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Eighth Report of the DEPARTMENT OF HEALTH AND WELFARE (HEALTH BRANCH) (Fifty-seventh Annual Report of… British Columbia. Legislative Assembly [1954]

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 PROVINCE OF BRITISH COLUMBIA
Eighth Report of the
DEPARTMENT OF HEALTH
AND WELFARE
(HEALTH BRANCH)
(Fifty-seventh Annual Report of Public Health Services)
YEAR ENDED DECEMBER 3 1st
1953
VICTORIA, B.C.
Printed by Don McDiarmid, Printer to the Queen's Most Excellent Majesty
1954  Office of the Minister of Health and Welfare,
Victoria, B.C., January 8th, 1954.
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, 1953.
ERIC MARTIN,
Minister of Health and Welfare. Department of Health and Welfare (Health Branch),
Victoria, B.C., January 8th, 1954.
The Honourable Eric Martin,
Minister of Health and Welfare, Victoria, B.C.
Sir,—I have the honour to submit the Eighth Report of the Department of Health
and Welfare (Health Branch) for the year ended December 31st, 1953.
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
G. F. Amyot, M.D., D.P.H.   -----    Deputy Minister of Health and Provincial Health Officer.
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.    -
Deputy Provincial Health Officer and
Director, Bureau of Local Health
Services.
Assistant Provincial Health Officer
and Director, Bureau of Special
Preventive and Treatment Services.
Director, Bureau of Administration.
Director, Division of Tuberculosis
Control.
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.
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.     -      -
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.     -      -
MissD. Noble, B.Sc.(H.Ec), C.P.H.  -      -
C. R. Stonehouse, C.S.I. (C.)
- Director, Division of Public Health
Nursing.
- Director,   Division   of   Preventive
Dentistry.
- Director, Division of Public Health
Education.
- Consultant, Public Health Nutrition.
- Senior Sanitary Inspector.  TABLE OF CONTENTS
Page
General—
The Population and Its General Composition  11
The Health of the People  12
Health Services Provided to the Public  13
Personnel  16
Accommodations  16
National Health Grants  18
Report of the Bureau of Local Health Services—
Administration  19
Health-unit Expansion and Development  20
Community Health Centres r  21
Nursing Home-care Programme  23
School Health Services  25
The Health of the School-child  27
Table I.—Physical Status of Pupils Examined, Showing Percentage in
Each Group, 1946-47 to 1952-53  28
Table II.—Physical Status of Total Pupils Examined in the Schools for
the Years Ended June 30th, 1949 to 1953  29
Table III.—Physical Status of Total Pupils Examined in Grades I, IV,
and X for the Years Ended June 30th, 1949 to 1953  29
Table IV.—Summary of Physical Status of Pupils Examined, According
to School Grades, 1952-53  29
Table  V.—Physical  Status  by  Individual  Grades  of  Total  Schools,
1952-53  30
Table VI.—Number Employed and X-rayed amongst School Personnel,
1952-53  30
Table VII.—Immunization Status of Total Pupils Enrolled, According to
School Grade, 1952-53  30
Disease Morbidity and Statistics  31
Table VIII.—Notifiable Diseases in British Columbia, 1949-53 (Including Indians)  35
Table IX.—Notifiable Diseases in British Columbia by Health Units and
Specified Areas, 1953  36
Report of the Division of Public Health Nursing—
Status of Service  37
Consultant Service  38
Public Health Nursing Training  38
Advisory  39
Local Public Health Nursing Service  40
Statistical Summary of Certain Public Health Nursing Services  42
Report of the Division of Environmental Management—
Rehabilitation  43
Occupational Health  43
Medical Care—Research  43
General  44
A. Report of the Nutrition Service—
Consultant Service to Local Public Health Personnel  44
Consultant Service to Hospitals and Institutions  46
Co-operative Activities with Other Departments and Organizations.  46 Y 8 BRITISH COLUMBIA
Report of the Division of Environmental Management—Continued page
B. Report of Sanitary Inspection Services—
Food-control  47
Eating and Drinking Places  48
Frozen-food Locker Plants    48
Slaughter-houses  48
Meat Inspection  48
Horse-meat  48
Housing  48
Summer Camps  49
School Sanitation  49
Plumbing  49
Garbage and Refuse Disposal  50
Rodent-control and Sylvatic Plague Survey  50
Barber-shops  50
C. Report of Civil Defence Health Services—
Regional Conferences  50
Emergency Medical Supplies  50
First-aid Stations  51
Study Forum  51
Emergency Blood Service  51
Training  51
General  51
Report of the Division of Preventive Dentistry—
Prevention  52
Dental Personnel  57
General  59
Report of the Division of Public Health Engineering—
Water-supplies  60
Sewage-disposal  61
Stream-pollution  62
Shell-fish  63
Swimming and Bathing Places  64
Tourist Accommodation  64
Frozen-food Locker Plants  64
General  64
Report of the Division of Vital Statistics—
Registration of Births, Deaths, and Marriages  66
Documentary Revision  67
Microfilming of Documents  68
Administration of the " Marriage Act "  68
Registration of Notices of Filing a Will  68
Certification Services  69
District Registrars' Offices  69
General Administration  70
Statistical Section  71
Cancer Registry  73
Table I.—Number and Percentage of New Cancer Notifications by Site
and Sex, British Columbia, 1953  74
Table II.—Number and Percentage of Reported Live Cancer Cases by
Site and Sex, British Columbia, 1953  74 DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 9
Report of the Division of Vital Statistics—Continued page
Cancer Registry—Continued
Table III.—Cancer Notifications by Sex and Age-group, British Columbia,
1953 (Age Specific Rates per 100,000 Population)  75
Table IV.—Live Cancer Cases Reported by Sex and Age-group, British
Columbia, 1953 (Age Specific Rates per 100,000 Population)  75
Crippled Children's Registry     75
Population Characteristics of the People of British Columbia     76
Principal Causes of Mortality in British Columbia     77
Mortality amongst the Indian Population     77
Mortality Improvements in Terms of Life-years Lost     78
Chart.—Comparison of Actual and Expected Life-years Lost Due to
Specific Causes of Mortality, British Columbia, 1953      79
Birth and Stillbirth Rate     80
Report of the Division of Public Health Education—
Local Health Educators     81
Consultative Services     81
Materials     82
In-service Training      84
Publications and Publicity     84
Staff       84
Report of the Health Branch Office, Vancouver Area—
Buildings     85
Faculty of Medicine, University of British Columbia     85
Voluntary Health Agencies     85
Civil Defence     87
General     87
National Health Grants     88
Acknowledgment     93
Report of the Division of Laboratories—
Table I.—Statistical Report of Examinations Done during the Year 1953,
Main Laboratory     94
Table II.—Statistical Report of Examinations Done during the Year 1953,
Branch Laboratories     95
Tests for Diagnosis and Control of Venereal Disease     96
Tests Relating to Tuberculosis-control     97
Salmonella-Shigella Infections     97
Other Types of Tests     98
Branch Laboratories     99
General Comments -.  100
Report of Division of Venereal Disease Control—
Treatment  101
Epidemiology  102
Social Service  103
Education  104
General  105
Report of the Division of Tuberculosis Control—
Bed Situation  106
Mortality  107
Morbidity      107
Miniature X-ray Programme  108
National Health Grants  109
General  110  Eighth Report of the Department of Health and Welfare
(HEALTH BRANCH)
Fifty-seventh Annual Report of Public Health Services
YEAR ENDED DECEMBER 31st,  1953
G. F. Amyot, Deputy Minister of Health and Provincial Health Officer
During 1953 the Health Branch encountered some few problems and disappointments but also had the happy experience of seeing many improvements in the public
health services. It is the intention in this Annual Report to describe the major problems,
the progress, and the general status at the year's end.
The first, or general, section of the Report deals with those events and activities
which had a broad influence and also summarizes the more important happenings described in the later sections.
Detailed descriptions of the various services and programmes are presented in these
later sections beginning on page 19.
In previous years it has been the practice of the Health Branch to publish its Report
on the Medical Inspection of Schools separately from the Annual Report. This year,
however, the information concerning schools has been included in this volume as a part
of the Report of the Bureau of Local Health Services.
In studying problems and devising solutions, in making plans for continual improvement in the service, and in conducting the daily routines of Health Branch business, the
Deputy Minister of Health once again received the willing co-operation of other departments of Government, professional groups, and voluntary agencies, as well as the firm
support of his co-workers and advisers in the Health Branch itself. Although these are
too numerous to name individually, the Deputy Minister extends to them his sincere
thanks.
GENERAL
A. H. Cameron, Director, Bureau of Administration
THE POPULATION AND ITS GENERAL COMPOSITION
The population of British Columbia was estimated to be 1,230,000 in 1953, an
increase of approximately 32,000 over the previous year. Over 40 per cent of this
increase occurred among the population under 10 years of age. However, British Columbia has a greater proportion of older people than has Canada as a whole. This
characteristic is illustrated by the fact that almost 16 per cent of British Columbia's
population was 60 years of age and over, whereas the Canada-wide figure for this same
age-group was only slightly more than 11 per cent. On the other hand, people under
20 years of age comprised approximately 34 per cent of the Provincial population and
38 per cent of the population of Canada.
The average number of persons in a British Columbia family was slightly more than
three. Of all Provinces in Canada, British Columbia had the smallest average family
group.
Over 68 per cent of the people resided in urban areas (metropolitan areas and communities with populations of more than 1,000). Only Ontario had a greater proportion
of urban residents.
11 Y  12 BRITISH COLUMBIA
More than 366,000 square miles in area, the Province as a whole had only 3.2
persons per square mile. This population density was the second lowest among the
Provinces of Canada. (Newfoundland had the lowest with 2.4 persons per square mile.)
In the vast regions of the Province outside the highly populated Lower Mainland and
Vancouver Island, the density was slightly less than one person per square mile.
All of these characteristics had, and will continue to have, an important bearing on
the approach to public health services and the costs of these services.
THE HEALTH OF THE PEOPLE
The health status of any group of people is generally, and possibly most meaningfully, reported in negative terms; that is, in terms of death rates, causes of death, and
sickness experience.   This will be the principal method used in this Report.
Notwithstanding the fact that there has been a steady ageing of British Columbia's
population—a fact which might be expected to produce a steady increase in the death
rate—the crude death rate has remained almost constant over the past ten years. The
preliminary figure for 1953 was 10.0 per thousand population, compared with the final
figure of 10.1 for 1952.
Numerically, the three leading causes of death continued to be heart-disease, cancer,
and vascular lesions of the central nervous system, in that order. However, the Director
of Vital Statistics again directs attention to the interesting and important concept of
life-years lost, which indicates that the three conditions listed as leading causes, on
a numerical basis, may not have been the most important causes. This concept takes
into account the fact that the death of a young person is usually a more serious event
than the death of an older person because more years of the anticipated life-span have
been lost. Calculations made on this basis place heart-disease, cancer, and vascular
lesions of the central nervous system in the third, fourth, and seventh positions of
importance and raise diseases of early infancy and accidents to the two most important
positions.
An encouraging change in the tuberculosis death rate has taken place in recent years.
In 1947 approximately 51 persons in every 100,000 died from this disease. In 1953
this rate had dropped to less than 12 per 100,000. (These rates include the Indian
population.) The Director of Tuberculosis Control attributes this decline in deaths
chiefly to improved methods of treatment, including the use of streptomycin and other
antimicrobials.
The decline in the incidence of tuberculosis has not been so marked as the reduction
in deaths from this disease, although the number of new cases discovered in recent years
has decreased. This is particularly encouraging in view of the increased efforts to discover
new cases. Analyses of the records over the past ten years reveal that the morbidity rate
is slightly higher for females than males up to age 39. Among the group over 50 years
of age, however, the morbidity rate for males is almost twice as high as that for females.
The Director of Venereal Disease Control states that the number of venereal-disease
cases reported in 1953, including non-specific urethritis, was 3,671, some 240 fewer than
the number reported in the previous year. Infectious syphilis has become a clinical
rarity, and late syphilis and prenatal syphilis, as reported to the Division, have also shown
a marked decline. Non-specific urethritis presents an increasing problem, and the
Division is taking the necessary steps to cope with it. It is encouraging to note that at
the Vancouver City Gaol examination centre the number of newly diagnosed gonorrhoea
infections decreased to an all-time low. The Director feels that this reflects accurately
the prevalence of gonorrhoea in Vancouver.
Although many of the foregoing data indicate gratifying trends, there was a large
number of cases of poliomyelitis. The incidence, which was 64.0 per 100,000 population,
was the highest of any year to date.    (The highest rate previously recorded was 49.6 for DEPARTMENT OF HEALTH AND WELFARE,  1953 Y  13
1952.) The epidemic was not concentrated in any one particular area, and it continued
over a longer period of the year than those of other years. However, notwithstanding
the greater number of cases during 1953, the case-fatality rate was lower than in any
previous recorded epidemic.   The incidence was decreasing slowly toward the year's end.
Drawing upon earlier experience, particularly that gained during 1952, Health
Branch officials, the Poliomyelitis Committee composed of experienced physicians, and
other agencies had already made co-ordinated plans to meet the problem and to provide
patient-care as efficiently as existing facilities would permit. Private physicians, the
Vancouver General Hospital, the Royal Jubilee Hospital in Victoria, the British Columbia
Poliomyelitis Foundation, and the Royal Canadian Air Force worked in close co-operation
with Provincial and local health services. Further plans are being made to deal with the
situation should there be many cases next year.
An earlier reference has been made to cancer as a cause of death. Although the
statistics, based on cases reported, may vary from year to year, there is good reason to
believe that the problem actually remains quite constant in magnitude. In helping to
combat this disease, the Federal and Provincial Governments share equally in meeting
the operating expenses of the British Columbia Cancer Institute and the nursing home,
both located in Vancouver, and the consultative and diagnostic clinics operating at ten
centres throughout the Province. With this assistance, the British Columbia Cancer
Foundation is able to provide very modern facilities and services.
The total incidence of notifiable diseases, including the four discussed above, was
3,104.9 per 100,000 population for 1953. (Indians are included in the calculation.)
A comparison with the incidences of 3,565.2, 4,092.7, and 3,312.3 for 1950, 1951, and
1952, respectively, indicates that there has been an improvement in 1953.
Among school-children there was the usual number of cases of chicken-pox, measles,
mumps, and rubella, with definite upward trends in certain instances. The incidence of
major infection among school-children was not serious.
The Director of Local Health Services reports that the health of school-children
during the academic year 1952-53 was, on the average, satisfactory and differed little
from that exhibited over the previous four years. A good immunity-level has been
achieved. More than 60 per cent of the pupils 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.
Studies conducted by the Consultant in Nutrition supported earlier findings that the
chief deficiencies in children's meals were milk, a Vitamin D supplement, and foods rich
in Vitamin C Although meat, potatoes, and bread are eaten in satisfactory amounts by
the majority of children, there is an excessive consumption of sweet foods, such as candy,
soft drinks, and cake.
Records of the past year again revealed that dental decay in children is a serious
problem. The Director of Preventive Dentistry emphasizes the great need of more dentists, particularly in the rural areas, and the hope which may be placed in fluoridation of
water-supplies in meeting the problem.
HEALTH SERVICES PROVIDED TO THE PUBLIC
In British Columbia the treatment and prevention of disease and the promotion of
positive good health are a co-operative effort on the part of private physicians and dentists
and several official and voluntary agencies. It is a source of pride to all concerned that
these groups work well, each with the others, in co-ordinating their programmes.
Local health services constitute one of the most important parts of the public health
programme. In Greater Vancouver and Victoria-Esquimau these services are rendered
by the city health departments, which do not come under the direct jurisdiction of the
Provincial Health Branch, although they co-operate effectively with it.   Broad objectives Y 14 BRITISH COLUMBIA
and basic policies are the same in the two large cities as they are in the rest of the Province. The Provincial Government, through the Health Branch, renders substantial financial assistance to the public health services of these two metropolitan areas.
Outside the boundaries of Greater Vancouver and Victoria-Esquimalt, local health
services are provided by teams of Provincially employed public health workers. Each
team consists of a public health physician, several public health nurses, at least one Sanitary Inspector, and the necessary clerical staff. If qualified personnel are available, a
public health educator, a dental officer, and a dental assistant may be added to provide a
more complete service. Each team constitutes the staff of a local health department, or
health unit, serving a defined geographical area which includes rural territory and one or
more population centres.
During 1953 the local public health services in the area adjacent to Slocan Lake,
the Arrow Lakes, and Kootenay Lake were organized as the Selkirk Health Unit, with
headquarters at Nelson. There are now sixteen such units outside Greater Vancouver
and Victoria-Esquimalt, and the organization of the Province into these local health
departments is almost complete. Only the Squamish-Howe Sound area, where there has
been public health nursing and sanitary inspection service for some time, remains to be
included in a health unit.
Because of this, and certain other relatively less important developments, practically
all of the people of British Columbia now receive public health services. Excluding
Indians, for whom services are provided by Federal authorities, the percentages of the
Province's population receiving public health service at the end of 1953 from the sources
named were as follows:—
Source of Service Per Cent
City health departments of Greater Vancouver and Victoria-
Esquimalt   46.7
Provincial health units  50.3
Non-health unit areas   (public health nursing and sanitary
inspection districts)      2.6
Total  99.6
Certain specialized services, for economic or other reasons, cannot be provided on
the local level to communities, nor even groups of communities. Included in these
specialized programmes are the services rendered by the Divisions of Tuberculosis
Control, Venereal Disease Control, and Laboratories.
Numerically the Division of Tuberculosis Control is the largest part of the Health
Branch and employs more personnel than all other Health Branch divisions and services
combined. With headquarters in Vancouver, it provides approximately 925 treatment
beds in the Willow Chest Centre, the Pearson Tuberculosis Hospital, and the Jericho
Beach Hospital in that city; the Vancouver Island Chest Centre in Victoria; and Tran-
quille Sanatorium near Kamloops. Making full use of these beds, the Division was able
to reduce the length of time that applicants for admission remained on the waiting-list
and to admit many applicants immediately. The Division continued to operate clinics,
both stationary and travelling, in strategic areas of the Province.
In the programme designed to X-ray admissions to general hospitals, thirty-four hospitals are operating miniature-film equipment. Although some of these hospitals participated
well in the programme, the percentage of admissions X-rayed by others was smaller than
it might have been. It is hoped that these hospitals will be able to take a greater part
in the provision of this service to the people of their areas.
At the beginning of the year the admission X-ray programme was extended to the
smaller general hospitals. These hospitals, in which miniature-film equipment has not
been installed, are paid a per capita rate for X-rays taken on their own equipment.
J DEPARTMENT OF HEALTH AND WELFARE,  1953 Y  15
Although this part of the programme is only in the organizational stage, the percentage
of admissions X-rayed is encouraging.
It is gratifying to be able to report that a chest X-ray is now available to any person
admitted to hospital in British Columbia.
The Division of Venereal Disease Control, with its staff of some thirty-three full-
time and seventeen part-time employees, continued to maintain its headquarters and
principal clinic and treatment centre in the old building which it has occupied for many
years on Laurel Street in Vancouver. Other clinic and treatment centres were operated
in Victoria, on the grounds of the Royal Jubilee Hospital; in Vancouver at the city's
Health Unit No. 1 and at the City Gaol; at the Prince Rupert and Prince George City
Gaols; at the Juvenile Detention Home, Girls' Industrial School, and Male and Female
Oakalla Prison Farms; and in New Westminster. Like all other specialized services
in the Health Branch, the venereal-disease control .programme was conducted in close
co-operation with the personnel of local health services. Through the Division, drugs,
free of charge to the patient, were again made available to all private physicians for the
treatment of venereal disease.
The Division of Laboratories again provided service of a very high standard in
spite of the poor accommodations in the buildings on Hornby Street, Vancouver, which
have for many years served as headquarters and main laboratory. The staff of the
Division numbers approximately forty-seven, and all but a few of these work in the
Hornby Street buildings. Branch laboratories were operated at Victoria, Nelson, and
Prince George. The Division as a whole performed some 440,000 tests relating to
communicable-disease control during 1953. The increase of approximately 7 per cent
over the 1952 total was the largest annual increment experienced by the Division in
several years.
Using data compiled by a sub-committee of the Technical Advisory Committee on
Public Health Laboratory Procedures, the Director of the Division makes some interesting and important observations concerning laboratory costs in British Columbia. These
data, which are based on units of work performed rather than on tests undertaken, show
that the work-load per staff member in the British Columbia laboratory is considerably
higher than it is in other Provincial laboratories in Canada. Consequently, the cost per
unit is considerably lower.
Voluntary health agencies once again provided outstanding services. These were
so integrated with those of the official agencies that duplications and omissions in services
were kept to a minimum. The Assistant Provincial Health Officer, aided by the Departmental Comptroller, devoted much time and thought to effecting this integration and
assessing the requests of the voluntary agencies for financial assistance from Provincial
and Federal sources. Elsewhere in this Report he describes briefly the programmes of
the British Columbia Cancer Foundation, the Western Society for Rehabilitation, and
the Canadian Arthritis and Rheumatism Society (British Columbia Division). Certain
other voluntary agencies also played significant roles in meeting health needs. Included
in these were the Vancouver Preventorium, the British Columbia Poliomyelitis Foundation, the British Columbia Tuberculosis Society, the Canadian Red Cross Society, the
John Howard Society, the Cerebral Palsy Association, the Canadian Cancer Society
(British Columbia Division), the Alcoholism Foundation, and the Multiple Sclerosis
Society.
Special mention must be made of the Canadian Red Cross Society's blood transfusion service. In view of the serious nature of the poliomyelitis epidemic, this sendee
assumed an even more important position in the public health programme. In this, its
seventh, year of operation, the service continued to collect blood from human donors—
the only source—and to make it available, free of charge, to those whose medical condition required transfusions.   Because gamma globulin, which has proven to be useful in Y 16 BRITISH COLUMBIA
the prevention of poliomyelitis, is obtained from human blood, the great need of blood
donors became even more apparent. However, notwithstanding the efforts of the Red
Cross personnel and public health workers, the supply of blood, blood plasma, and
gamma globulin remained too low.
PERSONNEL
The Health Branch, in its Province-wide field services, clinics, laboratories, hospitals, and administrative offices, employs more than 1,200 people. During 1953 the
number of employees who, for one reason or another, became problem cases was small.
Practically all such individual problems were resolved satisfactorily.
However, a general problem, relating to a large group of employees, nurses, and
seriously affecting the entire public health service, created much difficulty and remained
unsolved at the end of the year. Both public health nurses and institutional nurses are
in short supply in so far as the Health Branch is concerned. Officials responsible for
recruiting have strong reason to believe that the relatively low salaries are the main cause
of the problem. In any event, it has been necessary to leave some positions vacant and
to fill many others with nurses who lack the qualifications or attributes required. The
Health Branch and the Civil Service Commission have conducted extensive studies
of the problem, and the Civil Service Commission has submitted recommendations to
the appropriate authority.
The professional qualifications of a number of Health Branch employees, and their
usefulness to the Service, were improved by courses of training supported by the National
health grants. Some employees received postgraduate training of at least one academic
year's duration, while others attended shorter courses. Graduate nurses, undertaking
training in public health to qualify for positions in health units, formed a large proportion
of the former group. In the opinion of the Director of Public Health Nursing, only this
advantage, which she was able to offer to prospective employees, enabled her to recruit
sufficient nurses to maintain a minimum service.
The professional status of health-unit personnel and senior officials of the Health
Branch was enhanced by the Public Health Institute which was held in Vancouver in
April. The guest speaker was Dr. Hugh Leavell, Professor of Public Health Practice at
Harvard University, who presented a series of lectures on several aspects of public health.
The programme also included lectures and panel discussions in which Health Branch
personnel took prominent parts.
The five-day work-week, with a compensatory increase in the daily hours of work,
was inaugurated in August, 1953, when it was put into effect for Provincial Civil Servants
generally. Although it was not possible to extend the benefit to the employees of institutions in which service must be maintained twenty-four hours per day through the seven
days of the week, the new work schedules were established with a minimum of administrative difficulty in the Health Branch.
ACCOMMODATIONS
During 1953 several construction projects, designed to provide much needed accommodation, were either completed or well advanced.
After many years of planning, the construction of the new Provincial Health Building
in Vancouver was finally undertaken. The excavation and foundations were completed
in August, and the work on the superstructure was begun soon afterwards. It is estimated that it will be ready for occupancy early in 1955.
Situated on Tenth Avenue near the Division of Tuberculosis Control's Willow Chest
Centre, the Provincial Health Building will meet several long-felt and serious needs. The
most important of these is the need of modern accommodation for the Division of Laboratories which, for twenty-one years, has been located in a series of old houses on Hornby
Street.    The new building will also bring together, under one roof, other important DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 17
Provincial health services, including the headquarters and main clinic of the Division of
Venereal Disease Control, the Vancouver office of the Division of Vital Statistics, and
the office of the Assistant Provincial Health Officer. According to the terms of an agreement made several years ago between the Canadian Red Cross Society and the Provincial
Government, one floor of the building will be allocated to the Red Cross blood transfusion
service as a blood-processing depot.
