  54
  54
  54
  55
Garbage and Refuse Disposal  55
Pest-control  55
General Sanitation  56
Industrial Hygiene  56
Civil Defence Health Services  57
Report of the Division of Preventive Dentistry—
Dental Health or Dental Disease  59
Prevention  60
Dental Personnel  63
General  65
Report of the Division of Public Health Engineering—
Water-supplies	
  66
  67
  68
  68
Tourist Accommodation  69
General  69
Sewage-disposal__
Stream-pollution
Shell-fish	
Report of the Division of Vital Statistics—
Registration of Births	
Registration of Deaths	
Registration of Marriages
  71
  72
  72
Documentary Revision  73
Administration of the " Marriage Act"  73
Administrations of Sections 34 to 40, Inclusive, of the " Wills Act"  73
  74
  74
  75
  75
  75
  76
  76
  77
  77
Registration of Vital Statistics amongst the Indians	
Registration of Vital Statistics amongst the Doukhobors .
Effect of Old-age Security Legislation	
Survey of Division	
General Office Procedures	
Microfilming of Documents
District Registrars' Offices and Inspections-
Inspections	
Statistical Services	
Reorganization of Record System in Division of Tuberculosis Control  79
Cancer Registry  80
Table I.—Number and Percentage of New Cancer Notifications by Sight and
Sex, British Columbia, 1952  80 DEPARTMENT OF HEALTH AND WELFARE,  1952
BB 9
Report of the Division of Vital Statistics—Continued pAGE
Table II.—Number and Percentage of Live Reported Cancer Cases by Sight
and Sex, British Columbia, 1952     81
Table III.—Cancer Notifications by Sex and Age-group, British Columbia, 1952
(Age Specific Rates per 100,000 Population)     81
Table IV.—Live Cancer Cases Reported by Sex and Age-group, British Colum
bia, 1952 (Age Specific Rates per 100,000 Population)..
The People of British Columbia	
Mortality and the Ageing Population	
Mortality in Terms of Life-years Lost..
  81
  82
  82
  84
Chart.—Specified Cause of Mortality as a Percentage of Total Deaths and as
a Percentage of Total Life-years Lost, British Columbia, 1952  86
Report of the Division of Public Health Education—
Local Health Educators  87
Materials	
Consultative Service	
In-service Training	
Publications and Publicity.
Staff.	
  87
  8 8
  89
  89
  90
  91
Faculty of Medicine, University of British Columbia  91
Voluntary Health Agencies	
Civil Defence	
General	
National Health Grants	
Acknowledgment	
Report of the Health Branch Office, Vancouver Area-
Buildings ..
92
93
93
94
99
Report of the Division of Laboratories—
Table I.—Statistical Report of Examinations Done during the Year 1952,
Main Laboratory  101
Table II.—Statistical Report of Examinations Done during the Year 1952,
Branch Laboratories  102
Tests for Diagnosis and Control of Venereal Disease  102
Tests Relating to Tuberculosis-control  103
Gastro-intestinal Infections and Bacterial Food Poisoning  104
Other Types of Tests  106
Branch Laboratories  106
General Comments  107
Report of the Division of Venereal Disease Control—
Treatment	
Epidemiology,.
Social Service-
Education	
General	
Report of the Division of Tuberculosis Control-
National Health Grants	
Trends in the Treatment of Tuberculosis—
Death Rates	
Tuberculosis in Older Persons,
X-ray Programme	
108
109
110
110
111
113
114
114
115
115 BB  10
BRITISH COLUMBIA
Report of the Division of Tuberculosis Control—Continued
Travelling Clinics	
New Cases	
Social Service	
Nursing	
General	
Page
116
116
117
117
119
■
■ Seventh Report of the Department of Health and Welfare
(HEALTH BRANCH)
Fifty-sixth Annual Report of Public Health Services
YEAR ENDED DECEMBER 31st,  1952
G. F. Amyot, Deputy Minister of Health and Provincial Health Officer
In accordance with the practice of previous years, this Report's General section,
prepared by Mr. A. H. Cameron, Director, Bureau of Administration, presents a relatively
brief summary of the year's activities, events, and trends which appear to be the most
significant in their effect on the public health. Much of the summary is a digest of the
material submitted by other officials.
The latter part of the Report, beginning on page 23, consists of sections prepared
by senior Health Branch officials in charge of the various bureaux, divisions, and services.
These contain more detailed information.
GENERAL
THE POPULATION AND ITS GENERAL COMPOSITION
The final count of the 1951 Census placed the population of British Columbia at
1,165,210. This figure, correct at June 1st, 1951, represented an increase of 42 per cent
over the population counted in the 1941 Census. This truly remarkable growth has continued during the year and a half since June 1st, 1951.
The population has also continued to age. While the total population of British
Columbia rose 42 per cent between the census years, the increase in individuals 60 years
of age and over was 64 per cent. British Columbia has a greater proportion of older
people than has Canada as a whole.
Both of these factors—the growth and the ageing—have a most important bearing
on public health services.
THE HEALTH OF THE PEOPLE
A general indication of the health of the people may be given by some observations
on death rates, causes of death, and sickness experience. For the school-age population,
there are also some revealing facts concerning physical fitness, immunization status, and
dietary habits.
In 1952 the crude death rate was 9.8 per 1,000 population, excluding Indians.
A hasty conclusion might be that this was no improvement over the rate of 9.8 recorded
for 1942. However, when consideration is given to the fact that the proportion of older
persons in the population has greatly increased during the period 1942-52, it represents
a dramatic improvement.
Heart disease, cancer, and vascular lesions of the central nervous system again
accounted for the greatest number of deaths in 1952. Over 64 per cent of all deaths
occurring in the Province were due to these three causes. It is important to note, however, that these may not be the most important causes of death. If consideration is given
to the ages at which the deaths occur and the number of anticipated years of life which
11 BB 12
BRITISH COLUMBIA
have been lost through the deaths, these three causes, usually occurring among older
people, lose some of their relative importance and drop to third, fourth, and seventh places
respectively. Conversely, diseases of early infancy and accidents assume much greater
importance and rank first and second in terms of " life-years lost."
In the non-Indian population, the death rate from tuberculosis showed a further
decline in 1952 and the infant mortality rate showed a slight but statistically nonsignificant increase over the rate for 1951. The maternal death rate remained constant
at 0.6 per 1,000 live births.   (As recently as 1940 it was approximately five times greater.)
The general sickness experience is indicated by the fact that the notifiable diseases
which were reported during 1952 were somewhat less in number than they were in the
previous year.
However, the number of cases of poliomyelitis was much greater than it had ever
been before. The incidence was almost twice as great as it was in 1947, which, until
1952, was the year of greatest incidence. Although Kimberley and the Penticton area
suffered the largest number of cases, no part of the Province was spared entirely.
An opposite trend may be reported in respect to influenza. During 1952 the
incidence of this disease was very much less than it was for 1951.
The minor communicable infections so common to childhood—chicken-pox, measles,
mumps, and rubella—comprised the bulk of the diseases reported and accounted for
practically two-thirds of the total. They were recorded in approximately the same proportion as in previous years.
Streptococcal infections maintained a fairly high incidence. Extremely mild in
nature, they occurred most frequently on the Coast and in the Kootenay District.
Whooping-cough continued the downward trend observed last year. Although this
was gratifying, there is still an undue prevalence of this infection and a need to maintain
the efforts to provide early and repeated immunization.
The number of cases of cancer reported was again greater than that for the previous
year. There has been a slight increase over the past two years, but the rate is still lower
than it was in 1949.
There was a reduction in the number of new cases of tuberculosis discovered. However, it is interesting and important to note that the proportion of older persons, particularly older males, occupying beds in tuberculosis sanatoria is increasing.
The venereal diseases displayed a slight reduction in the number of new cases
reported. The use of penicillin has had a dramatic effect in controlling these diseases and
in making infectious syphilis a clinical rarity.
Physical examinations of school-children have revealed that, as in previous years,
the vast majority—more than 90 per cent—are in good physical condition clinically.
A large proportion—well over 75 per cent—have been immunized against such major
communicable diseases as diphtheria and smallpox, and a smaller proportion have been
immunized against scarlet fever, whooping-cough, and typhoid fever. Dietary studies
indicate that the three chief deficiencies in the children's diet are milk, a Vitamin D
supplement, and foods rich in Vitamin C. In their routine duties among pre-school and
Grade I children, dental officers noted that dental disease is widespread.
PUBLIC HEALTH SERVICES AND THEIR GENERAL
ORGANIZATION
The people of British Columbia are provided with official public health and preventive medical services by field-workers stationed throughout the Province, institutions,
clinics, laboratories, and special consultants. These official services are strengthened and
supplemented by the physicians and dentists in private practice and by the voluntary
health agencies whose services are well co-ordinated with those of the Provincial and local
health departments. DEPARTMENT OF HEALTH AND WELFARE, 1952
BB 13
LOCAL HEALTH SERVICES
British Columbia's two largest population centres, Greater Vancouver and Victoria-
Esquimalt, are served by their own health departments. Although these do not come
under the direct jurisdiction of the Provincial Health Branch, particularly in so far as
day-to-day administration is concerned, they receive substantial financial assistance from
the Provincial Health Branch and take an active and co-operative part in over-all Provincial planning and service.
In the remainder of the Province, local health services are provided by Provincial
Government personnel who, although they receive guidance from senior Health Branch
officials and consultants, are responsible to their own local boards of health. Each local
health department or health unit, as it is officially known, provides service to a defined
geographical area, including both rural territory and one or more population centres. At
the end of 1951 thirteen such health units were officially organized and in operation.
During 1952 two other areas, in which there had been public health services for many
years, became fully organized as health units. These were the South Central Health Unit
in the Kamloops area and the Boundary Health Unit in the Surrey-Delta area. The
present fifteen health units, together with the metropolitan services of Greater Vancouver
and Victoria-Esquimalt, provide an almost complete coverage of the Province. The only
populated areas in which there are not officially organized full-time services are the
Kootenay Lake district (Nelson and surrounding territory), the Squamish-Howe Sound
area, the Municipality of Oak Bay, and the McBride district. It is hoped that it may be
possible soon to include these in the health-unit organization.
The percentage of the population receiving public health service at the end of 1952
Was:  PerCent
City health departments of Greater Vancouver and Victoria-
Esquimalt  48
Provincial health units  47
Non-health unit areas (public health nursing and sanitary inspection districts)     3
Total.
98
During the school-year 1951-52 preventive dental services operated continuously
in five health units and, during some months of the year, in two other health units. Seven
hundred and fifty-two pre-school children and 1,506 Grade I pupils received complete
dental treatment. Six new clinics for younger children, with chair-side services provided
by local resident dentists, were opened during 1952. This raised the total of such clinics
to nineteen. Sets of transportable dental equipment have been made available to private
dentists in order that they may extend their services to communities which have no
resident dentists. Communities benefiting by this arrangement are Merritt, Slocan City,
Ganges, Kitwanga, Hazelton, Usk, Tahsis, Greenwood, and Edgewater. In each of these
cases the dentist agreed to devote at least a part of his time to work in community clinics
for younger children.
TUBERCULOSIS-CONTROL
In May, 1952, the newly constructed Pearson Tuberculosis Hospital in Vancouver
was opened. This hospital, in its present state, contains 264 beds, although definite
consideration is being given to the construction of another section which will provide an
additional 264 beds.
Structural alterations at Tranquille Sanatorium were completed near the end of the
year.   These alterations made 50 additional beds available in that institution.
The increases in beds noted above were partly offset by the closing of a ward at the
Willow Chest Centre.   This ward, known as T.B. 1, was located in a frame annex which BB  14
BRITISH COLUMBIA
must be moved or demolished to allow for other construction in that area. The net
increase in beds was also reduced slightly by the discontinuance of certain other accommodations which were deemed unsatisfactory.
However, the serious situation with respect to the shortage of beds, which had existed
for many years, was very much improved. At the year's end it appeared that sanatorium
care could be provided to those persons on the waiting list which had been compiled on
the basis of the most urgent needs. This should not be taken to mean, however, that there
will no longer be a waiting-list, nor that there is no need of further construction to provide
additional beds. There are undoubtedly many persons who should be given sanatorium
care, but whose names, in the past, have not appeared even on the waiting-list because
of the serious shortage of beds.
There was an expansion of the chest X-ray service provided by equipment stationed
in general hospitals and community health centres at strategic locations throughout the
Province. X-ray equipment was installed at five additional centres, bringing the total to
thirty-nine, exclusive of those operated directly by the Division of Tuberculosis Control.
VENEREAL-DISEASE CONTROL
The number of venereal-disease cases reported for 1952 was slightly smaller than
that for 1951—3,647 compared with 3,916. Infectious syphilis has become a clinical
rarity, and late syphilis has also shown a marked decline. The over-treatment of
gonorrhoea patients with penicillin has continued to be the practice of the Division of
Venereal Disease Control with a view to aborting early syphilis and appears to have been
of real importance in reducing the number of new cases of syphilis. However, the number
of new cases of non-specific urethritis is not diminishing, and the treatment of this condition remains an unsolved problem.
Although penicillin is the greatest single factor in the control of venereal diseases,
the epidemiology programme of contact-tracing, case-finding, and related activities holds
a strong second place. The Division has continued to strengthen its services in this field
of endeavour.
In February, 1952, Dr. C L. Hunt, who had directed the Division for several years,
relinquished his appointment because of the demands of his private practice of medicine.
In view of his outstanding services as Director of the Division and as Health Branch
representative on several important standing committees, it is fortunate for the Division
and the Health Branch as a whole that he has agreed to continue serving on a part-time
basis as consultant in internal medicine. Dr. A. John Nelson, a highly qualified physician
who had previously served with the Divisions of Venereal Disease Control in British
Columbia and, more recently, in New York State, returned to accept the dual appointment of Director of the Division and Consultant in Epidemiology.
ENVIRONMENTAL MANAGEMENT
The descriptive but new and sometimes misunderstood term " environmental management " refers to the public health programme and activities designed to meet the
health needs of the adult in his total environment at work, at home, and at play.
Important parts of the programme are nutrition, sanitation, occupational health, chronic
care, rehabilitation, public safety, problems of addiction, and, particularly in this era of
world history, those health services included in the civil-defence organization.
During the past year the Chief Sanitary Inspector and the two Nutrition Consultants,
who had previously operated somewhat independently within the Bureau of Local Health
Services, were included as members of the Division of Environmental Management. In
addition, a member of the Provincial civil-defence staff was attached to the Division to
assist in the programme of civil-defence health services. DEPARTMENT OF HEALTH AND WELFARE,  1952
BB  15
It is perhaps unfortunate that civil defence has been such an important problem
during the whole of the relatively short history of the Division of Environmental Management. Since his appointment as head of the Division, the Director has been required to
devote what would, under normal conditions, be a disproportionate amount of his time
to civil-defence planning as it relates to health services. In consequence of this, the
progress which he desired in certain other areas of his over-all programme has not been
achieved. For example, the programme of industrial hygiene remains limited in scope
and consists largely of investigations of special problems referred to the Division from
time to time.
The staff of the Nutrition Section of the Division was brought up to strength in July
by the appointment of a Nutrition Consultant particularly experienced in institutional
food services. This new staff member filled a position which had been vacant for
several months.
The Nutrition Section continued to co-ordinate and direct rat-feeding demonstrations
in schools throughout the Province. Reports from teachers and public health nurses
indicate that these demonstrations, conducted in eighty-six schools outside Greater Vancouver, have resulted in definite improvement in the diets of many children.
Dietary studies consisting of analyses of food records of school-children were conducted in four areas and very generally confirmed the findings of like studies conducted
in sixteen other areas since 1949.
The Chief Sanitary Inspector reports that laboratory samples of pasteurized milk
reveal improvement over previous years on a bacteriological basis.
In respect to eating and drinking places, there were only four complaints received
during the year. In addition, two requests were received from the Liquor Control Board
for the examination of licensed premises. Much of the improvement is probably attributable to the classes which have been conducted for food-handlers.
The regulations governing the construction and operation of frozen-food locker
plants were more rigidly enforced during the year. As a result, two plants discontinued
operations and other plants, which were deficient in certain respects, instituted remedial
measures.
The annual licensing of slaughter-houses continued to be a co-operative procedure
on the part of the Department of Agriculture and the Health Branch. The Recorder of
Brands, Department of Agriculture, issues a licence only after the applicant has submitted
an inspection certificate completed by the Medical Health Officer. This procedure, to
which there was strict adherence during 1952, has proved most beneficial.
As the result of a survey of food-handling and related practices in general hospitals,
the British Columbia Hospital Insurance Service agreed that local health-service personnel
should continue their supervisory work in this field of activity.
In the matter of school environment, there has developed a close liaison with the
Department of Education and local school authorities. Health unit directors, in their
capacity of school medical officers, and the Division of Environmental Management have
participated with educational authorities in planning new schools and in evaluating the
facilities of those already constructed.
The Chief Sanitary Inspector is the British Columbia representative on the Technical
Advisory Committee on Plumbing Services to the National Research Council. In this
capacity he has become thoroughly familiar with the Recommended National Plumbing
Code and has taken part in planning which, it is hoped, will soon result in a Provincial
Code and a model municipal plumbing by-law.
Public health authorities in several parts of the Province instituted stricter policies
in the matter of garbage and refuse disposal. There was a trend to replace the primitive
method of dumping in ravines, etc., by trench-and-fill methods. n) BB  16
BRITISH COLUMBIA
In the civil-defence programme, the health-unit directors throughout the Province
are now recognized as the local directors of Civil Defence Health Services. Plans for
civil-defence organization in hospitals have been distributed to the majority of strategically
important hospitals throughout the Province. The inventory of hospital beds and emergency hospital facilities has been revised, and the record of all available physicians,
nurses, and technicians has been maintained.
Twenty-eight first-aid stations have been established at strategic locations, and each
has been provided a large training kit to be used by the volunteer members. (It is
important to note that a first-aid station in the civil-defence meaning of the term, consists
of more than 150 persons, including physicians, dentists, and nurses.)
Civil Defence Health Services have been instrumental in providing first-aid classes
throughout the Province, and large numbers of trainees are participating. These supplement the courses conducted by voluntary organizations and the training provided to
school students.
A plan of mutual aid between the State of Washington and the Province of British
Columbia has been developed. However, some details of this plan require further
clarification.
HEALTH EDUCATION
Health education is the responsibility of all public health workers and is probably
the basic and most important method of improving the health of the people. Included
in the meaning of the broad term are education of the public, pre-service and in-service
training of staff members, and the provision of information and consultative services to
other organizations and agencies concerned with health matters. Because almost all staff
members undertake educational activities daily, only a few random examples can be
mentioned here.
Instruction of mothers at child health conferences (" baby clinics "), instruction of
food-handlers at work and in formally organized courses, and the information and advice
given by the public health nurses during their home-visits exemplify the daily routine
activities of the field-staff personnel throughout the Province. More formal lectures are
presented to both lay and professional groups by senior officials of the Health Branch
proper as well as by local health-service personnel.
In the field of in-service training, special mention must be made of the annual Public
Health Institute which was held in Victoria from April 14th to 17th. Designed particularly for the benefit of local public health personnel from all parts of the Province, it was
also attended by senior Health Branch personnel and divisional directors. The chief
speaker was Dr. Jennie Rowntree, Director of the School of Home Economics, University
of Washington, who gave a series of lectures on nutrition in public health. Senior Health
Branch officials, members of the field staff, and carefully selected representatives of other
agencies participated in the remainder of the well-rounded programme.
The Division of Public Health Education, whose staff members have undertaken
formal postgraduate training in this field, provides the consultant services of specialists.
The Division and the Health Branch as a whole suffered a severe loss when Mrs. Kay
Beard resigned at the end of October. Mrs. Beard was the first professionally trained
health-education specialist in British Columbia and was largely responsible for the development of the Division since its organization in 1945. Her position as head of the
Division was filled by Mr. R. H. Goodacre, a member of the Division's staff. Mr. Good-
acre, whose earlier academic training had gained him the Master of Arts degree in
sociology and anthropology, received his later public health training at the University of
Toronto.
VITAL STATISTICS
The Division of Vital Statistics continued to have two main functions, concerning
(a) statutory duties (administration of the " Vital Statistics Act," the " Marriage Act," DEPARTMENT OF HEALTH AND WELFARE,  1952 BB  17
the " Change of Name Act," and certain sections of the " Wills Act") and (b) statistical
services (the provision of data regarding births, deaths, and marriages, and the carrying-
out of the statistical requirements of all other divisions of the Health Branch).
The Director reports that the current registration of births is virtually complete,
except in isolated cases in remote regions of the Province and in the case of the Sons of
Freedom sect of Doukhobors. The bulk of applications for delayed registrations was
again concerned with persons born before the year 1920. This indicates that the registration coverage has been much more complete during the last thirty years than during
previous periods.
The registration of deaths is also virtually complete, except in isolated localities of
the Province.
Indian Superintendents are doing much to encourage the practice of obtaining birth
certificates for new-born children as well as for the older members of Indian families.
The results have been very gratifying, and it is reasonable to believe that the registration
of current births is virtually complete. The recording of Indian marriages is likewise
satisfactory. However, the registration of deaths among the Indian population still
presents difficulties. Largely because the registration of vital events of Indians was on
a voluntary basis until 1943, there is a deficiency in respect to the earlier years. The
Indian Commissioner for British Columbia and his Superintendents have made determined
efforts to improve this situation. As a result, many delayed registrations were completed
and filed.
The Division completed its work on the data compiled by the enumerators of the
National Sickness Survey, which was undertaken in 1950, and submitted to the Department of National Health and Welfare a comprehensive report covering all aspects of the
survey in British Columbia.   The data are now being tabulated in Ottawa.
In 1951 a revised form of the Physician's Notice of a Live Birth or Stillbirth was put
into use. During 1952 the first tabulations of data reported on this form were made. As
the series builds up, much valuable information on the circumstances surrounding births
within this Province will be forthcoming. However, it is still too early to draw any conclusions from the analyses of these tabulations.
At the request of the Provincial Secretary's Department, the Division reviewed the
existing record and statistical system in use in the Mental Health Services. As a result
of the recommendations, a revised system and service, in which the Division will participate, will be put into effect in April, 1953.
During the past several years the Division of Vital Statistics has taken a leading part
in evaluating and reorganizing the record system in use in the Division of Tuberculosis
Control. Included among the important changes have been the appointment of a trained
Medical Records Librarian to the staff of the Division of Tuberculosis Control, the complete review and revision or discard, where indicated, of medical-record forms, the institution of new procedures for the control of records, and the appointment of a permanent
committee, consisting mainly of medical personnel, to advise on the use which should be
made of the statistical material which is gathered.
LABORATORY SERVICE
During the first six months of the year the Division of Laboratories consisted of the
central laboratory in Vancouver and four branch laboratories at Victoria, Prince George,
Nelson, and Kamloops. In July, however, the Division discontinued the subsidy under
which the Kamloops branch laboratory operated because Kamloops officials could not
procure satisfactorily qualified staff.
The total tests performed by the Division approached 410,000. Approximately
345,000 of these were carried out in the central laboratory in Vancouver. The branch
laboratories at Victoria and Prince George showed roughly the same turnover of sped- BB  18 BRITISH COLUMBIA
mens as in 1951. In the case of the Nelson branch laboratory, however, there was an
increase in turnover from about 9,000 tests in 1951 to almost 15,000 tests in 1952. It
should be noted that this was accomplished without increasing staff and in spite of the
fact that a complete change of staff occurred during the summer.
The total sputum and miscellaneous specimens admitted for direct microscopic
examination for the tubercle bacillus declined slightly from the 1951 figures, but the
number cultured increased by 20 per cent. This exemplified the increasing demands
which are placed upon the Division—demands which are most difficult to meet in the
present extremely unsatisfactory and crowded accommodations.
Over 8,000 stool specimens were cultured for organisms of the Salmonella and
Shigella groups. This represented an increase of approximately 25 per cent over the
figure for 1951. More than 300 strains were isolated, some for the first time in British
Columbia.
The number of bacteriological tests on milk and water samples was about the same
as that for 1951. Close co-operation between the Division of Laboratories and local
health-service personnel, especially Sanitary Inspectors, will undoubtedly improve the
supplies of water, milk, and foodstuffs in general.
PUBLIC HEALTH ENGINEERING
The marked increase in industrialization created many public health engineering
problems and the expansion of local health services brought to light others which required
public health engineering knowledge and procedures for their solution.
The " Health Act " requires that all plans of new waterworks systems and alterations
or extensions to existing systems be submitted to the Deputy Minister of Health for his
approval. The Division of Public Health Engineering has the responsibility of reviewing
such plans. During 1952 thirty-three plans were approved. In addition, many waterworks plants were visited for the purpose of checking on sanitation hazards and assisting
generally in the improvement of the systems. Although many water-supply systems should
be better protected from contamination than they are at present, simple chlorination will
provide reasonable protection in most cases. However, chlorinating equipment requires
maintenance and intelligent operation if it is to give satisfactory service. Unfortunately,
these requirements are not recognized in all cases.
The " Health Act" also requires that plans for sewerage construction receive official
approval before construction is undertaken. Eleven such plans were approved during
1952. It is pleasing to report that the Municipality of Saanich undertook construction
of its new sewerage system. By the end of the year some of the homes in the municipality
were connected to the system.
In view of the changes in standards and the growth of Vancouver and surrounding
municipalities, the Vancouver and Districts Joint Sewerage and Drainage Board undertook
studies of its sewage-disposal system. A firm of consulting engineers was employed, and
it is anticipated that the new plan will be finalized during 1953.
Although approximately 55 per cent of the population of British Columbia is served
by public sewerage systems, much remains to be accomplished in a number of urbanized
areas in both organized and unorganized territory. At present there are both financial
and legislative difficulties preventing more rapid progress.
Stream-pollution, caused by the discharge of municipal and industrial wastes into
surface waters, does not present an alarming problem at the present time. There are only
a few cases in which waste discharges have affected down-stream water uses. However,
it is recognized that controls with a view to prevention are preferable to corrective
measures instituted after the problem has arisen.
Procedures for enforcing the shell-fish regulations have now become fairly well
established.   Inspection of shucking plants and handling procedures has been made the DEPARTMENT OF HEALTH AND WELFARE,  1952 BB  19
responsibility of local health services.   Reports are submitted on standard forms issued by
the Division of Public Health Engineering.
Tourist camps, auto courts, etc., are inspected by the Sanitary Inspectors of local
health services. The reports are co-ordinated by the Division of Public Health Engineering, and recommendations for or against licensing are made to the British Columbia
Government Travel Bureau. It is felt that this procedure has had a marked effect in
producing a good standard of tourist accommodation. At the end of 1952 there were
approximately 1,300 licensed tourist camps in British Columbia. Eight licences were
cancelled on health grounds in 1952.
PROBLEMS OF ALCOHOLISM AND NARCOTICS ADDICTION
Both of these problems received increased attention during the year.
The John Howard Society and other groups presented to the Minister of Health and
Welfare briefs concerning the problem of alcoholism, and several additional meetings and
discussions were held. Although a variety of proposals have been advanced, it is felt that
further specific action in respect to this very difficult problem should not be taken until
the findings of the Liquor Inquiry Board have been made known.
The problem of narcotics addiction was brought under active discussion as the result
of a report prepared by the Health and Auxiliary Division of the Community Chest and
Council of Vancouver. The gravity of this problem is increased by the fact that a satisfactory solution cannot be evolved by any single organization or agency. Many committees have been established at the local, Provincial, and National levels, and the problem
has also been discussed at the Dominion Council of Health by the Deputy Minister of
Health for British Columbia. Notwithstanding the recognized difficulties and complexities, it appears that some progress has been made through the co-operation of all interested
groups in the Province.
NATIONAL HEALTH GRANTS
By May, 1952, the National health-grants programme had been in operation for four
years. A review of the records reveals that British Columbia has made good use of the
funds in establishing new health and hospital services and in extending already established
services—the purposes for which the grants are intended. There is no doubt that the
people of the Province have benefited materially by improvements made possible under
all ten of the grants (Crippled Children, Professional Training, Hospital Construction,
Venereal Disease Control, Mental Health, Tuberculosis Control, Public Health Research,
Health Survey, Cancer Control, and General Public Health).
The total allocation to British Columbia for the fiscal year 1952-53 is $4,417,957,
excluding the Public Health Research Grant funds, from which are not specifically allocated to the Provinces. This amount is larger by almost $1,500,000 than the amount for
the previous year. The increase is due almost entirely to an actual increase of almost
$90,000 in the Mental Health Grant and the inclusion of those portions of the Hospital
Construction Grant which were unexpended in 1948-49 and 1949-50.
Although accurate data for the calendar year ending December 31st, 1952, are not
readily available, the trend is revealed by the data for the fiscal year ending March 31st,
1952. In that fiscal year British Columbia actually used—that is, spent—slightly more
than 85 per cent of the total funds available. This compares very favourably with the
figure of 69 per cent for Canada as a whole and with the figure of 59 per cent for British
Columbia for the previous fiscal year.
Although the Assistant Provincial Health Officer, in his report which appears elsewhere in this volume, gives specific examples of important uses to which the grants have
been put, special mention should be made of the " Survey of the Health Services and
Facilities in British Columbia in Existence on December 31, 1948."   Conducted by the BB 20
BRITISH COLUMBIA
Assistant Provincial Health Officer under the provisions of the Health Survey Grant, the
survey was finalized during 1952 and the report, including recommendations, was submitted to the Department of National Health and Welfare in March. Later in the year
printed copies were given wide distribution to interested individuals and agencies in
British Columbia and elsewhere on this continent. It is important to note that this health-
survey report does not necessarily represent the views nor policy of the Government of
British Columbia. The report and its recommendations constitute the thinking of administrative officials of the Health Branch, Provincial Department of Health and Welfare.
PROVINCIAL HEALTH BUILDING
(Proposed Administration, Clinic, and Laboratory Building,
Vancouver)
Public health officials, as well as others deeply concerned in the matter, had hoped
that this Annual Report for 1952 could contain the statement that construction of the
proposed administration, clinic, and laboratory building in Vancouver had been undertaken. For many years the need for such a building has been very great. Many architectural plans have been drawn and then discarded or modified, several sites had been
investigated, and numerous administrative problems have been encountered and solved.
During the earlier part of 1952 it seemed that the actual construction would at last be
undertaken. An admirable site had been selected and arrangements to transfer the deed
of the property to the Province had been made; the required funds had, for the most part,
been appropriated; architectural plans had been finalized and plans for such features
as lighting and heating had been almost completed; test-holes had been dug to determine
the type of foundation required. By the summer all phases of the planning had advanced
to such a degree that tenders were about to be called.
It was, therefore, a great disappointment and, in the opinion of public health officials,
a serious blow to public health services that a change in policy resulted in the postponement, once again, of further action. It was intimated that construction might be undertaken during the coming fiscal year. Administrative and professional personnel of the
Health Branch expressed the fervent hope that this tentative proposal will indeed be put
into effect.
In the meantime, services which have a fundamental importance in maintaining the
health of the people must continue to operate under physical conditions which are actually
dangerous. The Division of Laboratories, located in four converted and obsolete wooden
houses on Hornby Street in Vancouver, is the most seriously affected. Working in these
much overcrowded accommodations, the personnel are in danger of becoming infected
from the bacteriological specimens with which they must work. The fire hazard and the
danger of structural collapse are great. Second only to the Division of Laboratories in
the gravity of this housing problem is the Division of Venereal Disease Control. Only
good fortune can account for the fact that the Vancouver General Hospital, which owns
the ancient wooden structure in which the latter Division is located, has not yet made use
of the site for its own building programme.
It should be understood that the disappointment resulting from one postponement of
construction was not related to any ordinary desire merely to possess new and more
adequate quarters. " Disappointment " is probably a too conservative word. " Fear "
would be more appropriately applied—fear for the health and safety of the employees
and fear for the efficient conduct of the public health service.
VOLUNTARY HEALTH AGENCIES
It is pleasing to report that the close co-operation between the official health services
and the major voluntary health agencies has been maintained.   Serving as Health Branch DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 21
representatives on the governing bodies of these agencies, Health Branch officials have
assisted in developing balanced programmes and eliminating duplication of services.
During 1952 two new voluntary health agencies—the Multiple Sclerosis Society and
the Cerebral Palsy Association—were established. Both were urgently required, and
both were given financial assistance from the National health grants.
The British Columbia Cancer Foundation received financial assistance to pay the
operating expenses of its Cancer Institute and Nursing Home, in Vancouver, and its
consultative and diagnostic clinics throughout the Province. These moneys consisted of
funds derived from the National health grants and equal amounts provided by the Provincial Government through the Health Branch. The new clinic building of the British
Columbia Cancer Institute was opened in October. Included among its most modern
radiotherapy equipment is the third cobalt 60-beam therapy unit to be put into operation
anywhere in the world.
During the year the Western Society for Physical Rehabilitation changed its name
to the " Western Society for Rehabilitation." The deletion of the word " physical " indicates the trend of this society to interest itself in all aspects of rehabilitations. It has
become evident that larger accommodations are required, and plans for construction have
been initiated.
Demands of local communities were largely responsible for further expansion of the
programme of the Canadian Arthritis and Rheumatism Society (British Columbia Division) . At the end of the year this society was operating seven diagnostic and treatment
clinics in larger cities throughout the Province. From these clinics, mobile physiotherapy
service was provided to fourteen other communities. Treatment-rooms were established
in eight other cities, and from these centres another fourteen communities received the
mobile physiotherapy service.
The British Columbia Tuberculosis Society maintained its active and most welcome
support of the tuberculosis-control programme. Important among its contributions was
the provision of a new truck and generator for the mobile X-ray service of the Division
of Tuberculosis Control.
Although service clubs are not ordinarily considered to be voluntary health agencies,
several of these organizations gave valuable assistance in the construction of community
health centres and in the provision of equipment.
RED CROSS BLOOD TRANSFUSION SERVICE
December, 1952, marked the end of the sixth year of operation of this service in
British Columbia. During all of these six years the Service has faced a too constantly
recurring problem—an insufficient supply of blood. It is most important that two principles be understood: First, the Service makes blood and blood plasma available at no
cost to the recipients in their times of need, which may be grave; second, the human body
is the only source of blood-supply for this purpose—blood cannot be produced synthetically. Therefore, it must be obvious that, if the great benefits are to be maintained, donors
must appear voluntarily in large numbers at the Service's well-organized clinics. During
1952, as in previous years, these blood-donor clinics were held at frequent intervals in
most population centres throughout the Province.
The Provincial Government, through the Health Branch, continued to give financial
support to help the organization in defraying general maintenance costs in clinics and
offices and in meeting extraordinary transportation charges. It is regretted that delay in
constructing the Provincial Health Building has prevented the provision of adequate
accommodations for the Service's blood-processing depot in Vancouver. A commitment
to provide such accommodations was included in the agreement between the Canadian
Red Cross Society and the Provincial Government when the service was inaugurated. BB 22
BRITISH COLUMBIA
The year 1952 was marked by the gratifying progress in many, if not all, fields of
public health endeavour and also by some distressing experiences, including a poliomyelitis epidemic. In both the happier activities related to programme-planning and
administration and the hectic procedures required in emergencies, the Deputy Minister of
Health received firm support from all of those to whom he turned for assistance. Other
departments of Government, professional groups, and voluntary agencies gave unlimited
co-operation. Personnel of the Health Branch again displayed their loyalty to the Service.
To all of these, the Deputy Minister tenders his sincere gratitude.
■ DEPARTMENT OF HEALTH AND WELFARE,  1952
BB 23
REPORT OF THE BUREAU OF LOCAL HEALTH SERVICES
J. A. Taylor, Director
Previous Reports have recorded that one of the major functions of the Health Branch,
Department of Health and Welfare, should be stimulation toward the development of
full-time local health services. The term " local health services " denotes public health
services at the municipal level, embracing public health nursing and environmental sanitation, and is closely allied with the services in tuberculosis-control, venereal-disease
control, laboratories, environmental management, vital statistics, public health engineering, and public health education, which, although administered by separate divisions, are
interpreted to the community by the field staff in local health services.
