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Fortieth and Forty-first Reports of the Medical Inspection of Schools For the Years Ended June 30th 1951… British Columbia. Legislative Assembly 1954

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Full Text

 PROVINCE OF BRITISH COLUMBIA
Fortieth and Forty-first Reports
of the
Medical Inspection of Schools
For the Years Ended June 30th
1951 and 1952
VICTORIA, B.C.
Printed by Don McDiarmid, Printer to the Queen's Most Excellent Majesty.
1953  Department of Health and Welfare,
Victoria, B.C., November 25th, 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 Reports of the Medical Inspection
of Schools for the years ended June 30th, 1951 and 1952.
ERIC MARTIN,
Minister of Health and Welfare. Department of Health and Welfare,
Victoria, B.C., November 25th, 1953.
The Honourable Eric Martin,
Minister of Health and Welfare, Victoria, B.C.
Sir,—I have the honour to submit the Fortieth and Forty-first Reports of the
Medical Inspection of Schools for the years ended June 30th, 1951 and 1952.
I have the honour to be,
Sir,
Your obedient servant,
G. F. AMYOT, M.D., D.P.H.,
Deputy Minister of Health. -
Fortieth and Forty-first Reports of the Medical
Inspection of Schools
(A Report of School Health Services)
This Report contains information and statistics in relation to school health services
as conducted in the schools of British Columbia during the years ended June 30th, 1951,
and June 30th, 1952.
TRENDS IN SCHOOL HEALTH SERVICES
Recent reports outlining the school health services in British Columbia have emphasized changing concepts which are influencing the changing attitude of the school health
services. There was first the realization that the school-child could not be segregated
from the rest of the community, as he was actually a definite member of a family group
within the community. It became evident, therefore, that the health of the school-child
was dependent on the health services provided for the community as a whole, rather than
on the provision of school health services alone. It became increasingly apparent that
the more effective and more extensive the general health services, the fewer health
problems there would be in the schools.
At the same time, evidence was multiplying indicative of the need to provide concentrated service for certain individual children while providing routine service for the pupils
as a whole. The prevention of disease, psychosomatic disturbances, the relation between
medicine and the social sciences have all become legitimate subjects of concern to the
medical profession, and the health of the child has become an object of education. " The
Manual of School Health Procedures," Department of Health, City of New York, has
very ably summarized this, as follows:—
Behind us are the days of emphasizing great numbers of routine inspections and examinations which supposedly gave the administrator a cross-section of the health status of the whole
school population but which, without doubt, revealed little about the well-being or progress about
the individual child.   Today the individual child and his specific needs are of chief concern.
Behind us are many outmoded methods of controlling communicable disease, but ahead of
us are such unsolved problems as the prevention of rheumatic fever, dental caries, problems that
must remain unsolved until medical science reveals their causes.
Behind us also are over-specialized, independent, unco-ordinated efforts in caring for such
problems as defective vision and hearing, and emotional disorders. Before us is the need to fit
these activities into proper relationship through a comprehensive, over-all administrative program
so planned as to conserve our resources and at the same time serve the individual in the best
possible manner.
Discarded is the concept that school children owe their favourable health status solely to
medical examinations and administrations of school teachers and nurses. Today we see so much
more clearly than we did a generation ago that the prenatal instruction given mothers, better
professional attention at birth, training in infant nutrition and care, early immunizations, improvements in housing, advances in sanitary conditions of neighborhoods, protection of milk and other
foods, introduction of playgrounds, planned community attacks on tuberculosis and other communicable diseases—all can make their contributions. We have learned that without the co-operative functioning of each of these services, today's children cannot achieve well-being.
Thus, improved community health services are reflected in the health of the school-
child.   The school health programme, as it is developing, has several objectives:—
(1) It is designed to present an appraisal of the child, physical, mental, emotional, and social. What are his assets, his liabilities? What needs to be
done to help this child achieve a level of health commensurate with his
potentialities for health?
5 S 6 BRITISH COLUMBIA
(2) How can each child in school be considered as an individual? Unless
a way is found to accomplish this end, the knowledge of the principle of
the individual differences is to no avail.
(3) How can the school environment be improved so that the growth and
development of the child will not be impeded? The concern here lies with
both the sanitation and emotional environment; that is to say, the emotional environment of the classroom, including such factors as the effect
of the teacher's personality, the routines and disciplines imposed on the
children.
(4) How can an educational programme be developed in the school which
enables a child to learn how to make judgments which affect health
behaviour.
These, then, are the main considerations in the school health programme—health
service, health guidance, health instruction, and school environment. In order to accomplish this, the education and school health personnel are required to reorient their efforts
so that consideration is given to the needs of the children in developing a programme that
meets the mental, emotional, social, and physical needs of this age-group.
The classroom teacher is the foundation-stone in programme success. The good
teacher's observations can be invaluable to the school physician. The teacher should not
be content with a cursory " morning " inspection for rashes or dirty finger-nails; she
should be constantly alert for signs of deviation from normal. Such signs may be transient
and dramatic—the flushed face in the afternoon that may indicate fever and an on-coming
infection, or may be gradual and obscure, such as a slowly growing inattentiveness in
a child whose hearing or vision is failing, or whose home situation is becoming difficult.