Of extreme importance also were the plans to provide facilities for the care of those
who had been stricken with poliomyelitis and who were destined to spend long periods
in institutions even after they had passed the acute stage of the disease. During the
1953 epidemic the poliomyelitis centres at the Vancouver General Hospital and the
Royal Jubilee Hospital in Victoria became so overcrowded with such patients from all
parts of the Province that the situation became critical. Public health and hospital
authorities became concerned because it would be virtually impossible, with existing
facilities to care for the additional cases which might result from another epidemic.
However, Health Branch officials took definite action to cope with the problem of
inadequate facilities. On the basis of recommendations submitted by the Poliomyelitis
Committee, plans were made for the construction of accommodation for patients requiring
long-term care. Expenditure of the funds required to construct and equip this building,
which will accommodate approximately fifty patients, was approved by the Executive
Council. Every effort will be made to have the new facilities in operation by the summer
of 1954, to receive patients now in the Vancouver General Hospital and the Royal Jubilee
Hospital and so release space in these hospitals for the treatment of new, acute cases.
In Pearson Tuberculosis Hospital, capacity operation was achieved early in 1953
when the last ward of this new institution was opened. The landscaping of the grounds
is well under way.
At Tranquille Sanatorium the new laundry has been in operation for almost a year.
The final steps in converting from a coal-burning to an oil-burning power plant were
taken when the necessary storage-tanks and pumps were installed. Remodelling of the
ground floor of the Infirmary Building to provide improved facilities was nearing completion at the end of the year.
Renovations at the Vancouver Island Chest Centre will soon provide a separate
X-ray survey clinic at this centre. The New Westminster Stationary Clinic will, in the near
future, occupy new and enlarged quarters in the Gyro Health Centre.
This development in New Westminster, which will also provide more suitable
accommodations for the staff of the Simon Fraser Health Unit, exemplifies the co-operative planning which has been evident in several parts of the Province. The general
method of financing the construction of such community health centres is based on a
division of the costs among the Federal, Provincial, and local governments. Service clubs
and voluntary health agencies often assist the local government in providing its share.
On this basis, community health centres or health-unit sub-offices were built in
Armstrong and Maple Ridge. The Kelowna Community Health Centre, which was
completed and occupied in December, 1952, was opened officially by the Minister of
Health and Welfare in May, 1953. In Vancouver the construction of a building to
accommodate health and welfare personnel in one section of the city was well advanced
at the year's end. At Nanaimo, however, construction of the proposed building itself
will probably have to be deferred owing to shortage of local funds, although the site
has been prepared.
The required Federal and Provincial funds have been allocated for the construction
of a sub-office in Oliver in the South Okanagan Health Unit. It is anticipated that this
project will be undertaken as soon as the local share has been raised. At the end of the
year, Revelstoke and Salmon Arm were giving consideration to building sub-offices for
the North Okanagan Health Unit in their areas. Y  18 BRITISH COLUMBIA
Notwithstanding the proposals and actual developments described briefly above,
certain areas are still lacking in adequate accommodations for their health-unit services.
Cranbrook, Nelson, and Trail present the most urgent needs. Although some improvement may be anticipated in Nelson, the outlook is not bright in the case of the other
two cities.
NATIONAL HEALTH GRANTS
Many of the developments described in this Report have been made possible through
the use of Federal funds under the National health-grants programme. May, 1953,
marked the end of the first five years of the history of the programme. Federal authorities
reviewed the progress which had been made, assessed the needs which remained to be
met, and modified the programme accordingly. The most important change was the
inclusion of three new grants. The Laboratory and Radiological Services Grant is the
largest of these, and British Columbia's share is approximately $360,000 during the first
year, with larger amounts to be made available in subsequent years. The Medical
Rehabilitation Grant makes available to British Columbia approximately $43,000 per
annum. Although certain portions of these two grants are governed by a matching
principle and can be utilized only if the Provincial Government spends at least equal
amounts in financing the enterprises, it is understood that Provincial moneys already
being expended in the two fields of endeavour will be viewed as the required matching
funds. It is fortunate that these are sufficiently large to preclude the necessity of providing additional Provincial funds. The Child and Maternal Health Grant makes available
to British Columbia some $35,000 per annum.   There is no matching principle involved.
The Hospital Construction Grant was reduced by approximately $1,000,000, and
the Health Survey Grant was discontinued because the survey and the report which
resulted from it were completed in 1952. The amounts of the other seven grants remain
almost the same as they were in previous years.
Excluding the Public Health Research Grant, which is not distributed among the
Provinces on the basis of a definite formula, the total amount of National health-grant
funds available to British Columbia for the fiscal year 1953—54 is approximately
$3,850,000. This is some $600,000 less than the amount that was available in the
previous fiscal year.
In his report which is presented elsewhere in this volume, the Assistant Provincial
Health Officer describes the more important uses to which each grant was put. His report
also provides more detailed information concerning administrative procedures and actual
expenditures. DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 19
REPORT OF THE BUREAU OF LOCAL HEALTH SERVICES
J. A. Taylor, Director
ADMINISTRATION
The Bureau of Local Health Services continues to act as a liaison between the various
technical divisions and services of the Health Branch, Department of Health and Welfare,
and the local health departments, while offering, in addition, supervisory and consultative
services to the staffs of those local health departments. The actual provision of public
health services on a local level is vested in the local Union Board of Health, which, as
provided in the " Health Act," becomes a legally qualified body responsible to the Councils
and School Boards for the administration of the services, receiving technical advice and
assistance as required from the Bureau of Local Health Services, on request.
For several years now there has been a gradual transition within local health services
from a part-time basis to a full-time basis, during which new health units were becoming
established under Union Boards of Health. The increase in the number of Union Boards
of Health, coupled with the fact that the complement of the Board changes annually with
changes in Councils and School Boards, has emphasized the need for some type of
brochure which will explain the relationships of the Union Board of Health to local
Boards of Health and to the health unit, while outlining the duties and responsibilities
of the Union Board of Health. Preliminary drafts of this material were prepared by the
Health Branch, Department of Health and Welfare, for consideration of the Medical
Health Officers at one of their recent conferences. Arising from their study of the draft
have been a number of criticisms and suggestions. These are now receiving consideration,
and will be incorporated into a specimen pamphlet which will be presented to the various
Union Boards of Health for their further opinion. Arising from this, it is hoped to
finalize a pamphlet which will be satisfactory to all concerned and can be usefully
distributed to all incoming members of a Union Board of Health, so that they will have
some guidance in respect to the work that can be carried on by a Union Board of Health.
At the same time, in attempting to outline the duties and responsibilities of a Union
Board of Health, some deficiences in the present "Health Act" are brought to light.
This is not surprising considering that the present Act has been in existence, with only
minor change, for some sixty years, and it has long been felt that a complete revision of
the " Health Act" was indicated; it is proposed that a start be made to this end immediately. Contingent upon that revision is dependent also revision of the sanitary regulations,
which are considerably outmoded.
Biannual meetings of the Medical Health Officers, convened in April and September, continued to serve as advisory bodies advancing suggestions for modification and
changes in existing policies and programmes, while introducing the need for development
of completely new policies and programmes. It has now become common practice, as
the group has become more stable, to refer such matters as proposed new legislation and
new administrative materials, such as the brochure on duties and responsibilities of
Union Boards of Health, to the full-time Health Officers for their serious study and
comment before finalizing the details. Recently material on a proposed draft of Milk
Regulations for Unorganized Areas was submitted for consideration, resulting in a number
of very practical amendments being presented. As a result, the proposed regulations
will be considerably revised in content. Similar action was taken in conjunction with the
proposed revision of the Barber-shop Regulations, which were being finalized for approval
by Order in Council. In addition to their practical function in this way, these bi-annual
conferences of Health Officers serve as a clearing-house in which exchange of ideas leads
-to uniformity of public health practice throughout the Province, while promoting pilot
studies of new practices in specific areas.    One other significant revision in legislation Y 20 BRITISH COLUMBIA
was also given consideration during the year. This stemmed from suggestions advanced
by the Health Officers, in the field of communicable-disease control, and resulted in
modifications of the existing Regulations for the Control of Communicable Diseases.
Most of these were, more or less, minor changes to bring them in line with practical
control measures in the field, but one major feature was in relation to more adequate
control of persons infected with tuberculosis, which would require their strict isolation in
an institution, or in a manner satisfactory to the Medical Health Officer. These revisions
have been completed and submitted for approval.
During the year, discussions were held with representatives from the Department
of National Health and Welfare relative to uniform reporting of notifiable diseases across
Canada. Attempts are being made to bring the reporting more in line with practical
experience to omit those minor conditions which are very infrequently or sporadically
reported, and in which little, if anything, can be gained in attempted control measures,
while concentrating on the major communicable infections which have a serious effect
on mankind and in which control measures can lead to potential control. Negotiations
in this direction are to be continued and, it is hoped, will be reviewed at the Federal-
Provincial Conference on Notifiable Disease Reporting, when Provincial epidemiologists
will discuss the whole matter from the point of view of practical epidemiology.
In the whole field of general administration in local health services, the Local Health
Services Council continues to serve a vital function through its regular meeting. The
various divisions functioning with the Bureau of Local Health Services maintain representation on that Council, which serves as a clearing-house for information, so that each
is informed on changes and developments occurring in each division while serving to
unify the consultative and supervisory services provided to the various local health units.
HEALTH-UNIT EXPANSION AND DEVELOPMENT
It became evident over a year ago that final steps could be taken toward the establishment of a health unit in the area between the Slocan Lake, Arrow Lakes, and
Kootenay Lake. The return of a former Health Officer from postgraduate training in
public health at the School of Hygiene, University of Toronto, permitted the final attainment of that goal when in June an organizational meeting of the respective Councils and
School Boards resulted in the endorsement of these proposals and the establishment of
the Selkirk Health Unit, under a Union Board of Health. Since then the Municipal
Councils of the Cities of Nelson, Kaslo, and Slocan, and the Villages of Salmo, New
Denver, and Silverton have passed the necessary health-unit confirmation by-laws, while
School Districts No. 7 (Nelson), No. 8 (Slocan), No. 6 (Kootenay Lake), and No. 10
(Arrow Lakes) have passed the required resolutions transferring the school health
services to the Union Board of Health. The first meeting of the newly organized Union
Board of Health has still to be convened, but in the meantime the Unit Director and his
staff of senior public health nurse, five staff public health nurses, a Sanitary Inspector,
and a statistical clerk have been reorganizing the public health services into a unit
programme to provide uniform service throughout the whole health-unit area. The
groundwork is being exceptionally well planned and should lead to an effective, efficient
programme for the future.
This move establishes the sixteenth health unit in British Columbia, practically
completing the planned coverage of health units for the Province. There remains only
the Squamish-Howe Sound area uncovered, but in this there are employed two public
health nurses and a part-time Sanitary Inspector. Plans are under way to engage the
employment of a full-time Sanitary Inspector, and following on this graded step will be
consideration of inclusion of this area in the North Shore Health Unit to complete the
organization.
For a number of years there have been repeated requests from School District No.-
58 (McBride) for public health nursing services for that area, but these have always had DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 21
to be denied because of the unavailability of qualified public health nurses. During the
year a very definite appeal to the public health nursing group resulted in the transfer of
a public health nurse from Keremeos to McBride, and the initial introduction of public
health nursing services in that community. At the same time it was felt that the sanitary
inspection services from the Cariboo Health Unit should be extended to the McBride
area, and it was proposed that the Village of McBride and School District No. 58 become
incorporated into the Cariboo Health Unit. This action was finalized during the summer.
Thus the Cariboo Health Unit, already the largest unit from point of size, further extended
its boundaries to provide unified public health services across the whole of the Cariboo
area.
With the industrial developments which are occurring in the Kitimat-Kemano areas,
there is a parallel growth in the community settlement, and as the construction phase
gives way to manufacturing activity, increased family stability in population occurs,
necessitating educational and public health needs. Thus a new school district became
established at Kitimat during the year and led to the request for some type of public
health service. This was answered for the moment by the employment of a former public
health nurse, on a part-time basis, and the appointment of a practising physician as part-
time School Medical Inspector and Medical Health Officer. Consideration will have to
be given to the future public health needs of this growing community, as to whether it
can be adequately supervised under the already existent health-unit service or whether
it will attain a size sufficient to warrant its own health unit.
The local health services in the metropolitan areas of Greater Vancouver and
Victoria-Esquimalt continued to provide the same excellent co-operation with the Health
Branch, Department of Health and Welfare, and to co-ordinate their services with the
services provided in the other areas of the Province. As a result of this co-operation and
co-ordination, there is a uniform type of service over the whole of the Province, so that
residents of British Columbia can obtain the same degree of public health supervision
and service regardless of their residency, be it metropolitan city or unorganized hamlet.
Further, residents can move from one locale to another without interruption of service,
since the records in respect to each individual follow that individual to the degree that
continuity of service can be obtained soon after settlement in the new locality.
The negotiations that were proceeding toward consolidation of public health services
in the Greater Victoria area have become stalemated, although the principle has been
endorsed in part, but there seems to be no forward negotiations under way.
COMMUNITY HEALTH CENTRES
The plan whereby joint financing on a one-third basis by Federal, Provincial, and
local governments would provide construction of more suitable community health centres
proved so satisfactory during the previous year that it has been continued again this year.
In so far as the local government's share is concerned, contributions by local service clubs
or voluntary health organizations, or by public subscription, have been accepted, and in
most cases, with the exception of the City of Kelowna, where the municipality bore the
entire local share alone, this has been the method of local financing. In a considerable
number of instances the British Columbia Tuberculosis Society contributed from the funds
raised through the Christmas Seals campaign, recognizing the part that local health
services played in the broad programme of tuberculosis-control, while at the same time
acknowledging the contributions that had been made over the years to that fund by these
local communities. In much the same way, contributions from the British Columbia
Cancer Society have aided the construction of local health centres.
In addition to providing accommodation for the health-unit staff, and a board room
for the meetings of the Union Boards of Health, these community health centres are
recognized as centres co-ordinating all the health services in a community, voluntary and Y 22 BRITISH COLUMBIA
official. Thus facilities are provided in them for storage of supplies by voluntary health
agencies, while, at the same time, auditorium space is available for meetings of these
organizations, whether it be executive or group.
As the previous year ended, the Kelowna Community Health Centre became completed, permitting the staff to move into that fine new building in December, 1952.
During May, 1953, the building was officially opened by the Minister of Health and
Welfare. This is a credit to the City of Kelowna, which bore the major share of the
financing, becoming the first municipality to participate to this extent in the plan.
The Armstrong Community Health Centre, which was jointly financed by the City of
Armstrong and the Municipality of Spallumcheen, in co-operation with the Federal and
Provincial Governments, provided a sub-office for the North Okanagan Health Unit to
accommodate the resident public health nurse for that area. Clinic quarters become
available, while separate offices for the nurse and Sanitary Inspector are included, as well
as a small laboratory space, usable as an immunization clinic. This building was officially
opened during October by the Deputy Provincial Health Officer.
The Municipality of Maple Ridge participated in the plan, assisted by the British
Columbia Tuberculosis Society, British Columbia Cancer Society, and the Maple Ridge
Lions Club, to provide a sub-office for the North Fraser Valley Health Unit at Haney. The
building, constructed on the same site as the Municipal Hall, in the same type of architecture, is exceptionally well planned to provide administrative and clinical services under
one roof, providing accommodation for the voluntary health agencies, such as the Cancer
Society, the local branch of the Arthritis and Rheumatism Association, the British
Columbia Tuberculosis Society, the local branch of the Canadian Red Cross, and so forth.
Operation of the building is vested in a board composed of representatives from the
municipality, the health unit, the Lions Club, and others, space being rented on occasion
to establish a fund which will be used for maintenance and repairs, while actual operation
costs will be borne by the health unit. The official opening of this building occurred in
October, 1953, at which the Deputy Minister of Health officiated.
At the moment, construction is under way toward a considerable enlargement of the
Gyro Health Centre in the City of New Westminster to provide more suitable space for
the operation of the Simon Fraser Health Unit and the New Westminster Clinic of the
Division of Tuberculosis Control. In this plan the British Columbia Branch of the Canadian Red Cross, the British Columbia Tuberculosis Society, the British Columbia Branch
of the Canadian Cancer Society are also participating, in co-operation with the City of
New Westminster. The former building, constructed some years ago by the New Westminster Gyro Club, had become crowded and inconvenient, so that certain renovations
and construction of an addition became necessary to provide a building suitable to house
all the community health services in more spacious quarters.
Construction is also under way in the City of Vancouver for a health and welfare
building to house health and welfare services for one portion of the City, and the space
allocated to health services is to be jointly financed through contributions from the Federal
and Provincial Governments on the Community Health Centre Formula basis.
Consideration has been under way for some time in Nanaimo for construction of
a Nanaimo Community Health Centre to house the headquarters of the Central Vancouver
Island Health Unit. The land has been donated by the City of Nanaimo, and certain
excavations have been already undertaken, but complete financial arrangements have not
been effected. The plans call for construction of a two-story building, designed to fit
the needs of all the voluntary agencies as well as the official agencies, and will require an
amount considerably in excess of the one-third portion by the three branches of government. While funds have been earmarked to this project from the Federal and Provincial
Governments, the British Columbia Tuberculosis Society, the British Columbia Cancer
Society, and other agencies, and donations in kind by numerous firms, nevertheless the DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 23
total estimated cost has yet to be subscribed. It seems likely that this project will await
yet another year before it can be completely financed and construction completed.
Funds have also been earmarked by the Federal and Provincial Governments toward
construction of a sub-office for the South Okanagan Health Unit in Oliver to house two
public health nurses and provide clinic space for the various clinical services carried on
in that area. Arrangements for the local share, which it is contemplated will be raised
through public subscription and will permit commencement of the construction of the
planned building, are vested in the hands of a local board.
As the year closes, preliminary thought is being given for possible consideration
of community health centres in Revelstoke and Salmon Arm, under the same formula, to
provide additional sub-offices for the North Okanagan Health Unit in those areas. Completion of these possible projects would mean that both the North and South Okanagan
Health Units would be the most satisfactorily housed of all the health units.
The most urgent need in respect to office accommodation seems to lie in the East
and West Kootenay areas of the Province, where the three health units—namely, the East
Kootenay Health Unit with headquarters at Cranbrook, the Selkirk Health Unit with
headquarters at Nelson, and the West Kootenay Health Unit with headquarters at Trail —
are most inadequately accommodated. At the moment it is probable that more ideally
suited space will become available for the Selkirk Health Unit in Nelson, where rented
space in the second story of a down-town block will become available early in the new
year, as renovations to meet the needs of the unit will attain completion. There does
not, however, appear any hope in so far as the East Kootenay Health Unit and the West
Kootenay Health Unit are concerned, unless the municipalities or some community-minded
service club assumes some interest therein. The staffs of the units are searching for some
means of obtaining suitable space and would welcome such assistance, if at all possible.
NURSING HOME-CARE PROGRAMME
The nursing home-care programme, which was started as a pilot study in the Vernon
area to determine if home care could be provided to convalescent patients who might be
discharged from hospital earlier, if such care were available, thereby releasing hospital
beds for more acute cases, has now been in operation for over a year, and it is possible
to analyse the programme better on a year's figures. As originally set up, the programme
was expected to benefit the hospitals, provide service to the community, and effect an
economic saving by releasing patients from the hospital earlier in the convalescent stage
to carry on their convalescence at home under visiting nurses. It is necessary for a patient
to be admitted from hospital to this service by the attending physician, and thus the
home-care service can be considered an extension of hospital care to the home. The
health-unit staff is prepared to give nursing care in the home on an hourly basis, while
a housekeeping service is also available to patients requiring home help. A small daily
charge is made for both nursing and housekeeping service.
During the period from October, 1952, to October, 1953, 116 patients were admitted
to the service, with hospital-days saved amounting to 1,559, or an average of 13 days
per patient. It is evident that as the service becomes better established, more patients
are being discharged to it, and also, since the average length of time per patient on the
service has increased, their discharge from hospital to the service is occurring earlier in
the patient's convalescence as the physicians become more familiar with the service and
confidence in it increases. This may be borne out by the fact that each patient requiring
nursing care has received a greater number of visits over the past year than during the
previous six months' period. On an average, patients receive 5.6 nursing visits in
fourteen days or one nursing visit every two and a half days, indicating that a fairly acute
type of service is being maintained. However, future trend of this ratio of nursing visits
to days saved should be carefully noted, since it can reveal any tendency toward a chronic
type of service. Y 24 BRITISH COLUMBIA
In the annual report, 116 patients included 74 per cent medical, 22 per cent clinical,
and 4 per cent obstetrical cases. The type of nursing care required has been injections,
dressings, irrigations and other treatments, supervision of diet and exercise, observation
of progress, including temperature, pulse, respiration, and blood-pressure. To date there
has been no demand for time-consuming general nursing care or bed baths.
Regarding housekeeping care, patients on this type of service required an average
of forty-six hours per patient. This was an increase in housekeeping time required,
which would seem to indicate patients are being discharged much earlier in their convalescence when less able to look after their household duties. It must be pointed out
that the housekeeping service alone has saved hospital-days to the extent of 5 per cent
of the total days saved, while the number of patients requiring only housekeeping service
has been 8 per cent.
The cost of the service was in the neighbourhood of $4 per day during the initial
stages of the study in the period November, 1951, to May, 1952, but since costs were
reckoned on a different basis during this time, comparisons cannot be made between that
figure and the one of $2.06 per day on service for the period from January, 1953, to
September 31st, 1953. Both figures, however, compare favourably with the hospital
per diem cost of $11.35.
It seems evident that this service has proved to be of value far in excess of its cost,
and much less time-consuming than was at first anticipated. It has demonstrated the
fact that during the year October, 1952, to October, 1953, the service has increased the
facilities of the Vernon Jubilee Hospital to the extent of 4.3 beds in continuous use;
i.e., 1,559 hospital beds for 365 days. During the year, efforts were made to publicize
the programme in general to the patient; signs were displayed in the hospitals and
pamphlets were prepared which could be left on the bedside table of patients, thereby
encouraging them to inquire about the plan from their physician or the hospital staff.
Since the programme seems to have definitely proven the original contention that
discharge of patients from hospital during their early convalescence would save hospital
beds, it is now felt that consideration should be given toward extension of the programme
to see if patients might not be referred to the plan by their family physician prior to
admission to hospital, thereby obviating the admission of a number of patients to hospital.
This proposal is now to be investigated, since, as time goes on, the generalized public
health programme is expanding to include an increasing amount of the ordinary bedside
nursing load in addition to that of convalescent home-care service. This development
has occurred without any particular encouragement. However, future assessments should
reveal whether or not the need to enter hospital has been obviated for some patients by
this development in the programme. As a matter of fact, the need for nursing home-care
programmes seems to be increasing throughout the Province and there have been a
number of requests for the services of the Victorian Order of Nurses. These must, of
course, be carefully assessed to determine whether there is definite need for such service
in the requested areas or whether they are only felt to be needed. In many cases the need
can be absorbed by the existing public health nursing programme, either by the present
staff or by the addition of one or more nurses to the staff, and it must be judged whether
this is the more economical approach rather than the introduction of duplicate service
under the Victorian Order of Nurses. However, the decision rests with the municipalities
concerned, since the decision to bear the major share of the financing of the additional
service must be theirs. This decision has recently been faced by the Nanaimo area, where
requests for Victorian Order of Nursing services have been repeatedly forthcoming, and
the decision reached indicated a desire for the Victorian Order of Nurses providing the
home-visits, and a community appeal has been made to subscribe the funds necessary
to finance this service. It is anticipated that such a service will commence early in the
new year. Co-operation of the public health services will be extended to the new service
so that they can work side by side, the one serving to complement the other. DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 25
Similar proposals are being advanced for extension of the Victorian Order of Nursing
service from Victoria to the Municipality of Saanich. There again the request is sparked
by the local women's organizations who are pressing for an introduction of the service to
provide home-nursing care to elderly patients suffering from chronic disease but who do
not actually require acute care in the hospital. The decision will have to be faced by the
municipality to determine whether they wish to support this type of service financially
or whether they prefer to seek an extension of the public health nursing services to meet
this anticipated need.
SCHOOL HEALTH SERVICES
It has been repeatedly emphasized that school health services cannot be divorced
from community health services, since the school-child is a member of the community
duly influenced by conditions within the community. Actually the average child is in
the school for less than six hours a day, and is in contact with the family and the
community for the remaining eighteen hours of the day. It is primarily for this reason
that it is recommended that school health services be operated as part of the total community health services rather than as a separate entity.
In the past it has been customary to publish a separate Report on School Health
Services outlining the scope of the services carried on in the schools. However, it has
become increasingly difficult, and somewhat impractical, to continue this practice in view
of the fact that it is hard to distinguish where community health services cease and school
health services start. For example, in community health service, it is usual to provide
health supervision of the child from infancy through the pre-school years, which supervision it is felt has a definite effect on the improved health of the school-child. It seems
an anomaly to make a special report dealing with that same child as he commenced school
and ignore entirely the public health supervision that was given during the infancy and
pre-school years without indicating that the service was influencing the school health
services. Consequently, it has been argued that a special report on school health services
is not justified and that each report should be embodied in this Annual Report. From
this year forward it is proposed that the Report of the Medical Inspection of Schools will
be incorporated in these Annual Reports, thereby giving a better interpretation of the
co-ordination of the school health services with community health services, indicating
the interrelationship of the two.