Basically, the ideal type of full-time local health service has been found to be most
efficiently administered through a health unit, in which a number of municipalities unite
their Local Boards of Health into a Union Board of Health which employs qualified public
health personnel to render public health services to their communities. At the same time
an opportunity is afforded the district School Boards to transfer their school health services
to the Union Board of Health and to appoint the staff of the health unit to direct those
services for the future. Those municipalities and school districts which have taken this
action, to unite their community and school health services under a Union Board of
Health, have developed a uniform basic public health administration, not only for the
entire unit area, but which, because of consultation and supervision through the Health
Branch, is co-ordinated with all the similar services throughout the Province.
In the beginning the division of the Province into potential health-unit areas was
arbitrarily decided by officials within the Health Branch, and a degree of persuasion
was necessary to induce Municipal Councils and School Boards to participate in the
organization of the first few units. Once the initial units became established, however,
they served to demonstrate this type of administration so well that demands for formation
of other units exceeded the available personnel. It became necessary to accept the
requests on a priority basis and to establish health units as qualified personnel were
recruited.
The prime goal in the Bureau of Local Health Services has been toward the complete
organization of local health services for the entire Province. It now appears likely that
that goal will become attainable shortly, since only two areas in the Province remain to
be organized to complete Provincial coverage. Negotiations are proceeding, and it is
hoped that these areas will be organized into health units sometime in 1953. With the
organization of those two areas and the reorganization of one or two older units the goal
originally planned twelve years ago will have been attained. The establishment of that
complete basic public health service will permit development of additional services in
such related fields as public health dentistry, mental hygiene, morbidity studies, bedside
nursing, industrial hygiene, geriatrics, and so forth.
ADMINISTRATION
No particular administrative changes occurred within the Bureau of Local Health
Services during the year. The Division of Environmental Management, which became
established toward the end of the previous year, commenced to develop the planned
services, and a separate report of these is submitted for the first time.
The central committee known as the " Local Health Services Council," which was
established two years ago to provide for consolidation of administration within the Bureau
of Local Health Services-, continued to function satisfactorily. This body was established
to function on the Provincial level in much the same way as the health-unit staff on the
local level. Such unification provides a better co-ordinated administration. In effect, the
functions of this body are as follows:— BB 24
BRITISH COLUMBIA
To become an informed central committee on all phases of local health services,
so that each member is kept acquainted with developments in the field.
It is hoped that, possessed with this information, each member during
field-trips will be able to discuss, in generalities, service other than those
of his own division.
To study existing policies and programmes, to suggest improvements and
modifications.
To develop a manual of recommended procedures for local health services,
divided into sections for the guidance of each branch of the service.
To study, develop, and recommend new policies and programmes for presentation to the Deputy Minister of Health for his consideration as the future
policy of the Department.
The major task continues to be the compilation of a reference or policy manual,
which will outline and enumerate the functions and responsibilities of the various divisions
and personnel within the Bureau of Local Health Services, so that the responsibilities of
each division will be enumerated clearly for the future.    Work has been going ahead
through the year on this job, with sub-committees being set up and assigned to study and
recommend the content and character of the various sections involved.    Progress is
being made, but it will still be some time before the manual becames a reality.
In addition to the administrative guidance supplied by the Local Health Services
Council, additional suggestions and advice are sought from the full-time Medical Health
Officers, who convene bi-annually with the directors of divisions and senior officials of
the Health Branch. At these meetings, convened in March and September, an agenda is
drafted on the basis of topics recommended by the Medical Health Officers dealing with
points which they would like to discuss. A review of the subject is introduced by one
member for thorough discussion so that uniform handling of the problems and services
will prevail throughout the Province. At the same time existing policies and programmes
are analysed from time to time so that the recommendations of the field staff may be
considered in framing changes in existing services and development of new ones. At the
same time, where legislation seems necessary, the Health Branch has a degree of advice
from those individuals concerned with the local administration of that legislation so that
it is primarily designed to be as practicable as possible. The spring meeting, as usual,
convened during the annual Public Health Institute, and the guest speaker at that Institute,
Dr. Jennie Rowntree, discussed various points in relation to nutrition on the basis of
questions raised by individual Health Officers.
Formerly, Dr. L. Ranta, who was assistant to the Dean of Medicine, University of
British Columbia, had been appointed as an active member of the Health Officers' group.
He attended all conferences in a technical capacity. During the year his resignation was
received when he transferred his employment; at the same time Dr. J. Mather became the
first Professor of Public Health and Preventive Medicine in the Faculty of Medicine at
the University and was invited to assume the position vacated by Dr. Ranta. At his
initial meeting with the group in September, Dr. Mather presented a review of the trends
in teaching preventive medicine to undergraduate medical students, and outlined the
proposed manner in which this will be handled in the Faculty of Medicine at the University
of British Columbia. In relation to the question of teaching public health to undergraduate medical students, a plan was discussed with Dr. Mather whereby some orientation could be provided to those students through direct contact with existing public health
services. At present it is proposed that they gain this field experience by trips to the
specialized divisions of the Department of Health and Welfare located in Vancouver and
in study of the services provided in the metropolitan health services in that city. At the
same time, consideration is being given to the provision of summer internships for those
students indicating a preference for public health as their likely future medical career.
It is planned to accommodate three such students by employing one in each of three DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 25
selected health units. The plan was tried on an experimental basis during this past year
when one student was appointed to assist in various phases of public health during the
summer months. It proved so successful that it is felt advisable to further the experiment
as proposed. In this way it is hoped to inculcate some interest on the part of undergraduate medical students in public health practice as one of the specialties in medicine.
It offers one means toward increasing the potential number of public health physicians
that will be available in future years and may aid in overcoming the recruitment problem,
which has been the major hindrance encountered to date in the expansion of local health
services.
EXPANSION AND DEVELOPMENT
In the last Annual Report, mention was made that negotiations toward the establishment of health units for the Kamloops area and the Surrey Delta area were proceeding
satisfactorily, and that they would likely come into being in 1952. This prediction
developed as forecast. The Municipality of Surrey joined its Local Board of Health with
that of the Municipality of Delta to originate the Boundary Union Board of Health in
January. Subsequently, School District No. 37 (Ladner) and School District No. 36
(Cloverdale) transferred their school health services to that Union Board and became
active members of the Board, to be followed later by the Municipality of Langley and
School District No. 35, thereby completing the original proposals in relation to the establishment of that unit. This was one of the units which had been long delayed, awaiting
recruitment of a qualified public health physician to complete the formal establishment
of the service. During the waiting period graded steps were taken toward organization of
the unit as public health nurses were appointed, followed by Sanitary Inspectors, so that
much of the unit service was functioning prior to the finalization of the organization under
the Union Board of Health.
Another area which had been long on the priority list was Kamloops and district, in
which desires for health-unit services had been expressed as much as eight years ago.
Here again component units of the service were introduced in the persons of public health
nurses and Sanitary Inspectors, so that it merely meant the recruitment of a qualified
public health physician as director to bring about the finalization of unit development.
This became possible early in 1952, when the necessary formal by-laws and resolutions
by the respective Councils and School Boards resulted in the establishment of the Union
Board of Health to initiate the health-unit service. This area selected the name " South
Central Health Unit " to designate the service in an area which includes the City of
Kamloops, the City of Merritt, the Village of North Kamloops, the Village of Lytton, the
Village of Ashcroft, the Village of Lillooet, and the communities of Bralorne, Clinton,
Barriere, and Blue River, situated in School Districts Nos. 24, 25, 26, 29, 30, and 31.
This brings to fifteen the number of health units operating throughout the Province,
in addition to the metropolitan services in the centres of Vancouver and Victoria. There
remain two areas which, in the original planning, were designated as potential health
units; namely, one in the Kootenay Lake district with headquarters at Nelson and the
other in the Squamish-Howe Sound area. During the year certain negotiations were conducted in both districts, which solicited information from Councils and School Boards
therein indicating their desire for complete health-unit services. It is anticipated that it
will be possible to take steps early next year to finalize health-unit development in the
Kootenay Lake area, while the addition of sanitary-inspection services in the Squamish-
Howe Sound area, coupled with its consolidation with the North Shore health service,
will handle that situation.
In the original planning of the Upper Fraser Valley Health Unit it was proposed
that the Union Board of Health in that area should include the Municipality of Sumas,
the Municipality of Matsqui, the Village of Abbotsford, and School District No. 34. For
some years this has not been possible as there has been certain resistance toward expan- BB 26 BRITISH COLUMBIA
sion of the health unit to include those areas. However, during the year, as a result of
further discussions, School District No. 34 (Abbotsford) approved the proposals and
took formal steps to transfer their school health services to that Union Board of Health.
There remains completion of negotiations with the municipalities to finalize the expansion
of the unit which it is hoped will become possible in the very near future.
The selection of the nomenclature for health units usually has been based on a local
geographic basis rather than on any particular city or municipality. The Prince Rupert
Health Unit has been the one anomaly, but during the year the Union Board of Health in
that area corrected this by formally changing it to the Skeena Health Unit, which more
properly designates the area over which the Union Board of Health has jurisdiction.
The local health services within the metropolitan areas of Greater Vancouver and
Victoria-Esquimalt continued to make substantial progress during the year. While these
services operate somewhat independently of the direct supervision through the Health
Branch, they nevertheless maintain a very excellent co-operation and participate in the
annual Public Health Institute and the bi-annual Health Officers' meetings. There have
been some negotiations proceeding in the Greater Victoria area toward consolidation of
the services provided through Victoria-Esquimalt health service and the Saanich and
South Vancouver Island Health Unit. Sub-committees from both Union Boards have
been meeting periodically to discuss the feasibility of uniting under one Union Board of
Health. The Health Branch would endorse such consolidation toward a more completely
integrated service for the whole of the Greater Victoria area. It is not felt that it would
impair quality or quantity of service already being provided in the separate units, and it
is evident from the results in the Simon Fraser Health Unit, where an essentially metropolitan service united with a semi-rural service under one Board, that such union is
feasible and justifiable toward economic efficiency in operation.
Considerable study was given to the financing of metropolitan health services to
investigate the proportion being borne by the various levels of government—municipal,
Provincial, and Federal. As a result of this study, some readjustments were proposed and
presented to the senior Medical Health Officers for discussion with their Boards. The
proposals recommended an increase in the Provincial grants in all cases, with some
readjustment in the Federal proportion, involving a decrease in one instance and increases
in a few others. This results in equitable distribution of grants for all metropolitan areas
on a uniform basis, thereby eliminating some of the inequalities previously evident. At
the same time it takes into consideration the expanding population, augmenting the
financing to provide for the necessary expansion of service to handle the larger demands.
There remain two areas of the Province with only a part-time health service in which
it would be recommended that full-time public health services should be introduced. One
of these is in the Municipality of Oak Bay, which at present is operating under a school
nurse and part-time Medical Health Officer. It is felt that the best interests of this area
could be served through consolidation with the Victoria-Esquimalt health service, together
with the employment of additional full-time staff within the municipality. The Health
Branch is prepared to provide additional substantial grants to encourage development of
such a programme. The other area in which the need for full-time service is most evident
is in School District No. 58 (McBride). There has been a very voluble demand on the
part of the School Board and all organizations in that community for introduction of this
service. However, to date, it has not been possible to recruit a qualified public health
nurse to initiate public health nursing services in the area, this service being the preliminary to inclusion of the school district within one of the existing health units. While
every effort was been made to locate such a person, unfortunately it is not an area to
which a new graduate can be attracted, and progress is dependent upon the ability to
locate a person interested in pioneering the service in a new area. DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 27
PERSONNEL CHANGES
Greater stability in the ranks of public health physicians was noted during the year,
as only one resignation occurred while four new appointments became possible. In order
to open the Boundary Health Unit, the Director of the North Okanagan Health Unit was
transferred to Cloverdale to introduce and organize the service. The replacement within
the North Okanagan Health Unit, after only a few months' service, resigned toward the
end of the year. The Director of the Skeena Health Unit is being transferred to become
Director of the North Okanagan Health Unit as the year ends. A new appointment to
the Skeena Health Unit is being made with the recruitment of a physician formerly
employed in public health service in the State of Mississippi. The South Central Health
Unit was supplied through the appointment of a qualified public health physician formerly
engaged in a similar category in the Province of Alberta.
The Directors of the Cariboo and North Fraser Valley Health Units, who were on
leave of absence pursuing postgraduate study toward a Diploma in Public Health at the
School of Hygiene, University of Toronto, returned to their appointments in the spring.
Four present directors—namely, the Acting Director of the Cariboo Health Unit, Director
of the Simon Fraser Health Unit, Director of the South Okanagan Health Unit, and the
Director of the Peace River Health Unit—departed on postgraudate training on September
1st. Readjustments were made to handle the vacancies during their absence. The
Director of the Division of Venereal Disease Control is carrying an part time as Acting
Director of the Simon Fraser Health Unit, while a new appointee became Acting Director
of the South Okanagan Health Unit, and a new appointment was made to assume the
direction of the Peace River Health Unit.
These appointments and transfers have been planned to provide additional trained
public health physicians during 1953, who can be utilized to permit development of new
health units as previously outlined.
COMMUNITY HEALTH CENTRES
As a result of the proposals advanced by the Health Branch last year to assist
financially toward the construction of suitable health-unit accommodation, definite
progress is now being made toward improvement in the over-all community health-centre
situation in many areas of the Province. During the year Kelowna City Council undertook the construction of a community health centre to house the central offices of the
South Okanagan Health Unit in a modern, suitably appointed single-story structure on a
site facing Okanagan Lake. The financing is handled jointly through municipal, Provincial, and Federal Government participation, although the major share has been borne
by the municipality. This building was occupied during December, 1952, and provides
much more suitable office and clinic accommodation than was available for the unit in
the past, bringing the clinical and administrative phases of the service together under one
roof for the first time in its long history.
In Enderby the Lions Club undertook a project to construct a sub-office of the North
Okanagan Health Unit to provide accommodation for the resident public health nurse in
that area. This was entirely a service-club project in which almost all the construction
was done by members of the club on the basis of financing provided through Provincial
and Federal community health-centre construction grants. Clinic quarters were provided,
while separate offices for the nurse and Sanitary Inspector were made available. The
building was officially opened on December 14th.
This is the first time that there has been suitable accommodation of any sort available for the public health nurse in Enderby and is a credit to the Enderby Lions Club for
their foresight in undertaking its construction.
The third community health centre came into being in Kamloops, where a Health
and Welfare Building was constructed by the Provincial Government, assisted by National BB 28 BRITISH COLUMBIA
health grants. This is a modern two-storey structure, in which the Health Branch is
housed on the ground floor, with somewhat smaller quarters accommodating the Motor-
vehicle Branch, while the second floor accommodates the Welfare Branch. These are
extremely well-appointed quarters and answer a long-felt need for office and clinic space
in a community in which health services had been housed in old garages and old houses,
entirely unsuitable for either efficient administration or the operation of clinics. This
building became available for occupancy early in September and is now fully in use by
the appreciative staff.
The renovation of a school building in Coquitlam was undertaken under the grant
formula to provide quarters for the sub-office of the Simon Fraser Health Unit in that
area. It also provides, for the first time, the consolidation of administrative and clinical
phases of the public health service under one roof, while accommodating the recently
organized dental services in that unit.
During the year numerous discussions were engineered by the Director of the Central
Vancouver Island Health Unit in an endeavour to further the plans for construction of
a community health centre for the headquarters of that unit in Nanaimo. It was found
necessary to modify the original plans considerably to bring the estimated cost in line
with possible available funds. At the same time some thought has to be given to provision of suitable property by the City of Nanaimo, while the interest of some organization
to spark the necessary community fund-raising campaign must be sought. Continued
interest in the proposal has been evidenced, and efforts will be made locally to further
the negotiations toward completion.
Interest in similar projects is evidenced from Haney, New Westminster, Oliver, and
Vancouver, in which new space or enlarged space is very necessary. All have obtained
information concerning the grants available, the sole remaining hurdle being contingent
upon the provision of the local share of the financing under the grant formula.
In addition to these community-sponsored constructive efforts, in certain instances
where new Government buildings were under way, space has been provided for local
public health services. This occurred in new Court-houses at Chilliwack and Courtenay,
in which the headquarters of the Upper Fraser Valley Health Unit and the Upper Island
Health Unit, respectively, have become housed. Similarly, smaller Government buildings
at Terrace and Williams Lake provided sub-offices for the Skeena Health Unit and the
Cariboo Health Unit respectively. It would be preferable to have community health
centres to house the health departments wherever possible, but in these instances, where
an opportunity presented itself and the problem of accommodation was most severe, it.
was felt prudent to accept space within Provincial Government buildings. It is recognized, however, that this leads to a misinterpretation of the service as being a Provincial
Government service which is an entirely erroneous impression.
The most inadequate housing of the entire Province exists in the East Kootenay and
West Kootenay areas, where the three units—namely, the East Kootenay, Kootenay
Lake, and West Kootenay Health Units—operate from overcrowded offices, never properly planned for efficient administration. The need for new offices in each case is most
urgently recognized, but no community interest in construction of community health
centres is evidenced.
HOME-CARE PROGRAMMES
The pilot study into a home-care programme which was organized in Vernon under
an Advisory Committee with supervision by the North Okanagan Health Unit operated
for about a four-month period, from December, 1951, to March, 1952, according to
plan. During the period April 1st, 1952, to October, 1952, no patients were admitted
to this service, in consequence of the fact that records indicated no unprecedented demand
on hospital beds during those summer months. It was felt advisable to review the results
of the study before giving any consideration to further continuation of the programme. DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 29
Consequently, several separate approaches were made to assess the programme. Firstly,
Mrs. Pringle, Inspector with the British Columbia Hospital Insurance Service, made
a separate study of the service from the hospital point of view, while the Assistant Director
of Public Health Nursing, who had specialized in medical-care plans, made a study from
the public health point of view. Finally, the reports of these two separate investigations
were reviewed for discussion with the Advisory Board. It was fairly evident that the
programme had been a success within the limitations of its permissible operation, as outlined in the original proposals. It was felt that much of this resulted from the guiding
influence of the senior public health nurse in the North Okanagan Health Unit, who acted
as administrator of the Vernon Home Care Service.
During the initial four-month period forty-eight patients were admitted to this service
from the Vernon Jubilee Hospital, which, it is estimated, saved a total of 267 hospital-
days, as follows: 178 hospital-days saved by nursing service, 41 days by housekeeping
service, and 48 days by nursing and housekeeping service combined. The actual financial
saving, based upon a difference of the hospital home-care service at $4.22 per day and
the cost of a hospital bed at $11.35, indicates a total of $1,969.99 for the four-month
period.
It was felt that the service would be of more value to the hospital and the community
if the boundaries to which it was confined were extended, and if the period over which it
was possible to provide service could be lengthened beyond the designated fourteen days.
Acting upon these and other recommendations, the Advisory Committee modified the
plan to extend the scope of the service and decided to continue, as from October, 1952,
on a yearly basis, with a review to be undertaken periodically to determine whether it is
fulfilling a community need and overcoming a hospital problem.
This is the only test plan operating in the Province, since the proposals for two other
trial plans in New Westminster and Parksville did not materialize. It is deemed advisable
to carry on in the one area for a further extended period rather than duplicate similar
services elsewhere experimentally. Once the advantages and disadvantages of the present
programme can be determined, it may then be possible to extend the service to other
areas of the Province, contingent upon there being sufficient available nurses to permit it.
During the year three or four requests for the services of the Victorian Order of
Nurses were relayed to the Department, from such areas as Nanaimo, Duncan, Castlegar,
and Saanich. The merits of introducing this service were discussed with officials of the
Victorian Order of Nurses, during which it was pointed out that the advisability of establishing this service alongside the service of the official agencies is subject to some query.
It is questioned whether it is not an economic drain, apart from the administrative duplication, to provide for administrative offices and duplication of nursing visits, often in the
same direction and sometimes even to the same home, on the same day, when possibly
one nurse could have handled both calls on a single visit. It is therefore suggested that
an increase in the nursing strength of the official agency might feasibly handle this
problem on a less costly basis than the introduction of another separate service. The
decision, however, rests with the municipalities concerned, since the decision to bear the
major share of the financing of the additional service must be theirs.
RESIDENT PHYSICIANS' GRANTS
In collaboration with the Department of the Provincial Secretary, the Health Branch
supervises a programme of grants-in-aid to resident physicians, which is designed to
encourage physicians to take up residence in remote communities and to provide service
on a periodic schedule of visits to neighbouring communities which are not sufficiently
large enough in themselves to support a physician. Such a system of grants has been in
operation for a number of years, based upon a definite formula of grants on a sliding scale
on the basis of population and distances to be travelled.   At present, grants are being paid BB 30 BRITISH COLUMBIA
to some thirty-one physicians in thirty-one rural locations of the Province. During the
year the grants were subject to review, when the physicians were contacted to indicate if
any change in their status had occurred which would permit cessation of a grant. Thus,
if the volume of practice had increased, or if the physician was sufficiently busy to justify
the employment of an assistant or engagement of a partner, it was felt the grant was no
longer necessary.
During the year two new areas were brought into the plan, involving the communities
of Sayward and Sooke. It must be emphasized that any one grant is nominal in amount,
since it is not expected to provide for the full support of the physician; it is merely an
adjunct to assist the community, which assumes the major responsibility of attracting the
physician and paying for the services rendered.
SCHOOL HEALTH SERVICES
School health services are concerned with the medical and preventive health features
affecting the growth and development of a school-child. While attention is focused upon
the mental, emotional, physical, nutritional, and immunization status of the pupil, the
influence of the school environment is taken into consideration to ensure that such factors
as heating, lighting, ventilation, and sanitation conform to the requirements of healthful
living.
It must again be recorded that concentration toward ideal school health accomplishes
little unless similar healthful influences prevail throughout the community. In other
words, it is not possible to separate school health services as a distinct and definite entity
apart from community health services, since the school-child is a member of the community and influenced by conditions within the community. Thus the changing trends
in school health administration toward its transfer to Union Boards of Health seem
justifiable, since then the school health services become integrated with the community
health services, in which the same staff is handling, with continuity, the problems of the
individual from infancy to adulthood.
As in previous years, the physical examinations of school-children have revealed the
vast majority of them to be in good physical condition clinically, somewhat over 90 per
cent physically fit. In addition to the excellent physical status of the average British
Columbia school-child, the majority of the pupils, well over 75 per cent, are immunized
against such major communicable diseases as diphtheria and smallpox, maintaining their
immunity status throughout their school-life. A significantly smaller proportion of the
school population is immunized against scarlet fever, whooping-cough, and typhoid fever,
which is understandable as administration of these antigens is governed by the vagaries
of disease incidence, particularly since the immunity so conferred is somewhat less
permanent.
Other services falling into this category, such as preventive dental services, nutrition
services, sanitary-inspection services, and public health education services, have made
progress during the year. While they cannot be entirely separated, since one is to some
extent related to the other, a separate review of the essential components will be found
in the individual reports of the divisions dealing more specifically with those phases of
public health programme.
During the fall meeting of the Medical Health Officers a review of school health-
service programmes was undertaken. It was evident that there were modifications of the
service from unit to unit, and it was suggested that a study should be undertaken to determine whether these modifications would become policy acceptable to the Health Branch
generally. It was pointed out that any modifications should have the approval of the
Health Branch so that, in turn, the Department of Education can be kept advised on the
scope of the school health services being provided throughout the Province. Thus an
outline of the existing school health services in each unit has been requested so that the DEPARTMENT OF HEALTH AND WELFARE, 1952 BB 31
Health Branch may make a complete review of all existing services presently provided
and determine the recommended programme Provincially for the future. This is deemed
advisable, since it is agreed that all services should be reviewed periodically so that
progress may be recommended lest the service stagnate to a routine situation.
DISEASE MORBIDITY AND STATISTICS
The communicable-disease regulations, which were introduced in their revised form
in January, 1951, were brought up for review during the fall meeting of the Medical
Health Officers. After a full year of experience it was noted that there were one or two
minor changes necessary. It was proposed that a standing committee on communicable
diseases should be established to deal with periodic revision of the communicable-disease
regulations in order that they be consistent with the latest scientific knowledge and disease
experience.
A morbidity study or sickness survey, which was carried on from October, 1950,
through to October, 1951, in co-operation with the Department of National Health and
Welfare, has so far provided no results. At present the information which was garnered
across the nation is being correlated in Ottawa, and some preliminary information should
be released shortly. It is still felt that this would be of considerable significance in
guiding the recommendations for future medical and nursing-care programmes.
Results from the tests made on the practicability of caramel lozenges containing
diphtheria toxin as an effective method of reinforcing diphtheria immunization of schoolchildren and young adults have not yet been released. The method of oral immunization
held promise of distinct advantages over the present parenteral method, but the results
are dependent upon some long-term investigation, involving termination of immunization
titres in blood samples of test volunteers. The results of the study are still being assessed,
but some indication of the usefulness of the lozenges will be available shortly.
During 1952 the total recorded notifiable diseases in British Columbia were somewhat less than in the previous year, but comparable with the figures for other years,
indicating that 1951 was a somewhat exceptional year due to the marked incidence of
influenza. This is evident in the rate of 3,311.9 per 100,000 population for 1952, compared with the rate of 4,092.7 for 1951.
The incidence of influenza was a great deal lower, with a rate of 45.7 per 100,000
population for 1952, compared with the rate of 956.9 during 1951. In this connection,
mention should probably be made of the fact that some discussions are being held relative
to experimental studies on the value of influenza vaccine. A study was carried out in
Ottawa during the winter of 1952, but the incidence of influenza in Ottawa during the
period of study was too small to permit drawing any valid information. It is now proposed
that further studies be planned during the early months of 1953, during which season
influenza is usually anticipated. From the results of a series of studies across the nation in
the various Provinces, it is hoped to garner information concerning the possible value of
influenza vaccine as a preventive.
The most serious situation, in so far as the morbidity picture is concerned, was
occasioned in poliomyelitis, since British Columbia registered the highest incidence of
this disease ever recorded in the Province. A rate of 49.6 per 100,000 population for
1952 was almost twice as high as the previous high year in 1947, and considerably higher
than the normal annual average figures of 10.0 per 100,000 population. The incidence
was particularly high in midsummer in Kimberley, while in the early fall, when the
Kimberley incidence was decreasing, there was a high proportion of cases reported from
the Penticton area. Although these areas were especially heavy sources of cases during
1952, no area or section of the Province was altogether spared.
Poliomyelitis seems to engender a measure of community panic whenever it becomes
reported, in spite of assurance that it is fatal to proportionally few and that residual BB 32 BRITISH COLUMBIA
paralysis remains in only a small number. In this particular disease a considerable
measure of public health education is necessary to allay public fears and to acquaint
people with the true situation.
In the Kimberley area the epidemic seemed to be particularly virulent, as there was
a considerable incidence of bulbar cases. The local health services in that area, under
the direction of Dr. W. G. Watts, in co-operation with the hospital and medical profession,
were able to accomplish adequate supervision of the epidemic until late in August, when
additional nursing personnel were requested to relieve the hospital nurses who had been
putting in long overtime hours without rest. It was possible to fly in nurses from the
Boundary Health Unit and the Simon Fraser Health Unit, both of whom loaned public
nurses to the East Kootenay Health Unit to permit them to work in the Kimberley
Hospital to relieve that hospital staff. At the same time, Dr. A. J. Nelson, epidemiologist,
and Miss Fern Primeau traveled to the Kimberley area to confer with Dr. Watts and his
staff in an attempt to gain information on the epidemiology of that outbreak. It should
be mentioned that the control of poliomyelitis is very difficult from the point of view that
the epidemiology of the means of transmission has not been definitely established. In
Kimberley an epidemiological study was carried out to see if the distribution of the cases
bore any relation to water, milk, or sewage-disposal. The entire City of Kimberley is
furnished with water from one source, and investigation showed the water-supply was
not involved as examination of the water at Kimberley was consistently satisfactory. The
milk was supplied by two dairies, and a study of the milk situation did not show a predominance of cases in any one dairy. In so far as sewage-disposal was concerned, there
seemed to be no differentiation between areas served by sewage-disposal systems and
those relying upon septic tanks. The activities of the patients for the previous two weeks
indicated that every case was related in some way to the swimming-pool, and there were
a number of familial infections, some in families and some in neighbours. Normally such
a high degree of familial infection is not found in connection with poliomyelitis.
The physicians in the area indicated that the last real epidemic of poliomyelitis in
that area was in 1928, and it had always been considered a polio-free area. As the area
was apparently so free, thus an accumulation of susceptibles had apparently been built
up, and it was felt that the daily congregation at the swimming-pool had led to a rapid
dissemination of infection among these many susceptibles.
Specimens were taken of excretory and blood samples for investigation by the
Laboratory of Hygiene in Ottawa, and subsequently some Coxsackie virus was isolated
from at least one specimen. This further complicates the picture, since Coxsackie virus
is the creator of symptoms similar to poliomyelitis, but is less serious. There is always
some question as to whether this may not be present separately or coincidental with the
poliomyelitis epidemic. Unfortunately, it is not easy to differentiate between the two
clinically, and a definite diagnosis often can only be established after drawn-out laboratory
investigations are completed and the epidemic is reviewed in retrospect.
The situation in Kimberley began to abate during September, with only the odd
sporadic case remaining, but there was an immediate upswing in incidence in the Penticton area, wherein occurred an unduly heavy load of serious paralytic cases. Here
again the staff of the South Okanagan Health Unit, under the direction of the Medical
Health Officer, Dr. Donald M. Black, co-operated with the hospital and medical authorities to exercise such control measures as were possible. The hospital staff is to be
commended for the long hours of overtime performed in carrying out an abnormally
heavy load of duties, while the public health nurses likewise investigated contacts and
suspected cases around the clock while introducing quarantine and isolation measures in
the protection of the public generally. Subsequently, in Penticton, where a heavy fly
nuisance was evident, spraying of the community, with particular attention to garbage-
receptacles and garbage-dumps, was carried out.    Whether this had any effect on the DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 33
epidemic is conjectural, but it was a fortunate coincidence that with the abatement of fly
population, the incidence of poliomyelitis exhibited a parallelism.
The incidence in the Squamish area also became evident late in the year, where,
although there was an unduly heavy number of cases, the number exhibiting paralysis was
few, and the disease was much milder than in the two other areas. There was a considerable degree of community unrest in this instance, particularly as school-children from
neighbouring industrial communities were transported into Squamish for high-school
education. There was much conjecture as to whether schools should not be closed as
a control measure to prevent spread to these other communities. Subsequently, Dr. A. J.
Nelson, epidemiologist, visited Squamish to meet the Medical Health Officer, Dr. L. C.
Kindree, and the public health nurse, Miss L. Crane, to review the epidemiology of the
epidemic and to interview community groups in an endeavour to allay their fears. As the
disease in Squamish was so mild, there is some query as to whether this may not have
been actually a Coxsackie-virus epidemic rather than a poliomyelitis epidemic, and certain
specimens were being investigated along those lines.
The various local health services are to be complimented on the manner in which
they have handled the heavy loads of additional work placed upon their shoulders during
the poliomyelitis season, particularly the public health nurses, who put in so much overtime
without respite. At the same time the Health Branch is desirous that the valiant assistance
of the Royal Canadian Air Force be recorded, particularly the officers in charge of the
Air-Sea Rescue Squadron operations, Squadron Leader John Young and Air Commodore
Gordon. These officials were extremely co-operative in answering any request and provided emergency air transportation, without restriction, placing personnel and aircraft,
staffed with a medical officer, whenever an emergency flight was required to evacuate
poliomyelitis patients from isolated parts of the Province to hospitals, where facilities and
medical personnel were available for more complete treatment. Many of these flights
were undertaken in night hours under storm conditions, and no such service could have
been obtained from any other source. The Department is indebted to the Department of
National Defence for this co-operation, and particularly the individuals above mentioned.
In Vancouver a poliomyelitis committee, composed of medical specialists and public
health administrators, was set up to recommend a treatment follow-up of these cases
brought in to Vancouver, or diagnosed in Vancouver, and hospitalized there. The experience gained by that committee and by public health officials is now being studied, and it
is planned that meetings of the two groups will be organized to pattern control measures
and recommended treatment for future years. At the same time it is hoped that some
planned details can be pre-arranged relative to transportation of patients, cases requiring
treatment in respirators, and so forth. In the interim all respirators are to be completely
overhauled for use, if required in future.
The bulk of the reportable diseases is composed of the minor communicable infections so common in childhood. There has been recorded the same proportion of chicken-
pox, measles, mumps, and rubella as in previous years. Their aggregate total accounts
for practically two-thirds of the number of notifiable-disease cases reported.
During 1952 streptococcal infections exhibited a fairly high incidence comparable
with the high incidence recorded in previous years (a rate of 347.5 for 1952, as compared
with 359.6 for 1951). This incidence has been observed with some interest, as it is
evident that it has been of extremely mild nature, with extremely few complications and
little, if any, secondary familial spread. The incidence has been marked on the Coast
and in the Kootenays, but occurred to a degree generally throughout the Province.
A downward trend in the number of cases of whooping-cough noted last year has
been continued (81.5 per 100,000 population in 1952, as compared to 98.4 per 100,000
population in 1951). This, while a gratifying result, still indicates an undue prevalence
of this infection and emphasizes the need for continued endeavours to provide early and
repeated immunization as a preventive. BB 34 BRITISH COLUMBIA
In respect to salmonellosis, the same incidence of paratyphoid fever was recorded
(0.7 per 100,000 population, as compared to 0.6 per 100,000 population in 1951), but
typhoid fever almost doubled (2.5 per 100,000 population, as compared to 1.06 per
100,000 population in 1951). These cases have been recorded, in the most part, amongst
Indians, particularly in the Prince Rupert area and in the Alert Bay area, which is not
surprising when one realizes that the level of sanitation and personal hygiene amongst
this population is so primitive. It is felt that immunization against the enteric infections
should be commenced on a wide scale amongst Indians, while every endeavour should be
made to improve their household and community sanitary environment, if adequate
control is to be complete. There is inherent danger always as long as they act as a reservoir of infection, with sporadic spread to other citizens to be anticipated from time to time.
For the first time in many years the actual clinical reporting of salmonellosis-shigellosis infections parallels the laboratory reports; thus it seems evident that the measures
adopted jointly by the Division of Laboratories and the Division of Health Units are
finally yielding results in correlating the laboratory reports and the notification of clinical
cases. This is most desirable if an epidemiological follow-up is to be of future value.
In some respects this result probably stems from the development of adequate full-time
health services throughout the whole Province and is a corroboration of the fact that full-
time health units promote more thorough health measures toward protection of the health
of the people of British Columbia.
Epidemic hepatitis (jaundice) displayed a somewhat higher incidence, with a rate
of 17.7 per 100,000 population in 1952, as compared with a rate of 7.8 per 100,000
population in 1951, and a rate of 4.0 during 1950.
While no cases of botulism were reported during the year, apparently one fatality,
almost certainly due to botulism, should be mentioned. This occurred late in September
in a male resident of a small community near Fernie, whose hospitalization and treatment
was provided in a neighbouring Province. A detailed report of this case will be found
in the report of the Division of Laboratories, outlining the source of the infection, and the
results again incriminating home-canning measures.
While two cases of malaria were recorded during the year, these were not infections
arising in British Columbia, but were reported as developing in individuals recently
returning from tropical residence. It seems apparent that they obtained their initial
infection outside the country, but symptoms did not occur until they had returned to
British Columbia, resulting in their being reported as new cases.
The number of cases of cancer reported increased again (with a rate of 281.0 in
1952, compared with 247.2 in 1951, and 274.6 per 100,000 population in 1950). The
disease has increased slightly over the past two years but is still somewhat lower than the
rate of 315.0 in 1949.
Comments on the venereal-disease and tuberculosis incidence will be found in the
reports of these separate divisions.
Two cases of tetanus were recorded, indicating again that opportunity for this infection prevails throughout the Province, and that traumatic injuries may have this serious
complication. One of these cases, in the person of a farmer on Vancouver Island, required
considerable quantities of tetanus antitoxin to overcome his infection, a considerably costly
therapeusis as compared with the few cents involved in immunization. Fortunately, with
the triple antigens now being used, more and more of British Columbia's citizens are
being immunized against the possibilities of tetanus infection.