It is becoming increasingly clear that the teacher has much to offer to the physician, and
that she should be encouraged to make more careful observations, not to make diagnoses
such as enlarged tonsils, but to note these things that can be observed, such as the child
commencing to squint when he looks at the blackboard, leave the room more often to
urinate, or to change his normal patterns of behaviour.
These observations can be imparted to the public health nurse, who can correlate
them with her knowledge of the case-history of the child. The teacher-nurse conference
may provide sufficient information leading to satisfactory treatment, but in other instances
the support of the parents, family physician, and others will be required. The public
health nurse serves to link up the school with the health and welfare of the community.
ADMINISTRATION IN SCHOOL HEALTH SERVICES
Arising from the fact that school health services cannot operate efficiently and
effectively apart from community health services has been the proposal that School Boards
unite their school health services with municipalities in a Union Board of Health, to have
the school services administered by the health-unit staff as an integral part of the complete
community health service. Throughout the years more and more district School Boards
have become reconciled to that approach and have transferred the school health services
to Union Boards of Health, on which the School Board has individual representation.
During 1951 nine school districts—namely, No. 4 (Invermere), No. 18 (Golden), No. 12
(Grand Forks), No. 13 (Greenwood), No. 32 (Hope), No. 55 (Burns Lake), No. 47
(Powell River), No. 50 (Queen Charlotte), and No. 36 (Surrey)—joined the Union
Board of Health, while in 1952 nine additional School Boards united in the establishment
of two new health units—namely, the Boundary Health Unit with headquarters at
Cloverdale and the South Central Health Unit with headquarters at Kamloops. The
individual Boards include No. 36 (Cloverdale), No. 37 (Ladner), and No. 35 (Langley)
in the Boundary Health Unit, and No. 24 (Kamloops), No. 25 (Barriere), No. 26 (Birch
Island), No. 29 (Lillooet), No. 30 (Ashcroft), and No. 31 (Merritt) in the South Central MEDICAL INSPECTION OF SCHOOLS,  1951-52
S 7
Health Unit. In addition, School District No. 34 (Abbotsford) joined the already existent
Upper Fraser Valley Health Unit with headquarters at Chilliwack. This provides seventy
of the seventy-eight school districts with school health services through health units, a very
definite step forward in consolidation of community health services to include school
health services.
METHODS OF EXAMINATION
There continues some questioning as to the best procedures to follow in arriving at
a decision of the physical status of school-children. Increase in the school population
and development of a greater number of schools necessitate the need for school medical
staff to analyse the procedures presently being employed to determine those that are
practical in terms of results, and to develop new procedures to provide maximum service
to the maximum number of pupils, with concentration on the individual pupils who are
most in need of medical services. It has become self-evident that an annual physical
examination for every pupil cannot be justified and might not be entirely warranted.
A glance at Table I indicates that something over 93 per cent of the children examined
have been in the A group, exhibiting minor defects or none at all. The annual routine
examination of this group is time-consuming and yielding of unproductive results, other
than confirming their physical fitness in terms of clinical assessment. It would seem to
be much more valuable to spend time on the slightly more than 6 per cent in B Group
and considerably more time on the 0.1 per cent in C Group. Over the past few years
it has become customary, in so far as routine school medical inspections are concerned,
to confine them to Grades I, IV, VII, and X, with screening selection of the intervening
grades. This is reflected in the statistical analysis of the school medical examinations,
in Table IV, in which the percentage of pupils enrolled in those grades and examined is
considerably greater than that shown in Table III, showing the percentage of pupils
examined in all grades of school.
It is evident from Table III that the number of pupils in grades examined has
continued to increase year by year, from 121,542 in 1948 to 161,408 in 1952. At the
same time the actual number of pupils examined has remained fairly constant throughout
the years. There has been an approach to leave some of the routine services to concentrate on the children exhibiting emotional or physical deviations, while providing a greater
measure of service to the children in school. At present annual medical inspections are
provided to all students in Grades I, IV, VII, and X. There is some question as to
whether these examinations are necessary in all four grades, and consideration is being
given to limiting them to Grade I and one other grade. These questions are being raised
while endeavours are being made to develop screening methods which will permit selection
of the pupils who need more medical attention. Thus certain mass testing procedures
become necessary, and the one that has received the greatest attention in British Columbia
thus far has been the study of the Wetzel Grid as a screening tool. It provides an assessment of the physical status of the children on the basis of height-weight measurements
related to chronological age, plotted on a special graphical chart. If, as a result of consecutive plottings, the individual growth curve shows a deviation from a preferred channel
of growth, it is argued that something must be wrong, physically, nutritionally, or emotionally, and the child should be thoroughly investigated. The method was very carefully
analysed over two years in the school health services, and a report presented to indicate
that continued use of the grid as an ancillary to the physical examination by public health
nurses and School Medical Inspectors seems warranted. Arising from that work, the
Wetzel Grid has continued to be the screening tool in the sixty schools of the Central
Vancouver Island Health Unit, and during the year an extension of the programme was
undertaken in the North Okanagan Health Unit, where the grids were adopted for use
in the school medical services for Grade I pupils only. Gradual expansion will be undertaken as grades are added for the incoming Grade I classes.   As the South Central Health S 8 BRITISH COLUMBIA
Unit became organized, Wetzel Grids were added to that school health programme also,
so that as of June 30th, 1952, three health units in the Province were using the Wetzel
Grid as a screening tool.