The school health programme concerns itself with the promotion of health, the
protection of health, and correction of physical defects and departures from normal
health. In carrying this out, such services as medical examination of the pupils, immunizations, control of communicable diseases, inspection of the school environment, and
health education are embodied into the programme. The programme is designed to
attain certain objectives; these are probably extremely well stated by the Illinois Joint
Committee on School Health in the following list:—
To inspire the child with a desire to be well and happy.
To convey to the pupil the public and personal health ideal, designed to ensure
for him the continuation through life of wholesome and effective living,
physical and mental.
To educate the child, according to a definite plan, in the cultivation of those
habits of living which will promote his present and his future health.
To impart health knowledge and attitudes to the child, so that he will make
intelligent health decisions.
To develop in the child a scientific attitude toward health matters, and an
understanding of the scientific approach to health problems.
To maintain adequate sanitation in school, the home, and the community.
To protect the child against communicable and preventable diseases and avoidable physical defects by providing effective public health control measures,
both individual and social, throughout the school and the community. Y 26 BRITISH COLUMBIA
To bring each child up to his optimal level of health.
To extend the school health programme into the home by obtaining family
and community support for the programme.
To discover early any physical defects the child may have, secure their correction to the extent that they are remedial, and assist the child to adapt himself to any individual handicap.
To provide healthful school living for the child.
To relate the school health programme to the health programme of the community so that it may deal with real, current, and practical problems.
To organize effectively not only the programme of direct health instruction,
but the equally important direct learning experiences of the child in the
field of health.
Somewhat the same goals are being sought in the school health programme in this
Province, as the staff engaged in school health services attempt to analyse what has been
done in the past, what are the objectives, and how they can best be met. It is becoming
more and more evident each year that with the growth in the school population it is not
practical to expect to provide individual attention to each school-child, and it is questionable whether this is desirable. Analysis of annual statistics has shown that well over
93 per cent of the school-children are in a satisfactory physical classification and probably
do not require routine annual examinations, but could benefit from screening methods in
which those requiring more intensive attention would be selected for detailed and careful
examination. Each year this question of revision of the school health programme has
been raised at meetings of the Medical Health Officers, and as an attempt is made to
analyse the service throughout the Province, it becomes evident that there are variations
from area to area in the eighty school districts. It seems desirable to set a definite goal
which will provide a uniform policy in school health services so that the staff know what
is expected of them, School Boards know what to expect from the staff, and the educational authorities become aware of the objectives of the health programme.
With these thoughts in mind, then, the school health programme was set up this
year under the chairmanship of the Director of the North Fraser Valley Health Unit,
composed of representative School Medical Inspectors, public health nurses, and public
health administrators, to analyse the service and recommend a revised programme. It is
suggested that this committee should hammer out provisions of the programme, discuss
these with Inspectors of Schools and school principals, present them to the next Medical
Health Officers' conference, and endeavour to decide upon a definite Departmental policy
which can then be discussed with the Department of Education as the recommended
policy for the future in British Columbia. This, then, can be taken to the various School
Boards represented on the Union Boards of Health, and also discussed with the school
staffs to enlist their support.
In the field of school environment some consideration has been given to an attempt
to correlate the standard of construction between the Department of Education and the
Health Branch, Department of Health and Welfare, so that there would be uniformity
in the planning of new school buildings. It is felt that there should be some recommended similar standard for such items as lighting, cubic air-space per pupil, heating,
ventilation, sanitary facilities, and so forth. Consequently, a joint committee of the
Department of Education and the Health Branch, Department of Health and Welfare,
has been working on a pamphlet of recommended standards which could be used by the
School Inspectors and Sanitary Inspectors in the field as desirable features of all school
buildings. In addition, it would serve as a guide for architects designing new school
buildings in developing the layout of the building, and the equipment to provide conditions in keeping with recommended standards. This work is progressing extremely slowly
but is being carried forward as time permits. DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 27
THE HEALTH OF THE SCHOOL-CHILD
It seems desirable in discussing the school health programme to endeavour to
analyse the health of the school-children in British Columbia, as revealed by the various
reports submitted by the School Medical Inspectors over the past year. During the
attempt at evaluation of the health of the school-child, it becomes evident that it is
difficult to find a satisfactory measure of health status, and even if a much better measure
was available than now exists, it would still be difficult to determine which elements in
the school or community health programme are responsible for the improvement. There
is no exact objective and quantitative measure of the health of an individual, although
an extensive science of testing has been developed to measure growth status and organic,
muscular, and athletic efficiency.
Further, it must be mentioned that while it might be important to measure results
wherever possible, there are still many values arising from the school health programme
that cannot be measured quantitatively. The benefits of the programme will be felt by
the individual throughout his whole life. This might well be maintained if the school
health programme contributes enough to the health of the future adult to make it worth
while, even if no specific health improvement could be measured during the years in
school.
Improvement in the health and nutritional status of the child is often evident to the
physician and sometimes to the teacher, even though this improvement cannot be recorded
by an objective health index.
There are also some values in the improvement of home conditions, through the
indirect education of parents, that result from the health programme in the school. There
presumably will be a direct effect upon the health of the next generation through the
improved attitudes in health status of the present group of public-school pupils when
they become parents. Attitudes are difficult to measure, and yet the contribution of the
public school to the development of sound attitudes is one of its most important services.
Health education makes many contributions to the vigour, efficiency, contentment, cheerfulness, community health, and race betterment that can never hope to be measured.
In the reports of school health services over the past four years in British Columbia,
an attempt has been made to analyse the health of the school-child on the basis of immunization status, physical status, and morbidity figures of notifiable diseases. Based upon
an analysis of those factors, it has been evident that the health of the school-child has
been extremely satisfactory. For the purposes of comparison, and for lack of a better
measuring-tool, it is felt that this same approach should be made this year in analysing
that individual.
During the academic year of September, 1952, to June, 1953, the school health
programme was carried throughout the eighty school districts in 898 schools. Enrolled
in the grades examined were 186,912 school-children, a definite increase over the enrolment for previous years. Of this number, 27.8 per cent received medical examinations,
a percentage which is admittedly low but is explained upon the basis that the medical
examinations are being concentrated in Grades I, IV, VII, and X on a priority basis,
with special attention being proffered to those referred by screening methods, whether
these screening methods consist of such things as the Wetzel Grid or teacher-nurse
conferences. Indeed, a study of the results of the medical examinations by grades reveals
a much more reassuring situation in the fact that 84.2 per cent of the pupils in Grade I
were examined, with lesser but corresponding majorities in the selected subsequent years.
The results are presented in detail in the various statistical tables.
In scrutiny of these tables, it becomes evident from Table I that the physical status
of the school-children has revealed that the medical examination shows them to be in
good physical condition clinically. It becomes evident that somewhat over 93.0 per cent
of the pupils are in A Group, with a lesser number, 6.8 per cent, in B Group and, 0.2 Y 28
BRITISH COLUMBIA
per cent, in C Group. As was already mentioned, so many features affect physical status,
it is difficult to determine any definite reason behind this, but it is indicative of the fact
that the routine physical examination of pupils does not seem justifiably practical when
so many of them are in a satisfactory A Group. It points up the fact that a screening
method throughout the school would select the pupils requiring detailed examinations
and on whom concentration of medical services in the school health programme can be
devoted in an endeavour to improve their health.
In addition to the excellent physical status of the average school-child in British
Columbia, the majority of pupils (more than 60 per cent of each group) are immunized
against such major communicable diseases as diphtheria and smallpox, maintaining their
immunity status during their school-life. This bespeaks a satisfactory trend in the
immunity status of that population group, but the fact that diphtheria cases were recorded
during the year at a rate of 0.7 per 100,000 population emphasizes that immunization of
the total school population would be most desirable.
A significantly smaller proportion of the school population was immunized against
scarlet fever, pertussis, and typhoid fever. This is understandable, as administration of
scarlet fever toxin and typhoid fever vaccine is governed by the vagaries of disease
incidence, particularly since the immunity so conferred is less permanent. In the case
of pertussis, concentration of protection toward this disease is emphasized in the early
infant and pre-school years, in which population group the disease is most serious and
often fatal. Consequently, as the child becomes older, there is less need for immunity
protection to pertussis, and this is reflected in the gradually decreasing immunity status
to this disease in the higher grades.
The third factor reflecting the health of the school-child is the communicable-disease
incidence, the majority of which are childhood infections. During the year there were
the usual number of cases of chicken-pox, measles, mumps, and rubella, with definite
upward trends in certain instances. Many of these infections recur with a cyclic epidemic
periodicity as new susceptible groups enter the school, and communicable-disease control
measured seem to bear little effect upon the trend. Poliomyelitis showed a marked
increase during the year, with a rate of 64.0 per 100,000 population, but the incidence
was equally confined to adult groups as it was to school-aged groups, so that the effect
on the general health of the school-child was not too marked.
In general, the health of the school-child during the academic period 1952-53
coincided with that obtaining over the past four years as being, on the average, satisfactory. Although an average number of minor communicable diseases was recorded, the
incidence of major infection was not serious, while the immunity status on the whole was
satisfactory, and the medical status was excellent.
Table I.—Physical Status of Pupils Examined, Showing Percentage
in Each Group, 1946-47 to 1952-53
Academic Group
Percentage of
Pupils, A Group1
Percentage of
Pupils, B Group2
Percentage of
Pupils, C Group3
194647    	
1947-48
91.1
91.7
93.3
93.4
93.1
93.5
93.0
8.3
7.8
6.4
6.5
6.8
6.4
6.8
0.6
05
1948-49  	
0.3
1949-50 -   	
1950-51       	
0.1
0.1
1951-52                            	
0 1
1952-53	
0.2
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. DEPARTMENT OF HEALTH AND WELFARE,  1953
Y 29
Table II.—Physical Status of Total Pupils Examined in the Schools
for the Years Ended June 30th, 1949 to 1953
1948-^9
1949-50
1950-51
1951-52
1952-53
137,536
54,682
39.8
42.2
48.9
0.8
1.4
5.6
0.2
0.6
0.1
0.1
0.1
128,724
45,049
35.0
38.8
52.5
0.8
1.3
5.6
0.1
0.8
0.1
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
186,912
52,296
28 0
Total pupils examined   	
Physical status—percentage of pupils examined—
A	
Ad                             - -	
33.6
57 2
Ae            	
Ade      -                  ..~ - -
0.6
1 6
Bd   .                         	
5 8
Be  	
Bde.....	
0.1
09
Cd_                                   	
0 1
Ce          	
Cde 	
0.1
Table III.—Physical Status of Total Pupils Examined in Grades I, IV, VII, and
X for the Years Ended June 30th, 1949 to 1953
1948-49
1949-50
1950-51
1951-52
1952-53
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
36.7
54.7
0.7
1.7
5.2
0.1
0.8
0.1
70,222
38,273
54.5
Physical status—percentage of pupils examined—
A                                                                       	
34 9
Ad     	
Ae          	
57.1
0.5
Ade     	
Bd  ...	
Be        -
1.4
5.1
0.1
Bde     	
Cd   	
Ce                         -	
0.7
0.1
Cde              	
0.1
0.1
0.1
Table IV.—Summary of Physical Status of Pupils Examined,
According to School Grades, 1952-53
Total
Pupils,
All
Schools
Examined in Grades
Grade
I
Grades
II-VI
Grades
VII-IX
Grades
X-XIII
Total pupils enrolled in grades examined-
Total pupils examined-
Percentage of enrolled pupils examined
Physical status—percentage of pupils examined—
Ad...
Ae.-.
Ade.
Bd...
Be.-..
Bde-
Cd—
Ce ...
Cde-
86,912
52,296
28.0
33.6
57.2
0.6
1.6
5.8
0.1
0.9
0.1
0.1
23,919
20,289
84.8
32.5
59.6
0.5
1.3
5.2
0.1
0.6
0.1
0.1
96,046
15,210
15.8
30.8
57.6
0.8
1.8
7.4
0.1
1.3
0.1
0.1
43,673
10,678
24.4
36.5
54.4
0.7
1.9
5.3
TT
o.i
23,274
6,119
26.3
39.5
53.3
0.5
1.3
4.8
0.1
0.5 Y 30 BRITISH COLUMBIA
Table V.—Physical Status by Individual Grades of Total Schools, 1952-53
All
Schools
Grade
I
Grade
II
Grade
III
Grade
IV
Grade
V
Grade
VI
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      ...    	
86,912
52,296
28.0
33.6
57.2
0.6
1.6
5.8
0.1
0.9
0.1
0.1
23,919
20,289
84.8
32.5
59.6
0.5
1.3
5.2
0.1
0.6
0.1
0.1
20,130
3,279
16.3
31.6
56.2
1.2
1.8
8.0
0.1
0.9
0.1
0.1
20,012
3,644
18.2
23.1
64.4
0.5
1.8
8.2
0.2
1.5
0.2
0.1
19,949
4,845
24.3
34.7
55.0
0.7
1.6
6.9
0.1
0.9
0.1
18,727
1,969
10.5
31.4
56.9
0.6
2.5
6.4
0.1
1.9
0.2
17,228
1,473
8.6
34.4
53.8
1.3
2.2
6.6
0.1
1.3
0.2
0.1
Grade
VII
Grade
VIII
Grade
IX
Grade
X
Grade
XI
Grade
XII
Grade
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.
16,394
8,107
49.5
38.2
54.2
0.6
1.9
4.0
0.1
0.9
0.1
14,659
1,379
9.4
32.0
54.3
1.3
2.0
8.3
2.0
0.1
12,620
1,192
9.4
29.9
54.9
0.5
1.8
10.8
1.8
0.2
0.1
9,960
5,032
50.5
39.6
53.6
0.6
1.2
4.4
0.5
0.1
7,149
563
7.9
41.3
49.4
0.2
1.4
6.9
0.4
0.4
5,548
473
8.5
35.5
55.2
0.2
1.7
7.2
0.2
617
51
8.3
41.2
54.9
3.9
Table VI.—Number Employed and X-rayed amongst School Personnel, 1952-53
Total
Organized
Unorganized
7,779
4,120
6,684
3,733
1,095
387
Table VII.—Immunization Status of Total Pupils Enrolled,
According to School Grade, 1952-53
Total
Pupils
Enrolled
by Grades
Percentage Immunized
Smallpox
Diphtheria
Tetanus
Typhoid
B.C.G.
186,912
23,919
20,130
20,012
19,949
18,727
17,228
16,394
14,659
12,620
9,960
7,149
5,548
617
61.5
64.4
64.4
66.8
65.9
67.1
67.3
61.2
55.4
49.9
51.9
49.6
45.3
44.7
69.7
73.4
75.1
76.9
75.0
76.4
73.7
67.6
61.8
59.1
58.4
54.0
49.8
43.3
21.6
37.4
30.6
27.6
22.0
19.2
19.6
15.7
12.8
11.1
11.4
10.7
10.5
8.6
0.8
0.6
0.7
0.9
0.9     .
1.0
0.9
0.6
0.9
1.1
0.8
0.5
1.2
2.8
0.1
0.2
Grade II               	
0.1
Grade III                                             	
0.1
Grade IV               .. _ -	
0.1
Grade V    	
0.1
Grade VI 	
0.1
Grade VII                                        	
0.1
Grade VIII                                  	
0.1
Grade IX                                          	
0.1
0.2
Grade XI                                           	
0.1
Grade XII                                      	
0.5
Grade XIII     -
0.8 DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 31
DISEASE MORBIDITY AND STATISTICS
During 1950 and 1951 British Columbia, in common with the other Provinces,
participated in a National Sickness Survey, in co-operation with the Department of
National Health and Welfare. The statistics on that survey have been in the process of
compilation in Ottawa, and during the last year some of the preliminary figures have been
issued. These dealt with the costs of sickness at varying family economic levels, indicating
the amounts spent on medical care, hospitalization, dental care, treatments, and drugs.
These figures are shown on a National basis, indicating the average amounts of money
required for each of the services and the total amount involved in medical care. Further
compilations are being prepared which will detail the expenditures and, it is hoped, bring
it down to a Provincial level, so that information can be gained on the costs of medical
care, types of sickness involved, and the amount of sickness receiving no particular
medical or nursing attention. Thus the work that was done throughout the Province in
previous years mainly by the public health nurses, who so diligently followed the gathering
of the material among a sample of the population, is beginning to show results. Bulletins
are being released to provide interim information until the final report containing more
detailed information, together with a fuller description of the methods used, is prepared.
The tests that were conducted during the fall of 1951 and the spring of 1952 into the
possible use of an oral vaccine, contained in caramel lozenges as a method of immunization
for raising immunity to diphtheria, have since been analysed. Specifically the test consisted of analysing the immunity-level of a number of school-children prior to consuming
these lozenges and again after a lapse of eight months to one year. This was to test the
initial level of immunity with the second to find out how much the level had been increased,
following consumption of the lozenges. The result indicated roughly that 50 per cent of
the pupils participating showed an increase in protective level, 38 per cent showed no
increase, and 12 per cent showed an actual decrease. There seemed to be a slightly better
result in the older age-group than in the younger, although this was too slight to be
significant. In general, it was felt that efficacy of use of oral vaccine in caramel-lozenge
form as a means of bolstering immunity against diphtheria was questionable. It was
likely that where full dosage had already been administered, the ease of shipping caramels
to carry on as booster might be appreciated, but, taking into consideration the extreme
cost of the caramels, the results obtained were so small as to hardly justify the costs
involved. It did seem that oral immunization as a reinforcing antigen against diphtheria
had some merit, but it was useless as a primary immunizing agent.
During 1953 the total incidence of notifiable disease was 3,194.9 per 100,000
population, which is compared to the incidence over the past five years in Table VIII.
In so far as the morbidity statistics for the Province are concerned this year, probably the
most outstanding feature is in relation to the poliomyelitis picture, in which the highest
incidence of any year to date is exhibited in the rate of 64.0 per 100,000 population, in
contrast to the rate of 49.6 per 100,000 population for 1952, which had been the highest
recorded incidence previously. The incidence this year does not seem to have been
concentrated in any one particular area of the Province and has been prevalent over many
more months of the year rather than being confined to late summer and early fall. As the
year ended, there was indication that the incidence was decreasing gradually.
There is some evidence on the basis of stool cultures that new strains of virus may
be creating this higher incidence, presumably on the basis that the population, which had
formerly been exposed to a Lansing strain, to which immunity had materialized, is now
faced with the necessity of building up population immunity to the newer strains, known
as the Brunhilde and Leon strains. If this is the case, it may be expected that annual
recurrent epidemics of poliomyelitis may be anticipated until disease experience confers
population immunity to them, in the same relation as now apparently exists to the
Lansing strain. Y 32
BRITISH COLUMBIA
While there were 787 cases of poliomyelitis reported throughout the Province during
the year, it is of interest to note that almost half of these—namely, 358 cases—were mild,
exhibiting no paralysis. At the same time, because of the number involved, there were
296 cases of severe bulbar type of paralysis and a remaining 133 cases with other types
of paralysis.
In spite of the higher incidence a very creditable picture was obtained from a
mortality view-point, as only 26 deaths were recorded this year, compared to 37 deaths
the previous year. As a matter of fact, the case fatality rate for 1953 was 3.3, compared
with a similar rate of 6.8 in 1952 and 3.8 in 1947, the other years of high incidence.
Actually the following table indicates a very creditable showing in the case of fatality
figures, indicative of a remarkable improvement in deaths from poliomyelitis over the
years.
Poliomyelitis Case Fatality Rates
Year
Cases
Deaths
Case Fatality Rate
1927
182
102
43
34
42
313
584
787
37
19
13
8
11
12
37
26
Per Cent
20 3
1928    	
18.6
1929                                     —
30.2
1930                                         -     	
23 5
1931     -  	
1947	
26.2
3 8
1952 ...	
6.3
1953	
3.3
This improvement may be more significant than real if improved reporting in the
last few years has promoted recording of the non-paralytic cases, but, at the same time,
improved methods of treatment can be stated to have occurred and probably have had
a definite effect. In any case, it does bear out the argument that poliomyelitis is not a
particularly fatal disease, even in the face of increasing incidence.
On the basis of experience gained a year ago, it can be recorded that a programme
was evolved for this year which permitted better handling of the epidemic in providing
for care of poliomyelitis patients. This has only been possible through the remarkable
degree of co-operation by the private physicians, the Provincial and local health services,
the Vancouver General Hospital, the Royal Jubilee Hospital, the Royal Canadian Air
Force Air-Sea Rescue Unit, and the British Columbia Poliomyelitis Foundation. The
need for a Province-wide programme arose from the fact that the specialized services
were located almost entirely in the Infectious Disease Unit of the Vancouver General
Hospital and, to a lesser degree, the Royal Jubilee Hospital in Victoria. Up until last
year these two hospitals were able to meet the demands for admission of patients from
outside the metropolitan areas of Vancouver and Victoria. The programme was originally
drafted by the Poliomyelitis Committee of the Vancouver General Hospital in conjunction
with representatives of the Health Branch of the Department of Health and Welfare, and
later concurred in by the full-time Medical Health Officers throughout the Province.
Poliomyelitis Committees were set up in Vancouver and Victoria in conjunction with
the two hospitals, composed of physicians specializing in the various branches of medicine.
The members of the Committee had to accept the treatment of cases of poliomyelitis
referred to the hospital and to serve as consultants to the private physicians for the proper
care and rehabilitation of their patients.
The co-operation of the Royal Canadian Air Force Air-Sea Rescue Unit stationed
in Vancouver has been outstanding. As soon as a request for transportation was cleared
through the necessary channels, every effort was made to complete the evacuation, despite
hazardous flying conditions in some cases. A medical officer and a nurse of the Royal
Canadian Air Force are included in the crew of the aeroplane, which carries a portable
J DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 33
respirator. Certain it is that without their material assistance, many of the evacuations
would have been impossible, since commercial aircraft could hardly have undertaken
flights under such conditions.
Specialized equipment required for the care of poliomyelitis patients is located almost
entirely in the Vancouver General Hospital and the Royal Jubilee Hospital, with the
larger share being in the former. A number of hospitals in other parts of the Province
do have respirator equipment, but this is not all up to date or the type which can be used
for any length of time. Because of the cost of such equipment, it is considered more
economical to concentrate it in the two larger centres of population. It has been necessary
this year to purchase twenty-eight respirators of the tank type in addition to other equipment, such as rocking-beds, positive-pressure breathing-therapy units, and so forth.
Approximately $75,000 has been expended on equipment, just over half the expenditure
being from the National health grants and the remainder from the British Columbia
Foundation for Poliomyelitis.
The British Columbia Foundation for Poliomyelitis is a voluntary agency supported
largely through the efforts of the Kinsmen's Clubs throughout the Province. In addition
to the provision of equipment, funds have been given toward the purchase of equipment
for one or two other institutions, the provision of additional physiotherapists, and research.
Because of the greater flexibility in the use of voluntary funds, it has also been possible
for this organization to assume certain extraordinary expenses.
The cost of hospitalization is covered by the British Columbia Hospital Insurance
Service as long as the patient is in the acute stage of the disease. After this stage is
passed, the cost of hospital care becomes the responsibility of the individual.
More specialized rehabilitation services are given at the Western Society for Rehabilitation, but some services are available at the Royal Jubilee and Vancouver General
Hospitals, and, in addition, through the co-operation of the British Columbia Division
of the Canadian Arthritis and Rheumatism Society, physiotherapists on its staff throughout the Province are giving treatments to post-poliomyelitis patients at the request of the
private physician.   In general, patients are expected to pay for rehabilitation services.
Toward the latter part of September a supply of gamma globulin was made available
to British Columbia and is being distributed to physicians for prophylactic administration
to familial contacts who are 16 years of age or less or who are pregnant. The new serum
globulin is an antibody concentrate prepared from the fractionation of human plasma
and is only permitted for the prophylaxis of paralytic poliomyelitis in so far as present
use is concerned because of the shortage of available stocks. Between the time this
became available and the end of the year, some 823 vials of gamma globulin were distributed for administration to 447 such contacts.
Provision for research in poliomyelitis is a recent innovation in this Province and
has been due to the support of the Kinsmen's Club and the British Columbia Foundation
for Poliomyelitis. Prior to this year an amount of $12,500 was given to the University
of British Columbia for the purchase of research equipment. This year the Kinsmen's
chair of neurological research has been established in the Faculty of Medicine, University
of British Columbia, through the contribution of $5,000 per year for five years. Additional research into the epidemiological aspects of poliomyelitis is carried on under the
direction of the Consultant in Epidemiology to the Health Branch, Department of Health
and Welfare. With the co-operation of health units in the field and the Provincial
Division of Laboratories in Vancouver, a number of studies into the spread pattern of
epidemic poliomyelitis, identification of virus in epidemic areas, and field evaluation of
gamma globulin are under way.