The table showing the rates for the various notifiable-disease incidence for the past
four years, for comparison, are shown in Table I, page 36, while a complete list of the
notifiable diseases as reported from the various health-unit areas of the Province, by
Medical Health Officers, is recorded in Table II, page 37. DEPARTMENT OF HEALTH AND WELFARE,  1952
BB 35
Finally, in line with morbidity, mention should probably be made of the study which
has been going on this year into the question of " swimmer's itch." Under National health
grants a project was arranged in 1951 which has been carried on during 1952, permitting
a team from the Department of Zoology, University of British Columbia, to investigate
the cause and possible prevention of " swimmer's itch," which has been reported as
prevalent in Cultus and Okanagan Lakes particularly.
This condition of " swimmer's itch " is caused by a parasite which lives part of its
life-cycle in snails and is found in the lake-waters during the summer months. As the
swimmer emerges from the water and the skin becomes dry, the small larva, of the
parasite penetrate beneath the skin-surface, causing an initial sharp prickling sensation,
the intensity varying according to the number of larva, or cercaria. present. Later small
red macules appear when each parasite had penetrated the skin. These macules usually
develop into papules. Subsequently, these disappear and the condition clears up. However, re-exposure to the waters will recreate the same symptomology once again.
Specifically, the investigation has been conducted into searching for the cercaria. in
specimens of the waters, study of the snails, and recommendations as to possible control
measures. It seems apparent that if the swimmers dry their bodies entirely with towels
upon emergence from the water, there would be less evidence of the condition. In order
to control the parasite cercaria., however, application of chemicals to the waters is evidently necessary, possibly copper sulphate. However, this may create undue problems
for fish reproduction, and therefore, such control measures must be carefully investigated
in order to gauge the dosage which might prevent the incidence of " swimmer's itch "
while, at the same time, allowing the fish to reproduce normally. BB 36
BRITISH COLUMBIA
Table I.—Incidence of Notifiable Diseases in British Columbia
(Including Indians)
1949
1950
1951
1952
Notifiable Disease
Number
Rate per
Number
Rate per
Number
Rate per
Number
Rate per
of
100,000
of
100,000
of
100,000
of
100,000
Cases
Population
Cases
Population
Cases
Population
Cases
Population
1
0.1
1
0.1
1
0.1
Brucellosis (undulant fever)	
16
1.4
22
1.9
18
1.6
12
1.0
3,509
315.0
3,125
274.6
2,850
247.2
3,366
2S1.0
7,370
661.6
5,001
439.5
6,671
578.5
6,266
523.0
Conjunctivitis.-    .
287
25.8
280
24.6
374
32.4
346
28.9
Diphtheria	
12
1.1
63
5.5
5
0.4
11
0.9
Dysentery—
1
0.1
1
0.1
Bacillary (shigellosis)    .
23
2.1
189
16.6
253
21.9
102
8.5
1
0.1
1
0.1
2
0.2
10
1.0
46
4.0
90
7.8
212
17.7
Influenza, epidemic. .  	
47
4.2
460
40.4
11,033
956.9
548
45.7
1
0.1
2
0.2
1
0.1
2
0.2
10,765
966.3
5,648
496.3
6,269
543.7
8,227
686.7
18
1.6
15
1.3
30
2.6
33
2.8
4,314
387.3
8,634
758.7
5,835
506.1
7,088
591.7
Pertussis.   	
214
19.2
1,740
152.9
1,134
98.4
976
81.5
225
20.2
73
6.4
92
8.0
594
49.6
Rubella 	
567
50.9
7,935
697.3
2,288
198.4
1,986
165.8
Salmonellosis—
17
1.5
11
1.0
18
1.6
30
2.5
1
0.1
35
3.1
7
0.6
8
0.7
Other....   	
95
8.5
152
13.4
149
12.9
109
9.1
Streptococcal infections—
32
2.9
36
3.2
38
3.3
26
2.2
102
491
9.2
44.1
183
871
16.1
76.5
300
4,146
26.0
359.6
536
4,163
44.7
347.5
Scarlet fever-	
1
0.1
1
0.1
Tetanus
3
0.3
1
0.1
2
0.2
2
0.2
Trachoma    	
9
0.8
5
0.4
8
0.7
3
0.3
4
2,202
0.4
197.7
160.6
1,828
1,662
144.1
1,411
117.8
Venereal disease—
3,833
344.1
3,579
314.5
3,301
286.3
3,057
255.2
Syphilis (including non-spe
cific urethritis—venereal).
859
77.1
630
55.4
568
49.3
541
45.2
3
0.3
6
0.5
48
4.2
19
1.6
Totals	
35,036
3,145.1
40,572
3,565.2
47,189
4,092.7
39,677
3,311.9 DEPARTMENT OF HEALTH AND WELFARE,  1952
BB 37
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H BB 38 BRITISH COLUMBIA
REPORT OF THE DIVISION OF PUBLIC HEALTH NURSING
Monica M. Frith, Director
The Public Health Nursing service continued its steady development through the year
1952. This service is available to 98 per cent of the population of British Columbia, in
spite of the fact that no new districts were organized this year. The remaining 2 per cent
of the population not receiving direct service is scattered along the coast of the Province
and in very rural Interior points.
PRESENT STATUS OF SERVICE
To maintain the standard of service, it was necessary to add Public Health Nursing
personnel at six centres in order to give more adequate coverage and to keep pace with
the rapid growth in population. In 1949 the ratio of public health nurse to population
was one public health nurse to 4,000 people. In spite of increased numbers of public
health nurses on the staff, the ratio of public health nurse to population is now 1:5,000.
It was recommended by Haven Emerson, in his book " Health Units for the Nation," and
by the National Organization for Public Health Nursing that a public health nurse serve
not more than 5,000 people where a generalized public health programme is carried. If
the public health nurse is to give health guidance and bedside care, it is recommended
that the ratio be one nurse to 2,000 people. Because of the scattered population in rural
British Columbia, which necessitates a considerable amount of travelling, and because
the generalized public health nursing programme includes some nursing care, the former
ratio of one nurse to 4,000 population should again be attained if a good quality of service
is to be maintained.
The six centres where public health nurses were added are as follows: Nelson, where
a senior nurse was appointed for the first time; Boundary Health Unit, where two nurses
were added, one at Langley and the other at Cloverdale; Central Vancouver Island Health
Unit at Nanaimo; Upper Fraser Valley Health Unit at Chilliwack; and the West Kootenay
Health Unit at Trail. These appointments were made possible with funds obtained from
National health grants. The Federal Government, through the Department of National
Defence, this year appointed a qualified public health nurse, who had formerly been on
the Provincial staff, to serve in the area formerly carried by the staff of the Saanich and
South Vancouver Island Health Unit. It is hoped that additional nursing personnel can
be added next year to the following: Central Vancouver Island Health Unit, at Duncan
and Port Alberni; South Okanagan Health Unit, in the Penticton-Oliver area; North
Fraser Valley Health Unit, at Haney; and Upper Island Health Unit, at Courtenay. The
McBride public health nursing service will be opened as soon as a qualified public health
nurse is available for appointment.
Since the inauguration of the National health grants in 1948, twenty-three areas have
benefited from financial assistance, which enabled the organization of new public health
nursing districts or the addition to the numerical strength of the Public Health Nursing
personnel in districts where services had already been established.
During the year thirty-eight appointments were made to the Public Health Nursing
staff. Of this group, seven were married public health nurses who were able to accept
positions in their own communities; seven nurses returned to the staff following completion of the public health nursing training at university; seven were public health nurses
recruited for placement; while the remaining fifteen were registered nurses without public
health nursing training.
There were thirty-one resignations, including nine members of the staff who
undertook to take public health nursing training at university. Six registered nurses
resigned and did not go on for further training.   Ten public health nurses resigned for DEPARTMENT OF HEALTH AND WELFARE,  1952
BB 39
marriage and family reasons, four left to take positions outside the Province, while one
public health nurse transferred to the Division of Venereal Disease Control, and one
joined the public health nursing staff of the Department of National Defence in British
Columbia.
Fourteen public health nurses transferred within the service. Three senior-nurse
positions were involved. Table I shows a comparison of the staff situation over the last
ten-year period. It is interesting to note that the percentage of staff turnover is 12 per cent
lower than last year and 8 per cent lower than the ten-year average.
Table I.—Comparison of Provincial Public Health Nursing Staff Changes
DURING THE PERIOD 1943-52
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
52
37
71
17
12
8
56
33
59
13
11
9
64
48
75
22
16
10
77
88
117
42
27
19
98
65
65
37
11
17
111
52
46
24
14
14
115
94
82
41
28
25
121
81
67
332
313
174
123
98
76
45
36
171
129
Total staff changes1 	
Staff turnover (per cent)-
83
64
38
Resignations	
Transfers   	
31
14
1 Includes appointments, resignations, and transfers.
2 Returning from university included.
3 Leaving for university included.
1 Exchanges included.
The trend toward stability of the Public Health Nursing staff has certain advantages
in providing continuity of public health nursing service. However, it is interesting to
note that 24 per cent of the public health nurses have married status, and are unable to
transfer to other positions because of family responsibilities. These nurses tend to live
in the larger population centres, and thus it becomes necessary to place the single public
health nurses, who frequently have less experience, in the single-nurse districts. It is
pointed out that the percentage of nurses without public health certificates on the staff
dropped from 14 per cent in 1951 to 10 per cent in 1952. This is probably due to the
larger number of married nurses who are qualified as public health nurses and who have
returned to the service.
PUBLIC HEALTH NURSING TRAINING
National health grants have proved to be of great assistance in providing an
opportunity for training suitable nurses for the public health nursing field. Each year
a limited number of nurses without formal preparation in public health nursing are being
taken on the staff, placed in districts under close supervision, and given the opportunity
of gaining some experience in the public health nursing field before taking the required
course at university. During the past four years twenty-eight nurses completed university
courses in public health nursing and became fully qualified members of the staff, with the
help of bursaries made available through National health grants. Twenty-one per cent
of the present qualified staff public health nurses received their public health nursing
training in this manner.
During 1952 nine nurses, who had been on the staff, enrolled in the basic university
public health nursing course, with assistance from National health grants. The freedom
of choice of a Canadian university giving a recognized programme in public health nursing
tends to assist recruitment to the public health nursing service in this Province. This year,
candidates are at the University of British Columbia, McGill University, and Dalhousie
University. Seven qualified public health nurses returned to the staff following completion
of the public health nursing course. Since these nurses have had a period of employment
on the staff prior to their university course, they complete their public health training BB 40 BRITISH COLUMBIA
better equipped to fill public health nursing positions than the nurse without previous
public health nursing experience. Thus it has been possible to place these nurses in areas
where a greater degree of independent judgment is required of the nurse.
In order to improve and maintain the quality of service provided by public health
nurses, it is necessary to have well-trained senior and supervisory nurses. Through the
help of National health-grant money it was possible for one of the senior nurses, Miss
Janet Pallister, to enrol in the course in public health nursing supervision at McGill
University.
The heavy programme of in-service training for nurses without public health qualifications has continued this year, as 40 per cent of the new staff do not have all the
necessary preparation for the public health work. A planned orientation programme is
provided for these nurses similar to the field-work experience given to nursing students
from the University. This orientation programme usually is given in the district where
the nurse is appointed for service. However, the required training period throws an
additional burden on the senior public health nurse, who must assume responsibility for
training and supervising so that a minimum service to the community can be provided.
Field-work facilities were provided for twenty-one public health nursing students
from the University of British Columbia in January and May. During the year a student
from the public health nursing supervision course at McGill University was given a
month's experience on an advanced level in the South Okanagan Health Unit.
Observation periods have again been provided by the local Public Health Nursing
staff for undergraduate nurses from St. Joseph's Hospital in Victoria, the Royal Inland
Hospital at Kamloops, and the Royal Columbian Hospital at New Westminster. It is
hoped that this introduction to public health nursing will encourage more nurses to enter
this special branch of nursing.
In-service education is being carried on continuously in each local area. This year
the study groups were reorganized in certain areas in order to make the boundaries
coincide with those of the health unit. Study groups select topics which will assist them
in carrying out the public health programme. For example, a group may study the
physiology and hygiene of pregnancy before initiating a series of mothers' classes in
a district which was not given this service before. The study groups also provide an
opportunity for the nursing staff to make their wishes known through their official organization, the Public Health Nursing Council, which meets annually at the Institute.
Once again at the annual Institute a full day's programme was devoted to public
health nursing. This provided an excellent opportunity for members of the staff to
present papers on pertinent subjects related to public health nursing. The panel on public
health nursing supervision was excellent, as well as the papers on new trends in maternal
care, the family of the tuberculosis patient, and vision-testing. The Public Health Nursing
group look forward to more opportunities for group meetings of this type.
RECORDS COMMITTEE
As the result of recommendations, made by both study groups and individual members of the staff, regarding revisions of various record forms and the use of records, a
Provincial Records Committee was set up, advisory to the Local Health Services Council.
The Committee's function is to study and make recommendations regarding the record
system and the use of the individual forms, with a view to reducing to a minimum the
amount of clerical and professional time required to achieve the maximum service. The
Committee consists of Public Health Nursing personnel from Central Office, senior nurses
from the Fraser Valley, and the Director of the Division of Vital Statistics. To date the
Committee has accomplished a great deal of valuable work in revising records and
reorganizing procedures. DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 41
PUBLIC HEALTH NURSING CONSULTANT SERVICE
Public Health Nursing Consultant service is available to local health services to
assist with the development of the generalized health programme. However, the activities
of the Public Health Nursing Consultant have undergone considerable change as health
units developed throughout the Province and as less time was required for the organization of new districts and the direct supervision of nursing staff. As senior and supervisory nurses became available locally, the responsibility for the supervision of the nursing
staff was transferred to a local level.
During the year the work of the Public Health Nursing Consultant has been clarified
in relation to the present type of service. Consultant public health nurses have had
special preparation in public health nursing by reason of well-rounded experience and
university preparation in a special field of public health nursing. To facilitate the use of
the Public Health Nursing Consultant service, the Province has been divided into four
regions, with one Consultant responsible for service in the generalized programme in each
region. Specialized help is available for mental hygiene, maternal and child care, and
public health economics.
Considerable progress has been made during the year in the field of mental hygiene,
with the assistance of the Consultant in Mental Hygiene. A policy was established concerning the relationships of the Child Guidance Clinic and the Public Health service. The
position of the Public Health staff in relation to the Social Welfare Branch workers in
dealing with local situations and referrals to the clinic has been set forth. This year there
has been an increased use of clinic facilities as well as an improvement shown by the public
health staff in screening and follow-up of cases.
As the maternal and child health programme embraces the total field of child care,
beginning with the expectant mother, the Consultant in this specialty is in a position to
offer assistance to local services to help them evaluate the various activities being carried
out in this field of work. She guides the development of new services within the framework of the generalized public health service. During the year a number of districts
commenced " parentcraft classes " for the first time. The Consultant assisted with the
preparation of technical material for mothers' classes, child health conferences, and
home-visits.
The Assistant Director of Public Health Nursing has specialized in the field of public
health economics. She is particularly interested in the nursing aspects of medical-care
programmes. She was able to render valuable assistance in analysing the home-care
pilot study in operation in the North Okanagan Health Unit at Vernon. Recommendations were made to increase the effectiveness of this plan in order to meet the needs of
the community more adequately.
Special assistance is available to the Public Health Nursing staff in the field of tuberculosis through the Public Health Nursing Co-ordinator assigned to the Division of Tuberculosis Control, Vancouver. On request, through the Bureau of Local Health Services,
arrangements may be made for a field-visit.
Through the senior epidemiology worker at the Division of Venereal Disease Control,
assistance is available to the Bureau of Local Health Services to guide the field staff in
the development of the public health nursing aspects of the venereal-disease programme.
LOCAL PUBLIC HEALTH NURSING SERVICE
Because the scope of the public health nurse is not always understood, the following
highlights may give some appreciation of the work of the public health nurse in the district.
An average public health nurse on the Provincial field staff in British Columbia serves
a population of about 5,000 people. Generally, she lives in a rural area in the largest
population centre in her district and may travel within a radius of 20 to 90 miles to serve BB 42 BRITISH COLUMBIA
the people in the surrounding area. Although the public health nurse usually drives to
the various centres in her district, she sometimes finds it necessary to use other methods
of transportation, such as train, chartered aeroplane or boat. This is necessary if she is
to serve Interior points and scattered isolated communities on small islands and along the
Coast.
The public health nurse supervises the health of about 1,000 school-children. They
usually attend two large schools and eight or ten one- or two-room schools, which the
public health nurse visits on a regular schedule. She inspects those children not seen by
the doctor and visits in the children's homes to explain physical or behaviour difficulties
to the parents. She assists the parents to obtain the care needed for the child. For
example, following preliminary tests at school, there may be indications that the child
needs further eye examination. If the parents are unable to pay for this examination and
glasses, the public health nurse has the case referred to an agency which will arrange for
the necessary treatment and correction. At the school the public health nurse advises on
lunch programmes and assists the teacher with her classroom instruction by providing
her with the latest scientific health information and frequently with teaching aids, such
as films, posters, and pamphlets. She watches over the environment and general sanitation of the school. She is for ever watchful of the development of communicable diseases
and skin infections. She arranges for chest X-ray and immunization clinics as indicated.
The teacher is given assistance with first-aid procedures. During the year 68,143 school
pupils were examined by the public health nurses, while assistance was rendered to School
Health Inspectors with 31,060 medical examinations. A total of 47,371 conferences
was held with teachers, 43,824 with pupils, and 9,382 with parents. In all, 34,462
visits were made to homes by public health nurses, to interpret to parents health matters
pertaining to the school-child.
Each public health nurse supervises about fifty persons with tuberculosis, their
families and contacts, and regularly arranges for chest X-rays for them with the travelling
clinic. Depending upon local facilities, arrangements are made for chest X-ray surveys,
using the miniature X-ray units in local hospitals or the Mobile Chest X-ray Survey Unit.
A total of 18,595 visits for supervision of tuberculosis cases and contacts was made.
The public health nurse organizes and attends about five child health conferences
per month. During the year, child health conferences were used to the advantage of
42,383 infants and 32,537 pre-school children. In addition, home-visits for infant supervision is an extensive part of the programme, particularly in those areas where a scattered
population makes clinics impractical. A total of 31,256 infant-visits and 31,099 preschool visits were made to homes for general health supervision.
Health supervision is offered the expectant mother through home-visits and at
organized classes in which the mother is given the opportunity of learning to prepare
herself and her family for the new arrival. A total of 12,221 visits was made to expectant
mothers, while 12,150 visits were made to the mother in the home within six weeks of
the birth of the baby.   Pre-natal clinics or classes showed an attendance of 895.
The public health nurse further assists in the communicable-disease control programme by organizing and operating immunization clinics at strategic areas throughout
her district. There were 8,734 persons completing the series of injections for protection
against whooping-cough, 12,593 for diphtheria, 11,942 for tetanus, 1,472 for typhoid,
and 25,162 were vaccinated against smallpox, while 398 were given B.C.G. vaccination
against tuberculosis.   In all, a total of 107,796 inoculations was given.
Sanitation, particularly in the home, diet, and general health practices are stressed
by the public health nurses in dealing with adults. The public health nurses made 24,771
visits to adults.
A modified home nursing-care programme is carried in most districts as the public
health nursing service is the only community nursing service in rural areas.   The public DEPARTMENT OF HEALTH AND WELFARE,  1952
BB 43
health nurse renders nursing care in the home in an emergency and teaches someone in
the home to carry out routine care under her supervision. Demonstrations of nursing-care
procedures, the baby-baths, and preparation of the formula are part of the programme, as
well as short-term treatments and hypodermic injections. Kelowna, in the South Okanagan Health Unit, continues to carry a full bedside nursing programme, while at Vernon,
in the North Okanagan Health Unit, a pilot study on home care offers a full bedside
nursing service in a selected area. One nurse works half-time to assist in carrying out the
nursing-care programme in the Saanich and South Vancouver Island Health Unit.
Home-visiting is an important part of the service, as indicated by the 88,824 homes
which were visited by the public health nurse during the year.
The activities of public health nursing have expanded as more facilities for diagnosis
and treatment become available on the local level. There has been increased activity as
the result of cancer clinics, children's or.hopa.dic travelling clinics, child guidance clinics,
and arthritis programmes. Therefore, it becomes necessary to modify the programme to
meet the changing needs in local areas.
SERVICE ANALYSIS
In a constant effort to improve the quality of the public health nursing service so
that it is rendered in the most efficient and economical manner, a critical analysis of the
service should be made by statistical methods. This year the Public Health Nursing staff
again submitted studies showing the time spent on the various activities as well as details
of their case-loads for analysis. In this way it is possible to determine how much time
is being devoted to certain services and make changes to provide a more efficient service.
As a result of study of the case-loads of the various public health nurses, recommendations
were made for additional personnel or for rearrangement of service loads.
Time studies submitted by 113 nurses in May, 1952, were analysed and compared
with the results of similar studies during the past four years. Table II shows the percentage of time spent on various activities as demonstrated by time studies during the
four-year period 1949-52, while Table III sets forth in detail the percentage of time spent
on home-visits and office activities.
Table II. — Comparison of Time Spent by Public Health Nurses in Specified
Activities as Indicated by Time Studies in 1949, 1950, 1951, and 1952
Activity
Nov., 1949
May, 1950
May, 1951
May, 1952
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
20.11
23.3
6.1
17.4
6.1
3.1
6.4
100.0
18.1
8 3
20.4
Office, total   -	
22.0
6.4
17.6
Meetings.  — —	
3.7
3.52
7.4
1 This includes 2.3 per cent spent on sickness survey.
2 This includes 0.5 per cent spent on health classes. BB 44
BRITISH COLUMBIA
Table III.—Breakdown of Amount of Time Spent in Home-visits and Office by
Percentage of Total Time on Duty as Shown in Time Studies in 1949, 1950,
1951, and 1952.
Activity
1949
1950
1951
1952
Home-visits—
0.5
3.2
1.0
3.0
3.1
1.9
1.7
0.3
2.4
0.5
3.4
1.1
3.0
4.2
1.9
1.7
0.2
1.3
0.5
3.7
1.4
3.0
4.2
1.7
2.0
0.2
3.4
0.6
4.8
Postnatal
1.6
3.2
4.3
Nursing care	
2.2
2.0
0.2
Other                      	
1.5
Totals   	
17.1
O)
C1)
O)
17.3
C1)
C1)
20.1
5.4
2.1
7.4
20.4
Office—
Clerical-professional—
6.0
2.3
7.7
Totals	
15.1
4.8
8.6
13.5
5.8
5.1
14.9
3.3
5.1
16.0
3.4
2.6
Totals
28.5
24.4
23.3
22.0
1 Data not available for these years.
The percentage of time spent in schools has increased appreciably over last year,
while the percentage of time spent at child health conferences is continuing the gradual
upward trend. The percentage of time spent on home-visits has increased, particularly
when it is realized that 2 per cent of the figure 20.1 per cent shown in 1951 was devoted
to sickness-survey visits, leaving 17.3 per cent on home-visits in connection with the
public health programme.   It is hoped that this favourable trend will continue.
It is noted that the amount of nursing care in the home has been gradually increasing,
as shown in Table III. However, since the time studies were completed in May, 1952,
the streptomycin programme has been assumed by the public health nurses. This entails
two injections per week to be given to certain tuberculosis patients living at home, over an
eight- to twelve-month period. This has increased the volume of nursing care considerably and has added a heavy load to the public health nurses, who are now giving an
average of 7.4 per cent of their time in excess of the regular working-day.
CIVIL DEFENCE
Miss M. Campbell, Assistant Director, Public Health Nursing, continued to serve on
the Advisory Committee on Civil Defence Nursing of the Registered Nurses' Association
of British Columbia. She attended the Western Civil Defence Health Services' Regional
Conference at Regina in May and reported on the activities of nurses in civil defence in
this Province.
In December, 1951, an apportunity was offered to a limited number of registered
nurses to attend an instructors' course in the Nursing Aspects of A.B.C. Warfare. Among
the group taking the course were eleven members of the Public Health Nursing staff.
These nurses subsequently taught the course to approximately 500 graduate nurses in
their own districts.
GENERAL
Public Health Nursing personnel from the Central Office have continued to act on
a number of Provincial committees. These include Red Cross Nursing, the Junior Red
Cross Crippled and Handicapped Fund, Sub-committee of the Nursing Curriculum, DEPARTMENT OF HEALTH AND WELFARE,  1952
BB 45
Public Health Nursing, Labour Relations, and Educational Policy Committees of the
Registered Nurses' Association of British Columbia, and the Advisory Committee to the
University of British Columbia School of Nursing.
Visitors included Miss Mona Wilson, Director, Public Health Nurses, from Prince
Edward Island, and Miss M. Bathgate, Public Health Nursing Officer of the Ministry of
Health, London, England.
The year 1952 has seen the public health nursing programme expand and develop
in a continuous effort to keep pace with current problems. In the future it is hoped that
more time will be available to assist with the growing volume of work in cancer-control,
geriatrics, arthritis, alcoholism, and drug addiction. Tribute should be paid to the public
health nurses, who, in accepting the challenge of public health nursing have adapted themselves to changing conditions and carried out their duties in spite of many difficulties. BB 46 BRITISH COLUMBIA
REPORT OF THE DIVISION OF ENVIRONMENTAL
MANAGEMENT
Thomas H. Patterson, Director
This Division, recently formed within the Bureau of Local Health Services, is making
a report for the first time in the Annual Report of the Health Branch. It is therefore felt
that although the formation of the Division was announced in the 1951 Report, a further
word of explanation of its scope should be included in this Report.
In 1948 a survey of the health services and facilities in British Columbia was carried
out, and in the report of this survey it was recommended that an additional division be
formed which would encompass not only several new services, but some of the established
services as well.
Originally it was the intention of the Health Branch to form a Division of Industrial
Hygiene to meet the growing need for a service that could deal with the many health
problems related to the occupations of people in the Province. However, as the time
approached when the Health Branch found itself in a position to establish this service, the
concept of industrial hygiene was changing.
The trend was away from concentration on the problems of the worker in solely the
place of his employment. Specialists in the field of industrial hygiene were recognizing
the fact that it was not enough to deal with the individual adult at work, to the exclusion
of all his other activities and interests. All the factors of his total environment at work,
at home, and at play were equally important and needed to be taken into consideration.
To continue dealing with these factors in an unrelated and separate manner was to follow
the dangerous practice of over-specialization.
Recognizing this trend, the Health Branch took steps to form a division which would
have responsibilities across the whole scope of adult health, dealing with nutrition, sanitation, occupational health, chronic care, rehabilitation, public safety, problems of addiction,
and the development of civil-defence health services. In order to avoid the impression
that industrial hygiene alone would come within the division, the name of " Environmental
Management" was adopted.
Prior to the formation of this new Division, two services were operating independently
within the Bureau of Local Health Services. These services were those offered by the
Nutrition Consultants, Miss D. Noble and Miss L. Gadbois, and by the Chief Sanitary
Inspector, Mr. C. R. Stonehouse, and have now been included as sections of the Division
of Environmental Management. They, therefore, are under the immediate direction of
a trained and experienced public health physician. The inclusion of these services in one
division will serve to integrate or co-ordinate them to a greater degree.
The Nutrition Consultants, of which there are two, are responsible for providing
consultant service to public health personnel throughout the Province on all matters of
nutrition as it relates to the public health programme. This includes the provision
of technical information and recommendations as to methods of nutrition education and
direct assistance with local studies or projects. The Consultants also offer to evaluate
the local problems and findings which result from studies carried on in local nutrition
programmes.
The Nutrition Consultants also provide a consultative service, at the request of
hospital administrators and directors of other institutions, on all phases of institutional
food service related to the technical problems of nutrition and quantity food-handling.
The Consultants maintain contact with other Government departments and voluntary
agencies whose programmes are related to the field of nutrition education. This assists
the Consultants to keep informed regarding new developments in this particular field.
The sanitation programme provides the consultative service of the Chief Sanitary
Inspector and deals with all matters related to environmental sanitation. DEPARTMENT OF HEALTH AND WELFARE, 1952
BB 47
The field of sanitation is very broad, and new problems arise daily for the members
of the field staff who are the Sanitary Inspectors in the health units throughout the
Province. The Chief Sanitary Inspector deals with requests for advice on all sanitation
matters. The questions which the Sanitary Inspector may receive concern sanitation of
milk production, dairies and farms, or the handling and distribution of milk in restaurants
and private homes, the safety of public and private water-supplies, garbage-disposal
systems, food-handling in restaurants and other public eating-places, living conditions in industrial camps, tourist camps, and hotels, frozen-food locker plants, and
slaughter-houses.
The Chief Sanitary Inspector is required to keep abreast of new developments in the
field of sanitation and to promote new approaches in dealing with sanitation problems,
as well as being able to evaluate the present services being carried on in health units.
He is also required to maintain close contact with other Government departments which
have interests in food production, such as the Department of Agriculture, and through this
contact plan to co-ordinate the services of these department to operate for the benefit of
all concerned.
Civil Defence Health Services have been organized largely under the direction of the
Health Branch of the Department of Health and Welfare. This is the logical place for
responsibility in developing this service, as the Health Branch has representatives in
the persons of directors of health units, located strategically throughout the Province. The
Deputy Minister of Health acts as an adviser to the Provincial Civil Defence office on all
health matters, and it was therefore considered advisable that one medical officer in the
Health Branch should be made responsible for maintaining contact with the office of
the Provincial Civil Defence Co-ordinator. The Director of Environmental Management
was assigned this responsibility, and during the year a member of the Provincial Civil
Defence staff was attached to the Health Branch for the purpose of assisting the Director
of the Division of Environmental Management in dealing with the Civil Defence Health
Services programme for the Province.
The Industrial Hygiene Service is at present very limited, for only the Director of
Environmental Management has any special qualifications in this field. A few specific
problems concerning industry have, however, been referred to this Division during the
past year, and limited steps have been taken to deal with the problems as they arise.
However, this part of the programme will eventually be developed to provide a consultative as well as investigatory service to industry in dealing with all phases of the health
of workers.
It is the intention of the Division, in developing this programme, to promote health
services, consisting of industrial nurses and physicians, on a full- and part-time basis for
industries already established and being established in British Columbia. It is realized
the Government cannot provide actual service of this nature, but it can materially assist
by informing industry of the benefits of such services and of the type and quality of
services available or required.
Rehabilitation and care of the chronically ill are two problems which are now being
dealt with on the basis of study and discussion by organizations and persons throughout
the Province of British Columbia who are interested. When definite plans are agreed upon
to deal with these problems, they will be included in the programme of environmental
management.
The problems of alcoholism and drug addiction have also recently come under very
active consideration, and it is expected that early in 1953 definite steps will be taken to
deal with these matters.
Lastly, in co-operation with the Department of Public Works, the Civil Service
Commission, and the Health Branch, a proposal has been made for the formation of an
industrial nursing service for the Provincial Government employees located in the Parlia- BB 48 BRITISH COLUMBIA
ment Buildings, Victoria. There is no doubt that the need for this service has been
recognized for some years, especially by the Health Branch, whose doctors and nurses
have been called upon from time to time to administer health and medical service to the
employees. Unfortunately, however, this assistance is not always available from members
of the Health Branch at the time that it is required. The establishment of an industrial
nursing service for Government employees would not only fill a definite need, but would
also serve as as an example to private industry of the value of establishing such services.
A.   REPORT OF THE NUTRITION SERVICE
The year 1952 marks a decade since the establishment of a Nutrition Service with
the Provincial Department of Health. During this ten-year period there has been a steady
growth in the variety and extent of nutrition consultant service provided. Numerous
studies of the variety of foods eaten by families in this Province have served to define more
clearly common problems toward which the nutrition-education programme must be
directed. Every effort has been made to develop the consultative services and methods
of nutrition education which have proven most effective in meeting these needs.
Consultant Service to Local Public Health Personnel
A review of activities during the past ten years reveals a steady increase in the amount
and type of consultative services requested and provided to local public health personnel.
The service of the Nutrition Consultant in providing technical information and advice,
assistance in studying food habits, and developing effective methods of education is
available to all members of the local health unit.
The Nutrition Consultants visited a number of health units during the year in order
to meet with the staff and assist them in dealing with problems of their own area. Visits
to health units were arranged to coincide with a regular staff meeting, where it is possible
to review the latest information on nutrition and provide advice regarding local problems.
During the additional time spent in health-unit areas, the Nutrition Consultant met with
social workers to discuss food selection for low-income families and School Cafeteria
Committees, or other groups, as requested by the health-unit staff.
Rat-feeding Experiments
An important responsibility of the Nutrition Consultant is that of advising and
assisting public health personnel in developing more effective methods of nutrition education. One of the most effective methods during 1952 has been the rat-feeding experiment.
These experiments were conducted in eighty-six schools outside of Greater Vancouver
during the year.
The rat-feeding projects are planned co-operatively by public health nurses and
teachers as a school health project. Directions for conducting the experiments, arrangements for shipping and cages, and general guidance is provided from the Nutrition Service.
During the first four weeks, one pair of rats is fed a variety of foods recommended in
Canada's Food Rules, and the other pair receive such foods as soft drinks, white bread,
cake, and candy. After about four weeks the difference in weight, appearance, and
disposition between the two pair of rats is readily noted by the children.
Teachers and public health nurses were asked to assist in evaluating the effectiveness
of the experiment by reporting on the results obtained in their area. Detailed reports
were received from all areas. A summary of the reports revealed that the rat-feeding
project stimulated a greater interest in the study of foods among the children in the
classroom. In most areas this interest was carried over to the parents in the community.
The majority of the experiments were displayed at Parent-Teacher meetings or during
Parents' Day at the school. In some areas the rats were used in exhibits in community
store windows.    Seventy-five per cent of the teachers and public health nurses reported DEPARTMENT OF HEALTH AND WELFARE, 1952
BB 49
that there were definite indications of improvements in the children's diet as a result of
the experiment.
The rat-feeding experiments in British Columbia were possible only through the
excellent co-operation of the staff of the Animal Nutrition Laboratory at the University,
who showed a continual interest in the projects and have supplied all the rats required
for the experiments.
Dietary Studies
Dietary studies among school-children, another method of nutrition education, has
proven effective in conjunction with the rat-feeding experiments. The studies are valuable
in providing information about the food habits of the community and in directing attention
to dietary deficiencies. The information provided from a dietary study serves in a tangible
way to arouse interest and point out problems to parents and children.
The Nutrition Consultants assisted local health units with these studies by analysing
three-day food records of school-children in four areas of the Province during the year.
The results obtained from these studies were very similar to those found in sixteen
other districts of the Province studied since the first survey of this type late in 1949. In
each area it was found that the three chief deficiencies in the children's diet were milk, a
Vitamin D supplement, and foods rich in Vitamin C. It was also noted that the majority
of the children consume liberal amounts of meat, bread, potatoes, and sweet foods, such
as cake, candy, and soft drinks. In view of these findings it continues to be an important
objective of nutrition education in this Province to inform people of the need and value
of milk, a Vitamin D supplement for children, foods rich in Vitamin C, and to encourage
them to include adequate amounts of these foods in their daily meals.
Other Services
Another major problem related to nutrition is that of obesity, which is recognized as
one of the serious health hazards of to-day. The association of obesity with many serious
physical impairments and an increased death rate is evident from numerous studies. In
view of this, considerable time was spent studying methods and compiling materials that
will assist public health personnel in their educational efforts to inform the public of the
dangers of being overweight and the rational approach to lasting weight-control. Several
discussions were held with a group of overweight people during the fall, and this provided
an opportunity to study methods of assisting with weight-control. Further study and
assistance in this field is planned for the coming year.
Considerable assistance regarding low-cost meal-planning was requested by local
health and welfare personnel. The current prices of essential food items were studied,
so that it was possible to offer practical suggestions regarding economical food-purchasing.