In addition, the nurse-teacher and the nurse-parent conference serves as another
screening method which selects the pupils exhibiting physical or emotional deviation
requiring intensive medical examination to determine, if possible, the causative factor
and possible treatment. This still seems to offer definite advantages in selection of the
pupil while concentrating the time and skill of the school medical staff for those pupils
most in need of it. It thus seems that a chain of responsibility exists in referral of the
pupil by the teacher to the nurse, by the nurse to the parent, the parent to the family
physician, the family physician to the specialist, followed by adequate treatment and
follow-up of the treatment, usually again by a combination of parent-teacher-nurse-
physician. It is only in this way that the facilities of the school and the medical services
can be expected to yield the maximum results in promoting the health of that smaller
percentage of B and C Groups, while maintaining the health of the larger percentage
of A Group.
Also during this period, inquiry was made into the procedures of visual testing in
schools in an endeavour to ascertain if present Snellen Chart methods could be improved.
The Snellen Chart test is the most widely used for the purpose of vision testing, acting
again as a screening tool to select those pupils showing visual defects requiring more
intensive examination. It has been found that children with inability to read letters on
the Snellen Chart at an average distance do require more specialized examination, but
the question arose as to whether some children were being neglected, having other visual
defects not detected by Snellen Chart testing. The inquiry complemented a study made
two years ago when reliable information indicated that the adequately lighted Snellen
Chart was the most satisfactory method. Inquiries conducted in 1951 again substantiated
the properly lighted Snellen Chart as a very efficient vision-testing technique. It was
borne out that adequate illumination to approximately 10 foot-candles can be obtained
by placing a gooseneck lamp reflector on each side of the chart 3 feet away, each lamp
containing a 100-watt daylight bulb. With this method it was definitely borne out that
few additional defects of serious import are likely to be detected through specialist examination, and that the extra time and expense of examining every school-child along those
lines would be unnecessary and wasteful of public funds. After careful consideration
of all the facts, the effectiveness of the programme, the personnel, time, and money
involved, it was recommended to continue the Snellen Chart screening method, coupled
with parent-teacher-public health nurse referral, as constituting the most ideal visual
testing method for all practical purposes.
DENTAL HEALTH SERVICES
During the school-year 1950-51 arrangements finally were completed whereby it
was possible for full-time dental officers to be appointed to the health units of the
Province. During that year the Union Boards of Health of nine health units, with the
agreement of the majority, if not all, of their respective Boards of School Trustees,
requested this service and agreed to contribute toward its cost. Nevertheless, no suitable
applicants to these appointments presented themselves until the summer of 1951.
However, during this year, in ten communities outside the metropolitan areas, clinics
were organized for the younger children in the offices of private dentists on a part-time
sessional basis. The Health Branch made grants to such programmes on the basis of
50 per cent of the total remuneration paid to the dentist. The balance of the cost of the
programme has been met by community resources, and to offset this a flat fee, usually
between $2 and $5, has been charged to the parents of children receiving treatment.
In an endeavour to provide this type of service to communities without a resident
dentist, sets of transportable dental equipment, especially designed by the Division of MEDICAL INSPECTION OF SCHOOLS,  1951-52
S 9
Preventive Dentistry, were loaned during the summer of 1951 to dental practitioners
willing to undertake this type of programme when visiting a more remote community.
By this means such programmes were carried out for the younger children at Port Alice,
Port Hardy, Bella Coola, and the more remote parts of the Seechelt Peninsula and
adjacent islands.
Nevertheless, during the school-year 1951-52 full-time 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.
During this year it was also possible to increase significantly the grants made by the
Health Branch toward the costs of the school dental services provided within the
metropolitan areas.
In all, twenty-nine school districts were in receipt of preventive dental services
provided by full-time dental officers, and another school district was served by a dentist
providing half-time services.
In addition, in a further fourteen school districts, dental clinics were organized in
which private dental practitioners provided regular services in their own offices for the
younger children of the community on a clinic basis. Sets of transportable equipment
were forwarded to Merritt, Slocan City, and Ganges so that dentists might regularly visit
these communities to provide clinics for the younger children. In addition, a further
set of equipment was also issued on permanent loan so that a dentist might similarly visit
Kitwanga, Hazelton, and Usk. During the fiscal year 1951-52 no less than 1,874
children were restored to or maintained in dental health through these clinics.
Through School Medical Inspectors, full-time dental officers, and public health
nurses, audio-visual and visual teaching aids for dental health education have continued
to be provided to schools. It cannot be stressed too strongly that to-day the vast majority
of dental disease can be prevented. The teaching within the health curriculum of schools
of the latest and accurate information as to how dental disease, and especially the scourge
of dental decay, can be prevented cannot therefore be too strongly recommended. The
Health Branch, through its field staff, stands ready to give every possible assistance to
School Inspectors, school principals and teachers in this regard.