There were a number of cases of diphtheria reported, to give a case rate of 0.7 per
100,000 population, approximately the same as in the previous year, when a rate of 0.9
was reported. It is still significant that this disease should occur in a Province where
public health services are so widespread and opportunities for immunization against the Y 34 BRITISH COLUMBIA
disease are constantly available. Upon investigation, these invariably occur among
non-immunized persons who have been exposed to diphtheria carriers. It continues
to emphasize the need for maintained diphtheria-immunization status amongst all members of the population, both in the child and adult.
An extremely high incidence of bacillary dysentery of the Shigella type was reported
in the case of 588 persons, to yield a case rate of 47.8 per 100,000 population. This was
anticipated, as it had been indicated by the Director of the Division of Laboratories that
a reservoir of unidentified carriers of Shigella sonnei was very likely as a result of outbreaks of bacillary dysentery at certain summer camps in the Howe Sound area during
the summers of 1950 and 1952.
There was also a major upswing in the incidence of epidemic hepatitis, in which
789 persons suffered illness, to promote a case rate of 64.1, much the highest incidence
ever recorded in British Columbia. This is an acute virus infection in which the usual
mode of transmission is not clear, since several epidemics have been reported caused by
contaminated water, food, or milk, or by direct personal contact. Susceptibility is
general, and a single attack seems to confer a considerable degree of immunity as second
attacks are infrequent. The incidence tends to be highest in the autumn and early winter,
occurring most commonly amongst children and young adults. Prophylaxis seems to
depend upon good community sanitation and personal hygiene, with particular emphasis
on sanitary disposal of respiratory and bowel discharges.
The incidence of epidemic influenza was about average with a case rate of 65.7,
which is considerably less than the case rate in the peak year of 1951, when it was
recorded as 956.9 per 100,000 population. Preparations were made in the early spring
months to provide for typing of specimens from patients in the Laboratory of Hygiene
at Ottawa, but, as the incidence was not significant, these procedures were not invoked.
One case of leprosy was recorded during 1953, in the case of a young Chinese,
who was immediately transferred to the jurisdiction of the Department of National Health
and Welfare for hospitalization at the leper centre on Bentinck Island.
A considerable number of cases of salmonellosis were reported, particularly of the
paratyphoid type. Investigations were conducted in the Prince Rupert area, where
there has been a considerable amount of paratyphoid reported among the Indian population group, in which it was finally proven that carriers were creating the situation.
Control measures are under consideration which, it is hoped, will decrease the annual
incidence in that locale and bring about a much better Provincial picture for the future.
Streptococcal infections were considerably decreased, resulting in a much improved
situation from that point of view over the Province generally. There was a much lesser
number of scarlet fever cases, and considerably less septic sore throat reported.
Two persons contracted tetanus during the year, to present the same incidence this
year as in the previous year. Fortunately, no fatalities were recorded, as anti-toxin
was administered immediately diagnosis was established.
The incidence of minor communicable infections, such as chicken-pox, measles,
mumps, pertussis, and rubella, was apparent throughout the year, accounting for a considerable proportion of the notifiable diseases reported in the Province. There seems
to be so little that can be done to promote control of these minor infections that consideration is being given to discontinuance of their reporting. This situation has been
under discussion with the Department of National Health and Welfare, which is endeavouring to gather the opinions of the various Provinces in respect to notifiable-disease
reporting for the future.
The results of notifiable-disease reporting are presented in the statistical tables that
follow, showing the totals and the rates for the past five years, as well as the breakdown
of the incidence throughout the Province by health unit for the year. DEPARTMENT OF HEALTH AND WELFARE,  1953
Y 35
Table VIII.—Notifiable Diseases in British Columbia, 1949-53
(Including Indians)
1949
1950
1951
1952
1953
Notifiable Diseases
Number
of
Cases
Rate per
100,000
Population
Number
of
Cases
Rate per
100,000
Population
Number
of
Cases
Rate per
100.000
Population
Number
of
Cases
Rate per
100,000
Population
Number
of
Cases
Rate per
100.000
Population
I
0.1
1
1
16
3,509
7,370
287
12
0.1
0.1
1.4
315.0
661.7
25.8
1.1
2.1
0.1
1.0
4.2
0.1
0.1
966.4
1.6
387.4
19.2
20.2
50.9
1.5
0.1
8.5
2.9
44.1
9.2
0.1
0.3
0.2
0.8
0.4
197.7
1
22
3,125
5,001
280
63
1
189
1
46
460
0.1
1.9
274.6
439.5
24.6
5.5
0.1
16.6
0.1
4.0
40.4
Brucellosis	
Cancer  	
18
2,850
6,671
374
5
1.6
247.2
578.5
32.4
.0.4
12
3,366
6,266
346
11
1
102
2
212
548
1.0
281.0
523.1
28.9
0.9
0.1
8.5
0.2
17.7
45.7
5
2,785
6,869
193
8
1
588
4
789
808
1
1
7,646
42
8,071
717
787
1,095
10
23
83
24
2,220
206
1
2
0.4
226.5
558.6
15.7
Diphtheria-	
Dysentery—
0.7
0.1
Bacillary (Shigella)	
23
1
10
47
1
1
10,765
18
4,314
214
225
567
17
1
95
32
491
102
1
3
2
9
4
2,202
253
21.9
47.8
0.3
90
11,033
2
7.8
956.9
0.2
64.1
Influenza, epidemic	
65.7
0.1
2
8,227
33
7,088
976
594
1,986
30
8
109
26
4,163
536
0.2
686.8
2.8
591.8
81.5
49.6
165.8
2.5
0.7
9.1
2.2
347.6
44.7
0.1
Measles-  - 	
Meningitis, meningococcal.
Mumps- 	
Pertussis.. 	
Poliomyelitis.. 	
Rubella 	
Salmonellosis—
5,648
15
8,634
1,740
73
7,935
11
35
152
36
871
183
1
1
5
496.3
1.3
758.7
152.9
6.4
697.3
1.0
3.1
13.4
3.2
76.5
16.1
0.1
0.1
6,269
30
5,835
1,134
92
2,288
18
7
149
38
4,146
300
543.7
2.6
506.1
98.4
8.0
198.4
1.6
0.6
12.9
3.3
359.6
26.0
621.7
3.4
656.3
58.3
64.0
89.0
0.8
1.9
Unqualified 	
Streptococcal infections—
Erysipelas 	
Scarlet fever  	
6.7
2.0
180.6
16.7
0.1
2
0.2
0.2
0.4
8
0.7
3
0.3
13
1.1
Tuberculosis—	
1,828
160.6
1,662
144.1
1,411
117.8
1,494 |
1  |
2,969 |
691  |
11 1
26 |
121.5
0.1
Venereal disease—
Gonorrhoea 	
Syphilis   (includes nonspecific urethritis—
venereal)	
3,833
859
344.2
77.1
0.3
3,579
630
314.5
55.4
3,301
568
286.3
49.3
3,057 |
541  |
19 1
255.2
45.2
241.5
56.2
0.9
3
6
0.5
48
4.2
1.6
2.1
Totals 	
35,036
3,145.5
40,572
3,565.2
47,189  |
4,092.7
39,677 |
3,312.3
38,185  1
3,104.9 Y 36
BRITISH COLUMBIA
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OmOZ.i DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 37
REPORT OF THE DIVISION OF PUBLIC HEALTH NURSING
Monica M. Frith, Director
The Division of Public Health Nursing forms an integral part of the Bureau of Local
Health Services. The completion of health-unit development within the Province has
resulted in almost all the public health nursing districts being incorporated into health
units, and accordingly it has been possible for the Division to modify its programme to
fit the present situation. Formerly a great deal of time was spent on the organization
of public health nursing districts and on the provision of direct public health nursing
supervision to these districts. At the present time the responsibility for direct public
health nursing supervision has been transferred to the local health-unit staff. The
Division now concentrates its activities on recruiting, placing, transferring, and training
nursing personnel and providing consultative nursing service to local health units to assist
them in developing their public health nursing programmes to meet local needs. The
work of the public health nurse in the field is carefully assessed in order to give the best
possible service to the people of each district.
STATUS OF SERVICE
In order to meet the ever-increasing demand for public health nursing service brought
about by the increased population in certain areas of the Province, and also to meet the
demand for new types of public health nursing service, it has been necessary to increase
the number of public health nurses in the field. Even with an increase of ten new positions over those of last year, it has not yet been possible to return to the ratio of one nurse
to 4,000 population which existed in 1949. Therefore, it will be necessary to continue
to add public health nursing staff if a high standard of service is to be maintained and if
the public health nursing needs are to be met.
During the year ten additional public health nursing positions were approved under
National health grants. With the exception of the new district, McBride in the Cariboo
Health Unit, all new positions were extensions of existing services. The new positions are
located in the following health units: Central Vancouver Island Health Unit at Duncan
and Port Alberni; Cariboo Health Unit at Williams Lake and Quesnel; Upper Island
Health Unit at Courtenay; East Kootenay Health Unit at Creston; Saanich and South
Vancouver Island Health Unit at Saanich; South Okanagan Health Unit at Oliver;
Simon Fraser Health Unit at Coquitlam. In addition, a part-time public health nursing
service was established for School District No. 80 at Kitimat. During the coming year it
is hoped that additional public health nursing staff may be located in the North Fraser
Valley, Boundary, and Simon Fraser Health Units.
The demand for public health nursing service has increased the recruitment problem,
as it is now necessary to find nursing staff for 139 positions, compared with 56 positions
ten years ago. At the present time there are seven vacant positions, with two more being
held on a very temporary basis. The number of resignations during the year has remained
about the same as last year, but it has not been possible to recruit sufficient numbers of
public health nurses to the service to fill the positions. It is believed that this is largely
due to the unfavourable salary levels in the Provincial service.
During the year thirty-six appointments were made to the public health nursing staff.
Of this group, ten were public health nurses who returned to the staff following leave of
absence for public health nursing university training, fifteen were qualified public health
nurses, while the remaining eleven were nurses without public health nursing qualifications.
It is interesting to note that this year it was possible to interest only one public health
nurse, who was completing her training independently at the University of British Columbia, to join the service. Y 38 BRITISH COLUMBIA
There were twenty-two resignations from the staff. Sixteen nurses left the service
for family reasons or marriage, two to obtain further education, and four for other positions. Twelve nurses were granted leave of absence. Of this group, eight nurses are
completing the certificate course in public health nursing, two experienced public health
nurses are completing degree programmes in public health nursing, and two public health
nurses are on extended leave of absence due to illness.
Eighteen nurses transferred within the service. Five of these involved supervisory
or senior personnel.
CONSULTANT SERVICE
The Division of Public Health Nursing is constantly striving to improve the quality
of the public health nursing service. This is accomplished by public health nursing consultant field visits and by analysis of the work done. To determine whether the service is
being rendered in an efficient and economical manner, a critical analysis of the service is
made each year using statistical methods. Each public health nurse submits a case-load
analysis and, in addition, participates in a three weeks' time study. In this way it is possible
to determine how much time is being devoted to certain services, and to make changes to
provide more efficient services where this is indicated. The statistical information collected is utilized by the public health nursing consultants during their field visits. Information obtained by statistical analysis along with the field report of the consultant assists
the Division of Public Health Nursing to make recommendations to the Bureau of Local
Health Services concerning such matters as staff, new types of programmes, equipment,
etc.
The Division of Public Health Nursing provides public health nursing consultative
service to the health units and nursing districts in the conduct of the generalized public
health nursing programme. The consultants visit the health units regularly, and during
these visits assist the director of the health unit and senior nurse to analyse the public
health nursing service being rendered in the unit and to plan modifications as the situation
indicates.
The public health nursing consultants provide assistance in special fields of work
such as mental hygiene, maternal and child health, medical-nursing care programme, and
Civil Defence, on a request basis. Since consultant service has been available, an improvement has been shown in the development of the public health nursing programmes on the
local level, not only in the special fields of work, but also in the routine public health
nursing programmes.
Special assistance is available to the public health nursing service in the field of
tuberculosis from the public health nursing co-ordinator assigned to the Division of Tuberculosis Control, Vancouver. On request to the Bureau of Local Health Services, arrangements may be made for a field visit. The senior epidemiology worker at the Division of
Venereal Disease Control 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.
Records Committee
The Provincial Public Health Nursing Records Committee has met regularly throughout the year and has been able to revise many records to suit the changing needs of local
health services. A pilot study on the family folder system of filing records has been in
operation for over a year, and it is expected that major changes in office procedure may
result from this study during the coming year.
PUBLIC HEALTH NURSING TRAINING
The in-service training of nurses prior to the completion of the public health nursing
course at the University has been an important aspect of the recruitment plan for obtaining public health nurses for the Provincial service.   It was possible this year to send eight DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 39
nurses to the University to enrol in the certificate course in public health nursing with the
assistance of National health-grant bursaries. Following the University course, these
nurses are available for placement throughout the Province. This group of nurses makes
a valuable contribution to the service, as they return to a service with which they are
familiar and, therefore, can be placed in more responsible positions than those without
this experience or training. The nurses who accept financial assistance under this plan
agree to remain in the Provincial service for at least two years. Nine public health nurses
returned to local health services following their basic academic training in public health
nursing, while one nurse returned to the staff, having completed a course in public
health nursing administration and supervision. Seventeen per cent of the qualified public
health nurses on the staff at the present time have been trained under this plan. As 20 per
cent of the staff nurses do not have public health nursing qualifications, it is necessary to
depend very substantially on this type of training in order to maintain the quality of public
health nursing service.
During the year, field-work facilities were provided for twenty-one students from the
University of British Columbia during the month of January and again in May.
In addition, observation periods have been made available to undergraduate nurses
in health units adjacent to schools of nursing as follows: Students from the Victoria
schools of nursing, St. Joseph's and Royal Jubilee, went to the Saanich and South Vancouver Island Health Unit; the South Central Health Unit was used for students from the
Royal Inland Hospital, Kamloops; and the Simon Fraser Health Unit was used for
students from the Royal Columbian Hospital, New Westminster. This opportunity of
observing the work of the public health nurses in a district has helped to recruit nurses to
public health nursing and has given undergraduate nurses a better understanding of the
function of a local health unit.
A continuous in-service educational programme is carried on in each health unit to
assist public health nurses to keep abreast of new developments and procedures in the
public health field. This is accomplished largely through staff and study-group meetings,
where relevant problems are discussed in relation to the public health nursing service.
At the annual Public Health Institute a full day's programme was devoted to public health
nursing, and a number of the nursing field staff were able to participate in the programme.
The agenda included " The Use of Records," " Classes for Foster Parents," "A Programme for Over-weight Girls," and " Screening of Health Problems in High School."
The Institute provides an excellent opportunity for interchange of ideas, and for stimulating the development of certain health programmes.
With the help of National health grants the Division of Public Health Nursing was
fortunate in being able to send seventeen senior public health nurses to the University of
Washington to participate in a two-week course in mental hygiene. The course was conducted by Miss Ruth Gilbert, Co-ordinator, Course for Mental Hygiene Consultants, and
Associate Professor of Nursing Education at Teachers College, Columbia University. On
return to their health units, the public health nurses gave general summaries of the course
content to the members of the public health nursing staff, and followed this up with staff
education, general supervision, and guidance to utilize the new background of information received. It is expected that this course will have been of help to all public health
nurses in the field by assisting them to incorporate mental-hygiene principles into the
generalized public health programme.
ADVISORY
The Division of Public Health Nursing has continued to function in an advisory
capacity to the bureaux within the Health Branch—the Bureau of Administration, the
Bureau of Special Preventive and Treatment Services, and the Bureau of Local Health
Services. Y 40 BRITISH COLUMBIA
Members of the Division have been active on a number of Provincial committees.
These include Junior Red Cross Nursing, the Junior Red Cross Crippled and Handicapped
Fund, Public Health Nursing Labour Relations and Educational Policy Committee of the
Registered Nurses' Association of British Columbia, the Advisory Committee to the
University of British Columbia School of Nursing, and the St. John Ambulance Nursing
Committee.
LOCAL PUBLIC HEALTH NURSING SERVICE
The public health nursing group makes up the largest number of health-workers in
local health service. Because of their regular and frequent contact with all age-groups, in
homes, schools, and clinics, they are important members of the public health team.
The public health nurse in a local health unit gives a generalized service which is
available to every age-group irrespective of economic and social circumstances. She is
concerned with the health of all members of the family and is prepared to assist with the
solution of health problems confronting individual members.
The public health nurse gives guidance to the mother during her pregnancy, in order
that she may make the best possible preparation for the birth of the new baby. This
guidance may be carried out through mothers' classes or through visits to the mother in
the home. She encourages expectant mothers to seek early and continuous medical care.
She interprets the doctor's orders and teaches the family how to carry them out. She
explains about such things as diet, rest, breast feeding, dental hygiene, clothing, and exercise. She helps the mother in planning the baby's layette. She assists in developing and
maintaining wholesome family attitudes toward the arrival of the new baby. During the
year a total of 2,475 visits was made to expectant mothers. Prenatal classes showed an
attendance of 1,286. Plans are under way for classes to be started in a number of health
units.
Assistance in carrying out daily routines is given by the public health nurse after the
mother returns from the hospital. Included in this may be demonstrations of approved
methods of infant-care, such as bathing the baby and preparing the formula. Seventeen
thousand one hundred visits were made to mothers at home within six weeks of the birth
of the baby.
The child-health programme is concerned with the physical and mental well-being
of all children, and is continued throughout the growing period from infancy to adulthood.
The programme is effected through child-health conferences, health supervision in the
schools, and through visits to the mother in the home. Information is given to the family
on understanding the child as well as planning for his physical care to enable the child to
develop a sound, healthy mind and body. During childhood many physical defects and
behaviour problems can be prevented or corrected. Frequently it is the public health
nurse who brings these matters to the attention of parents in order to assist them in securing the necessary help. A total of 44,829 infants and 38,721 pre-school children attended
child-health conferences during the year. Public health nurses made 28,990 home-visits
regarding infants and 29,539 visits regarding pre-school children.
The public health nurse supervises the health of the school-children in the schools of
her district. She visits the schools regularly and offers certain nursing services to the
school-children and provides consultative assistance to the teachers in health matters. In
the school the public health nurse assists with school medical examinations, screening tests
such as vision and hearing tests, 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 teachers, parents, and pupils, she
works toward the improvement of the health of the school-child. While visiting in the
home she is in an excellent position to interpret health matters, 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. DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 41
During the year public health nurses assisted with 26,910 medical examinations and
completed 55,469 nurses' examinations. The public health nurses held 47,385 conferences with members of the school staff, 44,550 with school pupils, and 10,903 with
parents. There were 5,172 first-aid demonstrations. A total of 30,562 visits was made
by public health nurses to homes of school-children. Of these, 22,826 were for general
health supervision, 959 were for mental hygiene, while 1,236 were for skin infections and
communicable diseases. During the year public health nurses used the resources of the
Child Guidance Clinic by referring 130 children to the Clinic for guidance.
The public health nurses continued to supervise tuberculosis cases in the homes and
to arrange for examination of contacts to cases. As tuberculosis patients are now being
discharged earlier, because of continued chemo-therapy carried on in the home, the
amount of work in connection with the tuberculosis programme has increased over that
of last year. Public health nurses have been giving an average of 1,200 injections of
streptomycin per month since this programme was taken over by the public health nurses.
During the year 9,784 visits were made to tuberculosis patients, and 8,421 visits were
made to tuberculosis contacts. B.C.G. vaccinations were given to 712 individuals. Public
health nurses in certain areas have been concerned with arrangements for the mobile chest
X-ray and tuberculin surveys.
The public health nurses continue to provide nursing care in the home on a short-
term basis. This includes such procedures as hypodermic injections, enemas, treatments,
dressings, etc. Demonstration of nursing-care procedures may include instruction on how
to bathe a patient in bed, prepare a formula, etc. The public health nurse renders nursing
care in the home in an emergency and teaches someone else to carry out routine care when
it is necessary to arrange for long-term care. During the year 516 nursing-care demonstrations were given.   A total of 4,224 visits was made for nursing care in the home.
Kelowna in the South Okanagan Health Unit continues to give a full bedside-
nursing programme, while Vernon in the North Okanagan Health Unit provides a pilot
study on home care. It should be noted that these two areas provide housekeeping
service in conjunction with the nursing-care programmes. As it is felt that housekeeping
service is needed in most communities, it is encouraging to note that the Local Council
of Women in Kamloops, in the South Central Health Unit, has just organized a housekeeping service which will supplement the service provided in the home by the public
health nurse.
In the South Okanagan Health Unit at Keremeos, a special committee has been set
up to arrange for nursing care to be given on an emergency basis as this area does not have
a resident physician nor a hospital.
The public health nurse assists in the communicable-disease control programme by
organizing and operating immunization clinics which are located at strategic areas throughout her district. There were 10,003 completing the series of injections for protection
against whooping-cough, 14,081 for diphtheria, 13,330 for tetanus, 924 for typhoid, while
27,617 were vaccinated against smallpox during the year. Public health nurses have
assisted with epidemiological investigations of communicable diseases, and this year have
been particularly active in the poliomyelitis programme.
The public health nursing staff has played an active part in the organization of
consultative travelling clinics and in the follow-up of referred cases. These clinics include
the Tuberculosis Travelling Clinics, the Children's Hospital Clinic, the Cancer Consultative Clinic, and the Child Guidance Clinic.
The staff has been grateful for the financial assistance received from the Junior Red
Cross Crippled and Handicapped Fund. This was rendered to children who would not
otherwise have been able to have physical defects corrected.
The variety and scope of the public health nursing programme has continued to
increase as the need for new services becomes evident.   Tribute should be paid to the Y 42 BRITISH COLUMBIA
public health nurses, who have adapted themselves to changing conditions and accepted
and expedited new programmes promptly and efficiently.
The following statistical summary shows the volume of work in certain public health
nursing services during the year:—
Home Services
Infants  28,990
Pre-school children  29,539
School-children   30,562
Adults   20,614
Expectant mothers  2,344
Tuberculosis cases and contacts  18,205
Venereal-disease cases and contacts  874
Mothers within six weeks after the birth of their babies  16,189
Clinic A ttendance
Attendance at prenatal clinics or classes  1,368
Attendance at child-health conferences—
Infants  44,829
Pre-school children  38,721
Immunizations
Whooping-cough  10,003
Diphtheria  14,081.
Tetanus  13,830
Typhoid   924
Smallpox  27,617
B.C.G  712
Total inoculations  175,369 DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 43
REPORT OF THE DIVISION OF ENVIRONMENTAL
MANAGEMENT
Thomas H. Patterson, Director
This is the second year of operation for this Division, and although some progress
has been realized, it has been slow.
The Nutrition and Sanitary Inspection Sections of the Division, being well established, continue to give their special service, as outlined in the following separate reports.
Civil Defence Health Services Section has also become reasonably well established
and, because of the amount of activity in this field, merits the more detailed report,
which follows.
REHABILITATION
The other phases of environmental management are largely in the early developmental stage. Therefore, it is found in the field of rehabilitation that plans are still in
the process of being discussed among senior staff members of the Provincial and Federal
Governments for the purpose of establishing a sound basis on which the programme
can be developed and methods of financing the employment of a suitable Rehabilitation
Co-ordination Officer.
OCCUPATIONAL HEALTH
In the occupational-health field, of which industrial hygiene is a part, final steps
have been taken toward the establishment of an industrial nursing service for Government employees located in Victoria. This unit is being established in the Douglas
Building, and, besides providing a direct service to the employees, will provide a limited
amount of consultative service to private industry. This is accepted as a very sound
principle to follow in developing a good industrial-nursing consultative service.
The growing use of insecticides and other toxic chemicals, both in industry and the
home, has continued to present problems that can only be dealt with to a very limited
extent by the present facilities. When space becomes available for the provision of
proper industrial-hygiene laboratory services and the employment of qualified persons
to give this service, more progress in dealing with these hazards may be expected.
Another occupational hazard, in the form of the growing use of radioactive substances in industrial processes, is receiving increased attention. The Division of Occupational Health of the Department of National Health and Welfare has established a
Radiological Section, which co-operates with this Division by giving notification of the
destination of all shipments of radioactive substances into this Province. Study has also
been given to the formulation of regulations governing the use of radioactive isotopes,
for the sole purpose of protecting the persons working with these materials and the
general public who may inadvertently be exposed to dangerous radiation.
A programme of surveying the X-ray shoe-fitting machines, for the purpose of
detecting possible dangerous radiation exposures both to operators and customers, is
being developed in co-operation with a large city health department.
MEDICAL CARE—RESEARCH
A project of research into the health and care of persons admitted to hospital in
British Columbia and the health and care of persons subscribing to medical-care insurance plans has been undertaken. The project has been designed to operate for two years,
at which time review of its findings will determine its future course. The study is staffed
by two statistical research assistants and one clerk-stenographer, and is guided by a
steering committee consisting of the Commissioner and Assistant Commissioner of British
Columbia Hospital Insurance Service, the Deputy Minister of Health, and the Director
of the Division of Vital Statistics. Y 44 BRITISH COLUMBIA
GENERAL
During the year the Director of the Division maintained contact with various other
developments in the field of public health. Meetings of government and public representatives were held for the purpose of initiating programmes to deal with the problems
of drug and alcohol addiction. Besides accumulating valuable data and information on
the above subject, study has been given to the statistical data on mortality caused by
accidents outside of industry. Unfortunately, very little data on the non-death-causing
accidents is available, but it is quite obvious from mortality statistics that steps must be
taken to reduce the number of accidents taking toll of our population.