As new schools were constructed with lunchroom and kitchen facilities, there were
a number of requests for information on equipment requirements for lunch-supplement
or complete-meal programmes, economical methods of preparing food at school, and
large-quantity recipes. This type of information was compiled for public health personnel
in several areas, and, when possible, schools wishing assistance were visited during trips to
health units.
Consultant Service to Hospitals and Institutions
In September arrangements were made, in co-operation with the British Columbia
Hospital Insurance Service, to extend the institutional consultant programme to include
hospitals where information and advice concerning the food service is requested. To date
three hospitals have received this service, and a number of other hospitals have requested
a visit during the coming year. The assistance requested from hospitals concerned the
reduction of food costs and improvement of the over-all food service.    The Nutrition BB 50 BRITISH COLUMBIA
Consultants are working closely with representatives of the British Columbia Hospital
Insurance Service in developing this consultant programme to hospitals.
Institutions which received a consultant service during the year include Oakalla
Prison Farm, Young Offenders' Unit, New Haven, the British Columbia Cancer Institute,
and the Marpole Infirmary.
At the request of the Warden, a comprehensive study was made of the food service
at the main kitchen of Oakalla and the kitchens of the Women's Gaol and Young
Offenders' Unit. As a result of the study, a number of recommendations concerning the
kitchen layout and meal service in each of the three buildings were made in a report to
the Attorney-General's Department. The per capita food consumption was analysed for
Oakalla, Young Offenders' Unit, and New Haven. Where necessary, recommendations
were made concerning the reduction or increase of various groups of foods to improve
the general diet.
A study was made at the Marpole Infirmary to assist in determining the number of
trained cooks and other kitchen staff required in that institution.
Co-operative Activities with Other Departments and Organizations
Monthly meetings were held with nutritionists from the University of British
Columbia, Metropolitan Health Committee, the Vancouver School Board, Home Service
Departments, and other agencies to review programmes and work together on common
problems. One project of this group was the complete revision of the booklet " Family
Meals." Copies of the revised edition were distributed to health and welfare personnel,
Women's Institutes, teachers of home economics, and other key groups. Following this
initial distribution, requests for the booklet have been numerous, and there are many
indications that the booklet is proving to be of practical assistance to families.
A second project of the group was the compilation of a list of low-cost food
allowances for various age-groups. This material was submitted to the Bureau of
Economics and Statistics for use in compiling the quarterly cost of food budget for various
areas of British Columbia. The list was also useful in providing assistance to the Welfare
Branch for studies relating to the cost of food for individuals and families.
Consultant service was provided to the Department of Education regarding
equipment requirements and kitchen layout for school cafeterias. Assistance was also
provided to the Home Economics Division of this Department relative to nutrition
education in home-economics courses. The Nutrition Consultant met with teachers of
home economics at Summer School to discuss nutrition-education methods.
The co-operation of the Junior Red Cross in organizing the sale of apples in a
number of schools in the Province as a practical project in nutrition and dental-health
education is most commendable. Through arrangements of the Provincial director of this
organization, local Junior Red Cross groups in all larger centres of the Province may now
develop the apple-sales project in their school.
The objectives and activities of the public health nutrition programme were outlined
in talks to public health nursing students at the University, student-nurses in hospitals,
social workers, and teachers of home economics. Various phases of the nutrition
programme were outlined in talks presented to the Canadian conventions of the Dietetic,
Public Health, and Home Economics Associations this year.
B.   SANITARY INSPECTION SERVICES
Sanitary inspection is carried out by local health services in accordance with the
policies set by the local Union Board of Health and under the direction of the Medical
Health Officer. The Sanitary Inspectors' activities include the following: Inspection of
all food-handling establishments; supervision of milk as delivered to the consumer;
collection of milk samples for bacteriological analysis and performance of field tests; DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 51
inspection of housing, particularly industrial, tourist, and summer camps; inspection of
schools; collection of water samples for chemical and bacteriological analysis and advice
on private and public water-supplies; inspection of plumbing installations and private
sewage-disposal systems; advice on insects and rodent-control; and otherwise carry out
a programme of community sanitation under the direction of the Union Board of Health.
The Division of Environmental Management provides an advisory and consultive
service to the local Medical Health Officer and Sanitary Inspector. Local programmes are
evaluated. The Director performs liaison duties with other Government departments and
industrial and trade organizations. He conducts special investigations in areas outside
the boundaries of established full-time local health services.
FOOD-CONTROL
Milk-control
The quality control and licensing of milk vendors is the responsibility of the
municipalities under milk by-laws. The grading of the producers' premises, the health
of animals, and the licensing of dairy plants is the function of the Department of Agriculture. The Health Branch continues to act as the liaison between these two bodies and
to provide an advisory service on matters relating to bacterial quality and the control
of the products as it is delivered to the consumer.
Repeating the procedure used for the previous year, an evaluation of laboratory
reports on samples of pasteurized milk from all points throughout the Province submitting
samples to the central laboratory leads to an interpretation that the bacterial quality of
pasteurized milk this year betters that of previous years. Allowable limits are 50,000
bacteria per cubic centimetre. The average for this year is 13,000 per cubic centimetre,
compared to 22,000 per cubic centimetre for the previous year.
Amongst the problems referred to this Division were the following:—
(1) An attempt to continue the export of milk to Alaska.
(2) Proposals to fortify fresh fluid milk by the addition of vitamins.
(3) The distribution of milk in packaged cartons, which in some cases would
be contrary to good milk-handling practices.
Three municipal by-laws were reviewed prior to submission for the required approval
of the Lieutenant-Governor in Council.
The co-operation which exists between the Department of Agriculture and the
Department of Health and Welfare is reflected by the number of joint meetings which were
held, our attendance at the Dairy Branch Inspectors' meeting, and our participation in the
University Extension training course for dairy-plant workers conducted by the Dairy
Branch.
Eating and Drinking Places
The low incidence of complaints in this category continues. Four complaints were
received during the year. Two requests were received from the Liquor Control Board
for the examination of licensed premises.
Continued improvement in eating- and drinking-place sanitation is attributed to
food-handling instruction classes, including food-handling techniques and the instruction
of food-handlers in those diseases likely to be spread through improper food-handling
methods. Instructional classes for food-handlers have now replaced the former practice
of physical examinations of persons employed in this industry. This Department informed
local health services accordingly that emphasis should now be placed on food-handling
instruction.
The Peace River Health Unit presented an interesting survey on the inspection
of eating-places, and in summary fifty-eight premises were placed in the following
categories:— BB 52 BRITISH COLUMBIA
(1) Seven premises were awarded a perfect score on two semi-annually scored
inspections.
(2) Thirty premises showed improvement.
(3) Thirteen new premises were scored only once.
(4) Seven premises remained stationary, with no improvements noted.
(5) One premises was scored as having retrogressed during the year.
Frozen-food Locker Plants
The locker-plant industry is comparatively new, commencing in this Province in the
late 1930's, and has been of immense value in the field of food preservation, particularly
to the rural dwellers during the war years. While the frozen-food locker plant has been
of most value to the agricultural areas, it has nevertheless extended to the urban areas for
the convenience of quantity purchasers, hunting enthusiasts, and for quick-freezing service
to the owners of home-freezing storage units.
Facilities and services available to the public have been expanded by the recent
advent of frozen-food suppliers catering to the owners of home freezers. It is possible
in the coming year that package-storage units may be installed in markets and groceterias.
At the request of the Frozen Food Locker Plant Association, regulations were passed
in 1947 governing the construction and operation of frozen-food locker plants. These
regulations primarily provided for the approval of plans of proposed construction, the
provision of equipment and sanitary facilities, the compulsory sharp freezing of food prior
to storage, and the cutting and wrapping of meat by the plant operator. Since the passing
of the regulations, and particularly during the past two years, there has been a hesitancy
in some quarters to submit plans for the required approval. There have also been requests
for exemption from providing the required quick-freezing facilities and the cutting and
wrapping requirement. During the year the regulations were more rigidly enforced due
to requests for such enforcement from the Frozen Food Locker Plant Association, the
Department of Agriculture, and the Game Commission. As a result of action taken, two
plants have discontinued operations. Other plants with deficiencies instituted remedial
measures.
In the Fraser Valley five health units pooled their inspection reports in the form of
a survey of the plants in that particular locality.
Plans of four new premises were approved during the year.
Slaughter-houses
There is an arrangement, on behalf of local health services, with the Department
of Agriculture whereby, before the annual slaughter-house licence is issued by the
Recorder of Brands, an applicant for a licence must submit an inspection certificate
completed by the Medical Health Officer. This arrangement is in its third year of
operation and has been an asset to local health services in improving slaughter-houses
throughout the Province.
The number of licences issued in 1951 dropped, compared to the number of licences
issued in 1950, prior to the arrangement, indicating that poor or unsatisfactory premises
failed to obtain the required approval of the Medical Health Officer in 1951. In 1952
eighty-two licences were issued, compared to seventy-three in 1951, an increase of nine.
Fifteen of the 1952 licences were issued to new operators, indicating that seven of the
1951 licence-holders either failed to qualify in the continuing improvement programme
of slaughter-house construction and maintenance or that they decided to discontinue
operations. Of the eighty-two licences issued in 1952, no less than nineteen of the
applicants failed to enclose the Medical Health Officer's inspection certificate with the
application, although the certificate was requested at the time the application forms were
distributed. In all instances the licences were held in abeyance until the inspection
certificates were completed. DEPARTMENT OF HEALTH AND WELFARE,  1952
BB 53
The appreciation of the Health Branch is extended to the Department of Agriculture
for the co-operation given in this programme of slaughter-house improvements.
Meat Inspection
Several inquiries were made concerning the possibility of a Provincial meat-inspection
service. Again, as in previous years, such inquiries were relayed to the Department of
Agriculture, as it is a matter related to veterinary services and diseases of animals. Until
the present, meat inspection was confined to Federal inspection of meat entering the
Province, the Federal inspection of animals slaughtered in the Province primarily intended
for export, and the inspection of meat by the City of Vancouver.
Examples of interest in meat inspection are as follows:—
(1) An inquiry from the West Kootenay Health Unit on behalf of the local
butchers for inspection " so that poor grade or diseased meat would not
be sold."
(2) A letter from the secretary of the South Okanagan Union Board of Health
stating in part that " there is an immediate need of compulsory meat
inspection, especially in the Okanagan Valley . . . that Provincial
legislation should be introduced as soon as possible."
(3) A resolution by the Okanagan Valley Municipal Association requesting a
meat-inspection service for the protection of both the consumer and
farmer.
(4) A resolution from the City of Kamloops " unanimously endorsing the
resolution of the Okanagan Valley Municipal Association."
During the year the Cities of Penticton and Kelowna passed meat-inspection by-laws,
providing for the inspection of animals slaughtered within their municipal boundaries.
Concern was expressed on the sale of non-inspected meat in the unorganized territory
adjacent to these municipalities. The Municipality of Richmond passed a meat and fish
by-law during the year.
The British Columbia Cattle Growers' Association expressed itself as being in favour
of meat inspection.
Horse-meat
The sale of this product gained momentum in 1951, continuing into 1952. However,
the quarantine restrictions imposed on meat imports to the Province during the year
curtailed this enterprise considerably, and no revival has occurred since the lifting of the
quarantine restrictions.
Sanitary Inspection of Hospitals
As a result of inquiries from the Division of Consultation and Inspection of the
Hospital Insurance Service, a survey was conducted on food-handling and related sanitation practices in hospitals. The conclusions reached from this survey were discussed with
the Hospital Insurance Service, and the decision reached that local health services should
continue their supervisory practices, thus relieving the Hospital Insurance Service of any
necessity of entering this field of activity. Any information desired by the Division of
Consultation and Inspection could be obtained through the Department of Health and
Welfare or the health-unit offices at any time it was desired.
Housing
Industrial Camps
This phase of housing sanitation included the usual number of inquiries for copies of
the regulations, questions concerning the interpretation of the regulations, and complaints.
The Cariboo Health Unit, an area from which complaints have originated possibly in
greater number than any other area in the past, has reported as follows:  " Several indus- BB 54 BRITISH COLUMBIA
trial developments, logging, lumber, and construction camps throughout the unit have
demonstrated first-class industrial sanitation. The companies have constructed their
camps with an eye to both health and comfort and have eliminated the ' roughing it' as
commonly associated with new developments."
In February, 1951, the Regulations Governing the Sanitary Control of Industrial
Camps were amended to allow special permission to contractors to have trailer accommodation on construction projects. Three such permits were issued early in the year
in connection with housing on the trans-mountain oil pipe-line, but were cancelled in
August pursuant to unfavourable reports in respect to overcrowding by the use of
double-tier bunks. By arrangement between the contractors on the project and the
Building Trades Council, all double-tier bunks in trailer accommodation will cease
January 1st, 1953. A similar type of accommodation provided by the Department of
Public Works, to a limited extent, has also proved unpopular and has been discontinued.
The Aluminum Company of Canada project, the largest construction job in progress
in the world to-day, was visited on separate occasions by the Director of the Division and
Chief Sanitary Inspector. The accommodations and other facilities were found to be well
beyond the preliminary construction stage, and in most places the accommodations were
of a satisfactory quality or better, with but occasional minor deficiencies. At the time of
the visits approximately 1,050 men were employed on the Kitimat smelter and townsite
project, 1,200 on the Nechako Dam operation, and 3,000 on the Kemano power-house
and transmission-line construction.
Farm-labour Housing
An evaluation of housing in connection with the small-fruit growers in the Fraser
Valley, which was commenced by the Matsqui-Sumas-Abbotsford Public Health Service
in 1951, continued into 1952. The evaluation was conducted in co-operation with the
Dominion-Provincial Emergency Farm Labour Committee, Director of Land Clearing
and Extension, Department of Agriculture, and the Growers' Association. Earlier
standards for this seasonal type of housing were revised through joint meetings with the
Growers' Association and endorsed by that group. The revised standards were distributed
amongst the growers by the Department of Agriculture and were used as a guide for the
Sanitary Inspectors' inspections before and during the harvest season.
At the request of the Department of Agriculture, the housing of fruit-pickers in a
section of the Interior came under a cursory review during the harvest season, with the
added request from the Department of Agriculture that the matter be further reviewed in
1953.
Summer Camps
The endeavour to make as complete a coverage of summer camps as possible, as
requested by the Welfare Institutions Licensing Board, resulted in an increase in the
number of inspections. Fifty-six camps were inspected this year, compared to forty-nine
in 1951. The reports were reviewed and summarized, with the indication that compliance
with standards, prepared by this Department and endorsed by the Welfare Institutions
Licensing Board and British Columbia Branch of the Canadian Camping Association,
showed improvements compared with the sanitary environment of 1951.
School Sanitation
The Division of Environmental Management was stimulated by the School Medical
Inspectors to obtain a close liaison with the Department of Education. The School
Medical Inspectors requested the privilege of reviewing school plans prior to construction
and also asked that items of interest to them be inserted in the proposed manual on school DEPARTMENT OF HEALTH AND WELFARE,  1952
BB 55
requirements contemplated by the Department of Education. The Division circularized
the School Medical Inspectors, inviting their individual suggestions and comments.
Included amongst the items commented upon were fire protection, plumbing, heating,
grounds, buildings, classrooms, ventilation, health services, lunchrooms, sewage-disposal,
lighting, water-supplies, toilets, and washrooms. These were tabulated and submitted to
the Department of Education.
The school environment C. 6 report form, introduced for use of School Medical
Inspectors in the school-year 1945-46, has been the official report form since that time,
although there have been deviations by several School Medical Inspectors in submitting
a short supplemental form. This year 250 C. 6 reports were received, compared with 360
in 1950-51, 295 in 1949-50, 334 in 1948-49, 421 in 1947-48, 411 in 1946-47, and
371 in 1945-46. A complete compilation of the reports of each school-year was prepared
for a study by a committee on school environment appointed at the semi-annual meeting
of health-unit directors and for discussion with the Department of Education.
The decided increase in the numbers of inquiries from the Department of Education
in respect to school environment has reflected a closer liaison between the local school
authorities and the health-unit officers, particularly in the selection of school-sites,
improved water-supplies, improved sewage-disposal and food-handling facilities.
Plumbing
The fact that the Provincial representative on the Technical Advisory Committee on
Plumbing Services to the National Research Council is from the Health Branch has
afforded us the opportunity of becoming most familiar with the proposed revisions to the
Recommended National Plumbing Code. The first draft of the National Code was
circularized to the manufacturers, Plumbing Contractors' Association, municipal and
Provincial departments of government during the year. It was possible to prepare concurrently a draft for the oft-requested Provincial Plumbing Code. It is therefore proposed
that a model municipal plumbing by-law, incorporating the technical features of the
National Code and proposed Provincial Code, be made available to municipalities which
have been inquiring for some years for such a model by-law. When the proposed
Provincial Code and proposed model municipal by-law have been completed, the
standards will be uniform in all respects. It will be acceptable to the manufacturers
of fixtures and supplies and to the British Columbia Branch of the National Association of Plumbing and Heating Contractors, and will require less restrictive plumbing
installations than hitherto possible under existing standards or practices.
Garbage and Refuse Disposal
It has been noted in reports of various Union Boards of Health that stricter policies
were advocated and implemented in disposal methods in order to minimize rodent
infestation and indiscriminate dumping of garbage and refuse. The tendency is to replace
the primitive method of dumping in ravines, etc., by that of trench and fill methods.
From various unorganized communities, requests have come for Provincial assistance
in the maintenance of disposal-grounds and institution of trench and fill practice.
In many municipalities as well as unorganized territory the usual arrangement to
obtain disposal-sites is to have Crown land set aside for disposol purposes. It is the
concensus of interested executive bodies that regulatory control or specific standards be
invoked upon the land leased or reserved for garbage- and refuse-disposal purposes.
Pest-control
Mosquito-con trol
Requests for assistance in control measures by way of grants from the Health Branch
were practically negligible during the year.   It has been recognized that the efforts toward BB 56 BRITISH COLUMBIA
the elimination of mosquitoes are best accomplished in local areas by local organizations.
While health units are in a position to provide the necessary advice on eradication
measures, both the Federal and Provincial Departments of Agriculture provide advisory
services in this field.
Rodent-control
The co-operation extended to the Department of National Health and Welfare by
the collection of ground-squirrels, marmots, and domestic rodents (rats) and their
ectoparasites and submission to the Laboratory of Hygiene continues.
In the collection of ground-squirrels and marmots the survey was confined to that
particular area in which evidence of plague was found in 1950.
The metropolitan area of Vancouver and the Victoria-Esquimalt Union Board of
Health both extended their rodent-control activity to the collection of specimens and
submissions to the laboratory. With definite advantages to this local contribution to the
sylvatic-plague programme, it is proposed that health units be equipped to do the dissection
procedures and macroscopic examinations, and thus augment the existing programme.
General Sanitation
Complaints and inquiries in this category resulted in investigations or considerations
with respect to the following: Ventilation in an electric-welding shop; odours from pulp
plants and in oil-refineries; sanitary facilities at beaches in unorganized territory; mill
noises allegedly contributing to ill-health; the sterilization measures employed in the
manufacture of upholstered articles and mattresses; use of approved or non-approved
liquids in dry-cleaning processes; thermo-vaporizers for use in insect-control and other
matters of varying natures.
C.   INDUSTRIAL HYGIENE
Early in the year a visit was made to the orchard areas of the Okanagan area to
initiate an investigation of hazards related to agricultural insecticide spraying procedures.
It was learned that large quantities of a very dangerous insecticide had been used during
the previous year, and that similar or large amounts of the same substance were expected
to be used in 1952. Because this insecticide (Parathion) had proved so effective in
controlling insect damage, and as there was no other insecticide capable of giving
equivalent results, there was no practical possibility of preventing its use.
With the co-operation of representatives of the Provincial and National Departments
of Agriculture and staff of the North and South Okanagan Health Units, steps were taken
to emphasize the dangers of handling Parathion and educating operators regarding safety
measures. However, several cases of Parathion poisoning did occur during the year's
spraying operation, but fortunately no fatalities occurred among the patients.
This co-operative study resulted in the inclusion of a medical representative in the
Okanagan Spray Committee deliberations held in October. Medical evidence of the
toxicity of Parathion and information regarding the availability of an effective but less
toxic alternative insecticide led to the exclusion of Parathion from the 1953 Spray
Calendar.
An investigation was made of welding conditions existing on one of the special naval
ship-building projects in Vancouver. Several of the welders were experiencing considerable discomfort and some disability during this operation. The major cause of this
condition was related to the extreme difficulty encountered in providing adequate ventilation. Improvement has, however, resulted to the extent that the symptoms of illness
are no longer being encountered on this project. DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 57
D.   CIVIL DEFENCE HEALTH SERVICES
These services continued to develop throughout the Province. The directors of
health units were recognized by all the voluntary and professional health agencies in the
Province as the local Directors of Civil Defence Health Services, working in co-operation
with the regional and area Civil Defence Co-ordinators.
Following the development of the Civil Defence Health Services Manual, the Civil
Defence Health Services Planning Group of the Department of National Health and
Welfare provided plans for civil-defence organization in hospitals. These plans or hospital
disaster-kits, as they are termed, were distributed to most of the key hospitals. This plan
is quite detailed and requires considerable time to implement, however, several hospitals
are making progress in this matter.
Twenty-eight first-aid stations were located strategically throughout the Province,
and the National Civil Defence Office provided each station with a large training-kit to be
used by the volunteer members of each station. A word of explanation regarding the
first-aid station might serve to demonstrate the magnitude of this step, in that a first-aid
station could be said to be similar to a military casualty-clearing station. The civil-
defence first-aid station consists of over 150 persons, including physicians, dentists, and
nurses.
The inventory of hospital beds and emergency hospital facilities throughout the
Province was revised and brought up to date. A census of all available physicians, nurses,
and technicians in British Columbia is also maintained.
Although training in first aid is the direct responsibility of the Training Section of
the Provincial Civil Defence Office, it is also considered a health matter, as the greatest
demand for first-aid trained personnel will be made by the Civil Defence Health Services.
Besides the regular first-aid training classes being carried on by the St. John Ambulance
Association and the Red Cross, special civil-defence first-aid classes have been organized
throughout the Province, and large numbers of trainees are participating in these courses.
A very progressive step has been taken by the Department of Education by the inclusion
of first-aid training in the regular curriculum of the schools of British Columbia; therefore, large numbers of young people trained in first aid will soon be available to deal
with civil disaster as well as common emergencies.
The Health Branch, along with all other branches of Government in Victoria, is
organizing to deal with any disaster that might strike the Parliament Buildings during
working-hours, and in that respect has appointed a Departmental Warden to work in
co-operation with the Chief Civil Defence Warden for the Parliament Buildings. During
the past year twenty members of the Victoria staff of this Department have received the
basic civil-defence training being offered by the civil-defence organization of Victoria City.
Three physicians in British Columbia received special training at an A.B.C. Warfare
Medical Aspects Course offered at Camp Borden, Ont, by the National Office of Civil
Defence during 1952. These physicians are an addition to those who had already
received similar training during the previous year. It is hoped that eventually this type
of training will be made available to a larger number of physicians in this Province.
Eighty-nine British Columbia nurses received special training in the nursing aspects
of A.B.C. warfare to qualify themselves as instructors in this subject. Since receiving
this training, these instructors have held classes in their own localities throughout the
Province and have been responsible for extending this training to a very great number
of nurses, preparing them for their participation in Civil Defence Health Services activities.
Up to November of 1952 we were aware of 3,403 nurses who had received this training.
As a result of two meetings with civil-defence officials from Washington State, a plan
of mutual aid has been developed between that State and the Province of British Columbia.
All the details of integrating the civil-defence services between the State and the Province BB 58 BRITISH COLUMBIA
have not been entirely worked out, but considerable progress has been made in this
respect.
A Western Civil Defence Health Services Regional Conference was held in Regina,
Sask., in May of 1952, attended by representatives of Civil Defence Health Services from
Manitoba, Saskatchewan, Alberta, and British Columbia. The purpose of this meeting
was to discuss problems that had been encountered by the various Provinces in developing
these services and to make recommendations to the Department of National Health and
Welfare in developing a uniform type of Civil Defence Health Services across the nation.
This type of meeting both in Canada and the United States has proved of great value in
understanding the problems which arise in developing this type of service in which so few
persons have the necessary experience.
A Civil Defence Liaison Officer was appointed by the Office of the Provincial Civil
Defence Co-ordinator and attached to the Health Branch to assist in the development
of Provincial Civil Defence Health Services. DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 59
REPORT OF THE DIVISION OF PREVENTIVE DENTISTRY
F. McCombie, Director
The primary purpose of the Division of Preventive Dentistry is to assist the people
of this Province to improve their dental health by all and every means available.
This objective is not the sole prerogative of this Division. Also deeply concerned
in such an endeavour are all those persons serving in the field of public health. Many of
these workers have for years appreciated the ill effects of dental disease, especially as it
affects the children. Many members of the medical and teaching professions are also
aware of the urgent need for improvement in this regard and look for guidance as to how
it may be attained. Workers in the field of social welfare have for many years appreciated
that improved facilities for dental care, especially for the children of parents in receipt
of social assistance and those in the Industrial Schools, would be desirable. Some Boards
of Trade and similar organizations, especially in the smaller and more remote rural
communities, are deeply concerned about the lack of adequate facilities for dental treatment in their respective areas. Boards of School Trustees, who for many years in the
metropolitan areas pioneered in the provision of school dental services, are becoming
increasingly insistent that similar services be provided in the rural school districts.
Voluntary organizations, such as Parent-Teacher Associations, Women's Institutes, and
Junior Red Cross, have been and are to-day taking most active steps in the same
endeavour; namely, to improve the dental health of the people, especially the children,
of this Province.
Also, most interested in this endeavour are the senior members of the dental
profession and many of the far-thinking membership. They are deeply and sincerely
concerned about the dental ill-health of large segments of the population. They are
indeed conscious of their responsibility to safeguard the dental health of the people by
reason of the authority delegated to them by the " Dentistry Act " of this Province.
It therefore becomes the responsibility of this Division to correlate, to advise, and,
in some cases, to stimulate all these groups so that their respective endeavours may
produce the best possible results. In addition, in some fields it is desirable that this
Division take direct action. To carry out these functions, this Division at all times keeps
itself aware of the success and sometimes failure of action taken in this field in other
Provinces of this country and in other countries of the world.
DENTAL HEALTH OR DENTAL DISEASE
The optimum condition of the oral cavity is the presence of the natural dentition
unmarred by the ravages of dental disease. The next choice, which regrettably too
many persons to-day accept as the ideal, is the condition in which dental disease has
occurred but has been subsequently eliminated by successful treatment. The third still
less desirable or efficient choice is the removal of the diseased natural dentition and
the provision of artificial substitutes.
Some leading research-workers to-day claim that all dental disease is entirely
preventable. Arguable though this statement may be, it is certain that preventive
measures have now been proven which can and will reduce the incidence of dental disease
to an insignificant fraction of that which is occurring to-day in this country and in this
Province.
However, though this situation may be slowly improved in the years to come, and
maximum efforts must be devoted to this end, it is to be appreciated that to-day enormous
suffering is prevalent due to the widespread incidence of dental disease and the subsequent
dental ill-health. In the routine duties of dental officers in health units during the past
year, again was noted the terrible extent of dental disease, even amongst the youngest
children.   It was noted that the average 3-year-old already required three tooth surfaces BB 60 BRITISH COLUMBIA
to be restored; the average 4- and 5-year-old, five to six tooth surfaces; the average
6-year-old, seven to eight tooth surfaces; and the average 7-year-old, nine tooth surfaces
needed restoration so that those children could be made free of active dental disease.
At the rate preventable dental disease is presently occurring in this Province, only
approximately one-third of the people can possibly at the present time receive adequate
dental treatment. Therefore, it is nothing but realistic to appreciate at this time that
to improve the dental health of the people of this Province, not only must every effort be
made to reduce the incidence of dental disease and the consequent need for treatment,
but also that the facilities for dental treatment, by properly and adequately trained
personnel, must be increased.
PREVENTION
However, the best possible state of dental health (the natural dentition free from
dental disease) and the most economic solution to the provision of adequate dental-
treatment facilities are both attained by the prevention of dental disease. Therefore,
firstly will be reviewed the progress in this field which has been achieved during the
past year.
It is without any doubt that the dissemination of knowledge as to how dental
disorders may be prevented will be most rapidly accomplished by the appointment within
local health departments of full-time dentists who are especially well qualified in preventive and children's dentistry. It is pleasing, therefore, to be able to report that within
Greater Vancouver, New Westminster, and Victoria all such appointments were filled
at the commencement of the school-year 1952-53. Also, this year the Board of Trustees
of the Powell River School District were successful in filling a similar appointment.
In addition, by means of a Federal health grant and additional grants-in-aid by this
Department, a further clinic has been made possible in the Municipality of Burnaby.
Toward the end of the year, arrangements were completed for a dental clinic to be added
to the Vancouver Health Centre for Children. This clinic will also provide dental care
for children under treatment by the Western Society for Rehabilitation.
For the first time it may be reported that at the commencement of the present
school-year all school dental services within this Province had adopted a preventive
programme. Dental-health education and concentration of attention in restoring to
dental health the younger children, especially pre-school, kindergarten, and Grade I, is
now universally adopted. To achieve this desirable state of affairs has required the
withdrawal of dental treatment by school dental services to children of older age-groups
whose parents are in receipt of social assistance. Responsibility for the provision of
dental treatment for such children now rests squarely with welfare departments. However,
in co-operation with officials of the Provincial Welfare Branch, proposals for the early
introduction of a service to meet the needs of this group have been prepared by this
Division.   It is hoped that authority will be possible for its inauguration at an early date.
However, efforts to attract applications from suitably qualified dentists to fill
appointments with local health units were not too successful during the year. In all, four
resignations were accepted from dentists holding such appointments, all for varying
personal reasons. However, during the year two most suitable candidates have joined
the staff of this Division. They have first tried the field of private practice, and, though
therein successful, have made the change; their early resignation is therefore not anticipated. In addition, one of the most outstanding of the recruits to this Division during
1951 proceeded this fall on bursary to postgraduate training in public health dentistry to
qualify for a master's degree in public health. In all, whilst at the close of 1951 it was
possible to record seven such appointments with local health units, at the close of 1952
only four of these appointments are filled. It is to be noted that during 1952, at the time
that this Division was endeavouring to attract recruits from the ranks of new graduates
from the Dental Faculties, salaries were very significantly lower than those being offered DEPARTMENT OF HEALTH AND WELFARE, 1952
BB 61
by the Metropolitan Health Committee of Greater Vancouver. This situation has now
changed, and better recruitment from this group is hoped for in the coming year. Nevertheless, some thought has been given as to how the dentists of this Division with full-time
appointments may serve to the maximum advantage and to making the duties as attractive
and as satisfying as possible. With this in mind, two experiments are now in operation.
In one health unit an additional dentist has been engaged on a part-time basis to increase
the clinical dental services available in that area. In another health unit the full-time
dental director is acting as dental consultant to an adjacent health unit. He will
endeavour to encourage dental-health educational activities and to stimulate the coverage
of the whole health unit by Community Dental Clinics for Younger Children, in which
resident private dental practitioners are co-operating.
However, during the school-year 1951-52 preventive dental services operated
continuously in five health units, in which the service was provided to fourteen school
districts, and during some months of the year in two other health units to an additional
five school districts. Seven hundred and fifty-two pre-school children were restored to
dental health—that is, received complete treatment—and they, and in most cases a parent,
were instructed in the prevention of dental disease. One thousand five hundred and six
Grade I pupils similarly benefited. In the five health units which operated continuously
throughout the year, 61 per cent of the Grade I enrolment requested the service and
a further 11 per cent made arrangements with their family dentist. Of those requesting
the service, 91 per cent received complete treatment. In all, in these Grade I classes
67 per cent of the children were restored to dental health either by the family dentist or
the dental director of the health unit. The urgent need for this type of service was
revealed by the fact that of these children no less than 81 per cent had never before
visited a dentist. That the dental directors of these health units were truly most interested
in preventing dental ill-health and saving both foundation and permanent teeth is shown
by the fact that amongst the pre-school children, on an average, twenty-six tooth surfaces
were restored for every foundation tooth that was extracted, and for Grade I pupils
approximately thirteen tooth surfaces were restored for every tooth extracted.
To improve further the standard of clinical service provided by dental offices with
local health units, two further experiments are being undertaken. The routine diagnosis
and early dental lesions by use of X-rays has long been accepted as desirable, especially
in any programme of prevention. However, previously no dental X-ray equipment
sufficiently transportable to be used in the outlying areas of a health unit as well as in
the central dental clinic had been seen by this Division. Such a unit has now been
inspected, purchased, adapted for use with the transportable dental equipment of this
Division, and dispatched to a health unit for field trials. In addition, the lack of
compressed air and suction for operating the saliva ejector have been appreciated as
items regrettably not available when the dental operator was using the transportable
equipment. A light-weight air-compressor which, by means of a simple adapter, it is
claimed, can meet both of these needs is similarly undergoing trials with another health
unit.
During the past year the number of community dental clinics for younger children
wherein co-operate local resident dentists continued to increase. Six new clinics were
inaugurated, bringing the present total to nineteen. Two of the largest programmes which
have commenced during the year have been in Prince Rupert and Dawson Creek. Tribute
is sincerely paid to the lay committees sponsoring and organizing these clinics throughout
the Province. It is interesting to note that during the fiscal year 1951-52 no less than
1,874 children were restored to dental health through these clinics.
Educational Aids
To aid those providing preventive dental services, and indeed many others, to
accentuate their teachings of how dental disease may to-day be prevented further, audio- BB 62 BRITISH COLUMBIA
visual educational aids have been provided. It is encouraging to note the increasing use
of this material. For example, during the past year more than 15,000 persons viewed
dental-health films which were made available by the central film library of this Branch.
This is an increase of over 50 per cent above the previous year. In addition, health units
with full-time preventive dental services have been provided with sets of six dental-health
film-strips as an endeavour to encourage the use of this aid. Previously, of course, these
film-strips were available, but it was necessary for a health unit to order the film-strip in
advance from the central film library.
Furthermore, during the year was reviewed the most excellent dental-health
education material issued by the New Zealand Department of Health. Two of its film-
strips appeared to have excellent possibilities as additional items for this Division. The
New Zealand Department of Health has most generously offered to reprint copies modified
for use with the film-strip projectors used in this Province. In addition, the same
Department most graciously gave permission for one of their dental-health posters
to be reprinted for distribution within this Province.
Throughout the year were received routinely copies of all pamphlets in this field,
made available by the Department of National Health and Welfare. It is, however, to be
recorded that the supply of this material is often unfortunately sporadic, which thereby
often delays the meeting of requests submitted to this Branch and not infrequently makes
it impossible to meet such requests in full.
As a further example of widespread sources of such material reviewed and made
available by this Division, it may also be noted that during the past year a very excellent
dental-health pamphlet published by the Dental Board of the United Kingdom has been
distributed by this Branch.
The extensive programme of rat-feeding experiments carried out in the schools during
the past year is reported in detail in the report of the Nutrition Services of this Branch.
However, this Division takes cognizance of the fact that this programme also provides a
most excellent means of dental-health education. It is to be explained that the " poor "
diet fed to the rats also is one which will encourage dental disease, whilst the " good " diet
is equally favourable to the maximum degree of dental health.
Also, as a practical approach to changing the habits of children away from
decay-producing sweet beverages, two limited experiments were conducted with the sale
of a 6-ounce container of vitaminized apple-juice. Its sale would appear to be assured
by these experiments (if this item could be economically marketed at a competitive price).
However, some doubt in this regard unfortunately exists at the present time.
Fluoridation
Until very recently the generally accepted and practical means of preventing dental
disease could only provide some hope that any widespread improvement in dental health
could only be anticipated in the years to come, after personal habits had changed
sufficiently.
However, during the past years this Division has constantly kept under review the
rapidly accumulating evidence relating to the artificial fluoridation of communal water-
supplies which are naturally deficient in this regard. Therefore, during this year it became
our carefully considered opinion that the evidence in favour of such procedures had
advanced to the degree when a change of policy by this Department should be considered.