PUBLIC HEALTH NURSING SERVICES
Since the last Report, public health nursing service has been extended to the
following school districts: No. 50 (Queen Charlotte Islands), No. 31 (Merritt), and
No. 12 (Grand Forks).
The public health nurse continues to offer health supervision to school-children as
part of the community health service provided from a local health unit. The public
health nurse visits the schools in her area regularly and offers certain nursing services
to the school-children, and provides consultative assistance to the teachers in health
matters.
I S 10 BRITISH COLUMBIA
In the school the public health nurse assists with school medical examinations,
screening tests such as vision and hearing, arranges for immunizations, chest X-rays, etc.
She advises concerning the control of skin infections, communicable diseases, and first-aid
measures in the school.
Through conferences with the teachers, parents, and pupils, she works toward the
improvement of the physical health of the school-child. While visiting in the homes of
school-children, she is in an excellent position to interpret health practices to parents,
while at the same time she assists parents to understand the need for specific action. She
encourages parents to correct defects and refers children needing financial assistance for
this purpose to suitable agencies.   She acts as liaison between the school and the home.
During the school-years 1950-51 and 1951-52 public health nurses assisted with
68,255 medical examinations and completed 141,331 nurses' examinations. The public
health nurses held 89,563 conferences with members of the school staff, 82,904 with
school pupils, and 17,329 with parents. There were 12,081 first-aid demonstrations.
A total of 65,738 visits was made by the public health nurses to homes of school-children.
Of these visits, 44,755 were for general health supervision, 1,729 were for mental hygiene,
while 17,432 were for skin infections and communicable diseases.
Nursing-care service in the home was rendered to 1,822 school-children.
HEALTH EDUCATION
The importance of health from the point of view of the individual and the community
has been well recognized by the educational authorities in this Province, with the result
that health teaching has been given an important place in the school curriculum. Because
of the many opportunities which present themselves in the school for providing information and for influencing attitudes and habits in a practical manner as they relate to health,
teachers are discussing more and more their health-teaching problems with full-time local
public health personnel and are making use of the information and assistance provided
by them and by the Division of Public Health Education of the Provincial Health Branch.
One of the major problems among teachers who took their teacher-training prior to
the introduction of the courses in Effective Living is that of information regarding community health and local public health services. Although local health-unit personnel
have been providing information to teachers in their areas, the presence of a health
educator in the Central Vancouver Island Health Unit (headquarters at Nanaimo) has
effected a clearly defined liaison between that unit and the teachers in School Districts
Nos. 65 to 70 through, firstly, interpretation of health-unit services and, secondly,
familiarization with the visual aids maintained in the library of the Division of Public
Health Education.
As in the past, this Division continues to provide as much practical assistance as
possible to encourage a more active health education programme in schools by supplying
pamphlets, posters, films, film-strips, and statistical data to teachers and principals through
their local health services. It is heartening to note that greater use of these facilities,
especially with respect to films, is being made by teachers throughout the Province.
NUTRITION SERVICES
During the school-years under review two methods of nutrition education—namely,
dietary studies and rat-feeding experiments—have proven particularly effective in
encouraging children and their families to improve their food selection for their own
well-being.
Dietary studies were conducted in thirty-eight schools in districts on Vancouver
Island, the Fraser Valley, East Kootenay, and Northern British Columbia. These studies
were carried out under the supervision of the teacher and the public health nurse as
a school health project.   The children recorded all the foods they ate over a three-day MEDICAL INSPECTION OF SCHOOLS,  1951-52
S 11
period, and these records were analysed to obtain a clearer picture of the pattern of food
consumption for the group. It has been found that this type of study aroused a good
deal of interest among children and their parents in addition to providing needed
information for teachers and public health personnel regarding dietary problems in their
area. In each area it was found that the three chief deficiencies in the children's diets
were milk, a Vitamin D supplement, and foods rich in Vitamin C. It was also noted
that the majority of children consumed liberal amounts of meat, potatoes, and bread, and
in many cases excessive amounts of sweet food such as cake, candy, and soft drinks.
As a result of these findings, it has been recommended that nutrition education in the
schools give particular emphasis to the need and value of milk, Vitamin D supplement,
and foods rich in Vitamin C, as well as practical methods of reducing excessive consumption of sweet foods. Pamphlets, films, and film-strips emphasizing these points have
been widely distributed for the use of teachers and public health personnel.
A very effective method of following up dietary surveys has been the rat-feeding
experiment. The purpose of these experiments is to demonstrate to children and parents
the benefits and help that may be derived by a good selection of food as contrasted to
a poor selection of food. During the first four weeks, one pair of rats is fed a variety of
food recommended in Canada's Food Rules and the other pair receive such foods as soft
drinks, white bread, cake, and candies. After about four weeks the difference in weight,
appearance, and disposition between the two pair of rats is readily noted by the children.