A. REPORT OF THE NUTRITION SERVICE
The services provided through the nutrition consultant programme have been further
developed and extended during 1953. The year's activities have been directed toward
meeting the needs and requests of public health personnel, administrators of hospitals
and institutions, other Government departments and organizations for consultant service
as described in the ensuing report.
Consultant Service to Local Public Health Personnel
The consultant service provided to the staff of local health units has included
technical information and advice, assistance in studying food habits, and recommendations as to methods of nutrition education in the community.
During the year eight health units were visited by the Nutrition Consultant. In each
unit, conferences were held with public health staff to discuss local nutrition problems
and to review the latest information in the field of nutrition. Additional time was spent
in each area observing school-lunch programmes and meeting with school cafeteria
committees, social workers, parent-teacher organizations, and other key groups, to provide
assistance with nutrition-education activities.
Dietary Studies
The Nutrition Consultants have continued to assist public health personnel in
studying the variety of foods eaten by families in the community. The object of these
studies was to provide information about the type and extent of dietary problems in the
community and to stimulate interest in improving meals.
During the year dietary studies were conducted among school-children in seven
districts of the Province. It is interesting to note that the results of these studies were very
similar to those found from previous studies conducted in schools in many other areas of
the Province during the past four years. The chief deficiencies in children's meals continued to be milk, a Vitamin D supplement, and foods rich in Vitamin C. Meat, potatoes,
and bread are eaten in satisfactory amounts by the majority of the children. Sweet
foods, such as candy, soft drinks, and cake, are consumed in excessive amounts by many
children.
The need for increased consumption of milk, a Vitamin D supplement for children,
and foods rich in Vitamin C has been clearly shown. It therefore remains a prime
objective of nutrition education in this Province to encourage people to include adequate
amounts of these foods in their daily meals.
One of the most practical nutrition and dental-health projects directed toward
reducing the excessive consumption of soft drinks and candy among school-children has
been the school apple sales sponsored by the Junior Red Cross. A further development
of this programme during the year has been the completion of arrangements to make
individual 6-ounce containers of vitaminized apple-juice available to schools for sale at
a reasonable price. It is recognized that this programme merits the co-operation of public
health personnel, and the development of these projects in schools throughout the Province
has been encouraged. DEPARTMENT OF HEALTH AND WELFARE, 1953 Y 45
Rat-feeding Experiments
Another method of nutrition education that has proven particularly effective over
the past three years has been the rat-feeding experiment. During 1953 these experiments
were conducted in seventy schools outside of the Greater Vancouver area.
The purpose of the animal-feeding experiment is to illustrate to children and parents
the benefits to be derived from good daily meals. During the experiment one pair of rats
is fed a variety of foods recommended in Canada's Food Rules and the other pair receives
such foods as soft drinks, white bread, cake, and candy. The difference in weight,
appearance, and disposition between the two pair of rats is clearly noted by the children
during a period of four weeks.
The interest and co-operation of parents have been obtained in many areas by
displaying the rat-feeding experiment in community store windows and at group meetings.
Reports from public health nurses and teachers during the year have indicated that these
projects continue to be one of the most effective methods of encouraging improved food
habits.
The continual interest and co-operation of the staff of the Animal Nutrition Laboratory at the University of British Columbia in providing white rats for all the experiments
have been appreciated.
School-lunch Programmes
The consultant service requested by public health personnel in relation to school-
lunch programmes has increased in line with the continued construction of new schools.
Visits to nine school cafeterias were requested during field-trips, to observe the lunch
programme in operation and to provide information to lunchroom administrators.
Assistance was requested and provided to local School Boards in planning equipment
and layout for cafeterias in six new school buildings. Menu plans and quantity recipes
were compiled as requested by several school cafeterias.
In co-operation with public health nurses, meetings were held with Parent-Teacher
Associations in five areas to assist with problems concerning lunch-supplement programmes in schools of the district.
A reference manual is now in preparation for the use of local school authorities in
planning equipment, space, and layout requirements of school cafeterias of various sizes.
Other Services
Due to the importance of a good diet during pregnancy, information about wise food
selection is an important part of prenatal education. To assist public health personnel
in placing additional emphasis on nutrition in the prenatal programme, the Nutrition
Consultants have reviewed and collected suitable reference material for use in prenatal
classes. A leaflet describing food requirements and how these may be met through
family meals is now being prepared for distribution to mothers.
Through the kind co-operation of members of the Faculty of Pharmacy at the
University of British Columbia, an up-to-date list and description of Vitamin D supplements has been compiled for the reference of public health personnel.
A major public health problem of to-day is that of obesity, due generally to the
excessive consumption of foods. Since obesity is associated with many serious physical
impairments, it is recognized that weight-control plays an important part in the prevention
of some of the major crippling diseases of middle and later life. In view of this, the
Nutrition Consultants have continued to give considerable attention to studying methods
and materials that will assist public health personnel in an educational programme to
inform people of the dangers of overweight and the benefits to be gained by weight-control. Y 46 BRITISH COLUMBIA
Consultant Service to Hospitals and Institutions
Since the Nutrition Consultant service was extended to include hospitals in 1952,
there has been a steady development in this phase of the programme. As a result of
requests from hospital administrators, the Nutrition Consultant visited twelve hospitals
during field-trips this year. Information and advice of the Consultant has been requested
on many problems of hospital food service, including dish-washing and other kitchen
equipment, reference material for special diets, general layout of new hospital kitchens,
assistance with quantity recipes, menu-planning, and methods of controlling food costs.
The hospital consultant programme has been conducted in close co-operation with
members of the Hospital Insurance Service.
Institutions receiving consultant service included the Boys' Industrial School, the
Men's and Women's Gaols in Prince George, Oakalla Prison Farm, and New Haven.
Following the visit to each institution, a detailed report of observations and recommendations concerning improvements in the food service was submitted to the administrators
concerned.
In co-operation with the Warden and the Architect's Branch, Department of Public
Works, assistance was provided in planning the layout and equipment required for a new
main kitchen at Oakalla Prison Farm.
An analysis of the annual per capita food consumption was requested by New Haven,
and recommendations were made where necessary concerning the reduction or increase
of various groups of foods to improve the general diet.
The Nutrition Consultant spent some time observing the food service in the Tran-
quille Sanatorium and Pearson and Jericho Hospitals of the Division of Tuberculosis
Control, and assisting with special studies relating to the organization and operation of
the food service in each institution. A number of recommendations relating to changes
and improvements in the dietary programme have been submitted and are under consideration at the present time.
Co-operative Activities with Other Departments and Organizations
At the request of the School Planning Division of the Department of Education, the
layout and equipment lists for new school cafeterias were reviewed. Whenever possible
a visit was made to the area concerned to observe and study local needs prior to making
recommendations about the equipment and layout requirements.
In co-operation with the Provincial executive of the Parent-Teacher Federation,
a questionnaire was circulated to local Parent-Teacher Associations to obtain information
concerning their activities in school-lunch programmes and the type of assistance they
require in this field. It is hoped that the information obtained from the questionnaire
will provide a basis on which to plan the further development of a consultant service to
parent-teacher organizations relative to school-lunch programmes.
Assistance has been provided during the year to the British Columbia Hospital
Insurance Service in reviewing the layout, and equipment for new hospital kitchens.
In co-operation with social workers in several districts, a study was made of the
foods eaten for a period of one week by a group of elderly persons in receipt of old-age
pensions. Cognizance was taken of those persons wearing artificial dentures and those
without a natural dentition and without artificial substitutes. This study has provided
useful information regarding the food habits and problems of elderly persons on a limited
income and will assist in planning future consultant services for this group.
During the year monthly meetings were held with nutritionists from the Metropolitan
Health Committee in Vancouver, the University of British Columbia, the Vancouver
General Hospital, home service departments, and other agencies for the purpose of group
planning and working together on common problems.    One project of the group this DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 47
year has been the study and planning of Nutrition Consultant services that could be
provided to assist in training courses for key groups, such as nurses and social workers.
It has been recognized that persons coming to reside in this Province from other
countries encounter many problems in food-purchasing due to differences in food
products. In view of this, consideration has been given to methods of providing more
assistance to immigrants with their problems of food selection. This has resulted in the
preparation of a booklet describing Canadian foods and some of the differences between
British and Canadian foods for distribution to persons from Great Britain coming to reside
in this Province. It is hoped that in the future similar information might be prepared
to assist immigrants from other countries.
The public health nutrition programme in this Province has been outlined in talks
to the Victoria branch of the Canadian Association of Consumers, the Vancouver Home
Economics Association, dietetic interns, and teachers of home economics.
B. REPORT OF SANITARY INSPECTION SERVICES
The continual improvement and high standards in respect to milk-supplies; industrial, tourist, and summer camps; school sanitation; private water-supplies; private
sewage-disposal systems; rodent and insect control; and community sanitation should
be attributed to the inspectional and advisory services by the local Sanitary Inspector on
behalf of the local Union Board and its Medical Health Officer.
The Division of Environmental Management offers advisory, consultant, and
administrative assistance on technical matters to the local Medical Health Officer. This
Division, through afforded opportunities, is able to provide guidance in developing programmes on the local level and at the same time maintain a uniformity of minimum
requirements and interpretation of Provincial regulations. The Director performs liaison
duties with other Government departments, industrial and trade organizations. The
Director evaluates many sanitation programmes and performs special investigations in
the now limited areas beyond the boundaries of full-time local health services.
Food-control
Milk-control
For the third year an evaluation of laboratory reports on samples of pasteurized
milk from various points in the Province has been conducted. Observations indicate that
the low bacterial counts evidenced during the previous year have been maintained.
Included in the evaluation were 1,021 samples from fifty-six dairies, as compared to
732 samples from forty-six dairies the previous year. Fifty-one of the fifty-six dairies
averaged were in the allowable limit, and there is an estimated improvement of 4 per cent
in this respect during the year.
Two municipal milk by-laws were reviewed prior to submission for the required
approval of the Lieutenant-Governor in Council.
Amongst the problems referred to the Division for consultative and advisory services were the following:—
(1) Nine raw-milk vendors distributing milk from premises below the Grade
A category required by the " Milk Act."
(2) Two premises shipping milk to pasteurizing plants where there were
persons suffering from a communicable disease.
(3) One small epidemic suspected of being milk-borne.
(4) One import and one export milk problem.
The quality control and licensing of milk-vendors is the responsibility of each
municipality under its local milk by-laws. Consideration is being given to the adoption
of a regulation to license dairies and vendors which are outside the boundaries of
organized municipalities. y 48 british columbia
Eating and Drinking Places
Six complaints were processed through the Division during the year. These were,
in the main, from persons who continue to look upon the Provincial offices as a place
to lodge complaints of this category.   All cases were disposed of by the local authorities.
Food-handling instruction classes conducted on the local level continue to receive
emphasis, as compared to the previous method of complete dependence on routine
inspections.
Frozen-food Locker Plants
Stimulated by requests from the Frozen-food Locker Plant Association, the Department of Agriculture, the Game Commission, and the results of a survey by this Division,
the Regulations Governing Construction and Operation of Frozen-food Locker Plants
were more rigidly enforced in 1952, and this policy has continued in 1953. Eight complaints of non-conformance to the regulations were referred to local health services.
At its annual general meeting, the British Columbia Frozen-food Locker Plant
Association expressed appreciation of the increased inspection services now being given
to its premises.
Slaughter-houses
Continued improvement is noted in the sanitary environment of these premises
wherein food for human consumption is handled. The arrangement, on behalf of local
health services, with the Department of Agriculture whereby, before a licence is issued
by the Recorder of Brands, an applicant for a licence must submit an inspection certificate
completed by the Medical Health Officer has been carried into its fourth year of operation. This arrangement continues to be an asset to local health services in the improvement programme in slaughter-house construction and maintenance throughout the
Province.
Eighty such licences were issued in 1953. No less than fifteen of the applicants
failed to attach a completed Health Officer's certificate, and these licences were withheld
until the completed certificates were submitted.
Meat Inspection
Interest in a Provincial meat-inspection regulation continues. Inquiries regarding
such a regulation have been relayed to the Department of Agriculture, as it is a matter
related to veterinary services and the diseases of animals.
During the year municipal inspection was instituted by the City of Kamloops. The
by-law in that regard was reviewed prior to submission for approval by the Lieutenant-
Governor in Council.
Horse-meat
This product, for human consumption, which came on the market in this Province
in 1951 and lost some of its popularity in 1952, has almost totally disappeared from the
market in 1953.
Housing
Industrial Camps
This sanitation activity ran quite smoothly during the year, with but twelve complaints registered with the Division. The inspection of industrial camps is an important
function of the Sanitary Inspector, and records of the inspection are retained in the
health unit.
The North Fraser Health Unit made an all-out effort to cover the camps within its
district, and was commended by the International Woodworkers' Union for this work.
The Skeena Health Unit reports improvements in standards in its area. DEPARTMENT OF HEALTH AND WELFARE,  1953
Y 49
British Columbia industrial camps are noted for the absence of double-tier bunks
in their accommodations. With the introduction of trailer-camp accommodation in 1951,
double-tier bunks were reintroduced under a permit system. Due to dissatisfaction with
this type of housing, the permits were cancelled in 1952 and the operators discontinued
the practice on January 1st, 1953. One application for permission to use double-tier
bunks in 1953 was refused. The use of tent accommodation in semi-permanent types
of operation has grown in the past two years, and has been brought to the attention of
this Department by the Building Trades Council, with a request to curtail this growing
practice.
Summer Camps
Under the " Welfare Institutions Licensing Act," these camps are operated by
church organizations, welfare agencies, service clubs, fraternal organizations, Y.M.C.A.,
Y.W.C.A., and other charitable organizations.
The philosophy of the inspection is to visit the camp at a time when the personnel
first arrive in order to discuss good sanitation practices and to emphasize the early
recognition of gastro-intestinal diseases, the need of reporting, and the isolation of cases.
A special inspection project and a comprehensive report were made on eighteen
camps in the Howe Sound area by an advanced medical student who combined the
inspections with his summer employment as an epidemiology-worker. A further twenty-
seven camps were inspected and reported upon by local health services. In evaluating
the total of forty-seven camps inspected, twenty-eight were classified as A (good),
twelve as B (fair), three as C (poor), and two as Unsatisfactory. Comparative ratings
for the inspections conducted in the years 1951 to 1953, inclusive, are as follows:—
Class
1951
PerCent    j
1
1952
PerCent
1953
PerCent
A                                             -
22
18
6
3
1
46.0
36.0
12.0         |
6.0
35
13
4
4
62.0
23.0
7.5
7.5
29
13
3
2
61.5
B       	
C 	
D.	
27.5
6.5
4.5
Totals	
49
■   ■        1
56
......
47
It is proposed by the Departmental representative on the Welfare Institutions
Licensing Board that the existing printed material on " Summer Camp Standards " be
amended, and that the standards be put forth in terms of requirements pursuant to the
" Welfare Institutions Licensing Act."
School Sanitation
Copies of 239 reports prepared by School Medical Inspectors for submission to
School Boards were forwarded to the Department for the school-year 1952—53.
Continual improvement in school facilities is to be noted. The new schools constructed have the most modern sanitary facilities and environmental features, and existing
schools are being modernized. Sewage-disposal, which was frequently a post-construction problem, has been, to a very large extent, overcome. Lighting facilities continue
to receive improvement.
The school sanitation reports continue to be used by School Boards as the basis
of work-sheets for maintenance and renovation. School authorities express appreciation
for the special service given.
Plumbing
It was expected at the beginning of the year that the National Plumbing Code would
be completed and available as a uniform standard for Canada.
The Provincial representative on the Technical Advisory Committee on the Plumbing Services to the National Research Council attended one Committee meeting. It is
expected that the National Code will be completed early in the new year. Y 50 BRITISH COLUMBIA
Three municipalities have submitted requests for model plumbing by-laws, which
the Division had hoped would be completed this year, pursuant to the completion of the
National Code. The Division intends to prepare a model code based on the Provincial
Plumbing Regulations when they have received approval.
Garbage and Refuse Disposal
Five requests from the Department of Lands and Forests for inspection of Crown
lands, prior to lease as disposal-sites, were processed through the local health services
as to suitability for use.
Interest in replacing nuisance-grounds, usually ravine dumps, with sanitary land
fills continues. The neglect in nuisance-dumping is being minimized by improvement in
control methods, the extensive maintenance, and the use of machinery in the covering
procedure.
In the use of Crown land, maintenance requirements under the direction of the
Medical Health Officer are being made part of the lease terms.
RODENT-CONTROL AND SYLVATIC PLAGUE SURVEY
Co-operation between the Department of National Health and Welfare and this
Department in the collection of ground-squirrels, marmots, and domestic rodents (rats),
and their ectoparasites, continues. Collections and the submission of specimens to the
Laboratory of Hygiene at Kamloops continues by the Cities of Vancouver and Victoria.
The collections were extended and submissions were also made by the West Kootenay
Health Unit and the Selkirk Health Unit.
It is planned further to extend the collection by having the other health units in the
Province expand their rodent-control activities into the collection of specimens for
laboratory purposes.
Barber-shops
Early in the year the Barbers' Association proposed that the Department rewrite
the existing regulations. A draft revision has been prepared and endorsed by the Barbers'
Association and the Health Officers at their semi-annual meeting.
Hitherto, the Barbers' Association has had a self-inspection arrangement. They
appointed their own inspector, who carried out the routine inspections and called upon
the Medical Health Officer for occasional assistance with problem cases. The draft
revision of the regulations, at the request of the Barbers' Association, provides for the
routine inspections being carried out by the Medical Health Officer.
C.   REPORT OF CIVIL DEFENCE HEALTH SERVICES
The development of these services has continued along several lines during the year.
Regional Conferences
At a regional western conference of Civil Defence officials in Edmonton in January,
the problems of organizing hospitals and first-aid stations were thoroughly discussed and
recommendations were made for proceeding with this vital programme. Plans are now
being made for a Regional Civil Defence Health Services meeting to be held in British
Columbia early in 1954 and sponsored by the Federal Civil Defence office and the
Canadian Hospital Association. The purpose of this meeting will be to demonstrate
hospital disaster planning to selected hospital teams for Alberta and British Columbia.
Emergency Medical Supplies
Medical and surgical supplies purchased by the Department of National Health and
Welfare are to be stock-piled in regional warehouses in British Columbia. These supplies
will be maintained at definite levels for use in event of disaster. •      DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 51
First-aid Stations
Two very large demonstrations of first-aid stations were successfully carried out in
Vancouver and Victoria during March. These demonstrations were especially realistic,
as each dealt with fifty very impressively made-up casualties. The assistance given to
local Civil Defence Health Services by the National office of Civil Defence was invaluable.
Three first-aid stations have now been located in the Fraser Valley Mutual Aid and
Reception Area. These stations are to be used as emergency medical units, capable of
dealing with civil disaster and operating small emergency hospitals as well as functioning
as first-aid stations in time of war. In initiating this programme, meetings were held
between Provincial and local Civil Defence health officials at Abbotsford. Similar planning is also being carried out in the Vancouver Island Mutual Aid and Reception Area.
The total number of first-aid stations being developed in British Columbia is
thirty-four. Each station requires a considerable number of doctors, nurses, first-aiders,
and other auxiliary health personnel. Therefore, an extensive training programme has
continued throughout the year.
Study Forum
The Provincial office of Civil Defence held two study forums during the year in which
health services personnel participated, in order to become familiar with the procedures
for dealing with special medical problems in time of disaster.
Emergency Blood Service
Steps were taken in co-operation with the Red Cross blood transfusion service
toward the training and establishment of four emergency bleeding teams to be located in
strategic positions in the Province. Not only will these teams serve in time of disaster,
but they are expected to aid materially in meeting the new increased demand for blood
to be used in the production of gamma globulin for the prevention of poliomyelitis.
Training
The Registered Nurses' Association of British Columbia, having secured ninety-eight
instructors through a course given in 1952, has succeeded in holding many subsequent
nurses' training courses throughout the Province. This training is also being given in all
undergraduate nursing-schools in British Columbia, where a total of 1,533 graduates
took these courses during the year.
Three courses on the " Medical Aspects of A.B.C. Warfare " were held at Camp
Borden, Ont., during the year, and were attended by eight physicians from British
Columbia. In addition, one Sanitary Inspector attended a special Civil Defence Course
in Ontario for the purpose of evaluating such training with respect to the future development of emergency sanitation services.
The training of first-aiders has been carried on largely by the St. John Ambulance
Association, while the Red Cross Association has assumed the major responsibility for
training volunteers for home nursing. Both types of trainees are very valuable adjuncts
to all emergency medical services, and the training programmes during the forthcoming
year must be increased in order to meet the demand for trained persons.
General
It must be realized that the actual development of these services at the local level is
carried out by responsible citizens who, recognizing the need for preparing to meet
possible disaster, have voluntarily given much of their personal time. In order that these
people may know that their efforts are recognized and appreciated, it is necessary that
government at all levels endorse their actions and support them in every way possible. Y 52 BRITISH COLUMBIA •
REPORT OF THE DIVISION OF PREVENTIVE DENTISTRY
F. McCombie, Director
The scourge of dental disease throughout this Province continues to be cause for the
gravest concern.
During the past year it has been estimated, on the basis of the 1951—52 public-schools
enrolment, that to provide dental treatment to all school-children of this Province would
cost approximately $9,000,000 in the first year of such a programme. Moreover, to
provide such treatment would require no less than 545 dentists working full time. At the
close of 1952 there were only 555 dentists registered in British Columbia.
Also, during the past year some of the results of the Canadian National Sickness
Survey, which was carried out for a twelve-month period during 1950-51, have been
published. During that year only 27.6 per cent of the families of Canada received dental
care for which they paid directly, and yet they expended some $33,000,000 for such
treatment during that period.
The shortage of dentists in the rural areas of this Province, though somewhat
improved, remains acute; the same situation pertains across the length and breadth of
Canada. The most important single factor responsible for this unfortunate situation, it is
believed, is the high rate of need and demand for dental services in the metropolitan
areas coupled with the over-all shortage of dentists across Canada.
Records of the past year of preventive dental services of this Province again reveal
the ravages of dental decay amongst our children. The average 3-year-old required four
tooth surfaces to be restored; such treatment required one and a quarter hours of the
dentist's time. The average 4- and 5-year-olds required six or seven tooth surfaces to be
restored, for which an average of one and three-quarters hours of dental treatment was
necessary. As the age increased, so the situation deteriorated. The average 6-year-old
required seven tooth surfaces to be restored and two hours of the dentist's time, while the
7-year-olds, on an average, required eight to nine tooth surfaces to be restored.
Yet, to-day, the vast majority of dental disease, especially dental decay, can be
prevented. Furthermore, such prevention is not only possible by individual action, but
also, to-day, by community action. The value of improved health, fitness, and appearance
to our children cannot be priced. The economical savings to the family and the community as the result of avoiding needless expenditure for the treatment of dental disease
can and should be appreciated.
Prevention
To provide the necessary information to the many people and communities scattered
throughout the 360,000 square miles of this Province, it would be desirable for there to be
available many dentists especially trained in preventive and public health dentistry.
In the past years it has been the policy of the Health Branch to endeavour to provide
one such dentist to each health unit of the Province, and to provide financial grants-in-aid
toward the school dental services of the metropolitan areas.
At the commencement of the present school-year, all appointments were filled within
the preventive dental services of Greater Victoria and Greater Vancouver. The importance and size of the programmes undertaken within the metropolitan areas and the
commensurate financial grants-in-aid made available thereto through this Division are
noted. It is therefore considered likely that at a future date it will not only be desirable,
but a requirement for the continuance of such financial aid, and that those directing these
programmes have formal postgraduate education in public health and preventive dentistry
and have attained a degree or diploma within this specialty.
At the close of 1953 it is only possible to report that four health units of the Province
have on their staff a full-time dental director.   Numerically, this is the same situation as DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 53
at the close of 1952. In addition, one dentist is at university attending a year's postgraduate training in pasdodontia and preventive dentistry.
During the school-year 1952—53 preventive dental services operated continuously
in three health units, in which the service was provided to eight school districts, and
during some months of the year in one further health unit to three additional school
districts.   These services were in their second year of operation.
Two hundred and seventy-six children (including forty-three 3-year-olds and
eighty-two 4-year-olds) were restored to dental health; that is, received complete treatment. These children and 344 of their parents were instructed individually in the
prevention of dental disease. Of all the pre-school children inspected, only 14.4 per cent
were found not to be in need of dental treatment. Twenty-eight per cent of the pre-school
children who received treatment had previously visited a dentist, which is an improvement
on the previous year's figure of only 10 per cent.