Therefore, the policy of this Department is now amended to read as follows:—
" In communities where the artificial fluoridation of the public water-supplies could
be a practical procedure and the procedure has the full approval of the local health
authorities and others responsible for the communal health, and in the light of evidence
now available, local authorities are now strongly urged and recommended to adopt this
procedure, but having first submitted their plans for so doing to this Department for
approval. DEPARTMENT OF HEALTH AND WELFARE,  1952
BB 63
" However, in so doing, this Department feels that it must be fully appreciated that
the evidence clearly shows that the fluoridation of water-supplies must be considered an
adjunct to other existing methods of reducing dental decay and not a procedure to be
adopted in lieu thereof.
" Furthermore, since any community undertaking fluoridation will be in a position to
make valuable contribution to the scientific data now available, and also in order to prove,
in the years to come, to the citizens of the community the value of this procedure, it is
strongly recommended that the dental defects of at least representative samples of the
child population should be periodically recorded, beginning with a pre-fluoridation
survey."
The importance of this means of prevention must be fully realized. This procedure,
it is now believed, if used along with other preventive dental measures, offers for the first
time real hope that within the foreseeable future dental disease may be controlled to the
degree that dental treatment can be made available to all persons so needing.
It will be one of the major projects of this Division during the coming year to ensure
that there is available to public health personnel, members of the dental and medical
professions, and other interested citizens various types of material accurately describing
the advantages of the first method so far discovered whereby one of the major dental
diseases may be successfully controlled other than by individual co-operation. It is to
be appreciated that no widespread action to fluoridate communal water-supplies may be
anticipated immediately. Such will not be the case until sufficient people understand the
advantages and the entire absence of disadvantages of this procedure. To assist people
to become aware of these facts, now undisputed by qualified research-workers in this
field, will be the object of this Division.
Junior Red Cross
For their co-operation in practical dental-health education, and for their considerable
and most productive efforts in this field, we would extend our congratulations to the Junior
Red Cross of this Province. Largely, if not entirely, through the energetic work of the
Provincial Director, Miss Margaret Palmer, a practical programme of dental-health
education is now being carried out in many of the schools of this Province by members
of the Junior Red Cross. As a practical and positive approach to the dictum " eat less
sweet foods," apple sales in the school have been organized. Arrangements have been
made whereby apples in quantity have courteously been made available at lower than
retail cost to local groups of Junior Red Cross in the Greater Vancouver and Vancouver
Island areas and, at the close of the year, to any such groups of the larger communities
of the Province. It is hoped that as greater experience in the administration of this
programme is attained that these facilities will be made available to every community
throughout the Province. It is to be realized that the sale of apples is not considered by
Junior Red Cross as an end in itself, but as a positive approach and adjunct to dental-
health education carried out concurrently.
DENTAL PERSONNEL
During 1952 in this Province the over-all ratio of population to dentists remained
almost identical to that of 1951; namely, one dentist to approximately 2,000 persons.
As at January 1st, 1952, the ratio in this Province was better than in any other Province
in Canada. However, the considerable discrepancy between the ratio of dentists to
population in the metropolitan areas compared to that existing in the rural areas became
even more apparent after the 1951 Census of population. It is now revealed that within
the areas of Greater Vancouver, Victoria, and New Westminster there are located close
to 400 dentists, who provide a ratio of one dentist to approximately 1,450 persons.   The BB 64 BRITISH COLUMBIA
remainder of the Province—that is, more than 50 per cent of the total population—is
presently served by only 176 dentists, providing a ratio of one dentist to approximately
3,350 persons. However, some small encouragement may be taken from the fact that,
this year, of the twenty-two newly registered dentists, six located in the rural areas. Three
years ago, of the new dentists that year, one located outside the metropolitan area, and
the year previously, none. Nevertheless, it must be clearly understood that if the present
maldistribution is to be corrected, significantly more than 50 per cent of the dentists
entering this Province to practise each year must be encouraged to locate outside the
metropolitan area.
Dental Hygienists
As an endeavour to increase the effectiveness of the present dental personnel within
this Province, rules and regulations for the licensing of dental hygienists were prepared
by the College of Dental Surgeons of British Columbia, with the assistance of this Division,
and subsequently approved by the Lieutenant-Governor in Council. However, it is to
be reported that this year only one dental hygienist has applied for registration. Nor is it
anticipated that this auxiliary body will in any way assist the dentists of this Province
significantly to increase their services to the people until additional facilities for the
training of dental hygienists are established within Canada. At present, to provide for
the 5,000-odd Canadian dentists, only one school for training dental hygienists exists in
Canada, and this plans each year to graduate only ten students. It is suggested that
rightful consideration might well be given to the establishment of a school for training
hygienists within the University of British Columbia, and possibly as a precursor to the
Dental Faculty.
Dental Faculty
During the past year we are informed that the Senate of the University has given
consideration to the report of the committee it had previously established to investigate
the need for a Dental Faculty in this Province. It is understood that the President of the
University reports that the University is interested in the organization of a Faculty of
Dentistry and in the provision of graduates in dentistry to serve the people of this Province.
Although the Unhjersity is still in the process of organizing a Medical Faculty, and because
there is some limited relationship between the work of these two faculties, it is recommended that action on the Faculty of Dentistry should be postponed until the Faculty of
Medicine is fully established. It may also be recorded that the Council of the College of
Dental Surgeons of British Columbia and the British Columbia Dental Association are
giving active consideration as to how they may best assist in the early establishment of
the faculty.
It cannot be too strongly stressed that until a Dental Faculty is established within
this Province, needless suffering from dental disease will, of necessity, be the lot of many
of the people and especially many of the children of this Province.
Dental Service to Persons in Receipt of Social Assistance
Dental services available to children of parents in receipt of social assistance has
for a long time been a subject of serious concern to this Division. During the year 1951
a report on this subject and a suggested programme were prepared. It would now appear
that with certain agreed minor clarifications the suggested programme is acceptable to
officials of the Welfare Branch presently responsible for advice in this field. It is hoped
that the implementation of this programme may be authorized at the earliest possible
date so that such children as are now restored to dental health by the school preventive
dental services will not then lapse into subsequent gross dental ill-health through the
inability of their parents at that time to meet the costs of dental treatment provided by
a private practitioner. DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 65
Dental Services in Rural Areas
Although, as revealed above, the number of dentists presently practising in the
smaller communities of this Province cannot in any way be considered as satisfactory,
some improvement in this regard can be noted during the past three years. The degree
of improvement is, however, not such that activities in this field may be relaxed, but
rather reveals that further and renewed activities and possibly fresh approaches to this
problem must be made.
Sets of transportable equipment during the year were forwarded to Merritt, Slocan
City, and Ganges so that dentists may now regularly visit these communities. In addition,
a further set of equipment is on permanent loan so that a dentist may visit Kitwanga,
Hazelton, and Usk. For visits of three to four weeks' duration further sets of transportable dental equipment have also been loaned to dentists visiting Tahsis, Greenwood, and
Edgewater. In all the above cases the dentists agreed to co-operate at least part of the
time with Community Clinics for Younger Children, which were most successfully
arranged by local organizations.
Also as an endeavour to encourage dentists to reside in the rural areas, grants-in-
aid have been authorized this year to two dentists who are located in communities
previously without a resident dentist.
British Columbia Dental Association
Again it is indeed pleasing to be able to report that throughout the year the closest
liaison has been maintained with, and the fullest co-operation has been given by, the
Dental Public Health Committee of the British Columbia Dental Association. It is
further a pleasure to record that as an indication of the high esteem that this Committee
has now earned across Canada, and due to the personal attributes of its Chairman, Dr.
A. Poyntz was this year elected by the Board of Governors of the Canadian Association
as Chairman of the Dental Public Health Committee of the National Association.
Sincere acknowledgment is also made of the co-operation of the editor of the British
Columbia Dental Association News Bulletin and the Provincial editor of the Journal of
the Canadian Association, who have both assisted considerably in making known to the
dental profession the activities of this Division and the facilities which it offers.
To encourage that dental treatment for children be provided by private dental practitioners to a greater degree, and that treatment be of the highest standards, the Vancouver
and District Pasdodontia Study Club has worked extremely hard. To list all their
activities in this field would be a lengthy process. However, in addition to their activities
in Vancouver, they have also conducted demonstrations in Victoria and in Penticton.
It is hoped that, in the year to come, arrangements will be completed for individuals of
this group to visit the more remote centres of the Province, therein also to encourage and
assist the resident dentists in the practice of children's dentistry. For their co-operation
in this and other fields, this Division records its sincerest apprecation.
GENERAL
The object and purpose of this Division has been explained; namely, to endeavour
to improve the dental health of the people of this Province.
The two major fields of activity during the past year have been described. In the
field of prevention the outstanding importance of the early fluoridation of water-supplies
has been drawn to your attention.
To increase the dental services available to people of this Province, it is heartening
to note that a Dental Faculty within the University of British Columbia this year has been
accepted in principle. It is to be fervently hoped that all possible assistance will be
provided so that its establishment may be made possible at the earliest practical date. BB 66 BRITISH COLUMBIA
REPORT OF THE DIVISION OF PUBLIC HEALTH ENGINEERING
R. Bowering, Director
The specialized field in public health, in which engineering principles and techniques
based upon biological data are employed in the practice of public health, constitutes the
field of public health engineering. It deals essentially with the control of the environment, with those modifications and protective and preventive measures that have been
found desirable or necessary for providing optimum conditions for health and well-being.
This involves a wide range of activity, as engineering methods can be useful in solving
many diverse problems in public health. The Division of Public Health Engineering
functions as a part of the Bureau of Local Health Services, even though many of its
activities are on a Provincial rather than a local level or responsibility.
The industrialization that has been going on in British Columbia during the past
year, if continued, will create more and more public health engineering problems. Also
the expansion of the local health services has brought to light many public health problems
which require engineering for their solution. It has not been possible to deal adequately
with all the problems that have come to light to date with existing personnel, and increasing difficulties in accomplishing all that should be done are anticipated if there is no
increase in staff and the expansion of the Province's industry and population continues.
Staff changes during the year consisted of the return of Mr. R. Bowering to the
position of Director and the resignation of one public health engineer. The vacancy
created by this resignation remained at the end of the year because of the lack of applications from suitable candidates for the position.
WATER-SUPPLIES
The Division has the responsibility of reviewing plans for extensions, alterations, and
construction of new waterworks systems.
The " Health Act" requires that all plans of new waterworks systems, alterations,
and extensions to existing systems be submitted to the Health Branch for approval. One
of the major duties of the Public Health Engineering Division is the review of these plans.
A large amount of waterworks construction was carried on during the year. A total of
thirty-three plans were approved in connection with waterworks construction. The
approval of plans requires, in some cases, visits to the field and, in some cases, consultation with consulting engineers and municipal authorities.
In addition to the approval of plans, a large number of the waterworks plants in the
Province were visited for the purpose of checking on sanitary hazards and assisting generally in the improvement of waterworks systems.
Many water-supply systems should be better protected from contamination than
they are present. Simple chlorination will provide reasonable protection in most cases.
A number of water-supply systems have been equipped with suitable equipment during
the past ten years, and thus have the means of improving the bacterial quality of the water.
Chlorinating equipment requires maintenance and intelligent operation procedures in
order to give satisfactory service. Unfortunately, in many cases these requirements are
not recognized, and, consequently, expensive equipment is often providing inferior service.
Improvements in this situation could be obtained if more advice regarding the operation
of equipment could be given to the operators and owners. In most cases the local
Sanitary Inspector does not have sufficient engineering knowledge to assist in this regard.
At present all these plants cannot be visited more frequently than once in two to three
years by qualified sanitary engineers.
Also, there are other problems in the maintenance and operation of a waterworks
system which cause sanitary hazards. More frequent visits to the waterworks systems
in the field would be of much value in overcoming these problems. DEPARTMENT OF HEALTH AND WELFARE,  1952
BB 67
The local health units are responsible for the regular frequent sampling of water
from public water-supply systems. The Division of Laboratories performs the examinations of the samples. In this way a constant check is kept on the quality of water
served to the public of British Columbia.
At the close of the year there were no water systems in the Province to which fluoride
was being added. It is felt that during the coming year there will be some fluoridation
plants installed in the Province. For all practical purposes there are no fluorides present
in the natural water-supplies of British Columbia. A number of consultations were held
with waterworks operators and local water authorities regarding fluoridation, and in one
or two instances estimates of the cost were prepared. Regulations for the control of
fluoridation and other forms of water treatment are becoming more and more a necessity,
and these will be prepared during the coming year.
The Division receives a number of inquiries each year concerning private water-
supplies. It is customary for the Division to refer the person inquiring to the local health
unit. In many cases the local health unit refers to this Division technical problems that
arise in regard to private water-supplies. In addition, standards for well construction
and treatment are provided to the local health units.
SEWAGE-DISPOSAL
The " Health Act " requires that plans of all new sewerage construction be approved
by the Minister of Health before construction may commence. During the year eleven
approvals were given. In the case of the larger cities, such as Vancouver and Victoria,
the submission of plans of all extensions has not been insisted upon owing to the fact
that these cities have excellent engineering staffs, and owing also to the fact that the
review of plans from these larger cities would be too time-consuming. In the above
cases the over-all schemes and standards have been approved. Also, where a new
outfall is planned, or where any major change in the sewerage system is contemplated,
approval is sought and given in the usual way.
One of the municipalities in the Province, the Municipality of Saanich, that has been
unsewered even though highly urbanized in some areas had construction crews working
throughout the year on the building of their new sewerage system. By the end of the year
some of the homes in the municipality were connected.
The Vancouver and Districts Joint Sewerage and Drainage Board has been making
studies toward the ultimate disposal of sewage from Greater Vancouver. The present
development of sewerage in Greater Vancouver has followed a report prepared about
forty years ago. In view of the changes in standards, and in view also of the type of
growth of Vancouver and surrounding municipalities, it has been felt that a new plan
should be formed to guide the sewerage programme for the coming years. A firm of
consulting engineers was employed to do this. Several conferences were held with the
consulting engineers and with members of the staff of the Vancouver and Districts Joint
Sewerage and Drainage Board in connection with the proposed master plan. This plan
should be finalized during 1953.
About 55 per cent of the population of British Columbia is served by public sewerage
systems. There still are, however, a number of urban areas that are badly in need of
sewerage systems.
During the past year a number of villages in the northern part of the Province had
preliminary plans of sewerage systems prepared by consulting engineers. These villages
were all visited, and the plans for the sewerage systems were reviewed in the field. One
of the difficulties that the villages have is financing of sewers. Only three organized
villages in the Province have sewers.
In addition to the organized municipalities, there are a number of urbanized areas
in the unorganized territory.    In some of these, nuisances are constantly arising because BB 68 BRITISH COLUMBIA
of lack of sewers. While it is possible for these areas to provide sewerage systems for
themselves on a voluntary community basis, it is felt that some legislative machinery
should be prepared by which sewerage systems could be built and maintained without
the consent of the majority of the property-owners in the area in those cases where
improper sewage-disposal methods create a health hazard to adjoining communities.
STREAM-POLLUTION
Stream-pollution is caused by the discharge of municipal and industrial wastes into
surface waters. These discharges can have quite diverse effects on the quality of the
receiving body of water because of the extreme variations in the type and strength of the
waste and the quality and volume of the receiving bodies of water. The net result of
such discharges, however, makes the water less desirable and less useful.
The extent of stream-pollution in the Province is not alarming at present as there
are only a few instances where waste discharges have affected down-stream water uses.
However, it is recognized by most that adequate controls should be established in order
to prevent pollution rather than to wait until it becomes a problem and then try to
reduce it.
The Health Branch has had general legislation for the control of municipal wastes—
sewage—for a number of years. The control of pollution by sewage under this legislation
has not been perfect, but it has been possible to prevent the discharge of sewage from
affecting communities in lower stretches of streams and rivers.
A number of departments in addition to the Health Branch have legislation for the
control of industrial wastes. This legislation is of a very general nature, and is utilized
by each department to protect its special interest. As these interests involve such diverse
things as fish, navigation, public water-supplies, and irrigation, it is not surprising that
different interpretations of the general Acts of legislation are made by each department.
In the administration of stream-pollution legislation, an effort is usually made to
obtain the opinions of officials of all the departments which are interested in the specific
discharge before a decision is made. This seems the best possible arrangement under
the circumstances, but there are a number of disadvantages to it. These include:
(1) The industries are advised of problems after they exist, and are thus not able to plan
intelligently to prevent the problem; (2) the basic data necessary for a reasonable decision are seldom available, and no department has the technical staff able to spend much
time on such work; (3) individual decisions do not necessarily follow a pattern as there
is no over-all policy for the Province; (4) the most restrictive recommendation is liable
to be adopted by the group as there is no one person to decide on a relative value of the
suggested requirements. It is hoped that in the coming year a basis for a more reasonable administration of stream-pollution problems can be evolved by the interested departments so that these disadvantages can be eliminated.
Representatives from the Division sat in on a number of conferences on individual
stream-pollution problems during the year. Some progress was made, but because of the
difficulties already mentioned, the results were not too encouraging.
A meeting of the Pacific Northwest Pollution Control Council was attended. This
Council is a voluntary organization, made up of a representative from each State or
Province in the Pacific Northwest. The ideas obtained and the standards developed at
such meetings should prove useful in improving stream-pollution control in the Province
in future.
SHELL-FISH
The administrative procedures for enforcing the shell-fish regulations have now
become fairly well established. The inspection of shucking plants and handling procedures now come under the jurisdiction of the local health unit. Reports are made on
uniform forms issued by this office.   The Department of National Health and Welfare DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 69
also has an interest in shell-fish control since they have to approve licences for export
purposes. The Provincial regulations are such that any shell-fish produced in the Province in conformity with the regulations will automatically conform with the requirements
of the Department of National Health and Welfare. A number of new shell-fish leases
were forwarded to this Division for approval. All of these were found to be in unpolluted
areas and therefore approved. There still are some areas in the Province where shell-fish
cannot be produced owing to local pollution. These areas include portions of Ladysmith
Harbour, the tide-flats at the south end of Nanaimo Harbour, and the upper reaches of
Victoria Harbour, including the Gorge and Portage Inlet.
The matter relating to shell-fish toxicity is still before us. It is felt that during 1953
some decision must be made with regard to keeping closed or reopening at least portions
of the west coast of Vancouver Island for the taking of clams and mussels. Assaying of
clams by the laboratory of the Department of National Health and Welfare in co-operation
with Federal and Provincial fisheries and health agencies was continued during 1952.
It was not possible to find any correlation between the seasons and the amount of toxicity.
This year's sampling and assaying were done in areas where the toxicity was known to
be high.
TOURIST ACCOMMODATION
The Director of Public Health Engineering is one of the five members of the
Licensing Authority for Tourist Accommodation. Inspection of tourist camps, auto
courts, etc., is done on the local level by local Sanitary Inspectors. The reports of the
Sanitary Inspectors are co-ordinated by this Division, and recommendations for or against
licensing are made to the British Columbia Government Travel Bureau. There are about
1,300 licensed tourist camps in the Province at the present time, and the work done by the
Health Branch has had a considerable effect in producing a fairly high standard of tourist
accommodation.    Eight licences were cancelled on health grounds in 1952.
The requirement for licensing of tourist accommodation has had an excellent effect
in preventing nuisances. Where information has been received by a local Sanitary
Inspector that a tourist camp was to be built, he has been able to visit the owner and
advise him on his water-supply and sewage-disposal problems in many cases before
construction commenced.
GENERAL
One of the duties of the Division of Public Health Engineering is providing a consultative service to other divisions of the Health Branch and to the local health units on
any matters dealing with engineering. This entails a considerable amount of work.
During the year all of the health units except one were visited at least once. During these
visits the various problems requiring engineering for their solution are examined in the
field.
Consultative services also require a considerable amount of office work. For
example, the seven frozen-food locker-plant plans that were approved during the year
were all carefully studied as to refrigeration requirements, etc., by this Division.
The Division has also played a part in civil-defence work. Two meetings were
attended during the year for the purpose of arranging for the best use of public health
engineers and Sanitary Inspectors in civil-defence work. This work will continue into
the next year.
The position of Chairman of the British Columbia Examining Board for the Sanitary Inspectors' examinations was again filled by this Division. This involved organizing
three days of examinations and marking a number of papers. Valuable assistance was
given in this work by members of the Victoria City health department.
Several meetings were attended in connection with the proposed new plumbing
regulations. BB 70 BRITISH COLUMBIA
There is one field in which it is felt this Division should be active but finds it impossible owing to the lack of staff. This is in the preparation of at least preliminary plans
with cost estimates of building water-supply systems or sewerage systems in unorganized
territory. There are a number of unorganized communities in the Province where some
non-official agency, such as a Board of Trade, wishes to get information regarding the
building of a public water-supply system or a public sewerage system. In these cases
there are no local funds available for employing a consulting engineer to do the work that
would lead at least to an estimate. It is felt that the provision of such a service would lead
to an increase in the number of sewerage systems in the Province.
It is anticipated that the industrial expansion that the Province has enjoyed during
the past year will continue. This will lead to more and more public health engineering
problems. If these problems are seen in advance and plans made for their reasonable
control, there is no reason why the environment during the 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 proper recommendations may be made for the adoption by the Government
of adequate regulations and programmes. DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 71
REPORT OF THE DIVISION OF VITAL STATISTICS
J. H. Doughty, Director
The two main functions of the Division have remained unchanged. These are
divided between (a) statutory duties and (b) statistical services. The former comprise
the administration of the " Vital Statistics Act," the " Marriage Act," the " Change of
Name Act," and certain sections of the " Wills Act." The latter consist of providing
statistical data regarding births, deaths, marriages, and other phases of the Division's
activities, and also of carrying out the statistical requirements of all the other divisions of
the Health Branch.
It is interesting to note that although the number of births recorded in 1952 remained
approximately the same as the previous year, the number of birth certificates issued by the
Victoria office increased quite sharply, reaching a peak during August. Birth certificates
issued through the Victoria office numbered 32,360, as compared with 26,566 in 1951
and 20,271 in 1950. There were 3,706 marriage certificates issued and 5,307 death
certificates. Revenue-producing searches numbered 30,138, while 19,179 non-revenue
searches were made, in addition to which 6,097 searches were made free of charge for
other Government departments.
The revenue received by the Victoria office reached an all-time high with collections
of $48,966, an increase of almost 10 per cent over the previous year, which in itself was
the peak year up to that time.
REGISTRATION OF BIRTHS
Current Registrations
The registration of births has attained a level at which it may be stated that there is
virtually no lack of recording, except in isolated cases in remote regions of the Province
and with the Sons of Freedom sect of Doukhobors. In a very limited number of cases,
mothers enter hospitals under assumed names for the births of illegitimate children and
then disappear before filing registrations.
Applications were received from a small number of persons who requested that
registrations filed in a prior period be cancelled owing to fictitious information having
been supplied originally. Investigations of each case showed than an ill-advised effort
had been made to protect the interests of an illegitimate child. In several cases the mother
had been unmarried at the birth of her child and attempted to conceal the truth of her
plight by supplying a fictitious name as that of the child's father. In other instances,
children were born to married women after a period of separation from their respective
husbands and yet the mother had falsely recorded the husband as being the child's father.
There was no indication that these actions were attempts at deliberate fraud for financial
or other such reasons.
Since a great deal of credit for complete and prompt registration of births is due to
the splendid co-operation of the medical profession and hospital staffs in supplying birth
notifications to the various district registrars, the appreciation of the Division is hereby
expressed to them for the services rendered.
Gratitude is also expressed to the Regional Director of the Department of National
Health and Welfare for assistance rendered in cases involving investigations.
Delayed Registration of Birth
The bulk of applications for delayed registrations was again confined to persons
born before the year 1920, indicating there has been a much more thorough coverage of
registration during the last thirty years than existed before. BB 72 BRITISH COLUMBIA
The payment of Federal old-age security pensions and the lowering of the age-limit
for eligibility for Provincial old-age pensions has increased the number of applications
for birth registrations and for certification among this older age-group, and it is reasonable
to believe that this increased demand will be sustained.
The Division continued to be active in its search for material which could be used
for supporting evidence in conjunction with applications for delayed registrations. As
a result, some important additions, in the form of baptismal records, were made.
The Division has continued to be guided by the Schedule of Minimum Standards of
Evidence acceptable in the filing of delayed registrations of birth, which schedule was
laid down at the Dominion-Provincial Conference on Vital Statistics in 1944, and which
is uniformly adhered to by all Provinces of Canada. In effect, this schedule requires that
the registrar have documentary proof of a good quality before he accepts an application
for a delayed registration. The necessity of good supporting proof is often not understood by the applicants, who, if they are the parents, feel that no one is in a better position
than they are themselves to assert that the birth did take place at the time and place stated.
The insistence of the registrar on adequate documentary proof is, of course, a most vital
factor, since the whole value of birth certificates as legal documents proving the facts
stated thereon would be undermined if persons were permitted to file a registration at will.
The volume of delayed registrations received was somewhat higher than that for
the previous period, but it is reasonable to believe that this situation was caused by the
demand of actual and potential applicants for the new old-age security pension. It is
expected that the number of such registrations should soon commence to show a decrease
as the recording for the period involved becomes reasonably complete.
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.
Marriage registrations are also checked to ensure that the marriage has been solemnized by a duly registered minister or clergyman, or Civil Marriage Commissioner, as
required by the " Marriage Act." Occasionally, marriages are discovered which, through
ignorance or inadvertence, have been performed by an unregistered clergyman. Where
possible, steps are immediately taken to secure validation of the marriage. DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 73
DOCUMENTARY REVISION
It will be appreciated that there are many circumstances which may cause changes
in the personal records of any individual. For example, when given names and (or)
surnames are changed, adoptions, or dissolutions of marriage are ordered by the Courts,
errors in information originally supplied are detected, etc., it becomes necessary to amend
the registrations involved in order that they may reflect accurate and up-to-date
information.
In order to ensure that the number of future changes will be kept to a minimum, all
current registrations processed in the Division are carefully scrutinized to guard against
obvious errors and omissions which might later cause hardship to the individual and
additional work in the central office in making amendments. It will be readily seen,
however, that the accuracy of much of the information given on a registration can only
be checked by the informant or other members of the family.
All registrations which have been amended are immediately remicrofilmed and the
indexes amended accordingly.
ADMINISTRATION OF THE " MARRIAGE ACT "
Applications were made by four religious groups during the year for recognition
pursuant to the terms of the " Marriage Act" for registration of their ministers. Of
these, one group was granted recognition, one was refused, and the remaining two were
in the process of completing documentation at the year's end.
In addition, inquiries were made by thirteen other groups, who were advised of the
requirements to be fulfilled before their ministers may solemnize marriage. There has not
been a clear indication whether or not any of these groups will pursue the matter beyond
the first inquiry.
Orders permitting remarriage, as required by section 47 of the " Marriage Act,"
were approved in fourteen cases.
In eight instances where marriages had been solemnized in good faith but the
officiant had been unregistered at the date of marriage, validations were ordered as provided in the " Marriage Act."
Form M. 1, Application for Registration of Minister or Clergyman, was revised in
a simplified form and placed in the field.
ADMINISTRATION OF SECTIONS 34 TO 40, INCLUSIVE,
OF THE " WILLS ACT "
Nearly 15,000 notices showing the location of the last will of the respective testators
had been filed as at December 31st, 1952. Legislation requiring the Division to receive
and file such notices was enacted in 1945. Although the response from the general public
was slow for the first several years, there has been a great increase in the number of
notices filed within the last few years. During 1952 there were 3,989 notice filed by
the Division, as compared with 2,700 in 1951, while 2,200 were received in 1950 and
only 1,500 in 1949.
Notices are indexed as rapidly as received, so that searches made will include the
most recently filed documents.
As was envisioned at the commencement of this service, a problem is developing
regarding a means of identification due to repetition of like names in the index. The
Division has attempted to overcome this by providing a form of notice which embodies
certain identifying personal particulars and encouraging its use. However, since there
is no statutory obligation to furnish these details, many notices are received with very
limited identifying information. Ultimately, a portion of these will cause difficulty to the
Division and to the executors of estates in making positive identification of testators. BB 74 BRITISH COLUMBIA
Although this is an undesirable situation, it appears that the remedy lies in some statutory
changes being made with respect to the preparation and submission of wills notices.
REGISTRATION OF VITAL STATISTICS AMONGST THE INDIANS
Current Registrations
Efforts are continuing to be made to familiarize the Indian population with the value
of accurate registration of vital statistics. It is apparent that the Indian Superintendents
are doing much to encourage the practice of obtaining birth certificates for new-born
children as well as for the older members of families. The laminated type of plastic
certificate is particularly serviceable to Indians as its durability withstands the rigours
of the nomadic life followed by such a large group of these people.
Results of policies formulated and carried out during the last several years have been
very gratifying, and it is reasonable to believe that registration of current births is virtually
complete.   The recording of marriages is likewise satisfactory.
The registration of deaths still presents difficulties, due partly to lack of good transportation facilities in many areas settled by these people and by their indifference toward
this convention of the white man, from which they can see no immediate benefit. An
educational campaign in this respect is being carried on with the various chiefs by the
Indian Superintendents, who attempt to explain the true meaning and importance of
registration to them. Progress is slow, however, and in all probability many years will
elapse before Indian death registration is quite satisfactory.
Documentary Revision
The project of checking, revising, and reindexing Indian registrations filed during
the period from 1917 to 1946, inclusive, was continued throughout the year.
Comparisons are made between original records within the Division and Indian
Agency copies of the same documents. Where discrepancies are discovered, further
inquiries are made and, when necessary, the registrations are corrected.
One hundred and thirty-one schools submitted reports for the 1951-52 term, of
which eleven indicated that no Indian children were enrolled for the first time. A total
of 1,197 pupils attended school for the first time, and records of these children showed
a high percentage of discrepancies. In many cases the information supplied by the
parents to the schools was found to be inaccurate and amended accordingly in the school
records. In other instances the submission of the report enabled errors to be traced in
registrations, and action has been taken to correct them.
Progress on this project was unfortunately retarded due to several changes of the
personnel involved and to an unusual amount of minor sickness of the staff.
Delayed Registrations
Several important additions to verification material were obtained and have proven
useful in completing applications for delayed registrations.
The Indian Commissioner for British Columbia has made a determined effort,
through his Superintendents, to clear up the known cases of unregistered births. As
a result, many registrations were completed and filed. Attention will continue to be
directed toward the elimination of this deficiency, which was largely caused by the registration of vital events of Indians being on a voluntary basis until 1943.
REGISTRATION OF VITAL STATISTICS AMONGST THE DOUKHOBORS
Current Registrations
Little difficulty was encountered in the attitude of most Doukhobors toward registration of births. However, the Sons of Freedom remained adamant in their refusal to file
registrations. DEPARTMENT OF HEALTH AND WELFARE, 1952 BB 75
It appears that those Doukhobors who do not oppose registration are making use of
the facilities for the recording of vital events, while no effective means has thus far been
discovered for obtaining registrations from those who denounce the practice of registration
on religious grounds.
The field representative carried on his activities until he voluntarily resigned near
the end of the year in favour of other employment. After making a careful study of the
value of continuing such a service, it was considered that the gains which had been
anticipated during the last several years had largely been achieved, and that it would be
an opportune time to discontinue this appointment.
Exhibit at Nelson Fall Fair
Through the efforts of the Deputy District Registrar at Nelson, an interesting exhibit
on vital statistics was set up at the fall fair which was held in Nelson in September. The
exhibit depicted by a series of posters some of the forms and certificates used by the
Division and explained the purposes of each. A brief illustration of the statistical services
provided by the Division was also included.
The experiment was unique in that it was the first exhibit of this type to be displayed
at such a function in British Columbia. A good deal of public interest was aroused,
particularly centring on delayed registrations of birth, concerning which many inquiries
were received shortly after.
EFFECT OF OLD-AGE SECURITY LEGISLATION
As had been anticipated, the introduction of this legislation has caused a noticeably
higher volume of certification than was experienced previously. Although direct verification of birth of each applicant is the primary object of most persons, the lack of a birth
registration usually leads to the more indirect method of proving age by information
shown on marriage certificates, baptismal certificates, etc. There has therefore been
a heavier demand for certificates of this type than existed formerly.
SURVEY OF DIVISION
In August the firm of Kellogg & Stevenson carried out a survey of the Division.
This included a review of the organization of the Division and personnel allocation, duties
and responsibilities, routines and methods.
GENERAL OFFICE PROCEDURES
This is the fourth year since the Division introduced a multi-part form for the
processing of applications for certification with the minimum of delay. The combined
form provides (a) the cash-register receipt, (_.) 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. Several reprints of the
original form have been made since its introduction, and slight changes have been made
with each print. A further reprint was made this year, embodying some additional
refinements aimed at an increased rate of production.
A continual assessment is made of forms and procedures, with a view to maintaining
and increasing efficiency. Apart from the form specifically outlined above, several others
were simplified and reprinted during the year.
The Division laboured under extremely serious conditions of overcrowding and poor
facilities for most of the year. This was caused by a tremendous increase in volume of
certification within the last ten years and the undertaking of additional duties and responsibilities, which in turn had necessitated some increase in staff. During that period there
had been no increase in office space.    However, during November certain changes were BB 76 BRITISH COLUMBIA
made which increased the amount of space available to the Division and provided some
measure of improvement.
The year 1952 was a period of unprecedented changes of staff and absences due to
illness. Several persons resigned or transferred in favour of more gainful employment.
Recruitment of satisfactory replacements was exceedingly difficult. In most cases a
period of several weeks elapsed between the date when the vacancy occurred and the
date when the successor reported for duty. Furthermore, several replacements in the
lower-level positions proved unsatisfactory during their probationary period of employment and were dismissed. One member of the staff retired on superannuation in
September.
The frequency of minor illnesses considerably aggravated the problems created by
staff changes. There were many occasions during the year when the normal work-flow
was maintained under the utmost difficulties, which taxed the resourcefulness of the
senior staff. However, through the outstanding co-operation of the section heads, there
were only few periods when the issuance of certificates was delayed more than a day or so.
MICROFILMING OF DOCUMENTS
All current registrations of births, deaths, marriages, and stillbirths were photographed on a weekly basis, the records for all previous years having been done in a prior
period. Amendments to registrations, caused by adoptions, divorces, name changes, etc.,
were photographed currently, and the amended images spliced on to the appropriate rolls
of film.
(a) 250 complete files re change of name applications.
(b) 8,000 files of adoption orders and supporting documents (1920 to 1951,
inclusive).
(c) 1,400 files of dissolution and nullity of marriage (1935 to 1951, inclusive).
(d) 3,300 notices of change of name (1941 to 1951, inclusive).
(e) Miscellaneous medical and institutional records concerning births.
A separate project of photographing 806 large blue-prints of water and sewer
systems was carried out for the Division of Public Health Engineering.
DISTRICT REGISTRARS' OFFICES AND INSPECTIONS
Changes in Registration Districts
With the opening of the new Court-house in Courtenay, the Government Agency
was transferred from Cumberland to Courtenay. Accordingly, the Vital Statistics Registration Districts of Cumberland and Courtenay were redefined and consolidated into one
registration district, the Registration District of Courtenay. This change enabled the
Division to relieve the Royal Canadian Mounted Police detachment at Courtenay with
the appointment of a District Registrar and Marriage Commissioner, and to turn over the
records to the Government Agency.
The Royal Canadian Mounted Police headquarters have continued to press their
requests to be relieved of vital-statistics duties in certain areas. Therefore, in addition
to transferring the Courtenay office, five other district offices have been transferred from
police offices. These offices include Campbell River and Chemainus, which are now
handled by the Village and Municipal Clerks respectively; the Hope office, which has
been transferred over to the local Stipendiary Magistrate and Coroner; and the Haney
office, which has been taken over by a private individual. Also, the office at Teslin,
Yukon Territory, was closed out and no replacement made as it is felt that the few
registrations received do not warrant the continuance of an appointment in that district.