This type of rat-feeding experiment was introduced into 120 schools outside of the
Greater Vancouver area during the two school-years under review. Teachers and public
health nurses were asked to assist in evaluating the effectiveness of this 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 considerable interest in the study of food 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 Association meetings or during parents'
day at the school.
Considerable assistance has been provided to schools relative to school-lunch
programmes. The nutrition consultant and local public health personnel have provided
information to school authorities on such matters as equipment requirements and layout
for school cafeterias, economical methods of preparing food at school, and large-quantity
recipes and menus.
HEALTH OF THE SCHOOL-CHILD
Consistent with the findings of previous years, physical examinations of schoolchildren during 1951 and 1952 have revealed the vast majority of them to be in good
physical condition clinically. Table I, shown below, reveals slightly over 93 per cent
are in satisfactory condition clinically, either excellent or having minor physical defects
showing no effect on their health.
Table I.—Physical Status of Pupils Examined, Showing Percentage
in Each Group, 1945-46 to 1951-52
Academic Group
Percentage
of Pupils,
A Group1
Percentage
of Pupils,
B Group2
Percentage
of Pupils,
C Group3
1945-46
90.4
91.1
91.7
93.3
93.4
93.1
93.5
9.0
8.3
7.8
6.4
6.5
6.8
6.4
0 6
1946-47              _  	
0.6
1947-48           	
0.5
1948 49                     - -  	
0.3
1949 50                                —
0 1
1950 51                      -       	
0.1
1951 52                                                                    -	
0.1
1 A Group: A, Ad, Ae and Ade categories.
2 B Group: Bd, Be, and Bde categories.
3 C Group: Cd, Ce, and Cde categories. S  12
BRITISH COLUMBIA
In addition to the excellent physical status of the average British Columbia school-
child, the greater number of pupils (well over 75 per cent in each group) are immunized
against the major communicable conditions, such as diphtheria and smallpox, and continue to maintain their immunity status throughout their school-life. This is an encouraging trend, particularly as the percentage immunized in each grade has improved over
past years, and, as is evident in Tables XI and XII, was further improved in the school-
year 1951-52 over that pertaining in the previous year, 1950-51. There remains a need
for continual vigilance in this matter of population immunization, however, since cases
of diphtheria do continue to occur, as is evidenced in the rates of 0.4 case per 100,000
population in 1951 and 0.9 in 1952. Here again, however, there was a decrease in the
incidence of cases over previous years, and it may be that the improved immunization
picture had something to do in the control of that infection.
Immunization against other communicable infections is also evident from these
tables, although considerably lesser numbers are involved. This is to be expected, firstly,
in respect to scarlet fever, since the newer methods of treatment, using antibiotics, have
rendered this infection less serious than formerly, and control measures can be established
through prophylactic treatment with these same antibiotic or chemotherapeutic agents.
Consequently, since the immunization procedures involving five injections were extremely
time-consuming in administration, were painful in so far as the individual was concerned,
and were of questionable value in maintaining immunity status, the organization of
immunization clinics for this purpose has lessened, only being offered to those pupils
remote from medical care or definitely requiring immunization on the recommendation
of their physician.
In so far as pertussis (whooping-cough) is concerned, immunization is specifically
recommended for the very young, between the ages of 6 months to 2 years, in which this
particular infection is most likely to be fatal. As the child becomes older, the need for
pertussis immunization becomes lessened, as is borne out by the tables, which show
a very high level of protection in young children in the lower grades, but less and less
in the higher grades. The fact does remain, however, that pertussis constitutes a definite
threat in British Columbia, as shown in Table II, in which the number of cases created
a rate of 97.3 per 100,000 population in 1951 and 81.5 in 1952. Although this was
considerably lower than the rate of 152.9 in 1950, it was significantly greater than the
rate of 19.2 in 1949, and indicates that concentration of immunization in the young
age-groups is definitely warranted.
Table II.—Immunization Status of Total Pupils Enrolled,
According to School Grades, 1950-51
Total Pupils
Enrolled
by Grades
Percentage Immunized
Diphtheria
Scarlet
Fever
Smallpox
Pertussis
Typhoid
154,517
18,913
18.479
17,188
16,002
14,706
13,474
13,140
12,181
10,546
8,436
6,358
4,607
487
77.1
73.6
75.5
78.6
81.1
79.8
80.7
80.7
76.3
75.6
72.9
72.3
70.5
70.6
18.4
9.2
11.6
15.2
17.3
19.5
21.6
24.1
24.8
25.0
23.6
21.4
23.2
39.8
75.7
69.1
73.5
29.1
49.0
45.9
19 3
Grade 1                _	
11.1
Grade 11                                 	
15.5
Grade III                        ___._	
76.8 |        42.7
78.9 37.8
78.2        1        29.3
81.1         j        20.6
79.7        1        17.0
17.6
Grade IV   .....              • 	
20.1
Grade V                             	
21.3
Grade VI _	
22.0
Grade VII   .               	
21.6
Grade VIII                        	
76.6
75.4
72.7
71.6
72.5
72.9
13.8
11.7
9.1
6.9
6.6
4.1
22.6
Grade IX    ....             	