Of the 1,484 Grade I pupils within the above three health units, 1,157 were provided
with a dental examination, and of those inspected only 11.5 per cent were found not to
be in need of dental treatment. Parents of 70 per cent of the children inspected requested
that the necessary dental treatment be undertaken by the health-unit dental officer, and
virtually all of these received the requested treatment. A further 12 per cent of those
inspected arranged for treatment with their family dentist. Therefore, of the children
inspected, 93.5 per cent were treated by the health-unit dental officer or by the family
dentist, or did not require treatment. These children, who either received complete dental
treatment or were not in need of dental treatment, represent 73 per cent of the total
enrolment. In addition to the 809 Grade I pupils who received complete dental treatment by the health-unit dental officer, and instruction in the prevention of dental disease,
166 of their parents were similarly and individually instructed at the chairside. Of these,
the children who received dental treatment within the health-unit preventive dental
services, 42 per cent had previously received dental treatment, which is again an improvement over last year's figure of 22 per cent.
The preventive dental services within the above four health units and the school
dental services in Powell River, Greater Victoria, and Greater Vancouver provided dental
examinations to 1,815 pre-school and 13,226 Grade I children. The total enrolment of
Grade I pupils in the Province in the school-year 1952-53 is estimated as 21,500. During
the past school-year 509 pre-school children and 7,225 Grade I pupils received complete
dental treatment from these services.
The high standard of all these services is revealed by the fact that amongst the 1,465
pre-school and Grade I children for whom detailed records are available this year, 11.7
tooth surfaces were restored for every tooth (permanent or temporary) which was
extracted. Moreover, a total of only nine permanent teeth were extracted for all these
children.
In one health unit, as an experimental procedure and to the detriment of other
services, dental treatment was offered to a group of children of Grade II who the year
before, whilst in Grade I, had received from the health-unit dental officer complete dental
treatment. The total enrolment of Grade II pupils was 440, and whilst 194 Grade I
pupils were treated the previous year, 179 Grade II pupils this year were eligible for this
service. Unfortunately, it was only possible to provide treatment for 54 of these. Nevertheless, it is interesting to note that each of these pupils this year, on an average, required
one hour and thirty-four minutes of the dentist's time for complete dental treatment.
Community dental clinics for younger children, in which resident or visiting family
dentists co-operate on a part-time basis, continued to expand in number and scope
beyond all expectations. This expansion is particularly gratifying, since it demonstrates
that local communities are not only aware of the problems of dental ill health within their
midst, but also are prepared to devote time, energy, and financial support to finding and
supporting a practical solution.    The continued expansion of these programmes also Y 54 BRITISH COLUMBIA
indicates the increasing awareness of this problem by individual members of the dental
profession and also their willingness to co-operate in a spirit of public service with the
community in solving the problem. During the fiscal year 1952-53, 2,131 children,
pre-schools and pupils of Grades I, II, and III, were restored to dental health through
community dental clinics in which twenty-five dentists co-operated on a part-time basis.
At the close of 1953 no less than forty-three of these clinics utilizing the services of
forty-five dentists had been organized, whereas at the close of 1952 there were nineteen
such clinics.
In summary, full-time dental services were provided throughout the school-year
1952—53 in fifteen school districts, half-time services in one further school district, and
during part of the year full-time services in an additional four school districts. Within
seventeen school districts, part-time services were provided through community dental
clinics. In total, thirty-seven of the eighty school districts of the Province received
preventive dental services provided either on a full-time or part-time basis.
From the preceding paragraphs it will be appreciated that two major factors warrant
careful consideration; that is, the difficulty of attracting suitably qualified dentists to the
vacant full-time appointments with rural health units, and the rapid and successful
expansion of community dental clinics operated on a part-time basis with resident or
visiting family dentists. Consideration is therefore being given to the co-ordination of these
two programmes and to their evolution into a programme which will not only combine
the best features of both, but also provide for greater flexibility and rapidity of expansion
than has been possible before.
It is suggested that full-time dental officers in future may be allocated on a regional
basis, having responsibility within two or three adjacent health units. Within each health
unit the same relationship would pertain with the health-unit director as exists at present.
The duties of these dental officers, it is suggested, would be threefold. Firstly, it would
be their duty to encourage dental-health education within the area for which they are
responsible. This would entail interviews and conferences with School Inspectors,
principals, and teachers, meeting collectively and individually with the members of the
medical and dental professions of the area, and addressing Parent-Teacher Associations,
service clubs, and health-unit staff conferences.
The second area of activity would be providing assistance to communities to organize
and expand part-time preventive dental services, and to ensure that such services operate
at maximum efficiency by meeting with the dentists and sponsoring agencies as required.
Thirdly, such dental officers would provide direct clinical services to the younger
children in areas where it would not be possible at the time to arrange part-time services.
Under such arrangements the majority of the clinical services would be provided by
resident or visiting private dental practitioners on a part-time basis. They would be
employed by the local Union Board of Health, School Board, or other community
organization and would provide treatment to the younger children in their own office, in
the health-unit dental clinic, or in a health-unit branch office or school using transportable
equipment. Financial grants-in-aid would be available from the Health Branch for
such programmes. It is hoped these programmes would provide for clinical treatment
to pre-school children and pupils of Grades I, II, and III.
The above suggestions were presented to, and found acceptable by, the meeting of
full-time Medical Health Officers of this Province held in Victoria in September, 1953.
It was explained that a pilot study along the above lines was being undertaken in the
Boundary and Upper Fraser Valley Health Units, and also it was hoped that a further
experiment would be possible in the South Okanagan Health Unit. It was agreed that
for the coming year where no full-time preventive dental services were available in
a health unit, and also in the school districts of a health unit where there was a dental
officer, but in which he did not provide clinical services, that every encouragement be
given to establish community dental clinics on the present basis.    It was also agreed DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 55
that in health units where full-time preventive dental services are now operating, planning
would commence toward having, wherever possible, existing programmes taken over
on a part-time basis by resident family dentists of the community. Financial details
of the above programme still need to be finalized and approved; it is hoped they will
be available prior to the next meeting of the Health Officers to be held in the spring
of 1954.
It is to be explained that the above programme would require only six or seven
regional dental officers or consultants, each having received postgraduate training. There
are now available within the Division two such dentists in health units, another now
undertaking postgraduate training, and a fourth who, it is anticipated, will proceed to
take such training in the fall of 1954.
In an endeavour to improve, by whatever means possible, the standard of clinical
services provided in the health units, field trials with transportable dental X-ray units
and air-compressors were continued and completed during the past year. Both these
items were found to be entirely satisfactory and to fill a definite need. These have now
been purchased in quantity and are standard components of the transportable dental
equipment used by health-unit preventive dental services.
Dental-health Education
During the year this Division has continued, in co-operation with the Division of
Health Education,, to review all suitable and available dental-health educational aids.
Additional coloured film-strips have very kindly been supplied by the New Zealand
Department of Health. From the same source, gracious permission was also received
to reprint a further one of their most excellent dental-health posters, and copies of these
have been distributed to schools throughout the Province.
Also, during the past year a further very fine coloured film was purchased from
the United Kingdom. The total number of dental-health films now maintained in the
central film library of the Branch is thirteen, with, in addition, eleven different film-strips.
Again it is pleasant to record the continued activities of Junior Red Cross in the
field of practical dental-health education concurrently undertaken with its sale of apples
within schools. By personal interviews with school-teachers who have co-operated with
these programmes, it is possible to report that the decrease in the consumption of soft
drinks, candy, and gum in such schools is indeed praiseworthy and should serve as a
definite stimulant to others to encourage similar programmes whenever and wherever
such are at all possible.
In addition, we may now report that after successful pilot studies arranged in
co-operation with the manufacturers and the Nutrition Service of the Health Branch,
vitaminized apple-juice is now available in individual 6-ounce containers for sale in school
cafeterias. It is hoped that the provision of this item will also assist in the reduction of
the consumption of sweetened carbonated beverages, which have negligible nutritional
value and which have a proven relationship with dental decay.
Fluoridation
It will be recalled that during 1952 this Department announced its amended policy
regarding water fluoridation, in which it unreservedly endorsed this procedure. During
the past year all further evidence in this regard has been most carefully scrutinized, not
only by this Division, but by the senior officials of the Branch. All scientific evidence
continues to support the belief that this procedure is the greatest advance in preventive
dentistry yet discovered.
To acquaint the professional staff of the Health Branch with the facts relating to
the need for, and the benefits to be derived from, water fluoridation, a speaker especially
well qualified in this field was included within the programme of the Annual Institute Y 56 BRITISH COLUMBIA
of the Branch held in the spring of this year. Shortly thereafter an interdivisional committee was convened to formulate a programme for the encouragement of the fluoridation
of community water-supplies throughout the Province. The Deputy Provincial Health
Officer acts as chairman of this committee, and its members are the Directors of the
Divisions of Public Health Engineering, Health Education, and Preventive Dentistry.
The above committee drew up the following programme. Firstly, it was considered
desirable and essential to have all health-workers throughout the Province accurately
informed and enthused regarding the necessity and advantages of fluoridation. A newsletter was therefore prepared twice monthly during the period May to September by
the Division of Public Health Education and forwarded to all local health departments.
The Director of the Division presented a paper on this topic to the fall meeting of full-
time Medical Health Officers of this Province. A panel was presented at the annual
meeting of the Canadian Institute of Sanitary Inspectors, held this year in Vancouver.
Arrangements have been completed for articles on fluoridation to appear in the bulletin of
the Vancouver Medical Association, which reaches every member of the British Columbia
Branch of the Canadian Medical Association, in the " Canadian Nurse," which reaches
every member of the British Columbia Registered Nurses' Association, and in the " Western Druggist," which reaches every pharmacist in this Province.
In addition, the committee gave consideration as to how information could reach
other Provincial organizations, the individual members of which, it is anticipated, would
influence the decision of their local community regarding the installation of fluoridation.
Arrangements have therefore been initiated whereby it is hoped that speakers on fluoridation will be included within the programmes of the next annual meetings of the British
Columbia Teachers' Federation, the British Columbia Parent-Teacher Federation, and
the next Annual Convention of Women's Institutes. A speaker on this topic was also
presented to the annual meeting this fall of the British Columbia Municipal Engineers'
Association. In addition, it was also agreed by the committee that a brief news-letter
should be inaugurated for dispatch to all waterworks personnel throughout the Province.
This news-letter will include information as to the technical operation of fluoridation
installations and also the benefits to the community to be derived therefrom. Articles
for publication in the " B.C. Teacher " and the " B.C. Professional Engineer " have also
been submitted.
Through the courtesy and co-operation of the Department of Agriculture, suitable
notices have been prepared and inserted in their routine publications addressed to the
Women's Institutes and 4-H Clubs throughout the Province. In addition, descriptive
material has been similarly dispatched to every Farmers' Institute where a community
water-supply exists, with a covering letter commending to their attention study of this
most important procedure.
Suitable films, booklets, and pamphlets have been carefully reviewed and purchased
to assist local health departments in presenting the facts of fluoridation to the public.
In addition, a small kit of relevant material has been prepared suitable for distribution
to persons specifically interested in this project. Furthermore, seven sets of slides suitable for showing during talks on fluoridation are under preparation. These slides have
been especially collected, and many especially prepared, by the Division of Health
Education.
Through the courtesy of the United States Public Health Service, plans for a small
activated display on this topic were received, and two such displays are now available
on loan to local health departments.
The fluoridation committee of this Branch early in their meetings appreciated that
one of the most important requirements of a community contemplating fluoridation of
its water-supply would be technical data regarding the cost of installation and operation
of the equipment. A well-qualified engineer joined the staff of the Division of Public
Health Engineering this fall and, after collecting the necessary data and visiting similar DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 57
installations in the United States, has already prepared several detailed cost estimates
for communities requesting this service.
At the date of writing this report, one Union Board of Health and two other municipalities have endorsed water fluoridation in principle. One further community, it is
known, has ordered the necessary equipment.
DENTAL PERSONNEL
During the years 1950, 1951, and 1952 the ratio of population to dentists in this
Province continued to improve. During 1953 the ratio worsened. As at September
30th, 1952, the ratio, including dentists practising under temporary permit, was 1 dentist
to 2,034 persons; on September 30th, 1953, the ratio was 1 dentist to 2,041 persons.
The change is slight, but it is suggested that it confirms previous forecasts made by this
Division and is indicative of a trend now commencing. The situation will steadily and
continually worsen until increased training facilities are provided in Canada, and probably until such facilities are established within this Province.
The number of dentists practising in the metropolitan areas during the above period
increased by six, and in the remainder of the Province by eight. During the same period
it is reliably estimated that the population of the Province increased by 33,000 persons.
It is noted that on September 30th, 1952, there were nine dentists practising under
temporary permits. On the same date in 1953 there were twenty-two such dentists who
either were not desirous or not eligible for normal registration, yet had received permission to practise in this Province by the Council of the College of Dental Surgeons of
British Columbia in locations or appointments where dental services were inadequate.
It will be recalled that, during 1952, rules and regulations for the licensing of dental
hygienists were approved by the Lieutenant-Governor in Council. To date, three dental
hygienists are registered to assist 587 dentists practising in this Province. Again it is
to be explained that facilities for training dental hygienists in Canada are limited to ten
graduates each year. Therefore, it is obvious that until further training facilities are
provided, as have been repeatedly requested by the Canadian Dental Association and by
the College of Dental Surgeons of British Columbia, little increase in the availability of
dental services can be anticipated from dental hygienists in this Province.
Dental Faculty
During the past year it is reported that negotiations have been pressed by the Council
of the College of Dental Surgeons of British Columbia for the early establishment of a
Dental Faculty within the University of British Columbia.
It is understood that it is agreed that it would be desirable for a dean to be appointed
two years prior to the dental school being opened. There has also been some agreement
that the dean could be appointed in the fall of 1954, providing the necessary finances
for such an appointment are available and that financial support is assured for the construction of necessary accommodation.
Throughout the year, resolutions in considerable number were received by this
office from Chambers of Commerce, Boards of Trade, Women's and Farmers' Institutes,
and Parent-Teacher Associations urging the establishment of a faculty within the University of British Columbia at the earliest practicable date.
Dental Services to Persons in Receipt of Social Assistance
On September 15th, 1953, a new programme for dental care for younger dependents
of persons in receipt of social assistance was inaugurated by the Welfare Branch, Department of Health and Welfare, in co-operation with the British Columbia Dental Association.   For the present fiscal year this programme will be limited to children of 8 years Y 58 BRITISH COLUMBIA
of age and less.    During the coming fiscal year it is hoped that moneys will be made
available to extend this programme to 9- and 10-year-olds.
The British Columbia Dental Association has undertaken not only to administer
this programme as a public service, but also has agreed that remuneration to individual
practitioners will be less than the normal suggested minimum-fee schedule of the association.
It is understood that the detailed administration of this programme, prepared by
this Division in co-operation with the Welfare Branch and the association, has been well
received by social workers, health-workers, and the dental profession. Integrated within
the programme have been arrangements for instruction in the prevention of dental disease
to the parents and the children, and encouragement for regular and continuing dental
care.
This programme, whilst separate and distinct from preventive dental services, has
been designed so that it supplements but does not replace these services for these particular children.
Dental Services in the Rural Areas
The ratio of dentists to population in the rural areas of this Province continues to
provide cause for serious concern.
The Council of the College of Dental Surgeons continues to provide temporary
permits, without the cost or formalities of normal registration, to dentists willing to practise in communities without a resident dentist. The registrar of the Council continues
to direct inquiries to that office regarding suitable locations for practice in this Province
to such communities. The British Columbia Dental Association continues each year to
write to all students from this Province in their final two years at dental school explaining
to them the advantages of practising in the rural communities of this Province and listing
the larger communities without a resident dentist. Possibly due to these activities, of
the twenty-six new dentists writing their examinations in British Columbia this summer,
seven located outside the metropolitan areas.
Sets of transportable equipment remained on permanent loan to communities without a resident dentist where dentists visit regularly and co-operate in community dental
clinics for younger children, as previously reported, with the exception of Slocan City.
During the past year further sets were issued for dentists to visit similar communities
for periods of two to six weeks. Communities thus benefiting were Alert Bay, Bella
Coola, Edgewater, Golden, Nakusp, Salmo, Squamish, Tahsis, Tofino, Ucluelet, and
Zeballos.
British Columbia and Canadian Dental Associations
This Division, during the past year, again enjoyed the unqualified support and cooperation of the British Columbia Dental Association and maintained close contact therewith through the association's Dental Public Health Committee. It is perhaps not generally realized that the untiring and selfless efforts of the chairman of this Committee, Dr.
A. Poyntz, are closely related to this situation. Throughout the year, consultations and
exchanges of view-point and information have taken place on occasions without number
between this office and the chairman.
The British Columbia Dental Association has agreed to provide financial support to
a programme whereby it is planned that two selected members of the Vancouver Pasdo-
dontia Study Club will present clinics and lectures in children's dentistry at Prince Rupert,
Prince George, Nelson, and Cranbrook. It is hoped thereby that dentists resident in those
areas who are unable by reason of distance to attend Dental Society meetings in the larger
cities will have the opportunity to become personally acquainted with the latest techniques
in this field of dentistry. As a result, it is anticipated that their services within the community dental clinics for younger children and their willingness to accept child patients will
be improved still further. DEPARTMENT OF HEALTH AND WELFARE,  1953
Y 59
For the first time, during the past year, the British Columbia Dental Association, as
a public service, has carefully prepared and submitted to the daily newspapers of the
Province a series of very well-written dental-health education articles. In addition, the
office of the association now maintains a panel of speakers who are willing to present talks
on dental-health topics to lay groups on receipt of specific requests to do so.
During the year this Division was requested by the Dental Public Health Committee
of the Canadian Dental Association to provide assistance in the preparation of a pamphlet
regarding fluoridation. Though primarily designed for use in reception-rooms of dental
offices, this pamphlet has been prepared in such a way, with the assistance of the Division
of Public Health Education, that it is hoped that it will also be acceptable for bulk purchase
by departments of health of the whole country. The preliminary drafts have been reviewed by experts in this field from across Canada. It is hoped that this pamphlet will be
printed and published early in 1954.
GENERAL
We are pleased to be able to report the continued progress and expansion of preventive dental services within this Province during the past year. Future plans whereby
these services may be improved have been suggested.
The programme for the encouragement of communities to fluoridate their water-
supplies has been described. The importance of this procedure cannot be overemphasized.
To provide dental treatment to all school-children of this Province would require approximately all the dentists who are now registered in British Columbia to be working full time
for the first year on such a programme. Even for the second and subsequent years, such
a programme would require approximately one-third of the total time of all dentists of
the Province. Yet school-children represent only 15 per cent of the total population.
However, if all community water-supplies were fluoridated, and these serve 82 per cent
of the population, it is calculated that only 16.5 per cent of the total dental time would
be required to maintain this 15 per cent of our population in dental health. Therefore,
for the first time, it can be foreseen that the total need for dental treatment can eventually
be met.
Nevertheless, the above is dependent upon the present ratio of dentists to population
being maintained. This, it is suggested, will not be possible until and after a Dental
Faculty is included within the University of British Columbia.
Therefore, until the above action is taken, needless suffering and ill health from
untreated dental disease will be the fate of many of the citizens of this Province, including
the majority of our children. Y 60 BRITISH COLUMBIA
REPORT OF THE DIVISION OF PUBLIC HEALTH ENGINEERING
R. Bowering, Director
The Division of Public Health Engineering is concerned with the specialized field in
public health wherein engineering principles and techniques are employed in the practice
of public health. It deals essentially with the control of the environment, with those
modifications and protective and preventive measures that have been found desirable
or necessary in providing optimum conditions for health and well-being. Engineering
methods can be used in solving many problems in public health, and thus the Division is
involved in a wide range of activity. Within the framework of the Health Branch, the
Division of Public Health Engineering functions as a part of the Bureau of Local Health
Services.
The number of public health engineering problems is increasing mainly owing to the
industrialization of the Province. Also, with the increasing wealth of the Province, living
standards are improving and there is an increased demand for water and sewerage works
in some of the smaller towns and villages.
The vacancy that existed on the staff at the end of 1952 was filled by employing an
engineer who had the necessary training and experience for the position.
WATER-SUPPLIES
The Division is responsible for reviewing plans for extensions, alterations, and construction of waterworks systems. The " Health Act" requires that all plans of new
waterworks systems and alterations and extensions to existing systems be submitted to the
Health Branch for approval. The careful study of these plans, together with inspections
on the site in many cases, is one of the major duties of the Division. During the year
forty-five plans in connection with waterworks construction were approved, and seven
plans were provisionally approved.
In addition to approval of plans, waterworks systems in the Province are visited
from time to time for the purpose of checking on sanitary hazards and assisting generally
in the improvement of waterworks systems.
There are very few water-treatment plants in British Columbia. This is because in
British Columbia most sources of water provide satisfactory water for domestic consumption without expensive treatment. In many cases only bactericidal treatment is required,
and a number of chlorinators have been installed to provide this treatment.
Our inspections indicate that in some cases good chlorinating equipment is not being
properly operated, and, as a result, the desired improvement in the bacteriological quality
of the water is not always attained. Improvements in this situation could be obtained if
more advice regarding the operation of equipment could be given to the operators and
the owners of water-supplies. It is felt that in future some sort of training for waterworks
operators should be initiated. The Division plans in the coming year to institute a series
of informative letters to waterworks operators to keep them informed of some of the
recent developments in waterworks practice. It is also the hope of the Division that,
possibly in co-operation with the American Water Works Association, short schools for
waterworks operators may be held in this Province. There are a number of problems
in the maintenance and operation of a waterworks system which cause sanitary hazards.
Better training of operators and more frequent visits to the waterworks systems in the
field by competent engineers would be of much value in overcoming these problems.
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 bacteriological quality
of water served to the public of British Columbia.    In addition to the bacteriological DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 61
examination of water, there is also need for chemical examination of water. The Health
Branch does not at present operate a laboratory for doing chemical analyses of water.
For this service, reliance is placed upon the Public Health Engineering Division of the
Department of National Health and Welfare, which operates a laboratory for chemical
analyses of water. The establishment of a laboratory for such purposes by the Health
Branch would become necessary should the services of the National Health Department
in this regard be discontinued.
With the increased interest in fluoridation of water for control of dental caries, it
was felt that during 1953 some fluoridation would be carried on in British Columbia.
However, no fluoridation plans were in operation by the end of the year. A number of
Councils have gone on record as being in favour of fluoridation, and a number of cost
estimates for fluoridating water have been prepared by the Division. The preparation of
these estimates requires a considerable amount of work, since the method of fluoridating
water for any individual city or water system has to be designed especially for the particular water system in mind. A number of samples have been collected for fluoride determination, and a study of all past records has been made. These records show that there
are no natural fluorides present to any extent in the water systems of British Columbia.
The Division receives a number of inquiries each year concerning private water-
supplies. It is customary to refer these inquiries to the local health units. Advice is given
on request to local health units concerning technical problems that arise in regard to private water-supplies.
It is estimated that 80 to 85 per cent of the population of British Columbia receives
water through public water-supply systems. The fact that there has been no evidence of
water-borne illnesses in British Columbia for the past several years speaks well for the
care that is being taken in British Columbia by water authorities to provide a safe water
for the citizens.
SEWAGE-DISPOSAL
The Division has the responsibility of reviewing plans for extensions, alterations,
and construction of sewerage systems. 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 twenty-six approvals were given in connection with sewerage-
work and one plan was approved provisionally.
Study of plans for approval includes the study of profiles and plans of appurtenances
so that a good standard of sewerage-work is constructed. Study also includes treatment-
works, if any, and studies of the receiving body of water in order to determine the degree
of treatment required.
The Municipality of Saanich, which had been unsewered though highly urbanized,
continued its sewerage-construction work throughout the year. The Village of Vander-
hoof had an entirely new sewerage system constructed, which should come into operation
about the end of the year. There are relatively few villages in the Province that have a
sewerage system.
The Vancouver and Districts Joint Sewerage and Drainage Board published its
report on the ultimate disposal of sewage from the Greater Vancouver area. This report
is the most comprehensive report ever written on a sewerage problem in British Columbia.
It charts the course of action for the development of the sewerage and drainage systems
of Greater Vancouver for the next half-century. 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 report.
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
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 Y 62 BRITISH COLUMBIA
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.
The question of sewage-disposal for private homes comes generally under the direction of the local health services. However, the plans and specifications are provided by
the Division of Public Health Engineering. Also, a considerable amount of advice is
given to local health services regarding private sewage-disposal problems.
The Division also gives advice and approves plans on sewage-disposal for schools.
Some research was done during the year in order to determine the maximum discharge
of sewage from schools on a per pupil basis.
The Division also provides consultative service regarding sewage-disposal problems
for the institutions owned by the Provincial Government.
The percentage of the population of British Columbia served by sewers is high,
being over 50 per cent, but there are still many communities where sewerage systems are
needed. The continued growth of the Province will necessitate the building of sewage-
treatment plants for some communities which formerly disposed of sewage by dilution.
Constant education of the public is necessary in order to have them pay for the sewage
services which are necessary.
STREAM-POLLUTION
Stream-pollution is caused by the discharge of municipal and industrial wastes into
surface waters. These discharges may 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-users.