With the opening of the Kitimat area, it was felt that a representative in that district
would be desirable.    Accordingly, the local Stipendiary Magistrate was appointed a DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 77
Deputy District Registrar of Births, Deaths, and Marriages and a Marriage Commissioner
for the Registration District of Prince Rupert, with location of office at Kitimat.
As pointed out in the section on Registrations of Vital Statistics amongst the
Doukhobors, the special Deputy District Registrar working amongst the Doukhobors in
the West Kootenay area resigned his position, effective October 31st, 1952. At the time
of writing, a successor has not been appointed.
INSPECTIONS
Thirty-two offices and sub-offices, covering Vancouver Island, Powell River,
Squamish, Fraser Valley extending as far as Hope, and the Okanagan area extending to
Revelstoke, were visited by the Inspector of Vital Statistics during the year.
In addition, instructional visits were made to seven Indian Agencies. Visits were
also made to the New Westminster, North Vancouver, and Vancouver offices.
In those offices where the duties were transferred from the Royal Canadian Mounted
Police—namely, Campbell River, Hope, Chemainus, and Haney—the Inspector was on
hand to arrange the transfer of duties from the police officers and to instruct and familiarize the new incumbents with the various procedures, forms, etc., which a district office
must follow and use in order to operate in an efficient manner.
A visit was also made to Nelson to close the office of the special Deputy District
Registrar for Doukhobors and to take inventory of that office.
At the close of the year there were ninety-one offices and sub-offices in seventy-one
registration districts, one less than the previous year because of the consolidation of the
Courtenay and Cumberland Districts.
Thirty-seven of the offices are Government Agencies or Sub-Agencies, while
twenty-three of the offices are operated by Royal Canadian Mounted Police personnel.
Six more offices are operated by Village or Municipal Clerks, nine offices by Provincial Government employees, and sixteen by private individuals, including merchants,
postmasters, Stipendiary Magistrates, Game Wardens, and a Canadian Customs official.
STATISTICAL SERVICES
Those services rendered by the Division in its capacity of statistical workshop for all
vital and public health statistics continued throughout the year at a steady pace. Not only
were there numerous routine compilations of data, which became more extensive during
the course of the year, but there was also a wide range of requests for a variety of statistical
data, received not only from other Health Branch services, but from other Governmental
departments, both Provincial and Federal, and the general public.
Through the use of funds made available under National health grants, it was
possible for one member of the research section to proceed to the University of Minnesota for postgraduate work in biostatistics, and for another to attend a one-week institute
on public health statistics and administration held at the University of Michigan. The
value of such postgraduate training in equipping the staff to meet the requirements of the
expanding public health services is very great.
The current year saw the completion, on the Provincial level, of the National
Sickness Survey, with the submission to the Department of National Health and Welfare
of the data compiled by the enumerators and of a comprehensive report covering all
aspects of the survey in British Columbia. The survey was undertaken in 1950 as a joint
effort between Federal and Provincial Health Departments. The data collected during
this survey are presently being tabulated at Ottawa, and the first analyses are anticipated
in the near future. The statistics which will be forthcoming should prove to be a valuable
source of information and interest to all persons concerned with the health of the
population. BB 78 BRITISH COLUMBIA
The first tabulations of the data reported on the revised Physician's Notice of a Live
Birth or Stillbirth form, which was put into use in 1951, were made during the year.
Although it is still too early to draw any conclusions from the analytical study of these
tabulations, as the series builds up, much valuable information on the circumstances
surrounding births within this Province will be forthcoming. The information is also
being used in connection with infant-mortality studies, and a punch-card has been drawn
up and put into use which correlates information from the physician's notice, the birth
registration, and the death registration.
Early in the year the Division was requested by the Provincial Secretary's
Department to review the existing record and statistical system in use in the Mental
Health Services, with a view to making recommendations which might lead to improvements in the processing and utilization of mental-health statistics. A preliminary survey
was carried out, and from the information gathered, a number of suggestions were made.
It was agreed that certain statistics should be transferred to punch-cards, to be processed
by the Mechanical Tabulation Section of this Division. It is intended that the new
service, which is planned to commence by April, 1953, will provide not only the statistics
required for the planning and operation of the expanding mental-health programme in
the Province, but will also supply that information required by the Dominion Bureau
of Statistics in its compilation of institutional statistics on the national level.
Important changes were made in the system of notifiable-disease recording, with a
view to making the statistics more readily available and of greater use. The work of this
section was heightened greatly during the year because of the serious poliomyelitis
epidemic. A complete record was kept of every poliomyelitis case reported, and during
the height of the epidemic an up-to-the-minute picture of the situation was available at
all times.
Much of the work of the statistical section is routine in nature, but this work covers
a wide range. Following is a listing of some of the routine activities carried out by the
statistical section:—
Weekly:— !
Statistics on notifiable-disease incidence by health-unit areas.
Statistics on notifiable-disease by age and sex.
Poliomyelitis incidence by sex and location (during poliomyelitis season).
Monthly:—
Listing of cancer incidence for each health unit.
Listing of newly reported cases of tuberculosis.
Listing of newly reported cases of venereal disease.
Statistical report of notifiable-disease incidence by health-unit areas.
Statistical report of notifiable-disease incidence by age and sex for major cities
in the Province.
Statistical report and analyses of births, deaths, marriages, stillbirths, and other
vital-statistic registrations.
Statistical report and analyses of vital statistics for Greater Vancouver.
Statistical report and analyses of vital statistics for Greater Victoria.
Statistical report and analyses of venereal-disease incidence.
Quarterly:—
Statistical summary of vital-statistics registration.
Statistical summary of tuberculosis morbidity and mortality.
Statistical summary of venereal-disease notifications.
Statistical summary of venereal-disease contact investigation report.
Statistical summary of tuberculosis and veneral-disease incidence by health-unit
areas. DEPARTMENT OF HEALTH AND WELFARE, 1952
BB 79
Annually:—
Compilation of annual reports on:—
Vital statistics.
Infant mortality.
Physician's Notice of Live Birth and Stillbirth.
Compilation of statistical data for:—
Annual Report of the Division of Tuberculosis Control.
Annual Report of the Division of Venereal Disease Control.
Annual Report of Medical Inspection of Schools.
Annual Report of Environmental Sanitation.
Annual Report of Food Consumption within Provincial Gaols.
Annual Report of Notifiable-disease Incidence.
Annual statistics on:—
Population, births, stillbirths, deaths, tuberculosis, and venereal disease for
each health unit.
REORGANIZATION OF RECORD SYSTEM IN DIVISION OF
TUBERCULOSIS CONTROL
In 1948 the Division of Vital Statistics was requested by the Medical Director of the
Division of Tuberculosis Control to make a study of the tuberculosis record system.
The work was undertaken shortly thereafter and has been carried on largely by the
Vancouver office of the Division of Vital Statistics. When the project was planned, it
was organized as a survey to investigate changes which could be recommended in the
tuberculosis record system to make it more effective. However, as the work progressed,
it became apparent that this was a continuing project and could best be carried out with
the Vancouver office acting in an advisory capacity to the Division of Tuberculosis
Control. The problem has three distinct phases: the completion of the individual
patient's record, the actual record forms in use, and the statistics compiled from these
records.
One of the first problems tackled was the manner of completion of the individual
patient's record, and it was recommended by the Division of Vital Statistics in 1950 that
a trained medical-record librarian be attached to the Division of Tuberculosis Control to
be in charge of all records within the Division. This suggestion was implemented in
September of 1951, and since that time improvement has been noted in all the medical
records. Much work still remains to be done in the supervision of the recording
procedures in the various units of the Division, and in the compilation of a manual of
instructions covering all the records in the Division.
At the time the survey was commenced, there were 156 different medical records in
use in the Division. Not all of these forms were in current use in every unit, but very few
of them had been declared obsolete. With the appointment of the records librarian, these
were all reviewed in consultation with the statistician in the Vancouver office. Forty-two
of the numbered tuberculosis records have now been declared obsolete. Eighteen new
records have been added after consultation with the various medical and nursing staffs.
Three new procedures have been established in connection with records. (1) All revisions or new records are being circularized through the various sections of the Division
of Tuberculosis Control for comments and suggestions before they are finalized. Most of
the new records are being multilithed so that modifications can easily be made. These
will be reviewed for printing at regular intervals. (2) Each section has been supplied
with a register of all numbered record forms now in use in the Division of Tuberculosis
Control. (3) All sections are estimating their record requirements for a six- or twelvemonth period, and the requisitions for these orders are checked through the Vancouver BB 80
BRITISH COLUMBIA
office.   A consolidated order for the printing of records is now placed with the Queen's
Printer at one time instead of more frequent individual requisitions as in the past.
The statistics being compiled for the Division of Tuberculosis Control have been
under critical discussion several times. The annual statistical report of the Division has
been reviewed, and, as a result, certain tables have been deleted in the light of changed
procedures, some tables have been added, and certain other tables have been redesigned
in the interests of simplicity and clarity. However, the general subject-matter covered by
the statistical report has not been materially altered. It is the feeling of both the Division
of Vital Statistics and the Division of Tuberculosis Control that greater use might still be
made of the statistical material which is gathered within these Divisions. In view of this,
it was recommended that a Medical Record Committee, consisting mainly of medical
personnel, be appointed on a permanent basis. This Committee has been appointed and
is available to the medical-records librarian and to the Division of Vital Statistics in an
advisory capacity in connection with technical problems of the record system. The
appointment of this Committee is considered to be of major importance in further
developing the record system in the Division of Tuberculosis Control, and should result
in better planning and utilization of statistics on tuberculosis in this Province than has
been possible in the past.
CANCER REGISTRY
Cancer was made a notifiable disease in this Province at the request of the medical
profession in 1932, and since that time it has been the responsibility of this Division to
promote and establish the complete reporting of this disease. The purpose of this
reporting is to make possible the provision of up-to-date data on the cancer problem in
the Province, and to make these data available to the medical profession and other
agencies interested in cancer. Although the term " cancer " is almost universally used
by the layman to refer to any malignant growth, technically the term refers only to a
specific type of malignant growth. In order to remove any doubts which might result
from inaccurate terminology, Form A-7, used for reporting cases of this disease, was
revised to read " Report of Malignant Neoplasm " instead of " Report of Cancer " as
formerly.
During 1952, 3,366 new cases of malignant growths were reported, of which 1,944
cases were reported alive and 1,422 cases reported for the first time at death. The
following tables show the malignant neoplasms reported during 1952 classified according
to site, age-group, and sex:—
Table I.—Number and Percentage of New Cancer Notifications1
by Site and Sex, British Columbia, 1952
Site
Male
Female
Total
Number
Per Cent
Number
Per Cent
Number
Per Cent
624
191
271
1
265
126
138
42
28
13
124
34.2
10.5
14.9
0.1
14.5
6.8
7.6
2.3
1.5
0.8
6.8
374
338
171
374
28
54
25
34
22
10
113
24.1
21.9
11.1
24.4
1.8
3.5
1.6
2.2
1.4
0.7
7.3
998
529
442
375
293
180
163
76
50
23
237
29.6
15.7
Skin    —       	
13.1
11.2
Respiratory system i 	
8.7
5.3
4.9
Brain and central nervous system 	
2.3
1.5
0.7
7.0
Totals       	
1,823
100.0
1,543
100.0
3,366
100.0
1 Includes 1,422 cases reported for the first time at death. DEPARTMENT OF HEALTH AND WELFARE,  1952
BB 81
Table II.—Number and Percentage of Reported Live Cancer Cases
by Site and Sex, British Columbia, 1952
Site
Male
Female
Total
Number
Per Cent
Number
Per Cent
Number
Per Cent
Skin      	
260
109
188
1
125
79
91
11
13
8
51
27.8
11.6
20.1
0.1
13.4
8.4
9.7
1.2
1.4
0.9
5.4
164
258
140
311
19
38
5
18
11
5
39
16.3
25.6
13.9
30.8
1.9
3.8
0.5
1.7
1.1
0.5
3.9
424
367
328
312
144
117
96
29
24
13
90
21.8
18.9
16.9
16.1
7.4
6.0
Respiratory system. 	
Lymphosarcoma     	
Brain and central nervous system._	
4.9
1.5
1.2
0.7
Other and not stated	
4.6
Totals              	
936
100.0
1,008
100.0
1,944
100.0
Table III.—Cancer Notifications1 by Sex and Age-group, British Columbia,
1952 (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  	
12
9
29
37
99
257
524
549
248
59
10.0
11.3
35.0
41.4
125.3
426.9
888.1
1,577.6
2,883.7
16
9
29
94
193
268
363
383
142
46
13.9
11.6
33.3
98.5
273.4
493.6
753.1
1,372.8
1,797.4
28
18
58
131
292
525
887
932
390
105
11.9
10-19.	
11.5
20-29 	
34.1
30-39   	
70.9
40-49 „     	
195.2
50-59 	
60-69  ... .
70-79—. — 	
458.5
827.4
1,486.4
2,363.6
Totals  — — 	
1,823
296.9
1,543
264.2
3,366
281.0
1 Includes 1,422 cases reported for the first time at death.
Table IV.—Live Cancer Cases Reported by Sex and Age-group, British
Columbia, 1952 (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 _	
4
7
16
21
61
137
263
263
113
51
3.3
8.8
19.3
23.5
77.2
227.6
445.8
755.7
1,313.9
5
5
25
68
153
191
236
209
73
43
4.3
6.5
28.7
71.3
216.7
351.7
489.6
749.1
924.1
1
9       !           3.8
10-19—    	
20-29    	
12
41
89
214
328
499
472
186
94
7.6
24.1
30-39	
48.2
40-49. .        	
50-59	
60-69 	
143.0
286.5
465.5
752.8
1,127.3
936
152.4
1,008
172.6
1,944
162 3 BB 82 BRITISH COLUMBIA
THE PEOPLE OF BRITISH COLUMBIA
In last year's Report, certain highlights from the preliminary reports of the 1951
Census of the population were commented upon and the remarkable population increase
was noted. The final census count for British Columbia placed the population at
1,165,210 as at June 1st, 1951. Since that time there has been a continued increase, as
evidenced by Family Allowance records, birth and death statistics, and other measures.
With the further analyses of the data derived from the 1951 Census of Canada, a clearer
picture of the population structure in this Province is available, and it indicates that
British Columbia has a population structure which, in some aspects, is considerably
different from that of the rest of Canada.
A study of the age-grouping of the Province's inhabitants reveals that 53 per cent
of the population is 30 years of age or over, compared to only 46 per cent in this age-
group for all of Canada. On the same basis, the age-group 60 years and over constitutes
16 per cent of the Provincial population and only 11 per cent of the Canadian.
In the last ten years there has been a marked increase in the population 60 years
of age and over. This age-group has increased by 64 per cent, from 110,504 persons
in 1941 to 181,674 in 1951. During this same period the Canadian population in this
age-group rose only 36 per cent. The marked increase in this Province's proportion of
older population points up the fact that British Columbia may expect in the future an
increase in general mortality rates due to this ageing factor alone.
British Columbia maintains a rather unique position in the nation's population
picture with regard to the marital status of its inhabitants. Married persons account for
50 per cent of the total population, the single-status group for 44 per cent, the remainder
falling into the widowed and divorced categories. By comparison, only 45 per cent of
the total Canadian population are married, while, on the other hand, 50 per cent are
classified as single.
Almost one-quarter of the nation's divorced persons are shown to reside in this
most westerly Province. This population is, on the average, three times greater in its
proportion to the total population of the Province than is the case for the rest of Canada,
either Provincially or Nationally.
The percentage of widowed persons within the population is practically constant
throughout Canada, being 5 per cent of the total population.
It is interesting to note that in 1951 the married group included a larger proportion
of the population in both British Columbia and Canada than was the case a decade ago.
Although the percentage of males has remained in approximately the same proportion
in Canada between census years—namely, 51 per cent—that of this Province has
decreased from 53 per cent in 1941 to 51 per cent in 1951.
The spectacular growth in population experienced in British Columbia between the
census years of 1941 and 1951 is of great consequence to those dedicated to the task of
guarding the health and welfare of its people. Not only has the population increased
by 42 per cent, from 818,000 in 1941 to over 1,165,000 in 1951, but also it has continued
to age, and this has intensified many of the problems which must be met by the health
and welfare agencies. The figures highlight not only the necessity of increased facilities
for health-care and preventive measures, but also give some indication of the changing
emphasis which public health programmes must envision.
MORTALITY AND THE AGEING POPULATION
There has been little change in the death rate in British Columbia over the past ten
years. The crude death rate per 1,000 population, excluding Indians, in 1952 was
identical with the figure of 9.8 recorded in 1942. Although there is no actual decrease,
as evidenced by this rate, upon closer examination of the conditions under which such
deaths took place, it actually represents a much more dramatic improvement in the DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 83
mortality experience of the population. During this ten-year period the number of older
persons in the Province had been increasing faster than the total population. This ageing
of the population tends to result in a higher death rate, since the specific death rate for
the older ages is naturally very high. For example, while the over-all death rate in 1952
was only 9.8 per 1,000 population, the group 60 years of age and over had a specific rate
of 43.2 (that is, there were 43.2 deaths for every 1,000 persons in the population of the
group 60 years of age and over). This group, with its relatively high death rate, has
increased in numbers by 64 per cent in the past ten years, whereas the total population
has increased only 42 per cent. The effect of this ageing can be demonstrated by computing what the over-all death rate would have been in 1952 if the population had had
the same proportions in each age-group as it had in 1942. Under such conditions there
would have been only 9,946 deaths in 1952, but actually 11,426 deaths did occur. Thus
the crude death rate would have been only 8.5 per 1,000 population, when in fact it was
9.8, as previously stated, the difference between 8.5 and 9.8 being due solely to the ageing
of the population.
Had it not been for the remarkable improvements made in the death rate at virtually
all ages during the past decade, the over-all death rate in 1952 would have been 11.3
per 1,000 population instead of the 9.8 rate actually recorded. For example, the death
rate in the population under 60 years of age was 4.3 ten years ago, whereas it was only
3.5 per 1,000 population in 1952.
The three leading causes of death—heart-disease, cancer, and vascular lesions of the
central nervous system—continue to exact the greatest toll of lives in British Columbia.
This year 64 per cent of all deaths occurring within the Province were due to these three
causes.
Diseases of the heart accounted for 4,291 deaths in 1952, with a rate of 366.8 per
100,000 population, an increase over the 1951 total of 4,053, with a rate of 355.8.
Almost 38 per cent of all deaths were attributable to heart-disease, 1 per cent more than
last year. Of the total deaths falling within this category, 85 per cent occurred in the
age-group 60 years and over. This again points up the problem presented by the steady
accretion to the population of older age-groups within the Province.
Cancer caused 1,824 deaths in 1952 with a rate of 155.9, an increase over the figures
for the last two years. In 1951 this disease claimed 1,718 lives with a rate of 150.8 per
100,000 population, which was a decrease from the 1950 rate of 154.5. Once again the
greatest proportion of deaths from this cause occurred to persons 60 years of age and
over, 71 per cent of all cancer deaths being attributable to persons in this age-group.
Deaths from vascular lesions of the central nervous system, which, with the
introduction in 1950 of the Sixth Revision of the International Statistical Classification
of Diseases, Injuries, and Causes of Death, has come into greater prominence as a leading
factor in mortality, maintained its position as the third leading cause of death. There
were 1,149 lives claimed by this cause in 1952, compared with 1,174 in both 1951 and
1950, with corresponding rates per 100,000 population of 98.2, 103.1, and 105.9
respectively. Although a steady decline has been experienced over the last three years,
it is here also that a very large proportion of deaths occurred in the older age-groups.
During this year 87 per cent of the total deaths took place in the age-group 60 years and
over, and 64 per cent, 70 years and over.
The mortality rate for accidents has shown only slight change this year over last.
The average for the ten-year period 1942-51 was 76.9 per 100,000 population, whereas
in 1952 it was 75.6. The leading cause of accidental deaths was motor-vehicle accidents,
which took 197 lives, a 12-per-cent reduction over 1951 when 223 lives were lost.
Accidental falls came next, claiming 163 lives, with 59 per cent of these occurring in the
age-group 70 years and over. The transport accidents, other than motor-vehicles,
climbed considerably this year to the third leading cause for accidental deaths, 118 in all. BB 84 BRITISH COLUMBIA
Several bad aircraft accidents contributed greatly toward this rise. Ranking fourth were
drowning fatalities, of which there were 104. This is 7 more than in 1951. The three
age-groups which accounted for 47 per cent of all accidents were 70 years of age and
over, which featured in 19 per cent; the 20-29-year group, in 15 per cent; and the
30-39-year group, in 13 per cent.
A further dramatic decline in tuberculosis mortality occurred in British Columbia
during 1952. A comparison with the year 1942 shows a decline of 66 per cent in the
death rate from this cause over the past ten years. In 1942 the death rate for tuberculosis
in the non-Indian population was 45.9 per 100,000 population, whereas in 1952 it was
only 15.6.
The infant-mortality rate in the population excluding Indians showed a very slight
decrease this year over 1951, declining from 24.5 to 24.4 per 1,000 live births.
The birth rate decreased slightly from 23.5 per 1,000 population in 1951 to 23.1
in 1952. The rate of maternal deaths per 1,000 live births remained constant this year
at 0.6, thus retaining the spectacular improvement made during recent years. Only
twelve years ago, in 1940, the rate was 2.8 per 1,000 live births, or approximately five
times greater than it presently stands.
The epidemic of poliomyelitis which swept the Province during the year has had, as
would be expected, a most adverse effect on the mortality experience from this disease.
A total of 38 such deaths was recorded, with the rate per 100,000 population of 3.2.
These deaths were concentrated in the age-groups 0 to 14 and 20 to 49 years of age.
Deaths in the younger age-group accounted for 63 per cent of the total deaths and the
latter for 37 per cent.
Attention is directed to the fact that the numbers of deaths and the death rates
referred to in the foregoing paragraphs are preliminary only for the year 1952, and may
be revised slightly when final counts have been made and checked, and interprovincial
adjustments have been made on a basis of residence.
MORTALITY IN TERMS OF LIFE-YEARS LOST
The most commonly used measure of the severity of mortality from various causes
is the crude death rate, which is merely a statement of the number of deaths which have
occurred from each cause of every 100,000 persons in the population. Occasionally, for
comparative purposes, an age-adjusted rate is used, which eliminates the bias which
results when two populations being compared do not have identical age and sex composition. But neither of these measures takes into account the age at which the deaths occur.
Thus a death at age 70 counts just as much as one at age 10, yet few people would deny
that the death at age 10 is a much greater loss than the one at age 70.
Particularly in public health, which is dedicated not to the prevention of death, but
to the prevention of untimely or premature death, it is desirable to have a measure of the
force of mortality, which takes into account not only the number of deaths, but also the
ages at which those deaths occur. Such a measure has recently been evolved in several
forms, and one computation is known as the " life-years lost under age 70." It is a very
simple and straightforward measure. With the average life-span approaching 70 years,
it is possible to subtract the age at death from 70 and say that the difference is years of
life lost. For example, if an individual dies at age 10, he loses 60 years of life; if he dies
at age 55, he loses 15 years of life. For each cause of death these amounts are summated,
giving the total years of life lost through premature death.
When the force of mortality is measured in terms of life-years lost under 70, the
relative importance of the various causes of death changes radically. The accompanying
graph shows the force of mortality from the more serious causes, first, when measured as
a percentage of total deaths and, second, when measured as a percentage of the total
life-years lost under age 70.   It can readily be seen that when only the number of deaths DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 85
from the various causes are counted, the three most serious causes—diseases of the heart,
cancer, and vascular lesions of the central nervous system—account for 37.6 per cent,
16.0 per cent, and 10.1 per cent respectively of total mortality. However, in terms of
life-years lost, these three causes drop to third, fourth, and seventh places respectively,
and accounted for only 13.5, 10.8, and 3.3 per cent of the loss of life through untimely
deaths. The importance of diseases of early infancy and of accidents in causing
untimely deaths also become startlingly apparent.   These two causes resulted in 19.5 and
18.1 per cent of all life-years lost under 70, yet they constituted only 3.4 and 7.7 per cent
respectively of total deaths.
The foregoing discussion on mortality is presented because death rates constitute one
important criterion of the health of the population. However, it is well recognized that
death statistics alone do not purport to give a complete assessment of the health of the
people. Many diseases are of a long-term nature, and others result in varying degrees
of permanent injury or disability, and the effect of these factors must be measured in
other ways than through mortality statistics. BB 86
BRITISH COLUMBIA
•SPECIFIED CAUSES OF MORTALITY SHOWN AS A PERCENTAGE OF TOTAL DEATHS
AND AS A PERCENTAGE OF TOTAL LIFE YEARS LOST,  BRITISH COLUMBIA,   19S2.
PER CENT OF TOTAL DEATHS
I I
DISEASES OF HEART
CANCER
VASCULAR LESIONS
ACCIDENTS
RESPIRATORY
DISEASES
DISEASES OF EARLY
INFANCY
TUBERCULOSIS
CONGENITAL
MALFORMATIONS HI  1-4
37.6
DISEASES OF EARLY
INFANCY
ACCIDENTS
DISEASES OF HEART
CANCER
CONGENITAL
MALFORMATIONS
RESPIRATORY
DISEASES
VASCULAR LESIONS
TUBERCULOSIS
PER CENT OF TOTAL LIFE YEARS LOST*
19.5
*  Under age 70 0 5 10
**  Includes Bronchitis, Influenza,  and Pneumonia
20
PER CENT DEPARTMENT OF HEALTH AND WELFARE, 1952 BB 87
REPORT OF THE DIVISION OF PUBLIC HEALTH EDUCATION
R. H. Goodacre, Consultant
As a professional field of specialization in public health, health education is, of
course, still in its infancy, suffering at times inevitably from growing-pains. And yet it has
made remarkable progress during its short life of a decade or so. An eclectic discipline,
health education has been fortunate in being able to draw upon allied fields of education,
psychology, sociology, advertising, and even propaganda (in its true sense) for its fundamental principles. Although the methods and aims of each field may differ, they
nevertheless pertain basically to processes of learning and changes in behaviour, each
making use of theories developed by the other.
Just as advertising attempts to direct the consumers' thoughts and attitudes toward
the eventual purchase of a particular product, health education attempts to improve habits
and attitudes of the people toward improving their health. Thus the goal and method of
attaining that goal in advertising may differ from that in health education, but both are
attempting to induce first the learning and then a change in behaviour.
LOCAL HEALTH EDUCATORS
Health education is nothing new—it has been done by mothers, teachers, and the
family doctor for hundreds of years, and in public health by public health nurses, Sanitary
Inspectors, and health officers.
The term " health educator " may be confusing, for the health educator does the
educating only indirectly. Because of his specialization in educational methods, the health
educator is in a position to co-operate with other public health staff in making their health
education more effective. In essence, he is an enabler, a catalyst. The professional
health educator is " the man behind the man behind the gun," as it were.
In 1950 two health educators were placed in the field—one to serve the Victoria-
Esquimalt Health Department and Saanich and South Vancouver Island Health Unit,
and the other to serve the Central Vancouver Island Health Unit.
During this time their assistance in planning and co-ordinating programmes of health
education, in addition to their guidance on leadership to the staff and community on
matters concerning health education, has received rewarding acclaim.
No attempt is made by the Division to induce the placement of a health educator in
a health unit, since it is felt that first the request should originate from the staff of a unit,
and, second, for the development of a successful programme, the health-unit staff must
have a good understanding of the functions of the local health educator and an earnest
desire to work with a specialist in this field. Throughout the year continuous attention has
been given to explaining the functions of the local health educator through Local Health
Services personnel.
At the present time, however, the Division has not been able to fulfil the requests
made by two health-unit directors last year to have a health educator attached to the staff
of their units.   This is due largely to the inability to recruit suitable personnel.
As the situation now stands, there is only one health educator in the field, the other
from the Victoria-Esquimalt Health Department having been granted a two-year leave of
absence to take a position at Sarawak, Borneo, with the World Health Organization.
MATERIALS
To assist the field staff in their educational programmes, the Division maintains
central libraries of films, film-strips, and books, in addition to supplies of posters and
pamphlets. BB 88 BRITISH COLUMBIA
Since the dissemination of information alone is not considered to be health education,
but merely the first step in the educational process, constant efforts are being made to
ensure that field staff realize that films, film-strips, and pamphlets are aids in teaching and
not ends in themselves.
To further this end, catalogues of available materials are constantly being revised for
the guidance of the staff in the selection of appropriate materials. At the beginning of
the catalogue of films and film-strips now under complete revision will appear hints for
the most effective use of these media. During the year the film library was augmented to
include 208 films and 143 film-strips. Requests for films continue to increase, with the
greatest demand for films on personal health, primarily dental health, with sanitation,
nutrition, and mental health following in that order. Approximately 120 films have been
distributed each month, with a monthly audience varying from five to fifteen thousand.
The total audience for the year 1952 was slightly under 90,000 people.
During the past six months it has become increasingly difficult to obtain the free
literature on which the Division has had to rely in order to enable the field staff to continue
effective health-education programmes. This problem, common to several other Provinces, was discussed at a Federal-Provincial Conference for Health Education, called by
the Department of National Health and Welfare for the first time in three and one-half
years. Inasmuch as the majority of literature distributed in this Province originates from
the Information Services Division of the Department of National Health and Welfare, the
apparent budgetary problems existent with that organization are having a residual effect
upon the present health-education programmes in British Columbia. It is quite possible
that this Division will be required to produce a portion of its own materials should there
be no improvement in the availability of material from free sources.
At this same Conference, held on November 13th, 14th, and 15th, the Federal
Government's consideration of a move to charge for certain health pamphlets was
unanimously opposed by the Provincial representatives. It was felt that the Federal
Government should continue the practice of producing free literature, inasmuch as it is
generally more economical for a central agency to produce materials en masse for
decentralized distribution.
During the year this Division arranged for the production and printing of a nutrition
booklet entitled " Family Meals," compiled by a group of British Columbia nutritionists
and home economists, and a dental poster reprinted through the courtesy of the New
Zealand Department of Health.
CONSULTATIVE SERVICE
One of the major functions of this Division is to provide, on request, consultative
service on matters concerning public health education to local public health services, to
other divisions, and to other organizations.
In this connection, visits were made to a number of health units during the year to
discuss with respective staffs their local programmes in health education and, in some
cases, to assist in planning specific projects. It has not been possible to provide complete
consultative services to the field staff, since the shortage of Divisional staff has decreased
the opportunities for field-trips. Nevertheless, throughout the year, advice was given by
correspondence to local health services on various phases of health education, including
fall fairs, annual reports, planning talks and materials for co-operative play groups and
discussion groups.
As in the past, requests from persons living in areas supplied with public health
service were referred to local public health staff. Where the request was of an unusual
nature, the Division endeavoured to supply the local public health personnel with the
necessary information. DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 89
Consultative service to other divisions has been chiefly in the field of evaluation of
materials suggested for distribution to the public. At the request of the Department of
National Health and Welfare, draft copies of a number of pamphlets, including a revised
edition of The Canadian Mother and Child, were evaluated. In each case the comments
of persons representing the various groups, both lay and professional, were obtained and
summarized.   A similar service was provided for divisions within the Provincial service.
IN-SERVICE TRAINING
As in past years, the most extensive in-service training project during the year was
the Public Health Institute, held in Victoria from April 14th to 17th. The guest speaker,
Dr. Jennie Rowntree, Director of the School of Home Economics at the University of
Washington, gave a series of lectures on nutrition in public health. Her talks were most
valuable in that they presented a practical and sound philosophy regarding nutrition
teaching, which was of value to everyone in public health.
A member of the Health Education Division acted on the Institute Planning
Committee. In addition, the Division prepared a display of library books available to
the field staff, which resulted in many requests for books on loan. The local health
educator from the Central Vancouver Island Health Unit, who has prepared a large
number of displays, arranged a group of her exhibits for the benefit of the field staff.
It has since been possible to arrange for the loan of some of these exhibits to other health
units. An evaluation of the Institute programme was again undertaken through the use
of a questionnaire, designed by this Division. The results of the questionnaire were most
valuable in planning for the 1953 Public Health Institute, which will be held in Vancouver.
The orientation course for new members of the professional staff in the central office
and for new health-unit directors was continued during the year. Orientation was
arranged for three health-unit directors, one dentist, one nutritionist, one statistician, one
research assistant, and a civil-defence liaison officer.
Although health-unit directors receive copies of the two public health journals
published by the American Public Health Association and the Canadian Public Health
Association, both health officers and Sanitary Inspectors indicated a desire to see the
other journals, for which they felt individual subscriptions were not warranted. As a
result of these requests, the Division has inaugurated a system by which selected medical
and sanitation journals are circulated to medical officers and Sanitary Inspectors for their
perusal and information.
PUBLICATIONS AND PUBLICITY
One of the great problems facing the field of health education is the evaluation of
mass media in education. Falling within the category of mass media is B.C.'s Health, the
monthly bulletin of the Health Branch, which is designed to inform the general public
on Provincial, local, and voluntary agencies' services, in addition to its function of
providing simple, sound advice with respect to different aspects of public health.
Endeavouring to evaluate continually the effectiveness of this publication is the
Health Branch Public Relations Board, which, combined with its activities concerning
public relations and publicity of the Health Branch, guides both the content and approach
of B.C.'s Health.
Organized in April by the Minister of Health and Welfare's public relations officer
and members of this Division, the Board compiled during the year a written policy
covering the purpose, content, approach, and readership of B.C.'s Health, which is being
followed now, not as a directive, but as a flexible guide. A valuable outcome of the
Board's discussions was the decision to extend distribution of this bulletin to the various
house organs throughout the Province in order to reach ultimately a wider readership. BB 90
BRITISH COLUMBIA
STAFF
In the area of recruiting, this Division is by no means alone in its difficulties.
Nevertheless, the problem will become acute if the desired expansion of service is to be
realized. In 1952 two of the staff resigned, including Mrs. Kay Beard, the Consultant,
who had been with the Division since its inception. It will be indeed a challenge to uphold
the reputation of the Division which Mrs. Beard acquired during her six years of valuable
service, both to the Health Branch and to the field of health education.
If the programme of the Division is to be extended, it will be necessary to augment
the present staff of three in the Division's central office and one in the field. To date
there has been a definite problem in recruiting suitable applicants, since potential candidates are obtaining positions in other fields, notably that of teaching, which, from a
monetary point of view, are more rewarding for the qualifications required.
Health education is a field in which results are not immediately apparent or
measurable in dollars and cents. However, when the time arrives when salaries are
sufficient to draw desirable applicants, the Division will be in a better position to work
toward its goal of a Province-wide programme of health education both in the schools
and in the community. DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 91
REPORT OF THE HEALTH BRANCH OFFICE, VANCOUVER AREA
G. R. F. Elliot, Assistant Provincial Health Officer
This year has been an active one in all phases of the work of the Vancouver Area
office of the Health Branch, in charge of the Assistant Provincial Health Officer. The
latter is responsible for the Bureau of Special Preventive and Treatment Services, liaison
with voluntary health agencies in Vancouver, and the administration of the National
health grants to British Columbia.
The Bureau of Special Preventive and Treatment Services includes the Divisions of
Laboratories, Tuberculosis Control, and Venereal Disease Control. The Assistant
Provincial Health Officer is primarily concerned with matters of policy respecting these
Divisions, including co-ordination between these services, as well as between them and
the local health services. A detailed review of the work of each Division, which has been
submitted by the Director, follows this report.
The work of the voluntary health agencies and the activities under the National
health grants are reported herein.
The Vancouver office of the statistical section of the Division of Vital Statistics
continues to operate in the same location as this office, and to be a most useful development. The use made of the Division of Vital Statistics, not only by the divisions of the
Bureau of Special Preventive and Treatment Services, but by the voluntary health
agencies in the Vancouver area, continues to grow.
BUILDINGS
The year 1952 saw the completion and opening of the first half of the Pearson
Tuberculosis Hospital, which houses 264 patients. This development has certainly done
much to solve temporarily the problem of the shortage of hospital beds for patients
suffering from tuberculosis in this Province.
Plans for the second building mentioned in the 1951 Report, however, did not
progress as had been hoped.