23.5
Grade X                        	
21.7
Grade XI  -              	
21.8
Grade XII __
20.8
Grade XIII                     	
42.1 MEDICAL INSPECTION OF SCHOOLS,  1951-52
S 13
Table III.—Immunization Status of Total Pupils Enrolled,
According to School Grades, 1951-52
Total Pupils
Enrolled
by Grades
Percentage Immunized
Diphtheria
Scarlet
Fever
Smallpox
Pertussis
Typhoid
Total, all grades-
Grade I	
Grade II	
Grade III	
Grade IV	
Grade V	
Grade VI	
Grade VII	
Grade VIII	
Grade IX	
Grade X	
Grade XI  	
Grade XII	
Grade XIII 	
161,408
19,079
18,488
18,520
17,374
15,917
14,650
14,021
12,425
10,951
8,456
6,327
4,679
521
82.4
15.5
81.2
8.2
82.3
9.0
82.8
11.1
83.4
14.0
83.6
15.4
90.3
17.7
81.1
18.8
81.1
21.1
78.2
21.2
81.5
23.4
79.7
23.0
77.4
22.5
75.6
27.4
81.6
73.6
80.0
81.2
82.4
82.7
86.9
82.9
83.3
83.1
83.8
82.5
83.0
79.7
18.3
53.1
52.0
47.7
42.1
37.3
31.5
22.6
18.8
12.5
11.9
9.9
10.0
6.3
17.0
8.1
11.4
15.2
16.9
19.2
20.7
20.0
20.5
20.7
21.3
21.2
21.9
25.7
Immunization against typhoid fever is carried on in certain areas of the Province
where sanitation remains primitive, but is not routine or particularly recommended in
those areas where protected water-supplies and water-carried sewage systems exist.
This means that no typhoid fever immunization is offered in the large urban centres,
where the bulk of the school population is concentrated. Consequently, the proportion
of pupils immunized contained those pupils in more unsettled parts of the Province,
where the figures are resultantly low.
The general health of the school-child during the 1951-52 period, as reflected in
the communicable-disease incidence, would seem to be unfavourable. While there
were gratifying decreases in the number of cases of diphtheria, and there was some
decrease in the minor communicable infections of measles, mumps, and rubella over
that existent in 1949-50, there were very unfavourable trends in major communicable
infections such as influenza in 1951, scarlet fever and septic sore throat in both years,
and, most seriously of all, in poliomyelitis in 1952. As a matter of fact, during 1952
British Columbia suffered the worst epidemic of poliomyelitis to date, with a rate of 49.6
per 100,000 population, almost twice as high as the previous high year of 1947, and
considerably higher than the normal annual figure of 10 per 100,000 population. This
disease continues to be a source of worry, since so little is known of its cause and control
measures are still none too effective. The future holds some promise, however, as continued research is going on and hope is being held for development of immunization
procedures which will effect more adequate control to decrease the ravages of this disease.
Table IV.—Communicable-disease Incidence
(Rate per 100,000 population.)
1951 1952
Conjunctivitis  32.1 28.9
Chicken-pox  572.5 523.0
Diphtheria  0.4 0.9
Influenza  946.9 45.7
Measles  538.0 686.7
Mumps  500.8 591.7
Poliomyelitis  7.9 48.7
Rheumatic fever  5.3            	
Rubella  196.4 165.8
Scarlet fever  355.8 347.5
Septic sore throat  25.7 44.7
Tick paralysis  	
Pertussis  97.3 81.4 S 14
BRITISH COLUMBIA
During 1952 streptococcal infections exhibited a fairly high incidence comparable
to the high incidence recorded in previous years (a rate of 347.5 in 1952, as compared
with 359.6 in 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 was most marked on the Coast
and in the Kootenays, but occurred to a degree generally throughout the Province.
The downward trend in the number of cases of whooping-cough evidenced in 1951
was continued into 1952. This, while a gratifying result, emphatically points up an undue
prevalence of this infection and concentrates attention, as already stated, for continued
immunization in the lower age-groups.
Influenza, which reached a peak in 1951 with an unduly high number of cases, was
a great deal lower in 1952. It continues to be the cause of a considerable amount of
school absenteeism, and interest in the development of influenza vaccine is being observed
as tests are conducted into the possibility of an effective prophylactic agent.
In spite of the somewhat unfavourable communicable-disease picture, it is felt that
the health of the school-child during 1951-52 was consistently good. The physical status
remained, on the whole, excellent, while the immunity status was definitely improved.
STATISTICS DURING 1950-51
There were 154,517 children enrolled in the grades examined. This was increased
to 161,408 in 1951-52. Of the number of pupils enrolled, there was a somewhat
decreased number examined as compared to previous years, only 29.8 per cent in
1950-51 and 26.3 per cent in 1951-52. As was already mentioned, this is low, but is
due to the fact that concentration is on the pupils in specific grades and particularly those
in commencing grades. Subsequent tables indicate that 64.6 per cent of Grades I, IV,
VII, and X were examined in 1950-51 and 56.2 per cent in 1951-52, while well over
80 per cent of Grade I were provided a thoroughly complete physical examination on
entering school. Usually this was done with the parent present and was productive of
greater results as the parents endeavoured to ensure the child's complete preparation
to a new phase of development and education. In the latter grades, screening methods
were used to select the pupils most likely in need of physical examination. The results
in detail are presented in the various statistical tables.