However, it is recognized by most that adequate control 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
for a number of years. Control of pollution by sewage under this legislation has made it
possible to prevent the discharge of sewage from affecting communities in lower stretches
in streams and rivers. In addition to the Health Branch, other departments of Government have legislation for the control of industrial wastes. This legislation is of very
general nature and is utilized by each department to protect its special interests. 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. Often the industry concerned
is advised of the problem after the problem exists and is thus not able to plan intelligently
for prevention. Sometimes the basic data necessary for a reasonable decision are seldom
available, and no department has the technical staff to spend sufficient time on gathering
such data. Sometimes the most restrictive recommendation is liable to be adopted by the
group as there is no one person to decide on the relative value of the suggested requirements. However, as far as public health is concerned, the activities of the Health Branch
have prevented discharges of waste into streams from becoming a major public health
problem.
Work was continued during the year toward seeking a better and more reasonable
administration set-up for stream-pollution problems. Representatives from the Division
sat in on a number of conferences on individual stream-pollution problems during the DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 63
year. At the Sixth Natural Resources Conference held at Victoria in February, 1953,
representatives of the Division took an important part in a panel on stream-pollution.
Also during the year a meeting of the public health engineering representatives from
all the Provinces was held in Ottawa, together with the Dominion Council of Health, to
discuss stream-pollution problems in Canada as a whole. The older settled Provinces of
Canada have a much more serious pollution problem than does British Columbia. The
correction of these stream-pollution nuisances usually hinges around the question of who
will pay for the improvements. It is felt by the Division that in British Columbia, with
the co-operation of the other agencies interested in stream-pollution prevention, and with
improved methods of administering stream-pollution controls, serious pollution of streams
can be kept to a minimum.
Another type of pollution that has not been given too much study by the Health
Branch in the past is air-pollution. Air-pollution includes the pollution of air by smoke
and soot, and also includes the pollution of air by offensive odour-producing gases. One
reduction plant closed down during the year because of an odour-nuisance problem.
Representatives of this Division will take part in a panel discussion on air-pollution
at the Seventh Natural Resources Conference to be held in Victoria in February, 1954.
This panel will seek to give guidance, among other things, on what part a public health
department should take in air-pollution control.
During the year an interesting study of the water-quality conditions in Nanaimo
Harbour was made under the leadership of the Pacific Oceanographic Group, Pacific
Biological Station, Nanaimo, B.C., with the assistance of a large number of volunteers.
The City of Nanaimo and the Provincial Health Branch assisted in the survey. The
results of the survey will serve to guide future sewerage developments in the area. This
particular survey was unique in that such whole-hearted co-operation was given by the
public with many hours of volunteer work being done.
SHELL-FISH
The Division of Public Health Engineering has the responsibility of enforcing the
Shell-fish Regulations in the Province. The inspection of shucking plants and handling
procedures now comes under the jurisdiction of the local health units. Reports are made
on uniform records issued by this office. The Department of National Health and Welfare
also has an interest in shell-fish control, since it has 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.
Most of the oysters produced commercially in British Columbia are produced on
leased ground. Applications for all new leases, and applications for renewal of existing
leases, are forwarded to this Division for approval. Any ground found unsuitable for the
production of shell-fish on public health grounds will not be leased.
In some areas a pollution survey of a proposed oyster lease can be made relatively
easily, but in others a considerable amount of survey work is necessary. There are still
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 one that is still before the Pacific Coast
Shell-fish Committee. In its meeting in 1953 it was recommended that the west coast of
Vancouver Island be opened 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
the Federal and Provincial fisheries and health agencies was continued in 1953, with
emphasis being placed on more intensive assaying of fewer areas.   There is a tendency Y 64 BRITISH COLUMBIA
among control agencies to raise the maximum amount of toxicity that may be present in
shell-fish to be consumed by the public. There has not been a death due to ingestion of
toxic shell-fish in British Columbia since 1942.
SWIMMING AND BATHING PLACES
A considerable amount of time was spent during the summer in consultation work
on swimming-pools. There are no swimming-pool regulations in force in the Province.
However, the Division did prepare suggested requirements for swimming-pools, and these
have been used for several years. There is a demand on the part of some of the local
health authorities for swimming-pool regulations, and a committee will study the problem
during 1954 in order to make the necessary recommendations.
TOURIST ACCOMMODATION
The Director of the Division 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 over 1,300 licensed tourist camps in the Province at the present time, and the work
done by the Health Branch has a considerable effect in producing a fairly high standard
of tourist accommodation.    Three licences were cancelled on health grounds in 1953.
The " star " rating of tourist camps is not done by the Health Branch, but is done by
Inspectors employed directly by the Travel Bureau.
The requirement that tourist accommodation must be licensed has had an excellent
effect in the prevention of nuisances in that a local Sanitary Inspector has been able to
visit a tourist-camp site before construction and give the owner advice on water-supply,
sewage-disposal, and other environmental health problems.
FROZEN-FOOD LOCKER PLANTS
Under the Regulations Governing the Construction and Operation of Frozen-food
Locker Plants, plans of all new construction of locker plants must be approved by the
Deputy Minister before construction may commence. The Division of Public Health
Engineering studies the plans and recommends approval where such is indicated.
Approvals were given to sixteen locker-plant plans during 1953. Most of these were for
small installations in already-existing meat-markets and butcher-stores. In review of
locker-plant plans, care is taken to see that the required rooms necessary for a locker plant
are planned for, and care is also taken to see that the refrigeration equipment is adequate
to maintain the temperatures required in the regulations. Periodic inspection of the locker
plants is made by the local Sanitary Inspector.
GENERAL
The Division of Public Health Engineering provides 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 were visited at least once. During these visits the various problems requiring
engineering for their solution are examined in the field.
The position of Chairman of the British Columbia Examining Board for the Sanitary
Inspectors' Examinations is usually filled by this Division. In 1953 there were no examinations for Sanitary Inspectors conducted in British Columbia, there being no British
Columbia candidates. The fact that there were no candidates in British Columbia reflects
a change in the method of training Sanitary Inspectors which tended to make it extremely DEPARTMENT OF HEALTH AND WELFARE,  1953
Y 65
difficult for British Columbia persons to become candidates. It is recommended that
during the coming year assistance be given to enable desirable candidates to qualify.
During the year preliminary studies were made on one sewerage system and one
water system for unorganized communities. This type of work is not considered to be
among the items of work that should be done by the Division. However, there is no doubt
but that certain of the unorganized communities would construct waterworks systems and
sewerage systems if they could receive the initial reports and cost estimates without charge.
The continued expansion of the economy of the Province will lead to more and more
public health engineering problems. It is the intention of the Division to foresee these
problems and make plans for their reasonable control so that proper recommendations
may be made for adoption by the Government and by local health services for adequate
control of the environment. Y 66 BRITISH COLUMBIA
REPORT OF THE DIVISION OF VITAL STATISTICS
J. H. Doughty, Director
The Division of Vital Statistics provides a wide range of service to the general public
and to other branches of government. Its duties fall into two main categories—one
relating to matters of civil registration and the other to statistical service on behalf of the
entire Health Branch. The former duties comprise the administration of the " Vital
Statistics Act," the " Marriage Act," the " Change of Name Act," and certain sections of
the " Wills Act." The statistical services consist of providing detailed analyses regarding
births, deaths, marriages, stillbirths, adoptions, divorces, and of other data stemming from
the registration function, as well as providing extensive statistical service required for the
administration of other division of the Health Branch.
Once again there has been a further increase in the number of birth certificates issued
by the Victoria office, in line with the increase in the number of births registered during
the year. The demand for certificates was heaviest in the month of June and continued
at a high level until the last two months of the year. This is an interesting departure from
the pattern experienced in earlier years, when the volume has not reached its peak until
August and then has declined sharply. It is evident that the wallet-sized laminated birth
certificate which was introduced several years ago has now become very popular and is
used extensively by persons travelling to the United States.
The total number of birth certificates issued by the Victoria office was 39,100, as
compared with 32,360 in 1952 and 26,566 in 1951. There were 3,520 marriage certificates issued and 5,367 death certificates issued. Revenue-producing searches numbered 30,508, while 24,797 non-revenue searches were made, in addition to which 5,621
searches were made free of charge for other Government departments. Revenue received
by the Victoria office amounted to $53,246.55, the highest amount ever collected.
REGISTRATION OF BIRTHS, DEATHS, AND MARRIAGES
Current Registrations
Once again it is gratifying to report that the registration system is functioning in a
very satisfactory manner and that, with the exception of a certain group of Doukhobors,
virtually every birth, death, and marriage occurring in the Province is promptly registered.
The Division maintains routine continuous checks on the registration of these events and
actively pursues registrations which are known to be delinquent. The increasing demand
for proof of birth, death, and marriage in connection with social-security benefits, superannuation schemes, school enrolment, and employment purposes provides a constant
incentive to the registration of these events.
The registration of births is primarily the responsibility of the child's parents.
However, the " Vital Statistics Act" provides for the reporting of all births by the
attending physician and also by the hospital in which the births occurred. Returns from
these two latter sources are balanced against the birth registrations received in order to
ensure that the parents do not neglect their duty in this regard. The responsibility for
filing a registration of marriage rests with the officiating clergyman or Marriage Commissioner, while in the case of deaths the undertaker is required to file the completed
death registration before he may obtain a permit for burial.
Registrations of births, deaths, and marriages constitute important legal documents
from which several types of certifications are prepared. Hence, in addition to the checks
referred to above and which are designed to ensure the completeness of registration,
careful attention is given to reviewing all registrations before they are accepted in the
interests of accuracy and validity. DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 67
Delayed Registration of Births
As noted in previous reports, the greatest proportion of applications for delayed
registrations again stemmed from those persons born prior to the year 1920. Extremely
few applications for delayed registration are received for events which took place during
the last twenty years, indicating that the registration system in this Province has, in fact,
been very satisfactory during this time.
Realizing the difficulty which often confronts an applicant when he is called upon
to produce evidence in support of his application for a delayed registration of birth, the
Division has continued its efforts to gather independently material which may be of
assistance in this regard. This material consists of baptismal records obtained from the
various religious denominations, physicians' records, the records from hospitals and
nursing homes. These pieces of information are being tabulated and indexed so that
they may be available as occasion requires to assist in providing the necessary evidence.
In 1944, at a Dominion-Provincial conference on vital statistics, a schedule of
minimum standards of evidence to be used in applications for delayed registration of
births was drawn up and accepted by all the Provinces. Briefly, this schedule requires
that documentary evidence of good quality verifying the date of birth, the place of birth,
and the names of the natural parents must be furnished to the Director before a delayed
registration may be accepted. It is unfortunate that sometimes this requirement for
independent supporting evidence is not understood or appreciated by the general public,
who tend to assume that the request for proof to accompany the registration form is a
reflection on their own honesty. However, it must be pointed out that registrations and
the certificates which are issued from them are important documents upon which may
hinge important rights to the individual. It is therefore very much in the public interest
that the utmost of care be taken to ensure the accuracy and validity of all registrations
accepted.
Toward the end of the year a brief but informative pamphlet was drawn up and
placed in use for the purpose of assisting applicants to obtain delayed registration. It is
hoped that this action will materially assist the applicants to obtain the required supporting evidence with the minimum of time and effort.
With the assistance of the Indian Commissioner for British Columbia and the various
Indian Superintendents, efforts were continued toward the completion of delayed registrations amongst the Indians. Good progress was made, although in the older age-groups
great difficulty was encountered in obtaining verification of the essential details.
DOCUMENTARY REVISION
Many types of records remain unchanged once they have been filed, but this is not
true in the case of vital-statistics registrations. Through such procedures as adoptions,
divorces, changes of name, alterations of given name, legitimation of birth, and others,
it is constantly necessary to revise registrations in order to add the additional information.
During the year 1,103 adoptions were recorded, 1,574 divorces, 449 legal changes of
name, 326 correction declarations, 297 alterations of given name, and 218 legitimations
of birth. In each of these instances a notation was placed on the original registration,
provided that the birth or the marriage to which it was related had occurred in British
Columbia.
The revision and correction of Indian vital-statistics registrations was continued.
Owing to the fact that, prior to 1943, registration of Indian vital statistics was on a
voluntary basis only, many errors and omissions were found to exist among these earlier
records. The discrepancies and omissions are being eliminated wherever possible by
checking against Indian-band membership records, hospital reports of births, baptismal
registers, and various other sources. Y 68 BRITISH COLUMBIA
The maintenance of up-to-date registrations for the Indians presents the Division
with a particularly difficult problem due to the fairly common practice amongst this group
of changing names at will. Efforts are being made, however, through encouraging the
use of birth certificates and by comparing school registers with the birth records, to ensure
greater continuity and accuracy in names and birthdates on the registrations for Indians,
especially for those in the younger age-groups. In the 1952-53 school term, 166 schools
submitted reports of 1,130 pupils enrolled for the first time. By checking these school
reports against the original birth registrations, it was found that a high percentage of
error existed on both sets of records. Steps were immediately taken to determine the
correct information and to amend the entries where necessary.
MICROFILMING OF DOCUMENTS
The microfilm equipment of the Division was in constant use during the year. All
current registrations of birth, deaths, stillbirths, and marriages were photographed on
a weekly basis. In addition, amendments to registrations resulting from adoptions,
divorces, changes of name, and other types of documentary revision were photographed
and the amended images spliced into the appropriate rolls of microfilm.
Several miscellaneous filming projects were undertaken, as listed hereunder, in order
to permit removal of some of the original files and to allow for a better utilization of
space:—
(a) Delayed-registration files for the period from 1949 to 1952, inclusive.
(b) Baptismal records of several churches.
(c) The refilming of rolls which had become overloaded due to amendments
and additions.
(d) Special files concerning delayed registrations of marriages, 1932 to 1952.
(e) Marriage-licence applications.
ADMINISTRATION OF THE " MARRIAGE ACT "
The " Marriage Act" requires that before a minister or clergyman may solemnize
marriage in this Province, he must first be registered with this Division. For denominations previously recognized, the registration of a new minister or clergyman is made upon
the advice of the governing authority of the denomination. However, denominations not
previously recognized must first comply with certain requirements of the Act relative to
continuity of existence and established rites and usages respecting the solemnization of
marriage before their ministers may be registered.
During the year three new religious groups were granted recognition pursuant to the
" Marriage Act," thus enabling their ministers to solemnize marriage. Inquiries as to the
qualifications for recognition were made by six other groups.
By checking marriage registrations received at the central office, it was discovered
that five marriages had been performed by ministers who had not been authorized to
solemnize marriage. In each case the parties concerned were contacted and the marriages
were validated pursuant to section 37 of the " Marriage Act."
Fourteen applications for remarriage pursuant to section 47 of the Act were
approved. Most of these involved couples who had previously been married to each
other, subsequently were divorced, and then wished to remarry each other.
REGISTRATION OF NOTICES OF FILING OF A WILL
In 1945 an amendment was made to the " Wills Act " making it possible for anyone
to file a notice with the Director showing the date of execution and location of his will.
Provision was also made for the addition of information regarding changes on account of
new wills or the addition of codicils. During 1953, 4,279 notices were filed under sections
34 to 40 of the " Wills Act." This number was almost 300 higher than that for the
previous year.   Over 19,000 notices have now been filed and are preserved in the records DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 69
of this Division.   The notices have all been indexed to permit speedy searching of applications received.
CERTIFICATION SERVICES
While a great deal of attention is directed toward ensuring that all vital events which
occur within the Province are completely and accurately registered, an even greater
amount of work is taken up with the issuing of certifications, mostly in the form of certificates, from the some million and a half registrations which are now on file with the
Division. The certification services embrace several functions and are closely correlated
with the other activities of the office. During 1953 almost 5,000 separate applications for
certification were received and cleared each month. Many of these requests are for
documents urgently required for court hearings, travel visas, and other legal matters.
All applications are therefore screened by the chief certification clerk, who indicates the
action which is to be taken in the office and the degree of priority which attaches to the
application. An attempt is made to give consideration to all priority requests while at the
same time maintaining a good flow of work. In addition, there are statutory restrictions
placed upon the furnishing of information regarding illegitimate and adopted children,
and the chief certification clerk has the further responsibility of ensuring that all certification is supplied strictly in accordance with the Statutes.
Before any certification can be issued, it is necessary that the original registration be
located by a search through the appropriate indexes. Not only must the entry be located
in the index, but, in addition, the actual record itself must be produced so that the information may be extracted from it. In order to make this searching as simple, yet as thorough,
as possible, many refinements have been made in the indexes of the Division. Originally
index-books were handwritten, and listings were made alphabetically according to the
numerous registration districts of the Province. In later years the books were replaced by
typewritten volumes, and these have now been superseded by machine-run indexes prepared from punch-cards set up within the Division. All entries are now arranged in strict
alphabetical order and in one continuous sequence for the entire Province regardless of
the locality in which the event occurred. Each type of event is indexed according to the
year in which it occurred. However, as a further aid in searching, certain indexes have
been consolidated into single five-year sequences. Such indexes are particularly valuable
when the applicant is uncertain as to the exact date of the event.
Within the last three years there has been over a 40-per-cent increase in the yearly
total of searches performed. Searches for the year 1953 amounted to over 61,000,
including more than 5,600 that were made on behalf of other Government offices.
All certificates, other than those involving photographic processes, are prepared by
typists from the original registration. Because of the great importance of accuracy in
the transcription of these documents, every certificate is checked against the original registration by two independent checkers. Since many registrations are made in handwriting,
the interpretation of spelling of names constitutes a major problem. Photographic prints
are prepared independently by trained operators. Special machines are used to produce
the wallet-sized laminated birth certificate, which has gained great popularity since its
recent introduction because of its convenient size and its durability.
In spite of the many procedures which are involved in the handling of applications
for certification, most certificates are now issued within two working-days of receipt of
the application. This service compares very favourably with that provided by registration
offices in other Provinces and States.
DISTRICT REGISTRARS' OFFICES
Changes in Registration Districts
With the opening of Government Sub-Agencies at Terrace and Vanderhoof, the
Division was able to appoint the Sub-Agents as District Registrars and Marriage Commissioners, and this has resulted in a more satisfactory service in these areas. Y 70 BRITISH COLUMBIA
During the year it became necessary to transfer the vital-statistics duties at Trail from
the Motor-vehicle Branch to a private firm. This terminated the temporary arrangements
which have been in force since November of 1951, when the Mo tor-vehicle Branch took
over the vital-statistics responsibilities at Trail in response to an urgent request from the
Division. The generous co-operation of the Motor-vehicle Branch enabled uninterrupted
service of a very satisfactory nature to be given in this district, and appreciation is expressed for the work done by that Branch. The Division has now been fortunate in
securing the services of a firm which has had extensive previous experience in vital-
statistics work, and which has an office centrally located in the business section of the city.
The sub-office of the Registration District of Stewart located at Alice Arm has been
discontinued due to the small volume of business which has been handled through this
office in recent years.
With the closing of the Government Sub-Agency at Greenwood, arrangements were
made for the City Clerk to be appointed as District Registrar and Marriage Commissioner
for the Registration District of Greenwood.
Inspections
Twenty-two offices and sub-offices in the East and West Kootenays and the Fraser
Valley were visited by the Inspector of Vital Statistics during the year. Visits were also
made to the Vancouver, North Vancouver, and New Westminster offices.
These visits have again proved very beneficial both to the Division and to the district
offices in maintaining the smooth functioning of the registration system. Several modifications of existing forms and procedures have resulted from the on-the-spot discussion
of problems which have confronted the District Registrars.
Inspections of the district offices indicate that the standard of work is generally of a
very satisfactory nature and that the present organization of district offices appears to be
serving the*needs of the people and the requirements of the central office in a very adequate way. The district offices are doing an excellent job of collecting and transmitting
vital-statistics returns to the Division, and it is rarely necessary to remind a District Registrar of his responsibilities. It is a pleasure to be able to express appreciation of the
work carried out in the district offices.
At the close of the year there were ninety offices and sub-offices operating in seventy-
one registration districts, this being one less sub-office than in the previous year. Thirty-
eight of the offices are served by Government Agencies or Sub-Agencies, while Royal
Canadian Mounted Police personnel hold the Registrar's appointment in twenty-three
other districts. Eight offices are served by other Provincial Government employees, six
offices by Municipal Clerks, and fifteen offices by private individuals, including Game
Wardens, Postmasters, Stipendiary Magistrates, business-men, and a Canadian Customs
officer.
GENERAL ADMINISTRATION
Although the incidence of staff changes was less than in 1952, the turnover was still
high. Several members resigned, and several others were dismissed when their services
were found to be unsatisfactory during the probationary period of employment. Replacements were difficult to obtain, and in a number of cases a period of several weeks elapsed
before successors were appointed. Most of those reporting for duty had little or no
previous office experience, thus necessitating a longer period of training than otherwise
would have been required.
The Vancouver office experienced unprecedented difficulties, occasioned by staff
shortages and changes throughout most of the year. One of the senior employees retired
on superannuation in January, and her departure was followed almost immediately by
the resignation of another senior person by reason of marriage.   Several employees trans- DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 71
ferred to higher-paid positions or other types of employment. In almost every case the
vacancies were not filled for several weeks, and there were instances when several months
elapsed before a replacement could be obtained. It was largely through the splendid
co-operation of the junior staff with their two seniors that the functions of the office were
able to be carried on without a major disruption.
The widespread use of ball-point pens has created a problem for the Division in
several respects. Of these, the most important is the great range of permanency of the
various inks used by the manufacturers. Documents written with a ball-point pen may
last for months or years, but some are known to have deteriorated very quickly, and it is
doubtful whether they will stand up for the extended periods of time required of vital-
statistics registrations. The use of such pens for the completion of registration forms
has been strongly discouraged in the ultimate interests of the persons concerned. However, this type of writing medium has gained such popularity that it has become impossible
to refuse to accept registrations completed with ball-point pens. The use of ball-point
pens causes further difficulties in establishing identification of handwriting. The actual
identification of signatures is often of great importance in dealing with registration matters.
STATISTICAL SECTION
Purpose
A public health statistics section can be said to be fulfilling its proper function only
when it combines sound statistical routines with critical analyses of the statistics produced
and of the policies and procedures underlying them. The Division attempts to perform
this function through its statistical section on behalf of the Health Branch in this Province,
and, in addition, to give consultative service on all matters involving statistics, recordkeeping, and form preparation. Hence, an important part of the duties of the statistical
section is the critical examination and analysis of the statistics which are compiled in
order that they may be of maximum value to the various divisions of the Health Branch
in the planning, developing, and carrying-out of their programmes.
Routine Assignments
The extent of the routine work of the statistical section is very broad and includes
the completion of numerous reports, listings, summaries, and other statistical compilations and the performance of analyses of the statistics. A detailed list covering the more
important of these routine activities was shown on pages 78 and 79 of the 1952 Health
Branch Report. Apart from the compilation of extensive statistics from the birth, death,
stillbirth, and marriage registrations, the Division's largest routine commitments are to
the Divisions of Tuberculosis Control and Venereal Disease Control in the processing of
their records for statistical purposes.
A great deal of statistical information on morbidity, mortality, natality, and other
items of public health significance is kept on file in the statistical section. This has proven
to be very useful in the course of the regular duties of the section, as well as in providing
a valuable source of reference material to aid in the planning of special statistical assignments.
Staff-training
Through formal postgraduate training as well as through in-service training, the
Division is developing a small but competent staff of biostatisticians. During the summer
one member returned from a course of postgraduate training in public health statistics
at the University of Minnesota, while another member enrolled for similar training in
September at the University of Toronto. Funds for this professional training have been
made available through National health grants. Y 72 BRITISH COLUMBIA
Statistics for the Mental Health Services
Progress was made during 1953 in carrying forward several projects of considerable
importance started in the previous year, and, in addition, several new tasks were undertaken. Among the former was the work begun on the reorganization of the record and
statistical system of the Mental Health Services. This project has consumed a considerable amount of time of the staff both in Vancouver and Victoria, but satisfactory progress has been made. The first important phase of the job has been completed. This
involved the setting-up of a routine for transferring the information appearing on the
admission and separation reports of individuals entering and leaving institutions to punch-
cards. A number of problems arose in establishing the necessary codes and procedures
required for this phase of the work, but by the end of the year the new system was in
operation and the routine processing had begun in this Division.
Incidental to the foregoing work, it was found that certain nominal rolls required
by the Mental Health Services could be prepared mechanically by this Division on a
monthly basis, thus saving the Services considerable time in this regard.
The organization of the second phase of the statistical system for the Mental Health
Services was well under way by the close of the year. A staff member has worked closely
with the medical and administrative staff at Essondale and Crease Clinic in determining
the nature and extent of the statistics to be produced and in designing the system and
routine to be followed. This phase of the work will yield important information on the
status of patients in residence in the various institutions of the Services and on the treatments which have been used.
This difficult work of replacing and augmenting the recording and statistical procedures of a large service involving a number of separate institutions has been made a
pleasure to all concerned by the splendid co-operation and patience of the staff of the
Mental Health Services.