Several times during 1952 it did appear that construction would be well under way
before the end of the year, but circumstances beyond the control of this Bureau have
prevented the commencement of this most important construction; in fact, all that can
be said is that the buildings housing the Divisions of Venereal Disease Control and
Laboratories are merely one year older and in a much more decrepit and dangerous
condition. The remarks found in the 1951 Report are worthy of study to those seeking
more information regarding this deplorable and disgraceful situation.
FACULTY OF MEDICINE, UNIVERSITY OF BRITISH COLUMBIA
An extremely close working relationship continues with the Dean of the Faculty of
Medicine, University of British Columbia, and in particular with the heads of the
Departments of Pediatrics and Preventive Medicine. These two departments are of extreme importance in our expanding public health programme, and without this understanding and support, public health will not advance in this Province in the manner the people
deserve. This Province is fortunate in having physicians in charge of the Departments of
Pediatrics and Preventive Medicine at the University of British Columbia who are most
understanding and co-operative in all the mutual health problems and programmes, both
present and future, that are an integral part of the Provincial Health Branch. This
programme of co-operation and assistance between the Medical Faculty and the Health
Branch is still expanding. BB 92 BRITISH COLUMBIA
VOLUNTARY HEALTH AGENCIES
The voluntary health agencies located in the City of Vancouver which receive grants
from the Provincial Government continue 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.
During 1952 this Province saw the development of two new voluntary health
agencies; namely, the Multiple Sclerosis Society and the Cerebral Palsy Association.
Both agencies were urgently required. Not only was financial assistance given from
National health grants, but time was also spent by the Assistant Provincial Health Officer
in discussing problems and programme-planning with the officials of these two newer
agencies.
The activities of the British Columbia Cancer Foundation, the Western Society for
Rehabilitation, and the Canadian Arthritis and Rheumatism Society (British Columbia
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 it 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 requests for assistance from the National health grants.
British Columbia Cancer Foundation
This organization, named as the agent of the Provincial Government for the
treatment and control of cancer in this Province, made 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. These consultative clinics now operate at nine
centres in the Interior of the Province.
The diagnostic and treatment centre of the British Columbia Cancer Foundation
which was opened last year at the Royal Jubilee Hospital in Victoria continues to provide
for a needed and expanding service.
The year 1952 was marked in October with the opening of the new clinic building
at the British Columbia Cancer Institute. The clinic was built by voluntary funds and is
adjacent to the Vancouver General Hospital. This treatment centre is second to none in
Canada and houses the most modern radiotherapy equipment available, including the
third cobalt 60-beam therapy unit in the world.
Western Society for Rehabilitation
This voluntary health organization in the field of rehabilitation continued to expand.
It is interesting to note that during the year the name was changed to " Western Society
for Rehabilitation," the term " Physical" being deleted. This procedure indicates the
nature of the expanding facilities that are available here, since this centre actually is more
and more encompassing all aspects of rehabilitation. The increasing responsibilities of
this agency during the year necessitated the appointment of an assistant medical director,
an additional brace-maker, as well as other staff. DEPARTMENT OF HEALTH AND WELFARE, 1952 BB 93
The outbreak of poliomyelitis which the Province experienced this year will bring
additional demands on this centre, since it is the only service in Western Canada which
offers satisfactory rehabilitation services.
The Canadian Arthritis and Rheumatism Society continues to have its medical
branch housed at the Western Society for Rehabilitation, where treatment for arthritis
is given on both an in-patient and out-patient basis.
At the present time it is quite apparent that more space is urgently required, and
active expansion plans are now under way. It is hoped that these plans will materialize,
and, furthermore, that the majority of rehabilitation services for the Province will be
centralized here; in a field as highly specialized as rehabilitation, it is of paramount
importance that the skilled personnel, who are few in numbers, and the expensive
equipment be centralized if our programme in rehabilitation is to advance to the full
benefit of the people of this Province.
Canadian Arthritis and Rheumatism Society (British Columbia Division)
Further expansion has taken place during 1952 in this voluntary health agency
largely as the result of the demands of the local communities. There are at present seven
diagnostic and treatment clinics, located at Victoria, Nanaimo, Vernon, New Westminster,
North Vancouver, and two in Vancouver, and from these clinics mobile physiotherapy
service is given to fourteen additional communities. There are also treatment-rooms
and mobile physiotherapy services in eight other cities—Kamloops, Salmon Arm, Penticton, Kelowna, Trail, Nelson, Cranbrook, and Mission—and mobile physiotherapy
service from these cities is given to another fourteen communities, in four of which there
are limited treatment-room facilities.
There are forty persons now serving this agency, including a medical director, two
assistant medical directors, twenty-two full-time physiotherapists and one half-time, two
orthopaedic nurses, and tv/o social workers. A shortage of physiotherapists still exists
and has delayed expansion somewhat.
CIVIL DEFENCE
The heavy responsibilities that fell on this office in previous years relative to civil
defence were removed somewhat with the appointment of a medical officer in charge of
civil defence in the central office in Victoria. A fair amount of time is, however, still
taken up in lectures on A.B.C. warfare; the groups lectured are, in the main, the
nursing-school at the Vancouver General Hospital and the Vancouver Civil Defence
School.
GENERAL
During the year considerable time was spent by the Assistant Provincial Health
Officer as Vice-Chairman of the Council of Practical Nurses under the " Practical Nurses
Act " passed in 1951. The matters which were discussed were primarily concerned with
the writing of the regulations under this Act. Early in 1953 it should be possible to have
these regulations passed and the actual operations of the Act brought under way.
The year was also marked by attention being paid to the increasing problem of drug
addiction in this Province, which was originally brought under active discussion in 1952
following a report by the Health and Auxiliary Division of the Community Chest and
Council, Vancouver. Drug addiction is not only a serious problem, but it is also a difficult
one due to the fact that no satisfactory solution can be brought about by any single
organization. For example, both the Health and Welfare Branches of this Department,
the Mental Hospitals under the Provincial Secretary's Department, and the Attorney-
General's Department are all closely concerned in this problem at a Provincial level. BB 94 BRITISH COLUMBIA
Many committees at the local, Provincial, and National level have been established
regarding drug addiction, particularly as it pertains to this Province. It has also been
actively discussed by the Deputy Minister of Health for this Province at the Dominion
Council of Health. It appears at this time that all interested groups in British Columbia
are co-operating in this most important problem, and that some progress toward at least
possible solutions is being made.
Several meetings were attended relative to the problem of alcoholism in this Province
and particularly in the Vancouver area. The John Howard Society and other Vancouver
groups presented briefs to the Minister of Health and Welfare. It is felt that any positive
decision regarding future steps in this matter will likely await the findings of the Liquor
Inquiry Board which has been appointed by the Provincial Government to study all
aspects of the problem of alcohol.
A satisfactory screening committee for admissions to the School for the Deaf and
the Blind, particularly related to the deaf child, was established and is functioning
smoothly, following discussions between the Department of Education, Greater Vancouver Metropolitan Health Services, interested specialists in this field in the Vancouver area,
and the Health Branch, Department of Health and Welfare.
During the year this Bureau saw the appointment of Dr. A. John Nelson as Director
of the Division of Venereal Disease Control and consultant in epidemiology. Dr. Nelson
worked very extensively not only in the field of outbreaks of intestinal disease, but more
particularly has been of great assistance during the recent summer when the number of
cases of poliomyelitis rose to an all-time high. At this time special tribute should also
be paid to the Royal Canadian Air Force, who gave great assistance to this Branch in the
evacuation of poliomyelitis cases from the various points in the Interior to the Vancouver
General Hospital.
During the year three members of this Bureau participated in a series of in-service
training lectures for the 1,600 transit operators of the British Columbia Electric Railway
Company on the Lower Mainland. The subject that was dealt with was " Human Relations, Job Satisfaction, and Personal Well-being in the Transit Business." It was felt that
it was not only most valuable to the British Columbia Electric Railway Company, but
also to the members of this Bureau.
NATIONAL HEALTH GRANTS
General
The total amount of funds available to British Columbia for the fiscal year 1952-53
is $4,417,957, excluding the Public Health Research Grant, which is allocated in Ottawa.
This represents an increase of $1,494,807, which is due almost entirely to an increase of
$89,655 in the Mental Health Grant and an increase of $1,379,445 in the Hospital Construction Grant. The latter is the result largely of the inclusion of the unexpended portions of this grant for 1948-49 and 1949-50.
As it was found in September that the Professional Training Grant was almost completely allocated, an amount of $5,000 was transferred to this grant from the Cancer
Control Grant. There was no actual decrease in the funds available for cancer as the
amount of $5,000 was transferred from that portion of the Cancer Control Grant for
which no matching Provincial funds are provided.
Administration
Early in the year the Department of National Health and Welfare assigned Dr. R. B.
Jenkins to act as their liaison officer in British Columbia with regard to the National
health-grants programme. Dr. Jenkins is a member of the staff of the Department of
National Health and Welfare located in Victoria.    It is felt that this type of liaison is DEPARTMENT OF HEALTH AND WELFARE,  1952
BB 95
good, and that mutual benefit and understanding have resulted from his visits to various
agencies and institutions receiving assistance from the National health grants.
In February the Assistant Provincial Health Officer spent three days in Ottawa
reviewing with officials of the Department of National Health and Welfare all submissions
for continuing assistance in the year 1952-53. This was an excellent plan and no doubt
contributed materially to the approval of these submissions being received much earlier
than in previous years.
Efforts to reduce the amount allocated for continuing projects for 1952—53 were
reasonably successful with regard to both government and non-government agencies.
It is now recognized by these agencies that the amount allocated for continuing projects
must be controlled if sufficient funds are to be available for new or extended services.
Grants Received for the Year Ended March 31st, 1952
The figures given in the following table indicate that considerably greater advantage
was taken in this Province of the National health grants in the year ended March 31st,
1952, than in previous years. Total expenditures were $2,481,398 or 85 per cent of
the total grants, as compared to $1,701,011 or 59 per cent of the total grants available
in the year ended March 31st, 1951. These increased expenditures are largely due to
the increase in expenditures in the Mental Health, General Public Health, and Hospital
Construction Grants. Under the Hospital Construction Grant alone there was an expenditure of $1,078,708.
Comparison of Amounts Approved and Actual Expenditures with Total Grants
for the Year Ended March 31st, 1952
Grant
Total Grant
Approved
Actual Expenditures
Amount       Per Cent
Amount
Per Cent
$43,218
55,596
1,098,708
43,218
428,961
368,135
7,482
33,320
645,953
206,478
$16,362    |        38
43,885              79
1.078.708     1         98
$14,679
38,277
1,078,708
43,218
347,669
280,886
7,217
532,907
137,837
34
69
98
43,218
386,928
365,505
7,482
100
90
99
100
92
88
100
Mental Health  	
81
76
96
596,347
182,035
82
67
Totals    -	
$2,931,069
$2,720,470    |        93
•       I
$2,481,398
85
The figures for British Columbia also compare favourably to those for all Provinces.
Excluding the Public Health Research and Health Survey Grants, the percentage of funds
allocated was 93.8 per cent in this Province, as compared with 85.6 per cent for all
Provinces. Similarly, the amount expended in British Columbia was 85.6 per cent of
the total available, as compared with 68.9 per cent for all Provinces.
Present Status
The National health-grants programme is now well established, with the result that
it may be expected maximum use will be made this year of these funds in so far as circumstances relating to the individual programmes will permit. As a result of the experience
gained during the past four years, certain policies have been adopted both at the Federal
and Provincial level, which have facilitated the planning and implementation of projects.
General information regarding the distribution of each grant is given in the following
sections. BB 96 BRITISH COLUMBIA
Crippled Children's Grant
A new department under this grant is the provision of assistance for the programme
for cerebral-palsied children, which is being worked out under the auspices of the Cerebral
Palsy Association of British Columbia. The objectives of the association are to promote
diagnosis, treatment, education, and welfare of cerebral-palsied children and to provide
an environment in which the cerebral-palsied children may have the opportunity for the
best possible adjustment and development of personality, including occupational training
and opportunity for employment.
Facilities are provided at the Western Society for Rehabilitation at a nominal rental,
and the latter organization has also assisted in many other ways to get the programme
for cerebral-palsied children established on a firm basis. To date, assistance from the
National health grants has been only for the services of technical personnel.
The Registry of Crippling Diseases in Children has shown steady progress this year.
Crippled children are now registered routinely by the local health services, who consult
with the family physician before submitting the registration, and all new-born with congenital malformations or birth injuries are automatically registered by the Provincial
Division of Vital Statistics. A technical medical committee representing the various
specialties concerned is available for advice in particular cases. A definite working
liaison has been established with the local hospitals, the Provincial School for the Deaf
and the Blind, Child Guidance Clinics, and The Woodlands School, and private agencies,
such as the Junior Red Cross, Canadian National Institute for the Blind, and the Cerebral
Palsy Association of British Columbia. There are definite indications of increasing use
being made of this Registry.
Other assistance given under this grant was similar to that given in previous years.
Professional Training Grant
The number of persons completing training under all projects during the calendar
year 1952 was thirty-two, and total expenditures made in regard to this training were
$75,516.29. In addition, fifteen persons have taken short courses, varying in length from
a few days to two or three weeks.
Assistance is being continued this year to six members of the staffs of general
hospitals to cover their expenses in connection with the extension course in hospital
organization and management given by the Canadian Hospital Council. An additional
six persons who enrolled this year are being given similar assistance.
Two short courses of the in-service training type were given. Under the auspices
of the Registered Nurses' Association of British Columbia and the School of Nursing,
University of British Columbia, a workshop on tests and measurements was held from
July 15th to 18th, inclusive at the University. Dr. L. Heidgerken, Associate Professor
of Nursing Education, Catholic University, Washington, D.C., was the workshop director.
The enrolment was forty-six, which was larger than anticipated. Tangible evidence of
the success of this project is the fact that the Provincial instructors' group is continuing
the study of evaluation throughout the winter months. One aim of this continuing study
is to effect some standardization of evaluation procedures (including grading of tests)
in the schools of nursing in the Province.
Dr. MacDonald Critchley, Dean, Institute of Neurology, London, England, visited
the British Columbia Mental Health Services the end of May. Conferences were held
with the Directors of Research and of Neurology, and a lecture and clinic on Huntington's chorea was presented to the assembled medical staff of the Mental Health Services.
Dr. Critchley's visit was considered most worth while in stimulating the staff and in giving
them access to new developments in Great Britain. Provision for this training was made
under the Mental Health Grant. department of health and welfare, 1952 bb 97
Hospital Construction Grant
During the past four years there has been a gradual accumulation of continuing
hospital-construction projects due to the length of time required for construction to be
completed. In order to meet the claims anticipated this year, it was necessary to have
the amounts unexpended in 1948-49 and 1949-50 added to the grant for this year. This
carry-over of funds is one of the provisions of this grant. Although the total grant for
this year is $2,478,153, there is actually therefore no increase over previous years.
Assistance under this grant has been given this year toward the construction of
health centres in local communities, provision for which was made last year. Areas which
have taken advantage to date of this provision are Victoria, Maillardville-Coquitlam,
Kamloops, Enderby, and Kelowna, in addition to the new building planned for the Provincial Health Branch in Vancouver. Only a portion of the cost is provided under this
grant, the remainder being provided from Provincial and local funds.
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 venereal-disease control are considerably
in excess of the amount of the grant. The standard and extent of service given during
the year 1948-49 was 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.
Mental Health Grant
The Mental Health 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.
This year was one of gradual expansion of existing services rather than one of new
developments. Last year a consultant in neurosurgery was appointed to the British
Columbia Mental Health Services, and this year consultants in general surgery and in
orthopaedic surgery were added.
An additional study being undertaken by the Neurophysiological Research Unit,
which is located at the University, is the investigation of abnormal electroencephalograms
in relation to psychopathology.   Other services have similarly expanded.
The University of British Columbia, the mental-hygiene programme in the Cities of
Vancouver and Victoria, and the psychiatric services in the Vancouver General Hospital
again received assistance from this grant.
Tuberculosis Control Grant
This 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 Report of the Division of
Tuberculosis Control.
Two services for tuberculosis out-patients were discontinued this year. Under the
home-care project, housekeeping assistance was provided in selected homes of tuberculosis
patients to make it possible to discharge patients earlier from hospital and to prevent the
breakdown and readmission of patients, thereby partially relieving the acute shortage of
beds in British Columbia. As this was originally a short-term project, and as the opening
of the Pearson Tuberculosis Hospital would alleviate considerably the shortage of beds,
approval was not given for continuation of this service during the current year. BB 98 BRITISH COLUMBIA
The occupational-therapy service for tuberculosis out-patients, which was conducted
by the Metropolitan Health Committee of Greater Vancouver, was discontinued on June
30th, 1952. It was felt by officials of the Department of National Health and Welfare
that the project did not truly meet the requirements of the National health grants.
The administration of streptomycin to tuberculosis patients in the home, which was
formerly done by the Victorian Order of Nurses in the Greater Vancouver and Victoria
areas, has been assumed by the local public health nurses. The purpose of this project
was to commence treatment on patients awaiting admission to hospital. The number of
patients requiring home treatment was greatly reduced with the opening of the Pearson
Tuberculosis Hospital.
Public Health Research
Approval was given to a study of the antibiotic and hormonal control of tuberculosis
infections in order to endeavour to obtain a more effective form of chemotherapy than is
now available for the treatment of tuberculosis. This research, which is not yet fully
organized, is under the direction of the head of the Department of Biochemistry, University of British Columbia, in co-operation with the Provincial Division of Tuberculosis
Control.
The two projects approved last year, " Investigation of Schistosome Dermatitis in
B.C. Lakes " and " Control of Skin Infection in the Newborn," were continued this year,
and progress is being made.
Health Survey Grant
The report " Survey of the Health Services and Facilities in British Columbia,
December 31, 1948," which was required under the provisions of this grant, was submitted
to the Department of National Health and Welfare in March, 1952, and tabled in the
House of Commons on July 2nd, 1952.
General Public Health
The General Public Health Grant increased only $19,060 this year, and such increase
was due to the variable factors governing the allocation of the total amount voted by the
Federal Government. The principle of having the government and non-government
agencies absorb a proportion of the long-term recurring expenditures had its widest
applications to the services provided under the General Public Health Grant. However,
the saving in funds thereby effected made possible further expansion of local health
services. Detailed information in regard to these services is given in the section of this
Report on the Bureau of Local Health Services.
Apart from local health services, assistance was given this year to the Provincial
School for the Deaf and the Blind toward the purchase of dental equipment in order to
establish at the school a dental clinic, which will be operated by the Metropolitan Health
Committee of Greater Vancouver. Fifteen incubators were supplied to general hospitals
to facilitate the care of premature infants. Assistance was also given to the Multiple
Sclerosis Society to enable the medical adviser to conduct a survey to determine the incidence of multiple sclerosis in this Province.
Cancer Control Grant
The operations of the British Columbia Cancer Foundation, outlined earlier in this
report under the section " Voluntary Health Agencies," and the Provincial Biopsy Service
account for approximately 75 per cent of total expenditures under this grant. In addition,
over $50,000 was allocated from Federal and Provincial funds for the purchase of equipment for the new addition to the British Columbia Cancer Institute and the Victoria
Cancer Clinic. DEPARTMENT OF HEALTH AND WELFARE,  1952
BB 99
The Provincial Biopsy 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. In addition to the biopsy service, which is chiefly
concerned with the diagnosis of solid tissues, the service for diagnosis of cells in fluids is
still available on the same free basis to the patient. This service, which is known as the
" Cytological Service," is carried out at the Vancouver General Hospital.
This year three registered nurses will complete their training at the British Columbia
Cancer Institute as radiotherapy technicians, under funds supplied jointly by this grant
and the Canadian Cancer Society (British Columbia Division).
ACKNOWLEDGMENT
Valuable assistance and co-operation have been 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. BB  100 BRITISH COLUMBIA
REPORT OF THE DIVISION OF LABORATORIES
C. E. Dolman, Director
The Provincial Laboratories commenced operations as a distinct organization in
the late summer of 1931, so the year under review marks their coming-of-age.
Twenty-one years ago, when the then Provincial Board of Health assumed full
responsibility for providing public health laboratory facilities in British Columbia, temporary headquarters for the work were established in two converted frame houses on
Hornby Street, Vancouver. Over the years, two adjacent houses were taken over and
adapted to the Division's needs, and behind the resulting row of four conjoined, tumbledown buildings, a large hut was erected during 1952. Despite persistent efforts to secure
permanent quarters more worthy of, and better suited to, the importance of its work, the
Division remains in what may be described as unsafe, unhealthy, uneconomical, and
totally unsatisfactory shacks. Indeed, perhaps the most unforgettable feature of 1952
operations will prove to be the frequent conferences regarding a proposed new building;
the many hours spent on detailed plans by the Director, Assistant Director, and other
senior staff members; and the indefinite postponement once again of a project whose
fulfilment had seemed at last within reach.
The total tests performed by the Division approached 410,000, of which roughly
345,000 were carried out in the central laboratories. This figure is practically unaltered
from last year, but a changing distribution of tests, and trials of many new procedures
not included in monthly or annual totals, entailed a considerably heavier work-load. The
classified totals of tests done in Vancouver in 1952 and the comparative figures for 1951
are set forth in Table I. Similar data for the branch laboratories at Victoria, Nelson,
Prince George, and Kamloops are summarized in Table II. DEPARTMENT OF HEALTH AND WELFARE,  1952 BB  101
Table I.—Statistical Report of Examinations Done during the
Year 1952, Main Laboratory
Out of Town
Metropolitan
Health Area
Total in 1952
Total in 1951
137
4,636
1,516
768
88
7,764
2,198
1,597
776
147
7,488
5,105
1,743
32
8,155
5,828
16,196
2,741
6,054
1,308
22,523
5,410
3,099
250
181
587
1,166
105,319
17,911
2,110
18,060
133
1,794
96
539
1,350
1,865
1,741
1,741
1,404
857
1,770
152
152
152
63
57
284
12,124
6,621
2,511
120
15,919
8,026
17,793
3,517
6,054
1,959
26,758
12,993
4,288
278
225
757
1,740
142,071
25,324
2,842
26,368
188
2,845
131
827
2,171
2,936
3,225
3,225
2,394
857
7,015
152
152
152
63
117
598
Blood serum agglutination tests—
Typhoid-paratyphoid group 	
Brucella group..  	
12,204
6,203
2,208
69
Cultures—
M. tuberculosis-—     	
Typhoid-Salmonella-dysentery group  	
C. diphtheria; _ 	
13,631
6,426
26,433
4,516
N. gonorrhea;  	
6,352
651
4,235
7,583
1,189
28
44
170
574
36,752
7,413
732
8,308
55
1,051
35
288
821
1,071
1,484
1,484
990
1,661
Direct microscopic examination—
_V. gonorrhoea;   	
26,837
14,694
3,862
Treponema pallidum   _	
Vincent's spirillum   ...  	
351
267
756
Serological tests for syphilis—
Blood-
135,740
25,517
Quantitative Kahn  	
4,064
26,271
V.D.R.L _	
Cerebrospinal fluid—
2,769
Quantitative fixation   	
Cerebrospinal fluid—
176
1,084
Protein   	
2,155
2,774
Milk-
3,231
3,231
2,474
894
Water—
5,245
7,041
Ice-cream—
191
191
191
60
176
Totals   	
99,743
245,279
345,022
345,238
PROVINCIAL.   LIBRARY*
VICTORIA. 8. & BB  102
BRITISH COLUMBIA
Table II.—Statistical Report of Examinations Done during the
Year 1952, Branch Laboratories
Kamloops1
Nelson
Prince
George
Victoria
34
44
7
1
36
15
81
495
106
32
Blood agglutination—
460
115
85
Cultures—
102
242
246
1,987
Typhoid-Salmonella-dysentery group 	
	
607
2,045
2,045
528
10
101
106
23
118
264
669
15
9
11
Direct microscopic examination—
754
779
5,300
119
5
5
4
9
46
	
175
Serological tests for syphilis—
Blood—
21,092
1,427
7,157
84
	
	
1,806
347
588
Cerebrospinal fluid—■
19
11
13
85
103
1,511
1,485
482
49
1,331
4
430
667
683
2
562
61
421
546
Milk-
42
43
40
4
122
5
984
984
984
Water—
1,006
1,057
Unclassified tests
762
14,581
2,729
46,000
1 Kamloops totals to September 30th, 1952, only.
TESTS FOR DIAGNOSIS AND CONTROL OF VENEREAL DISEASES
As usual, slightly over two-thirds of all tests done in the Division were concerned
with the detection or exclusion of syphilis and gonorrhoea. But this high proportion, in
terms of actual tests reported, does not reflect a similar preponderance of time spent on
work under this heading. In fact, a cost-accounting analysis recently carried out in the
central laboratories by the Director and Assistant Director indicates that rather less than
one-third of total " work units " are devoted to these tests.
The number of blood specimens sent in for sero-diagnostic tests increased by around
6 per cent. However, this does not signify any rising incidence of syphilis. It is more
likely due to a combination of factors, such as the natural increase in the population, the
growing advocacy of such blood tests as part of a routine health examination, and the
requirement of a blood test under premarital legislation of certain States, or United States
immigration regulations. This supposition is borne out by the fact that the numbers of
supplementary sero-diagnostic tests did not increase correspondingly.
Growing concern has been felt over the possibility that the presumptive Kahn test
was not invariably a satisfactory screening procedure; that although supposedly hypersensitive, it might occasionally yield a false negative reaction. Since all Provincial laboratories in Canada agreed some years ago to adopt the presumptive Kahn test for routine DEPARTMENT OF HEALTH AND WELFARE, 1952 BB  103
screening, the question was referred by the Director to the Technical Advisory Committee (of the Dominion Council of Health) on Public Health Laboratory Services, which
met in Ottawa in December. The matter was thoroughly debated, and appropriate
measures will be taken. At the same time some attention was given by the Committee to
the allegedly increasing discrepancies between the results of the standard Kahn and the
Kolmer-Wassermann complement-fixation tests. By far the most complete details on
both these questions were furnished by this Division. Perhaps it should be emphasized
that these doubts do not point to any decline of technical proficiency, but rather to
serological peculiarities of certain groups nowadays subject to test. Discrepancies are
especially prevalent among blood specimens from infants at birth, from Venereal Disease
Clinic patients under penicillin treatment, and from apparently healthy adults convalescing
from certain types of febrile illnesses. Such patients furnish a much higher proportion
of the total specimens subjected to these serological tests than in former years.
There is little likelihood of serious errors of technique building up in a large sero-
diagnostic laboratory in Canada. Apart from the meticulous attention to detail which
traditionally characterizes such departments, there is the constant checking by physicians
and by venereal-disease control authorities, who are usually quick to notice serious disagreement between clinical and laboratory findings. Additional valuable safeguards are
the periodic sero-diagnostic surveys, and the system of supplying standardized reagents,
arranged by the Laboratory of Hygiene, Department of National Health and Welfare.
The sixth in the series of sero-diagnostic surveys was launched in November. In future
years some attempt might well be made to include the branch laboratories to some extent
in these surveys. Their much smaller turnover of specimens, and their liability to assign
this type of work to comparative novices, warrants less confidence in the accuracy of
their reports.
TESTS RELATING TO TUBERCULOSIS-CONTROL
Although the total sputum and miscellaneous specimens submitted for direct microscopic examination for M. tuberculosis declined slightly from the 1951 figures, the
number cultured increased by 20 per cent. In the past three years cultural examinations
for M. tuberculosis have more than doubled. This rapid increase reflects not only widening recognition of the greater sensitivity of cultural methods over direct microscopy, but
also the application of more stringent criteria for diagnosis and release of tuberculous
patients. Here then, as in many other fields, the public health laboratory is faced with
demands for more exacting techniques because of, rather than despite, a declining incidence of the disease in question. Institutions with adequate reserves of accommodation,
of supplies and equipment, and of staff might well thrive on such paradoxical situations.
But only professional laboratory-workers can fully appreciate how much extra work and
worry results from developments of this type in the painfully restricted circumstances
besetting this Division. The insidious parasitic habits of the bacillus M. tuberculosis,
which exposes its handlers to many infection hazards, may be partly related to its slow
growth on artificial nutrient media. This in turn necessitates incubation of cultures for
at least eight weeks before being finally reported negative and discarded, and their
inspection meanwhile at regular intervals. Mere inspection of hundreds of culture-tubes,
stacked high on trays filling several incubators, perched on precious bench space in hopelessly cramped small rooms, is in itself quite a staggering task. When due consideration
is also given to the special treatment required in preparing specimens for culture, it
becomes apparent that the trend toward routine cultural examination of suspected
tuberculous material cannot be light-heartedly accepted. The branch laboratory at
Victoria has, to lesser degree, suffered similarly.
On the whole, private physicians and the staff of the Division of Tuberculosis Control have shown sympathetic appreciation of the laboratory services rendered them under
_ BB  104 BRITISH COLUMBIA
severe handicaps. The arrangements described in the 1951 Annual Report, whereby
the Division of Tuberculosis Control undertook to relay positive laboratory reports on
patients under its jurisdiction to the appropriate officials, worked fairly efficiently, with
few exceptions, and to some extent lessened the pressure on the office staff in the
Laboratories.
Excellent co-operation was displayed by Tranquille in restoring the supply of guinea-
pigs for animal-inoculation tests. The supply was cut off altogether for the first several
months of the year owing to an unidentified epizootic, followed by ringworm, affecting
the Tranquille guinea-pig colony. During this period, emergency inoculations only were
performed, using animals begged or borrowed from various local sources. By the time
shipments of healthy pigs could be resumed, it had been decided to abandon the two
rodent-infested, draughty annexes hitherto used as animal-rooms in favour of concrete
quarters of smaller capacity, erected adjacent to the new hut. These factors account for
the total animal inoculations during 1952 amounting to around 300, only one-half of the
1951 figure.
GASTRO-INTESTINAL INFECTIONS AND BACTERIAL
FOOD POISONING
Over 8,000 stool specimens were cultured for organisms of the Salmonella and
Shigella groups, an increase of roughly 25 per cent over 1951 and double the 1949 figures.
The total number of Salmonella-Shigella strains isolated in the central laboratories
during 1952 exceeded 300. Of these, about 170 were Salmonella., a figure only slightly
above that for the previous year. Two types, S. California and S. heidelberg, appeared
in this Province for the first time; indeed, the former type (isolated from a nurse at the
Provincial Mental Hospital) had not previously been recognized in Canada. S. heidelberg
was first isolated in Canada in May, 1951, from poultry in the neighbouring Province
of Alberta, and in July of the same year the first human isolation was made in that Province. In September and October, 1952, a small outbreak of gastro-enteritis occurred
among children on an Indian reserve at Powell River. Six of the cases yielded S. heidelberg by stool culture. About the same time a case of Salmonellosis due to S. heidelberg
was identified in a Vancouver butcher. This sort of situation should provide a happy
hunting-ground for the epidemiologist.
Although the number of Shigella isolations was less than half that of 1951, the total of
133 was still more than double the average prevailing prior to 1950, in which year an outbreak of bacillary dysentery at a girls' camp in Howe Sound, identified by the Laboratories
as due to Sh. sonnei, proved a troublesome source of widespread infection subsequently
in various parts of the Province. A very similar situation developed again in July, 1952,
at a girls' camp in the same area. Although this time the outbreak was smaller, twenty-
six children yielded Sh. sonnei by stool culture. The original source of infection was
probably a child admitted to the camp while suffering from a mild attack of dysentery.
Very few secondary cases occurred owing to the stringent measures instituted, but more
careful screening of applicants for the camp might have averted the second episode of
this nature within two years, and the reservoir of unidentified carriers of Sh. sonnei may
well have been enlarged as a result of the incident.
Attention should also be drawn to the unduly high number of isolations of S. typhi
(the typhoid fever bacillus), which reached a total of 26—-a figure exceeded only twice
during the preceding decade (33 in 1944 and 28 in 1947). These cases and carriers
involved several small groups living in widely separated areas. S. paratyphi A, rarely
found in Canada, was isolated from a sailor who probably acquired the infection at a
port of call en route from the Orient. But, for the most part, it must be assumed that
a wide variety of Salmonella types, as well as Shigella flexneri and Sh. sonnei, are now
more or less indigenous to British Columbia, and that their presence will be revealed with DEPARTMENT OF HEALTH AND WELFARE,  1952 BB  105
a frequency roughly proportional to the prevailing levels of community sanitation and
personal hygiene. Hence it is not surprising that these intestinal infections displayed
a high incidence among Indians and their contacts. The Skeena and Central Vancouver
Island Health Units were especially heavy sources of positive specimens during 1952,
but no area or section of the community was altogether spared.
The importance of the healthy or convalescent carrier in spreading these infections
has been stressed in previous Reports. The distribution of such carriers is uneven and,
for any given group, rather unpredictable. But the desirability of routinely examining
a stool specimen at least once annually from food-handlers employed in public eating-
places, or from persons closely associated with milk or water supplies, was exemplified
by the isolation of a strain ofS. typhi-murium from a dietitian, and of a strain of Sh. sonnei
from another food-service employee, at the University, while S. derby was isolated from
a Greater Vancouver Water Board employee. Of a total of 693 apparently healthy
University food-service employees tested thus, over the period 1946-52, no fewer than 8,
or 1.15 per cent, have yielded Salmonella-Shigella organisms. Again, of 1,485 Greater
Vancouver Water Board employees, over a similar period, 6 were carrying Salmonella
organisms (including S. typhi in two instances); that is an incidence of 0.34 per cent.
Among nearly 1,000 specimens received from food-handlers employed at the Kitimat
Aluminum Company project, only 2 Salmonella carriers were detected, but even an
incidence of 0.2 per cent is a disturbing figure in terms of the harm such persons can do
unwittingly. If more than a single specimen had been examined from each individual,
no doubt the percentages quoted above would have been higher.
The foregoing comments should not be construed as advocating a greatly stepped-up
programme of stool-culturing. Indeed, the Laboratories already receive more of these
specimens than can be satisfactorily handled in present circumstances. Faeces examinations are especially time-consuming and intricate, so that any large increase in then-
numbers entails a disproportionately heavy burden. In 1952 the enteric department of
the Laboratories would have faced an intolerable situation had the new hut not become
available just before the incidence of these infections reached their seasonal peak. But
when proper permanent quarters finally become available, it is hoped these routine tests
on food-handlers may be extended. Meanwhile the conscientiousness and skill which
result in the provision of this information by the Laboratories might sometimes, with
great advantage to the public, be better matched by those to whom it is reported.
Bacterial food-poisoning episodes were mostly of Staphylococcal type, and unspectacular.
One fatality due almost certainly to botulism should be recorded. Late in September a male resident of a small community near Fernie ate some fish fillets which had been
home-pickled a few weeks previously. The fish, fresh trout caught by the man himself
in a near-by river, was stored in the refrigerator until enough had accumulated to fill
several jars. It was then made into patties, dipped in egg and cracker crumbs, " thoroughly fried," placed in the jars with sliced onions, and a hot vinegar and salt-water
mixture poured on. The jars were then sealed without further heat treatment. The
housewife had used this family recipe for many years, but had frequently disposed of jars
of fish thus prepared because they had gone bad. The lid of the particular jar whose
contents her husband consumed was apparently not tight. Within a few days he developed, in succession, nausea and vomiting, marked constipation, ptosis, inability to
swallow, double vision, extreme dryness of the tongue, and retention of urine—characteristic features of botulism. He died in a Calgary hospital eighteen days after the fatal
meal. The post-mortem findings were consistent with his physician's diagnosis of botulism, and not of bulbar poliomyelitis, which had been proposed by consultants. As seems
usual in such episodes, all the remaining contents of this particular jar were destroyed.
From a companion jar of trout sent to the Laboratories, a toxin-producing culture of BB 106 BRITISH COLUMBIA
Clostridum botulinum, type E, was eventually isolated in the Western Division of Con-
naught Medical Research Laboratories and the Department of Bacteriology and Immunology, University of British Columbia. This was the fourth isolation of CI. botulinum,
type E, accomplished in Vancouver. Fish products have been involved in all four
instances. Three of these botulism episodes have affected a total of six residents of
British Columbia, of whom five died. The fourth instance occurred in Alaska, where
five natives who became ill after a feast of uncooked beluga flipper were fortunate enough
to recover. Roughly one-half of all known isolations of this unusual micro-organism
have to date been made in Vancouver. Its predilection for fish is a baffling problem for
further research.