Table V.—Physical Status of Total Pupils Examined in the Schools
for the Years Ended June 30th, 1948-52
1947-48
1948-49
1949-50
121,542
137,536
128,724
43,662
54,682
45,049
35.9
39.8
35.0
39.5
42.2
38.8
49.6
48.9
52.5
0.9
0.8
0.8
1.7
1.4
1.3
6.7
5.6
5.6
0.2
0.2
0.1
0.9
0.6
0.8
0.3
0.1
0.1
0.1
0.1
0.2
.
1951-52
Total pupils enrolled in grades examined..
Total pupils examined-
Percentage of enrolled pupils examined	
Physical status—percentage of pupils examined-
A-
Ad_
Ae.__.
Ade..
Bd_.
Be —
Bde..
Cd...
Ce-
Cde_
154,517
46,028
29.8
34.4
56.3
0.7
1.7
5.8
0.1
0.9
0.1
161,408
42,401
26.3
36.5
54.2
0.8
2.0
5.4
0.2
0.8
0.1 MEDICAL INSPECTION OF SCHOOLS,  1951-52
S 15
Table VI.—Physical Status of Total Pupils Examined in Grades I, IV, VII, and X
for the Years Ended June 30th, 1948-52
1947-48
1948-49
1949-50
1950-51
1951-52
76,624
53,244
69.5
37.6
52.4
0.8
1.4
6.6
0.1
0.6
0.2
0.3
50,519
38,377
76.0
40.6
50.7
0.7
1.3
5.9
0.1
0.5
0.1
41,688
30,515
73.2
38.8
53.3
0.6
1.0
5.6
0.1
0.5
0.1
56,491
36,468
64.6
34.8
56.3
0.6
1.7
5.5
0.1
0.8
0.1
58,930
33,118
56.2
Physical status—percentage of pupils examined—
A             _       	
36.7
Ad  	
54.7
Ae                 	
0.7
Ade	
1.7
Bd	
5.2
Be	
0.1
Bde 	
0.8
Cd	
0.1
Ce	
Cde	
0.1
0.1
Table VII.—Summary of Physical Status of Pupils Examined,
According to School Grades, 1950-51
Total
Pupils, All
Schools
Examined in Grades
Grade I
Grades
Grades
II-VI
VII-IX
79,849
35,867
12,965
10,794
16.2
30.1
34.4
36.0
35.0
55.8
0.7
0.6
2.0
1.4
6.3
5.3
0.1
0.1
1.3
0.7
0.2
0.1
Grades
X-XIII
Total pupils enrolled in grades examined.
Total pupils examined-
Percentage of enrolled pupils examined 	
Physical status—percentage of pupils examined-
A .	
Ad  	
Ae     	
Ade_.
Bd___.
Be	
Bde..
Cd ...
Ce ___.
Cde...
154,517
46,028
29.8
34.4
56.3
0.7
1.7
5.8
0.1
0.9
0.1
18,913
15,785
83.5
29.7
60.2
0.7
1.7
6.5
0.1
0.8
0.2
~ 0.1
19,888
6,484
32.6
43.2
50.3
0.4
1.6
3.9
0.1
0.4
0.1
Table VIII.—Summary of Physical Status of Pupils Examined,
According to School Grades, 1951-52
Total
Pupils, All
Schools
Examined
in Grades
Grade 1
Grades
II-VI
Grades
VII-IX
Grades
X-XIII
161,408
42,401
26.3
36.5
54.2
0.8
2.0
5.4
0.2
0.8
0.1
19,079
15,422
80.8
33.5
56.8
0.8
1.6
6.3
0.2
0.7
0.1
84,949
12,021
14.2
35.9
52.4
1.1
3.3
5.8
0.2
1.1
0.1
37,397
9,138
24.4
35.7
56.5
0.5
1.7
4.5
0.1
0.9
0.1
19,983
5,820
29.1
Physical status—percentage of pupils examined—
A   	
47.5
Ad    	
Ae   	
Ade    .                                 -	
47.6
0.3
0.7
Bd     	
Be  	
Bde _      „,	
Cd   _    	
3.4
0.4
0.1
Ce __  _
Cde -   -    	
0.1 S  16
BRITISH COLUMBIA
Table IX.—Physical Status of Pupils Examined, According
to School Grades, 1950-51
All
Schools
Grade
I
II
III
IV
V
VI
Total pupils enrolled in grades examined ___
154,517
46,028
29.8
34.4
56.3
0.7
1.7
5.8
0.1
0.9
0.1
18,913
15,785
83.5
29.7
60.2
0.7
1.7
6.5
0.1
0.8
0.2
18,479
2,256
12.2
27.5
60.2
0.9
2.0
6.9
0.4
1.8
0.1
0.2
17,188
1,863
10.8
26.5
60.7
1.4
2.0
7.8
0.1
1.2
0.2
16,002
6,143
38.4
40.1
50.6
0.4
1.9
5.6
0.1
1.1
0.2
14,706
1,416
9.6
31.5
57.3
0.7
2.6
6.2
0.1
1.3
0.1
0.1
0.1
14,474
1,287
Percentage of enrolled pupils examined
Physical status—percentage of pupils
examined—
A           	
Ad  	
9.6
33.8
56.7
Ae  	
Ade 	
0.4
1.4
Bd 	
Be  	
Bde    	
Cd 	
6.2
0.2
1.3
Ce                       	
Cde                     	
0.1
0.1
Grade
VII
VIII
IX
X
XI
XII
XIII
Total pupils enrolled in grades examined ...
13,140
8,936
68.0
36.0
56.0
0.6
1.6
4.8
0.1
0.8
0.1
12,181
1,054
8.7
35.6
56.4
0.3
0.6
6.0
0.1
0.8
0.1
10,546
804
7.6
36.7
52.7
1.1
0.9
8.2
8,436
5,604
66.4
41.6
52.0
0.5
1.7
3.7
0.1
0.3
0.1
6,358
506
8.0
50.0
42.1
0.2
1.0
6.1
4,607
341
7.4
57.8
37.8
487
33
Percentage of enrolled pupils examined
Physical status—percentage of pupils
examined—
A               	
6.8
66.7
Ad        ..            	
15.2
Ae    -                 	
Ade
0.6
3.5
Bd 	
Be
6.0
Bde  	
Cd                       	
0.2
0.2
0.6
0.3
12.1
Ce
Cde
0.1 MEDICAL INSPECTION OF SCHOOLS,  1951-52
S  17
Table X.—Physical Status of Pupils Examined, According
to School Grades, 1951-52
1
All
Schools
Grade
I
II
III
IV
V
VI
Total pupils enrolled in grades examined
161,408
42,401
26.3
36.5
54.2
0.8
2.0
5.4
0.2
0.8
0.1
19,079
15,422
80.8
33.4
56.9
0.8
1.6
6.3
0.2
0.7
0.1
18,488
2,179
11.8
29.5
56.4
1.0
3.8
7.2
0.5
1.4
0.1
18,520
2,054
11.1
29.3
56.5
1.6
3.7
7.3
0.1
1.1
0.3
17,374
5,289
30.4
40.9
49.0
1.0
3.1
4.9
0.1
1.0
15,917
1,395
8.8
34.2
53.1
1.3
3.2
6.7
0.5
0.9
0.1
14,650
1,104
Percentage of enrolled pupils examined ___
Physical status—percentage of pupils
examined—
A     	
7.5
38.9
Ad  	
52.3
Ae   	
0.6
Ade 	
2.3
Bd   _
Be  	
4.6
0.2
Bde    ...
1.1
Cd 	
Ce ..	
Cde
0.1
0.1
Grade
VII
VIII
IX
X
XI
XII
XIII
Total pupils enrolled in grades examined
14,021
7,545
53.8
34.9
57.8
0.5
1.6
4.1
0.1
0.9
0.1
12,425
849
6.8
38.5
51.1
0.7
2.1
5.8
0.1
1.3
0.3
10,951
744
6.8
41.0
48.3
0.8
1.3
7.5
0.1
1.0
8,456
4,862
57.5
45.5
49.5
0.3
0.7
3.5
6,327
519
8.2
54.7
40.3
1.0
3.7
4,679
394
8.4
61.7
34.3
0.3
1.7
2.0
521
45
Percentage of enrolled pupils examined ...
Physical status—percentage of pupils
examined—
A     	
8.6
60.0
Ad    	
37.8
Ae
Ade
Bd  	
2.2
Be        ____
Bde   	
0.4
0.1
0.3
Cd  	
Ce 	
Cde ____	
0.1
Table XI.—Physical Status of School Personnel, Organized and
Unorganized Territory, 1950—51
Total
Organized
Unorganized
4,910
473
9.6
97.0
1.7
1.1
0.2
4,256
427
10.0
99.5
0.5
654
46
7 0
Physical status—percentage of personnel examined—
A    	
Ad  	
B 	
73.9
13.0
Bd	
c  	
Cd   	
10.9
2 2 S 18
BRITISH COLUMBIA
Table XII.—Physical Status of School Personnel, Organized and
Unorganized Territory, 1951-52
Total
Organized
Unorganized
5,118
408
8.0
98.5
1.5
4,352
363
8.3
100.0
766
45
5.9
Physical status—percentage of personnel examined—
A     	
86.7
Ad   	
B    	
13.3
Bd—— 	
c	
Cd   _.._	
	
FUTURE REPORTS
The development of Union Boards of Health and the administration of health
services through health units makes it less desirous and less easy to separate health services
in the schools from other health services in the community. As these are interrelated
and co-ordinated, a report on a separate service does not fully interpret public health
services on the single item. For this reason, future reports of school health services are
to be included within the Annual Report of the Health Branch, Department of Health
and Welfare.
victoria, B.C.
Printed by Don McDiarmid, Printer to the Queen's Most Excellent Majesty
1953
640-1153-6648  

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