OTHER TYPES OF TESTS
Bacteriological tests on milk and water samples totalled about the same as in 1951.
A number of bacterial counts on cottage-cheese samples were made on behalf of the City
of Vancouver, supplementing the tests started in the previous year on ice-cream samples.
Twelve new boxes for shipping iced samples of milk and water were procured during
the year and put into circulation in various parts of the Province. A recent cost analysis
of the central laboratories' activities has revealed that bacteriological tests concerned with
the sanitation of milk and water are relatively expensive when computed on a " per unit "
basis. There is good reason to believe that over the years the close co-operation between
the Laboratories and the field-workers, especially the Sanitary Inspectors, will bear fruit
in terms of better supplies of water, milk and milk products, and indeed in the general
sanitation of foodstuffs.
As usual, many bacteriological examinations of water-supplies from trains and other
common carriers were performed on behalf of the Public Health Engineering Division,
Department of National Health and Welfare. The same department requested us to make
a survey of the effectiveness of various procedures used in the cleansing of meat-blocks
in certain Government establishments. An extensive laboratory investigation was made
by Mr. Shearer on many swab samples brought in over a period of several months by
representatives of the above-mentioned Department, and his findings formed the basis
for a report prepared for internal distribution by that Department.
Cultural examinations for C. diphtheria? showed an appreciable decline, reflecting
the low incidence of diphtheria in the Province during 1952.
BRANCH LABORATORIES
The branch laboratories at Victoria and Prince George showed roughly the same
turnover of specimens as in 1951. The Nelson Laboratory, however, increased its turnover from about 9,000 tests to over 14,500 tests, a notable performance considering that
there was no increase in staff, and that during the summer a complete change of staff
occurred. The Kamloops Laboratory experienced a recurrence of its chronic difficulties
in procuring staff satisfactorily qualified to carry out public health laboratory tests, and
in July the subsidy was withdrawn.
Each of the other three laboratories was visited at least once during the year by one
or other senior staff member. Experience is confirming the view repeatedly expressed
that the eventual solution to the branch-laboratory problem in this Province must be the
establishment of two or three centres staffed and equipped by the Division itself. The
Nelson Laboratory has been particularly successful, and no difficulty is anticipated in
arranging for suitably qualified personnel from the central laboratories to serve a period
up there. During the year Miss Handlen, laboratory assistant, resigned to be married
and was replaced by Miss R. Schoeps. Miss M. Yeardye, bacteriologist, was replaced
by Miss D. Done, since the former, for purely personal reasons, preferred to return to the
Vancouver Laboratories. By suitably arranged overlapping, no dislocation resulted from
these changes. DEPARTMENT OF HEALTH AND WELFARE,  1952
BB  107
A short-term survey of swabs from restaurant utensils and dishes and from glasses in
beer-parlours was launched by the Prince George Branch Laboratory in co-operation
with the Cariboo Health Unit. It was felt that sanitation in eating and drinking establish-
lishments in that area was of a low order and that bacterial counts might furnish convincing evidence to the authorities of the low level of prevailing standards. Mr. Shearer
visited Prince George to help make suitable arrangements from the laboratory standpoint
for this survey.
GENERAL COMMENTS
The accommodation of the central laboratories continues to give rise to deepest
concern. A very serious situation might well arise if plans for new and larger fire-proof
quarters for the laboratories are further deferred. The already-mentioned provision of
a hut provided some measure of temporary relief to those who moved into it, but left
undiminished the risks and discomforts endured by those in the older buildings. The hut
itself is far from ideal in many respects for laboratory work, but this is not the fault of
those responsible for its erection, and a note of appreciation is due to Mr. Pendygrasse,
of the Department of Public Works, who did his best for us.
During part of May and June Miss V. G. Hudson, senior bacteriologist, received
a Professional Training Grant under the Federal health grants for attendance at a refresher
course on enteric bacteriology, given at the Laboratory of Hygiene, Ottawa. In September Miss M. Yeardye, bacteriologist, attended a similar course under the same arrangements, on syphilis serology. On her return from the Nelson Laboratory, Miss Yeardye
was thus well equipped to assume supervision of the Kahn-testing department.
In September the Director attended the annual meeting at Estes Park, Colorado,
of the International Northwest Conference on Diseases in Nature Communicable to Man.
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.
As a member of a sub-committee of this group, nominated at last year's conference to
investigate the costs of public health laboratory work, he assisted in compiling a report on
this important question. Following the Ottawa conference, the Director attended the
annual meeting in Quebec of the Laboratory Section, Canadian Public Health Association,
where he presented papers on " Salmonella-Shigella Infections in British Columbia " and
on " The Classification of Clostridium botulinum, type E."
At the September meeting of health officers, held in Victoria, reports were presented
by the Director on the costs of distributing biological products and specimen outfits, and
on methods of eliminating wastage in these items. Assurance of co-operation was
received from the health-unit directors, and beneficial results are already apparent. The
system of orientation visits to the Division by new personnel in the Provincial Department
of Health has also assisted in promoting better understanding of the Laboratories' objects
and difficulties.
It is fitting to close with a note of appreciation of the very fine spirit displayed by the
whole staff of the Division, despite all difficulties encountered. This is very largely due
to the excellent example shown by the senior members, among whom Miss D. E. Kerr,
Assistant Director, should again be selected for special commendation. BB 108 BRITISH COLUMBIA
REPORT OF THE DIVISION OF VENEREAL DISEASE CONTROL
A. John Nelson, Director
During the year the number of venereal-disease cases reported in the Province
continued to show a slight decrease—3,647 in 1952, compared with 3,916 in 1951.
Infectious syphilis has now become a real clinical rarity; only 34 cases were reported
as of December 31st, 1952. Late syphilis, as reported to this Division, has also shown
a marked decline.
TREATMENT
This Division continued to overtreat gonorrhoea patients with massive doses of
penicillin, thereby aborting any possible concomitantly acquired syphilis. This over-
treatment schedule appears to be of real importance in reducing the number of new cases
of syphilis in this Province, as elsewhere.
An important numerical change worthy of mention concerns the number of cases of
gonorrhoea that were treated and diagnosed by the private physician of this Province.
Private physicians treated more cases of gonorrhoea than the clinics of the Division of
Venereal Disease Control.
Prenatal syphilis continued to show a decrease in the number of new cases reported.
In fact, this is the first report in which it could be stated that the number of new cases
of prenatal syphilis was falling with the same rapidity with which the new cases of acquired
syphilis are being reported to this Division.
Qualified specialists are still employed by the Division to act in a consultative
capacity on the various problems that arise in treating venereal disease. This consultative
service is extended to all physicians who need such services throughout the Province.
Due to the decrease of the patient-load in the various treatment clinics, there was a
real attempt made to discontinue certain services, but at the same time not sacrifice the
services to the patients.
Free drugs were again made available to private physicians. In some cases where it
was necessary to alter the type of antibiotic used, because of allergic manifestations,
alternate drugs were supplied. The policy of this Division was not altered with regard
to supplying the directors of all health units with the drugs so that they can be dispensed
locally to the private physicians.
The consultant in medicine to this Division continued to interest himself with the
problem of non-specific urethritis. The number of cases falling into this category did not
diminish, and as yet no satisfactory diagnostic criteria have been established to classify
this troublesome condition. The treatment of non-specific urethritis still remains an
unsolved problem.
The Vancouver clinic and the New Westminster clinic maintained the same hours of
service as in previous years, in spite of the decrease in the number of new patients
reporting. This service is still considered to be sufficiently important to allow no change
at the present time.
During the year, clinic and treatment facilities continued to operate at the following
centres: Victoria clinic; Vancouver City Gaol; Prince Rupert and Prince George City
Gaols; Greater Vancouver Metropolitan Health Committee, Health Unit No. 1; Male
and Female Oakalla Prison Farm; Girls' Industrial School; and the Juvenile Detention
Home.
There was a decline in the new cases of chancroid, although a number of these were
diagnosed and treated by the Division. The majority of such cases were found among
mariners entering the port of Vancouver, and there was no evidence of increased spread
of this infection among the general population. DEPARTMENT OF HEALTH AND WELFARE,  1952 BB  109
EPIDEMIOLOGY
Although the greatest single factor in the control of venereal disease is penicillin,
epidemiology is the other very essential weapon for a complete armamentarium in any
health programme. It is felt that such epidemiological programmes were responsible
indirectly for the steady decline in the reported incidence of venereal disease, both in this
Province and nationally.
Through continued efforts to find new cases, it should be possible to reduce further
the rate of venereal-disease infections in this Province and maintain a steady decline in the
reported incidence of the disease.   The Division is now pursuing such a course.
The epidemiology section is constantly seeking new methods and tools to assist
public health workers engaged in case-finding and case-holding, and thereby make their
programmes more effective. The techniques used in eliciting the necessary information
from contacts are undergoing certain changes which should make such measures more
effective.
Consultations on epidemiology are available to all local health units through the
epidemiological section of the Division. During the past year two field-visits were
requested—one for the purpose of studying the problem presented by venereal disease
arising from alleged bawdy-house activity and the other for consultation on epidemiological
procedures.
During the year a diagnostic centre was established in the down-town Vancouver area
(Metropolitan Health Unit No. 1). The establishment of such a unit proved most
helpful, both in case-finding and in case-holding. This new unit provides clinic service
every day from 11 a.m. to 1 p.m. for the purpose of interviewing male patients and making
diagnostic tests for gonorrhoea. Treatment is offered to these patients on epidemiological
grounds or clinical evidence of infection.
The epidemiology section works in close liaison with the private physician and is thus
able to interview contacts and follow up patients with unsatisfactory serologic reports
which appear on the confidential lists obtained from the Provincial Laboratory. This
technique has been beneficial to both the private physician and the Division of Venereal
Disease Control. The epidemiology worker at the Vancouver City Gaol examination
centre has been particularly effective, and the services rendered have been most worth
while. Through an interview on radio station CKMO (police broadcast), this worker
was able to make known the activities of this centre.
The Indian Health Service is assuming the largest part of the responsibility for
case-finding and follow-up of the British Columbia Indians. During the past summer
many Indians were concentrated in the hop-yards, and this proved to be advantageous
to this section because many former patients were located and follow-up examinations
were thus possible.
This Division continued to explore the facilitating processes, maintained constant
vigilance over potential community trouble spots and made every effort to suppress the
spread of venereal disease.
Vancouver was again visited by a representative of the American Social Hygiene
Association, and the report made by this trained representative showed a marked improvement in the conditions existing in the city compared with the previous visit of one year
ago. Much of the information obtained from such a survey was of value to the Division
because it pointed up conditions which are frequently not drawn to our attention.
The Director of the Division of Venereal Disease Control was invited to attend the
annual convention of the British Columbia Hotels' Association. The subject of his
address to their representatives was entitled " The Facilitation Process in Hotels and
Rooming-houses."
The senior epidemiology worker presented a paper on " Venereal Disease Epidemiology " to the public health nurses at the Institute held in Victoria. BB  110
BRITISH COLUMBIA
SOCIAL SERVICE
The activity of the Social Service Section was curtailed during the year when the
case-worker in the Vancouver clinic was given extended sick-leave, and no replacement
was available for three months. During this period specific problems were dealt with on
an emergency basis by social-work staff from the Division of Tuberculosis Control.
However, in the first eleven months of 1952 there were 733 interviews of patients carried
out by the Social Service Section.
Continued use was made of the rating scale devised in 1951 to get a general picture
of the kind of people who were reporting to the Vancouver clinic for treatment. An
analysis of the ratings for the twelve-month period from July, 1951, when the rating
system was instituted, to June, 1952, indicated that about half the patients interviewed
needed help in solving some of the more basic problems that were facing them. In this
group were the older adolescents who were in conflict over sexual behaviour, and who,
out of curiosity and lack of knowledge, were seeking solutions in promiscuous sexual
activity. It was interesting to note the number of new immigrants in the young adult
group who had not adjusted to their new environment and had become infected with a
venereal disease because they were susceptible to the only kind of female companionship
available to them; namely, the casual street pick-up. These patients responded well to
the counselling interviews, but the lack of community resources to which they could be
directed for more wholesome recreational outlets was a handicap in working with them.
In addition to those patients who could utilize personal counselling, there was a
fairly large group who seemed to drift from place to place, and job to job, and whose
personal relationships, including their sexual ones, were all on a casual basis. Although
most of these individuals could be helped to co-operate in the treatment plan, they had
no incentive to change their promiscuous behaviour pattern because it met their particular
needs.
Because of lack of staff, no specific studies were undertaken by the Social Service
Section during the year.
EDUCATION
The Division of Health Education has the major responsibility for health-education
programmes and activities and shares this with the Division of Venereal Disease Control
in the case of lay education. Education directed to professional groups remains the
prime responsibility of this Division.
Members of the Division presented a total of 177 lectures during the year. Lectures
on the methods of control of the venereal diseases were given to the following: Student-
nurses at all the main training-schools in the Province, students at Essondale, practical-
nursing students, student-barbers, and students in the foods department at the Vocational
School. In addition, practical experience, as well as regular lectures, was provided to
student-nurses from the Vancouver General Hospital.
Lectures were also given to students in various other fields, including medical students
at the University of British Columbia Medical School and residents of the Vancouver
General Hospital.
Fortnightly meetings were held in the Divisional headquarters for all attending
physicians, at which time lectures were given by members of the consulting staff on various
aspects of venereal disease. The consultant syphilologist presented a lecture entitled
" Present Treatment Status of Syphilis and Gonorrhoea" at the Vancouver General
Hospital refresher course for general practitioners held in November.
There was a continuation of the programme of talks to youth groups, which was
established in 1950. Speakers were provided upon request to HI-Y groups in Vancouver
schools and to youth groups at the Y.W.C.A. Groups addressed during the year were
the Britannia and King Edward HI-Y's and the GAI-Y groups at the Y.W.C.A.   A talk DEPARTMENT OF HEALTH AND WELFARE,  1952 BB  111
was also given at the Girls' Industrial School. As a result of a meeting with representatives
from the Greater Vancouver Health League and the First Aid Attendants' Association,
lectures on the venereal diseases and films on the subject are now being presented to each
class of first-aid trainees.
The following is a list of articles written and published and papers presented by
various members of the Division:—
Articles written and published:—
"Undiscovered Case—the Problem"  (the March issue of B.C.'s Health),
Dr. C. L. Hunt.
" Community Responsibility and Venereal Disease " (the First Aid Attendant,
official magazine of the Industrial First Aid Attendants' Association of
British Columbia), Dr. C. L. Hunt and Dr. A. John Nelson.
" Progress in Venereal Disease Control " (published in the Vancouver Medical
Bulletin), Dr. A. John Nelson.
" Co-operation Key to Control in Venereal Disease " (the Tuberculosis Society's
publication Your Health), Dr. C. L. Hunt and Dr. A. John Nelson.
Papers presented:—
" Some Considerations in Public Health Control of Gonorrhoea," presented by
Dr. A. John Nelson to the annual meeting of the Canadian Public Health
Association.
" Co-operation between Police and Health Departments in Venereal Disease
Control," presented by Dr. A. John Nelson at the annual conference of the
Pacific Coast International Association of Law Enforcement Officials.
" Present Status of Premarital Blood Testing," presented by Dr. A. John Nelson
to the Provincial Council of Women, New Westminister group.
An exhibit was presented by the Division at the North Vancouver Kiwanis Annual
Fair and Trade Exhibition.   The theme was " Corky the Killer."   The exhibit was well
received and created interest.   Literature was distributed, questions answered, and blood
tests were offered to the public.   Pictures of the exhibit were published in the British
Columbia Tuberculosis Society's magazine Your Health.
GENERAL
The year was marked by anticipation that some clear-cut policy would be enunciated
with regard to more satisfactory headquarters and clinic space for the Division; apparently
plans have again met with delay. This is indeed unfortunate because it is possible that
in the not too distant future the present space may become untenable due to its physical
characteristics. There is also the possibility that it may soon be required by the Vancouver
General Hospital for its building programme.
During the year Dr. A. John Nelson was appointed Director of the Division. Dr.
Nelson had previously been with this Department and left to become associated with the
Division of Venereal Disease Control in the State of New York. Besides being Director
of Venereal Disease Control, Dr. Nelson is also consultant in epidemiology to the Health
Branch, and it is felt that this is a most satisfactory arrangement.
Dr. W. Stuart Maddin, following three years' postgraduate training in syphilology
and dermatology, under the National health grants, returned late in the year as physician
in charge of clinics. Dr. Maddin's specialized knowledge and ability will be most
valuable to this Department.
Dr. C. L. Hunt, the former Director, is now employed on a part-time basis as
consultant in internal medicine.
National health grants continue to prove extremely useful in assisting the Division
to maintain its ever-expanding services, as well as in affording opportunities for
postgraduate training of medical and nursing personnel.
_ BB  112 BRITISH COLUMBIA
Funds from these grants were made available to assist in the operation of the British
Columbia Medical Centre Library, where up-to-date literature on venereal diseases is
maintained. The Divisional Director is an active member of the management committee
of this library.
The Division is most appreciative of the co-operation and help extended by various
groups and agencies who have contributed so much to the success of the venereal-disease
control programme. Special mention must be made of the Vancouver City Police, the
Royal Canadian Mounted Police, the British Columbia Hotels' Association, the Liquor
Control Board, and the Indian Affairs Branch of the Department of Citizenship and
Immigration.
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 the helpful advice and assistance
so freely given at all times. DEPARTMENT OF HEALTH AND WELFARE, 1952 BB 113
REPORT OF THE DIVISION OF TUBERCULOSIS CONTROL
G. F. Kincade, Director
Probably foremost in our minds at the time of the last annual report was the
reduction of the waiting-list and its eventual elimination through the opening of the
Pearson Tuberculosis Hospital in May, 1952. This opening so markedly reduced the
waiting-list that at the present time there are less than fifty people waiting for beds in our
Provincial sanatoria.
The remodelling at Tranquille Sanatorium was completed, and, as a result, fifty
additional beds were made available near the end of the year. When these beds are
available and the Pearson Hospital is finally staffed and working to full capacity, the
present waiting-list will undoubtedly be eliminated.
However, it should be pointed out that the present waiting-list is from a highly
selected group, and undoubtedly additional cases could benefit from a sanatorium regime
or should be in sanatorium for the protection of others. If these standards for admission
were applied, the expansion of Pearson Hospital to its eventual capacity of 528 beds
would undoubtedly be required.
One of the biggest jobs in the Division during the past year was the setting-up of
a personnel section and the clarification of staff complements to cover all the activities
of the various units so that this phase of the work would be put on a sound basis. This
was a long and painstaking procedure and, when applied to almost a thousand members
of the staff, represented a great deal of work and detailed study. During the critical
period in the spring when a large number of appointments and transfers were necessary
with the opening of Pearson Hospital, this work was greatly retarded by the resignation
of the first personnel assistant. However, with the appointment of the present personnel
assistant the organization has come along rapidly. It is expected that when the
personnel section is properly organized and the office routine set up, the personnel
assistant will be able to devote considerable time to the investigation of office procedures
and organizational work.
As forecast in the last annual report, the two largest sanatoria have now the services
of trained administrative assistants. The purpose of these positions is to relieve the
medical superintendents of all that part of the work directly related to business so that
the superintendents may confine most of their attention to the gradually expanding
medical organization necessary for the treatment of tuberculosis. The administrators,
having had formal instruction and experience in hospital management, should improve
further efficiency in our sanatorium operations.
NATIONAL HEALTH GRANTS
National health grants continue to be of great assistance to the Division. To date
$294,000 has been allocated of the $370,329 made available by Ottawa. Approximately
58 per cent of this amount is being used in continuing projects, but new and improved
services were also provided under these grants.
The X-ray services were expanded with the installation of photoroentgen equipment
at Burnaby Hospital, University of British Columbia Health Service, Mission Hospital,
Dawson Creek Hospital, and Abbotsford Hospital. Additional darkroom installations
are being provided for three health units. Equipment was provided this year to complete
the furnishing of the pathology laboratory at Tranquille and the departments of respiratory
physiology and physiotherapy at the Willow Chest Centre. A project is now being
considered for the modernization of the X-ray department at Tranquille.
Approval has been obtained for the expansion of the admission X-ray programme
to the smaller hospitals in the Province.   At the present time this service is provided only BB  114 BRITISH COLUMBIA
in those hospitals large enough to warrant the provision of photoroentgen equipment.
It is now planned to pay all the smaller hospitals $2 for each chest X-ray taken on
admission, using their own equipment.
Assistance continues to be provided for postgraduate training. During the year one
doctor completed his training and returned to the Division. At the present time three
nurses and one doctor are receiving postgraduate training, and a project is being submitted
for the training of a second physician. One of the staff is taking a course as a medical-
record librarian and will return to the Division in that capacity. Funds are available for
short courses for senior personnel, and two members of the staff took such courses during
the year.
Throughout the various units of the Division eighteen members of the staff are being
paid through National health grants.
Plans are being made for the expansion of the rehabilitation programme by providing
rehabilitation officers for both Tranquille and Pearson, and expansion of the physiotherapy service by providing a part-time physiotherapist at Tranquille.
The project to provide P.A.S. and streptomycin was enlarged to provide isoniazid
as well.
Approval was not received for the continuation of the out-patient occupational
therapy nor the home-care service in the Vancouver area. The payment for streptomycin injections in the home was also discontinued.
TRENDS IN THE TREATMENT OF TUBERCULOSIS
In reporting the work of the Division of Tuberculosis Control the changing concepts
in the treatment of this disease should be pointed out. From the extensive studies that
have been made through the use of streptomycin and P.A.S., it is now evident that
resistance of the tubercle bacillus to streptomycin can be, to a great extent, controlled by
its combination with P.A.S. and its use in smaller dosages over long periods of time.
With the fear of resistance removed, it is now possible to treat and control tuberculosis
in over 75 per cent of cases without resistance developing and without toxic effects on
the patient. This has greatly broadened the use of these drugs, and it is now felt that
if a patient needs treatment for tuberculosis, he should have antimicrobial therapy.
Where formerly patients were treated from three to six months, they are now being
treated from one to two years and even longer with these drugs. The addition of isoniazid
to the armamentarium has further broadened the attack against tuberculosis, so that
medical cures can frequently be expected.
With the advances in chest surgery and refinements in techniques, pulmonary
resections are commonplace and, in fact, may soon outnumber surgical collapse procedures. Where formerly we hoped for arrest of the disease, we now strive for
eradication. This new approach, while offering great hopes to patients, is also stimulating to those who conduct their treatment. However, it does put the treatment of
tuberculosis on a highly technical plane and requires extensive investigation of patients
with modern equipment. Nevertheless, there is no doubt that when patients are treated
in this way the relapse rate will be greatly reduced.
DEATH RATES
The death rate from tuberculosis in 1951 continued to decline, and a rate of 18.4
per 100,000 was recorded for the other-than-Indian population, as against 21.7 the
previous year. The final corrected death rate for 1951 for the total population was
24.8, as against 27.2 in 1950. Since 1946 the annual number of deaths has been exactly
cut in half, from 576 to 288. This reduction in mortality continued in 1952, there being
214 deaths, compared with 288 in 1951.   This was chiefly due to a considerable reduction DEPARTMENT OF HEALTH AND WELFARE, 1952 BB  115
in Indian and Oriental deaths.   The mortality rate in 1952 for the total population was
17.9 per 100,000, as against a rate of 24.8 for 1951.
While the tuberculosis death rate for British Columbia approximates the death rate
for Canada and is reasonably satisfactory considering the rate of reduction, there is one
area in the Province where the death rate for other than Indians is three times that of the
average. This indicates the need for a concentrated effort in that area. It is pleasing
to report that discussions have already been held and plans are being laid for a special
effort in that area.
TUBERCULOSIS IN OLDER PERSONS
For some time the problem of tuberculosis in the older person has given some
concern. From the annual reports it will be seen that the incidence of tuberculosis in this
group is becoming more apparent, and that the death rate by age specific groups is higher
than in other groups. However, it should be pointed out that for the older persons the
death rate is falling, as in the younger age-groups. It is also apparent that this problem
is more serious among the older male patients than among the older females. This is
confirmed by an analysis of patients in sanatoria at the present time. As of October 20th
of this year a spot survey was made, and it was shown that 552 beds were occupied by
males, while 286 were occupied by females—a ratio of almost two to one for the males.
Of the 552 male beds, 252 or 45.6 per cent were occupied by persons 50 years of age and
over. Of the 286 female beds, 24 or 8.6 per cent were occupied by persons in these
age-groups. In all there were 276 persons, 50 years of age and over, occupying 32.3
per cent of the total of 838 beds. In view of the fact that 24.4 per cent of the admissions
in 1951 were for patients 50 years of age and over, it is apparent that these people tend
to accumulate in sanatoria. The trend in admissions is also interesting because in 1947
this group represented only 16.7 per cent of the admissions. From this it is apparent
that special consideration must be given to this problem by this Division.
The first consideration that presents itself is in respect to accommodation. Is a highly
developed medical service required to treat this type of patient or would ordinary convalescent care be sufficient? Is there any justification in restricting this type of patient
to a strict sanatorium regime, when most of them have little hope of cure and have, for
the most part, already received the maximum benefit from sanatorium care? In any
event it is apparent that tuberculosis in the older person is becoming one of our greatest
problems, and closer study of this problem than has been given in the past must be
carried out.
X-RAY PROGRAMME
At the time of the last annual report it was pointed out that the work of the mobile
survey unit would need critical review to determine a future course in this matter. The
work for 1951 was analysed, and as a result of this analysis it was shown that this was
not an expensive undertaking compared to other methods, and that the yield in cases
found was very satisfactory. The cost of 42 cents an examination compared favourably
to the rates paid to hospitals for miniature films, and the case-finding rate of 2.2 cases
per thousand compared favourably with other clinics. It was therefore recommended
that this service be continued, particularly where it reached into areas that otherwise
could not be covered.
It was also decided that the mobile X-ray programme should be on a continuous
basis. This Division is grateful to the British Columbia Tuberculosis Society for providing
a new truck and generator, which should enable us to carry out this work in every part of
the Province. There was an unavoidable delay in starting this work in the fall due to
non-delivery of equipment, but it was undertaken, and the unit continued to work in the
Lower Fraser Valley until the end of the year. At the first of the year it will be available
for work on Vancouver Island, and it is expected that the summer season will be devoted BB 116 BRITISH COLUMBIA
to work in the Interior. It has been asked that all areas of the Province submit their
requests for use of this equipment so that the itinerary can be planned. Once this is
established, it is hoped that a pattern can be developed so that the unit may move
continuously throughout the Province each year, it being understood, of course, that it
will not visit those areas that have been supplied with photoroentgen equipment.
In spite of a great deal of effort, the results from admission X-ray surveys have not
been as good as was anticipated this year, although there was an improvement over the
previous year, there being 47,793 admission X-rays during 1952, as against 28,700 in
the previous year. It is to be hoped that this showing will improve because the programme is backed by all the official organizations connected with hospitals, particularly
the British Columbia Hospital Insurance Service, which has taken an active interest in
this work and is attempting to stimulate the hospitals to make a better showing. The staff
of the Division must take every opportunity to promote this work and point out its
advantages both to the staff of the hospitals and to the patients. When some of the
larger hospitals are approximating 90 per cent examination of admissions, it is difficult
to understand why in smaller hospitals, where the organization is less complicated, similar
results cannot be achieved. However, it is encouraging to note that most hospitals, where
requested, have co-operated very well in the examination of out-patients. While the poor
showing in respect to admissions is to be regretted, it must be remembered that it is of
considerable importance that this examintaion was made available for out-patients.
Encouraged by the Chilliwack experiment, where an organizational plan for
canvassing the population to have chest X-rays at the survey unit in the hospital was
carried out, the British Columbia Tuberculosis Society is considering provision of an
organizer to expand this work to other centres in the Province. In this way it is hoped
that all of the centres with photoroentgen equipment will be organized along the same
lines as Chilliwack, and that a continuous survey at each centre will be carried out.
Credit should be given here to the members of the Junior Red Cross of Chilliwack, who
gave splendid co-operation.
In 1952 there were 212,742 X-ray films taken in the clinics of the Division, general
hospitals, and health units, as against 202,000 in 1951.
TRAVELLING CLINICS
It is pleasing to report that the district work of the Division through travelling clinics
is now on a more satisfactory basis. Because additional staff was made available through
new appointments, medical consultants are now able to accompany the travelling clinics
on their visits to the various areas. This has long been desired, and its accomplishment
makes for the provision of a better medical service and the promotion of closer relations
between the Division, the health units, and the practising physicians.
When consideration is given to the fact that a third of our known cases, or
approximately 5,000 persons suffering from tuberculosis, are scattered throughout the
smaller centres of the Province, and that their follow-up and supervision must be carried
out by the travelling clinics and the field health service, it can be seen that the provision
of the necessary services is a considerable task.
NEW CASES
The number of new cases discovered during the year amounted to 1,387. This was
a reduction and was partly due to changes in the system of notification whereby cases
which are healed on diagnosis are not included in the central index of known cases but
are followed by public health personnel on a referral basis. However, over and above
this there was an actual reduction in the number of new cases in 1952, but the extent of
this reduction is difficult to estimate. The new cases, broken down into racial groups,
show the following:   Indians, 256;  other than Indians, 1,131;  and into age-groups:— DEPARTMENT OF HEALTH AND WELFARE, 1952
BB 117
Indians—
0-4	
_____    31
5-9	
_____    48
10-14	
     36
15-19	
_____    32
20-24	
     24
25-29 	
13
30-39	
     21
40-49	
     14
50-59	
_____    14
60-69	
       4
70-79	
_____    12
80 and over	
       7
Not stated	
Other than Indians—
0-4
26
5-9	
___    17
10-14	
___    12
15-19	
___    26
20-24	
___    47
25-29	
___    58
30-39	
.__    99
40-49	
__ 109
50-59	
___ 106
60-69	
___ 103
70-79	
___    61
80 and over	
___    14
Not stated	
___    12
The sources of reporting of new cases during the year were as follows:—
Stationary clinics:   Tranquille, 10; Vancouver, 419;  Victoria, 48;  and New
Westminster, 81.
Travelling clinics: Interior, 52; Coast, 50; Island, 19; and Kootenay, 43.
Reported from outside the Division of Tuberculosis Control, 665.
SOCIAL SERVICE
During the year there was almost a complete change in the personnel of the Social
Service Section, but in spite of this a full complement of workers was maintained, and the
Section is now fully staffed.
A new policy of referral of patients was established, and is working out most
satisfactorily. Instead of waiting for a crisis to develop before a patient is referred to the
Social Service Section, it has become routine where social-work staff is available for all
newly admitted patients to be visited by the ward social worker soon after admission.
The purpose of this introductory visit is twofold—to acquaint the patient with the kind of
help that is available to him from the Social Service Section and to give the social worker
an opportunity of getting to know something about the patient as a person and how he is
responding to the pressures that are part of a long-term disabling condition. In all the
work on the wards the closest team relationship is maintained with the doctors, the nurses,
the rehabilitation officer, and other allied workers in order to achieve the common goal,
which is to help the patient accept his tuberculosis and fight it effectively with the weapons
which are available to him in the hospital setting.
The home-maker service, instituted in 1948 under National health grants to provide
housekeeping assistance in select homes of tuberculosis patients, was discontinued in
1952. The purpose of this service was to assist in relieving the acute shortage of beds
existent at that time. It was designed as a short-term project, and discontinued because
it was felt that the opening of the Pearson Hospital would relieve the shortage.
NURSING
In preparing the report on the nursing services for the past year, there does not seem
to be a great deal in the general picture that can be considered as entirely new, but steady
progress has been made toward maintaining standards and improving services to the
patients. The time seems opportune, therefore, to review the changes and developments
that have entered into the reorganization and expansion of the nursing services during the
past decade.
Four factors that stand out as a basic part of the nursing organization are as
follows:— BB  118
BRITISH COLUMBIA
(1) The educational programmes for tuberculosis nursing at the undergraduate
and graduate levels.
(2) In-service education for orientation of new staff, both auxiliary and professional nursing personnel. An article was prepared on the programme
at Tranquille for publication in The Canadian Nurse.
(3) Review and subsequent standardization of procedures and isolation
technique to arrive at uniformity for the various institutions throughout the
Division. This is important because lack of uniformity, among institutions
or among wards, can result in confusion.
(4) Studies made toward developing patient-centred care, which included staff
quota requirements and demonstrations and experiments with the team
nursing plan.
Under the team plan, assignments are based on patients' needs rather than ward
duties; for example, a group of patients is assigned to a professional nurse who is
responsible for their total nursing care, including the supervision of the duties done for
them by auxiliary personnel, aides, and orderlies. General staff nursing, done under this
pattern, is proving satisfactory from two standpoints: (a) Better over-all care for the
patients, and (b) greater satisfaction for the staff nurse. However, it should be pointed
out that successful implementation of the team nursing principle is dependent on three
important requirements:—
(1) Adequate numbers of well-prepared staff who are physically and professionally able to carry full responsibility for a group of patients and direction
of auxiliary staff members.
(2) A proper proportion of professional and auxiliary staff in relation to the
patient quota and volume of nursing service requirements.
(3) Convenience of physical layout of ward, patients' rooms and service areas,
and adequate equipment.
Much planning, organization, and staff education are still necessary before the team
nursing plan can be implemented successfully in the various institutions of this Division.
Nevertheless, actual experimentation with the plan has progressed to the extent that the
Division's nursing service was invited to present a demonstration on team nursing to
the Western Canada Institute for Hospital Administrators at the workshop which was
arranged by the School of Nursing at the University of British Columbia for the nurse
representatives to the Institute.
Additional factors that have a direct bearing on the nursing service are as follows:—
(1) The need for review and subsequent revision of practices and policies on
such routines as charting. Elimination of time-consuming and repetitive
routines would tend to make more time available for the nurse to spend at
the bedside or in consultation with co-workers, allied workers, relatives,
and patients in the interests of better care and understanding of the
patients.
(2) Instruction for orderlies: The setting-up of a basic course of instruction
and demonstration on essential procedures would strengthen and improve
patient-care.   Implementation would be at the local level.
Teaching Programmes
As in previous years, a variety of teaching programmes were undertaken to provide
instruction in tuberculosis nursing. The majority of nursing students were undergraduates from Mainland hospitals. These students spent five weeks with the Division.
A lesser number from Victoria hospitals attended classes for one week in Vancouver and
then returned to Victoria for clinical experience. DEPARTMENT OF HEALTH AND WELFARE,  1952 BB  119
The teaching programme also included practical-nurse students and public-health-
nurse students, who undertook courses or attended programmes planned to provide
experience.
The number and types of programmes were similar to those conducted in the previous
year.
The Pearson Hospital, the Jericho Beach Hospital, the Willow Chest Centre, and
the New Westminster Chest Clinic are all being used for student experience.
GENERAL
At this time, mention must be made of the splendid co-operation among parts of the
the Division and of the excellent relations with other departments of Government. The
Division of Tuberculosis Control must depend on a great many agencies to carry out its
programmes and to conduct its day-to-day business. It is therefore gratifying to be able
to state that every assistance possible has been extended to this Division.
With other organizations, such as the Indian Health Service, the closest and most
cordial arrangements for mutual assistance have been maintained. The British Columbia
Tuberculosis Society, as in the past, has been a tremendous force in the campaign against
tuberculosis. The work of the Preventorium Board is also noteworthy in that it provides
the facilities, not available within the Division, for the treatment of tuberculous children.
Plans are at present under way for the expansion of the Preventorium from forty to eighty
beds.
To all these and many other organizations who assist in this work, the Division,
therefore, records its sincere appreciation.
VICTORIA, B.C.
Printed by Don McDiarmid, Printer to the Queen's Most Excellent Majesty
1953
770-153-9352 

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