Standardization of Vital-statistics Tabulations in Canada
A major advance was made during the year in the standardization of the vital-
statistics tabulations for all Provinces of Canada. Because Canadian vital statistics are
presented on a " place of residence " basis, it is necessary to have an interprovincial
exchange of registration information relating to births and deaths of residents who are
temporarily absent from the Province. Thus no Province has been able to publish its
final vital-statistics data for a particular year until the last Province has submitted its
registration returns. The Provinces have now agreed upon uniform dates for closing off
the separate birth, death, and marriage series of events each year, and this alone will
speed up the production of the final tabulations by several months. In addition, the
Provinces have all agreed upon a uniform set of basic Provincial tabulations for publication purposes, and this action will further advance the publication date of the annual
Vital Statistics Reports.
This work on the uniform tabulation programme was undertaken by the Vital Statistics Council for Canada in co-operation with the Dominion Bureau of Statistics. It
has involved extensive research and study in order that the tabulations might fully accommodate present statistical needs as well as correctly anticipate future requirements. A
system of priority for the production of the specific tabulations was also set up, and this
will further expedite the publication of the annual Vital Statistics Reports. These measures will enable a saving of approximately six months in the time-lag in printing the
detailed Vital Statistics Report in this Province, and, in addition, it will greatly speed up
publication of the preliminary and final reports of vital statistics published by the
Dominion Bureau of Statistics which contain national rates and interprovincial comparisons. department of health and welfare, 1953 y 73
Infant-mortality Study
As noted in the 1952 Health Branch Report, a special infant-mortality study has
been set up to correlate information from the Physician's Notice of Live Birth or Stillbirth and the associated birth and death registrations. A complete year of experience
covering 1952 infant mortality was available this year, and tabulations were run from
the punch-cards. Information was tabulated revealing many interesting features, but the
number of cases involved is still relatively small for detailed analyses, and further data
must be collected before reliable inferences may be made. However, the results were
important in that they revealed several problems which will have to be overcome before
a satisfactory study can be completed. One of these relates to the lack of sufficient detail,
for a study of this nature, in the code of the International Statistical Classification covering complications of pregnancy and birth injuries.
Population Estimates
During the year, counts were obtained from the Census Branch showing populations
for each of the census enumeration areas in the Province. These figures were utilized in
conjunction with the enumeration area descriptions to produce population estimates by
school districts. These estimates are necessary in order to compile vital-statistics rates
for the health units of the Province and are also used in health-unit financing.
Nutrition Statistics
As in previous years, the Division carried out analyses of food studies conducted
by the Nutrition Consultants of the Health Branch, and which related to the Provincial
gaols. In addition, a pilot study was conducted to determine and compare the nutritional
status of those old-age pensioners with and without dentures in the Greater Victoria area.
Morbidity Statistics
Information on the health status of the people in this Province is, at the best, difficult
to obtain and interpret, yet it is of utmost importance to those who administer the programme of the Health Branch. The National Sickness Survey, mentioned in the 1952
Report, was carried out to provide some of the information on a sample basis, and some
of the results of this survey became available during the year. These first releases related
to expenditures for health services. Estimates of the incidence and prevalence of specific
morbid conditions are expected to appear in the near future.
During 1953, negotiations have been under way between this Division and the
British Columbia Government Employees' Medical Services with a view to obtaining
morbidity statistics for this group of the population. A co-operative arrangement is
being suggested whereby the Division will process the statistics of the Employees' Medical
Services, particularly relating to cost and the utilization, in return for the morbidity
statistics which will ensue as a by-product. Information on the sickness experience of
this group will help to fill in an important part of the health picture in this Province.
Epidemiological Statistics
The Division continued to operate the Province-wide notifiable-disease reporting
system and to compile statistics therefrom. In addition, special statistical studies relating
to the epidemiology of poliomyelitis and of venereal disease were carried out at the
request of senior medical personnel.
CANCER REGISTRY
The Division also continued to supervise the registry of new cases of cancer reported
within the Province.   This reporting system is designed to make possible the provision of Y 74
BRITISH COLUMBIA
up-to-date data on cancer incidence in British Columbia and to make these data available
to the medical profession and to other agencies interested in the cancer problem. Reports
of new cases are received from private physicians, the British Columbia Cancer Institute,
general hospitals, and from pathology laboratories. Death registrations are also used as
a source of reporting cases which have not been reported prior to death.
Preliminary figures showed that 2,785 new cases of malignant growth were reported
during the year, of which 1,366 were reported alive and 1,419 reported for the first time
at death.
The following tables show the malignant neoplasms reported during 1953 classified
according to site, age-group, and sex.
Table I.—Number and Percentage of New Cancer Notifications1
by Site and Sex, British Columbia, 1953
Site
Male
Female
Total
Number
Per Cent
Number
Per Cent
Number
Per Cent
520
190
260
4
174
136
123
80
30
5
54
33.0
12.1
16.5
0.3
11.0
8.6
7.8
5.1
1.9
0.3
3.4
370
236
35
279
98
64
45
25
21
9
27
30.6
19.5
2.9
23.1
8.1
5.3
3.7
2.1
1.7
0.8
2.2
890
426
295
283.
272
200
168
105
51
14
81
32.0
15.3
10.6
10.2
Skin —   —
9.8
7.2
6.0
3.8
1.8
Bone  	
Other and not stated    	
0.5
2.8
Totals	
1,576
100.0
1.209       1       100.0
2,785
100.0
1 Includes 1,419 cases reported for the first time at death.
Table II.—Number and Percentage of Reported Live Cancer Cases
by Site and Sex, British Columbia, 1953
Site
Male
Number      Per Cent
Female
Number      Per Cent
Total
Number      Per Cent
Skin..
Genital system	
Digestive system-
Breast-  	
Respiratory system-
Urinary system	
Buccal cavity...
Blood and hemopoietic tissue.	
Brain and central nervous system..
Bone  	
Other and not stated-
Totals	
169
101
116
2
108
77
66
44
10
3
25
721
23.4
14.0
16.1
0.3
15.0
10.7
9.2
6.1
1.3
0.4
3.5
100.0
96
153
114
190
12
24
20
23
3
4
 6_
645
14.9
23.7
17.7
29.5
1.9
3.7
3.1
3.5
0.5
0.6
0.9
100.0
265
254
230
192
120
101
86
67
13
7
31
1,366
19.3
18.6
16.8
14.1
8.8
7.4
6.3
4.9
1.0
0.5
2.3
100.0 DEPARTMENT OF HEALTH AND WELFARE,  1953
Table III.—Cancer Notifications1 by Sex and Age-group,
British Columbia, 1953
(Age specific rates per 100,000 population.)
Y 75
Male
Female
Total
Age-group
Number
Age
Specific
Rate
Number
Age
Specific
Rate
Number
Age
Specific
Rate
0- 9  	
10-19.	
20-29  	
30-39                                                   	
6
9
12
31
93
174
373
564
223
91
4.7
10.8
14.5
34.5
115.0
285.7
646.4
1,532.6
2,654.7
13
6
12
63
148
165
303
305
153
41
10.6
7.6
14.0
64.7
199.2
300.0
623.4
1,013.3
1,865.8
19
15
24
94
241
339
676
869
376
132
7.6
9.2
14.3
50.2
40-49	
50-59               - -
155.3
292.4
60-69           .                 	
635.9
70-79   	
1,299.0
2,265.1
	
Totals   —
1.576       1       250.8
1,209
201.0
2.785      1      226.4
Includes 1,419 cases reported for the first time at death.
Table IV.—Live Cancer Cases Reported by Sex and Age-group,
British Columbia, 1953
(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
3
2
7
20
52
92
163
226
70
86
2.3
2.4
8.5
22.2
64.3
151.1
282.5
614.1
833.3
4
3
9
51
104
91
156
145
47
35
3.3
3.8
10.5
52.4
140.0
165.5
321.0
481.7
573.2
7
5
16
71
156
183
319
371
117
121
2.8
10-19	
3.1
20-29
9.5
30-39 	
37.9
40-49	
50-59-  	
60-69    ...
100.5
157.9
300.1
70-79 —	
80 and over	
554.6
704.8
Totals	
721        I       114.7
645
107.2
1,366
111.1
CRIPPLED CHILDREN'S REGISTRY
During 1949 and 1950 a survey was carried out to determine the size of the problem
which existed in this Province with respect to crippling diseases of children. As a result
of this survey, a voluntary registry of crippled children was set up. The purpose of the
registry is twofold. In the first place, the registry is designed to provide accurate knowledge of the nature and extent of the problem of crippling diseases of children in British
Columbia. Only with such information can there be intelligent planning of the additional
facilities which might be required, or of the programme which should be undertaken.
The second purpose of the registry is to assist those children with handicaps to receive
the best possible treatment available for those specific handicaps. The registry has available the services of an advisory panel of fifteen specialists, the chairman of which reviews
all new registrations received with a view to recommending the best possible treatment
or disposition of each case. The Division of Vital Statistics supervises the statistical
aspects of the registry and assists in tabulating the statistics which derive from it.
Physicians throughout the Province have been made aware of the purpose of the
registry and have been encouraged to register on a voluntary basis those children under
their care who are suffering from any one of a group of specified disabilities which might Y 76 BRITISH COLUMBIA
prevent them from completing their education and becoming self-supporting. The registry has established close liaison with all public health authorities in the Province as well
as with numerous private agencies concerned with the care of children. The advisory
service of the medical panel is available to any physician upon request. The registry
also provides what might be termed a clearing-house of medical history regarding each
individual case, and this has proved valuable in those instances where the child does not
remain under the continuous care of one doctor.
Impairments which are noted at birth and reported on the Physician's Notice of Live
Birth or Stillbirth are routinely registered by the Division of Vital Statistics with the
Crippled Children's Registry. Additional information is obtained where necessary from
the reporting physician. A check is later made on these cases to determine whether the
condition is still present, has disappeared, or has become inactive.
The registry is receiving data on about 150 new cases each month. By the end of
the year over 2,000 cases were on the registry files.
During the year a follow-up was conducted of all post-poliomyelitis cases with
residual paralysis from the epidemic of 1952. An inquiry was made to determine whether
or not further treatment was required. When it was found that a case required additional
treatment but this treatment had not been forthcoming, the reasons were investigated
and, where possible, assistance was made available.
In order to enlarge the scope of the registry, it was suggested toward the end of the
year that a procedure be set up whereby cases known to the Welfare Branch would be
routinely registered. Regular social-assistance cases continue to be handled by the
Welfare Branch, their addition to the registry being primarily for record and statistical
purposes. It is hoped that the care of border-line social-assistance cases which are sometimes handled by the Welfare Branch would be facilitated if they are made known to the
registry.
POPULATION CHARACTERISTICS OF THE PEOPLE
OF BRITISH COLUMBIA
The 1953 estimate of the population of British Columbia was 1,230,000, being
32,000 higher than the figure for 1952. Of this increase, over 40 per cent occurred
among the population under 10 years of age. Over one-third of the increase in population which occurred in the last ten years has been in this same age-group.
Since the 1952 Report was published, additional information has been made available from the Ninth Census of Canada, and an account of some of the more important
features of the population of our Province which were disclosed follows.
British Columbia has the lowest average number of persons per family in Canada;
namely, 3.3, as compared to 3.4 for Ontario, which has the next lowest average, and 3.7
for Canada as a whole. The 1951 average for the Province represented only a slight
decline from the figure of 3.4 determined from the previous census in 1941.
With regard to the rural-urban population ratio, it was found that British Columbia
has a greater proportion of urban population than any other Province except Ontario.
According to the definition of an urban area as given in the 1951 Census (any city, town,
or village of over 1,000 population, whether incorporated or unincorporated, and all
parts of census metropolitan areas), over 68 per cent of this Province's population is
urban. This figure is slightly under that for Ontario, where 70.7 per cent of the population resides in urban areas. The National average is 61.5 per cent. Whereas over half
of the rural population in Canada as a whole resides on farms, in British Columbia the
proportion is under one-third, which is not surprising in view of the predominantly mountainous nature of the Province. Except for Newfoundland, British Columbia has a
smaller proportion of rural farm population than any other Province in Canada.
For the whole Province, the population density is 3.2 persons per square mile, a
40-per-cent increase over the figure for 1941, when there were 2.3 persons per square
mile.   British Columbia ranks ninth among the Provinces of Canada in density of popu- DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 77
lation, only Newfoundland having a lower density; namely, 2.4 per square mile. The
National average is only 3.9. If Census Areas 4 and 5, which cover the Lower Mainland
and Vancouver Island, are excluded, the population density for the remainder of the
Province is found to be just under one person per square mile. The scattered distribution
of population is a factor of considerable importance in increasing the expense and difficulty of carrying out public health work in this Province, and the accepted approach to
the many problems which arise has had to be modified accordingly.
PRINCIPAL CAUSES OF MORTALITY IN BRITISH COLUMBIA
A review of more important features of the mortality statistics for the year is pertinent to any report dealing with the health of the people. In last year's Report it was
pointed out that the crude death rate has changed very little over the last ten years, and
an explanation was given of the fact that the absence of an increase in this rate despite
the steady ageing of the population was in itself a most favourable reflection of the
improving health of the population. This year the crude death rate again changed only
slightly. Preliminary statistics show an over-all death rate of 10.0 per 1,000 population,
compared to the final rate of 10.1 for 1952.
Of particular interest are the specific rates due to the more important causes of
death. The two leading causes—namely, diseases of the heart and cancer—exhibited
lower rates of mortality this year than in 1952, the rate for heart-disease having declined
from 365.4 per 100,000 population in 1952 to 357.1 in 1953, the corresponding rates
for cancer being 158.2 and 154.4. Despite these lower death rates, the proportion of
all deaths contributed by these causes continues to increase, being up to 36.7 per cent
from 36.2 per cent for heart-disease and up to 15.9 per cent from 15.7 per cent for cancer.
The rate of deaths from vascular lesions of the central nervous system, including cerebral
haemorrhage, cerebral embolism, and cerebral thrombosis, was 104.0 in 1953, an increase
from the rate of 96.4 in 1952. This cause of mortality was responsible for 10.7 per cent
of all deaths, an increase from the 9.6 per cent recorded in 1952.
The mortality rate for accidents this year was 76.2 per 100,000 population, this
being a decrease from the rates which prevailed during the several previous years. The
ten-year average for 1943 to 1952 was 79.8. In 1953 the leading cause of accidental
deaths was falls, which resulted in over 20 per cent of all accidental deaths. Motor-
vehicle accidents were the second leading cause, having taken a toll of 201 lives, a
decrease from the 1952 figure of 220. A total of 115 people drowned in 1953, compared
to 104 in 1952.
The mortality rate from the group of causes referred to as diseases of early infancy
was 32.8 per 100,000 population in 1953, the lowest rate yet recorded, and well below
the 1952 rate of 38.5. Pneumonia deaths occurred at a rate of 33.8 per 100,000 population. The mortality rates from diseases of the arteries, suicides, and congenital malformations were 17.3, 15.9, and 15.1 per 100,000 population respectively. The tuberculosis mortality rate, which as recently as 1947 was 51.3 per 100,000 population,
dropped in 1953 to 11.4 per 100,000 population.
MORTALITY AMONGST THE INDIAN POPULATION
The foregoing preliminary rates for 1953 cover the entire population of the Province.
It has been customary in previous Reports to refer mostly to the mortality rate excluding
Indians, since Indians do not come under the jurisdiction of the Provincial Government
and in most areas they live on reserves quite apart from the remainder of the population.
However, since comparisons with other Provinces and States are generally made on a
total-population basis, the rates have been presented herein accordingly. Nevertheless,
the Indian mortality experience differs so widely from that of the population excluding
Indians that it warrants special comment.   Although the Indians constitute hardly more Y 78 BRITISH COLUMBIA
than 2 per cent of the total population, their effect on the mortality rates from certain
causes is quite marked.
Mention has been made of the effect of the ageing population in increasing the proportion of deaths due to the degenerative diseases, such as heart-disease, cancer, and vascular lesions of the central nervous system. This situation is of much less significance in
the Indian population, due in part to the different age distribution. Approximately 21
per cent of the Indian population is over the age of 40 years, while 38 per cent of the
population excluding Indians falls into this age-group. Furthermore, less than 10 per cent
of the Indian population is 60 years of age or older, while more than 15 per cent of the
non-Indian population falls into this category. Deaths under 40 years of age during 1953
accounted for over 66 per cent of the total Indian mortality but only 13.8 per cent of all
mortality in the rest of the population. The mortality rate in the age-group under 40
years was slightly over 10 per 1,000 population for Indians, compared with 2.2 per 1,000
in the group excluding Indians.
The three major causes of death in the population excluding Indians—namely, diseases of the heart, cancer, and vascular lesions of the central nervous system—accounted
for approximately 65 per cent of all deaths during the year, with a combined rate of 630.5
per 100,000 population. Amongst the Indians, however, these three causes represented
only 17.9 per cent of the total deaths, with a combined rate of only 236.2 per 100,000
population.
On the other hand, however, accidents, diseases of early infancy, tuberculosis, and
the other respiratory diseases accounted for almost 50 per cent of the total Indian mortality, compared with only 15.7 per cent for the remaining population. In the Indian
population under 40 years of age the combined rate for such deaths was 626.6 per
100,000 population but only 147.5 in the cases of non-Indians.
The difference between Indian and non-Indian mortality is nowhere more evident
than in infant and maternal mortality. During 1953 the infant death rate of the non-
Indian population was 23.5 per 1,000 live births, whereas amongst Indians the rate was
101.2. The rate of maternal deaths in the non-Indian population was 0.6 per 1,000 live
births, compared to a rate of 1.7 for Indians. Thus the Indian experience adversely affects
the rates for the whole population, and when Indians are included the total infant mortality
rate becomes 26.7.
MORTALITY IMPROVEMENTS IN TERMS OF   LIFE-YEARS LOST
Reference was made in the Health Branch Report for 1952 of the concept of measuring the force of mortality in terms of life-years lost rather than merely in terms of the
number of deaths which occurred. A description of the general method involved was
given on page 84 of the 1952 Report. By measuring mortality in terms of life-years lost,
account is taken of the age at which the deaths occur, and hence a death at age 10 is
considered to be a much more serious event than a death at age 65. This method of
measuring mortality has a particular significance in public health which is especially
interested in the prevention of untimely or premature deaths.
It was shown that the mortality picture appeared radically different when measured
in terms of life lost under the average life-span of 70 years. The three most serious causes
of death numerically—namely, diseases of the heart, cancer, and vascular lesions of the
central nervous system—dropped to third, fourth, and seventh places respectively in terms
of life-years lost, and their places were taken by diseases of early infancy, accidents, and
diseases of the heart, in that order.
It is also revealing to measure the changes and improvements in the mortality picture
during the last two decades in terms of life-years lost. One of the simplest ways to comprehend the changes which have taken place is to compute what the mortality would have
been in 1953 if the age-specific mortality rates of a year twenty years previous had applied. DEPARTMENT OF HEALTH AND WELFARE,  1953
Y 79
COMPARISON OF ACTUAL AND EXPECTED LIFE-YEARS LOST1
DUE TO SPECIFIC CAUSES OF MORTALITY
BRITISH COLUMBIA,   1953
INFANT
MORTALITY
XX^t.% "i --.    • :..    -   --.   "- '.   ~-   "- '■:.■:.-:-:. -^ -..-.. -_   V   -.   -- -_   -_-_■;„-_■ i. ■ ^ 'T. -..•;:.  -_  •_•■■. -L X V \\ \
""\
CARDIO-VASCULAR
RENAL DISEASES*
ACCIDENTS
RESPIRATORY
DISEASES3
INFECTIOUS AND
PARASITIC DISEASES'*
TUBERCULOSIS
y
CONGENITAL
MALFORMATIONS
J
EXCLUDES DEATHS
UNDER ONE YEAR
Actual life-years lost,   1953.
i
VH.VKX1    Life-years which would have been
"-O    lost if 1933 mortality rates had
existed in 1953.
40,000 60,000
LIFE-YEARS LOST
1   Under age 70
Intracranial lesions of vascular origin,  diseases of the circulatory  system,   and nephritis
Bronchitis,   influenza,   and pneumonia
Excludes respiratory diseases and tuberculosis Y 80 BRITISH COLUMBIA
Such a computation takes into account the increase in the population and also any changes
in the age composition of the population which may have taken place.
Since infant mortality is of special concern to public health workers, infant deaths
from all causes are shown in one group on the chart which follows, and, therefore, deaths
from the other specific causes which are enumerated apply only to the population over
1 year of age.
The chart reveals that mortality of infants during the first year of life is responsible
for almost as great a loss of life-years under age 70 as are the cardiovascular-renal diseases,
accidents, and cancer combined. It also highlights the impovement that has, in fact, been
made in infant mortality since 1933. It can be seen that life-years lost from infant mortality at the present time are only 60 per cent of what they would have been had the
mortality rates of 1933 prevailed.
Another notable feature indicated by the chart is the precipitous decline in the life-
years lost from tuberculosis and other respiratory diseases. The years of life lost through
tuberculosis deaths are less than one-tenth of what they would have been had no improvements been made in the past twenty years. Likewise, the life-years lost due to deaths
from other respiratory diseases—namely, pneumonia, bronchitis, and influenza—are only
30 per cent of what they would have been had the mortality rates of two decades ago
applied.
Deaths from the infective and parisitic diseases also show a remarkable decline and
now account for less than 50 per cent of the loss of life-years which they would have
occasioned had the 1933 experience prevailed.
It will be noted that the situation with respect to cardiovascular-renal diseases, accidents, and cancer appears more severe to-day than it would have been if the 1933 mortality rates from these causes had continued up to the present time. However, it is not
surprising to find some increases in the degenerative conditions such as the cardiovascular-
renal group and cancer, since it is evident that persons saved from premature death in
infancy or in young adult ages may fall prey to one of the degenerative diseases in later
life. In addition, there is strong reason to believe that the reporting of cancer as a cause
of death was understated twenty years ago due to less adequate diagnostic techniques. The
less favourable condition shown for the accident group compared to twenty years ago again
emphasizes the need for continued and increased measures to combat this unnecessary
loss of life. A further analysis of the accident picture reveals that there has been a marked
increase in mortality from accidents at ages from 20 to 59, while there has been a substantial decrease in mortality at ages under 20.
BIRTH AND STILLBIRTH RATES
There was a considerable increase during 1953 in the number of births which
occurred in this Province, and the birth rate per 1,000 population rose to 25.8. This is
the highest rate ever attained in British Columbia and exceeds the previous high of 25.2
which was set in 1947.
The stillbirth rate declined slightly during 1953. There were 11.3 stillbirths per
1,000 live births during this year, compared to 12.6 in 1952. The stillbirth rate has been
steadily declining since 1949. DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 81
REPORT OF THE DIVISION OF PUBLIC HEALTH EDUCATION
Raymond H. Goodacre, Director
If asked the question, " What is health education? " the uninformed would probably
reply by saying that it consists of telling people about health, giving lectures or showing
films, producing pamphlets and posters, or writing press releases.
And yet merely telling people about health is only one-third of the battle. They
must then learn and act on the information. The object of health education is to improve
people's health, and unless their health is improved they have not been educated. Professor Whitehead, the great educator, has defined education as the art of the utilization of
knowledge. Thus of the two words "health education," it is the word "education" that
is the important one. A person who is a good educator will make a good health educator,
but an expert on health does not necessarily make a good health educator unless he takes
some trouble to acquire at least the rudiments of the techniques of education.
The objective of this Division is, then, twofold: To provide information on health,
and to demonstrate the principles of education, not to the public direct, for that is uneconomical, but to those who are or will be dealing directly with the public. These include
local health-services personnel, the training institutions for teachers and public health
nurses in both Vancouver and Victoria, and the Department of Education. Just as
chlorine is applied at the main water-supply rather than at each household, the services
of this Division are directed at those who will in turn reach a wider range of groups and
individuals in the community.
LOCAL HEALTH EDUCATORS
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 schools 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.
One of the major problems among teachers who took their teacher-training some
years ago is that of information regarding community health and local public health
services. Although local public health personnel have been providing information to
teachers in their areas, the presence of a health educator in the Central Vancouver Island
Health Unit has effected a clearly defined liaison between that unit and the teachers
through, firstly, interpretation of health-unit services, and, secondly, familiarization with
the visual aids maintained in the library of the Division of Health Education.
Apart from her routine visits to schools, the unit health educator continued to provide advisory services to teachers on specific programmes and projects in school health.
Two nutrition-education programmes planned for schools in her area consisted of
one designed to replace the consumption of soft drinks and candy with milk and apples,
and another to help teachers who are confronted with the problem of children arriving at
school having eaten either no breakfast or, at best, a poor breakfast.
CONSULTATIVE SERVICES
Although the majority of routine requests from health units can be met through
correspondence, there are, of course, occasions when special visits are required. During
the year, trips were arranged to units to discuss public relations, public education with
respect to fluoridation, the role of education in public health, pre-school and school Y 82 BRITISH COLUMBIA
dental-health education, health-education opportunities open to a nurse making a home-
visit, education in accident-prevention, and other similar topics dealing directly with the
programme of local health services.
Activities outside the Health Branch included representation at a film institute sponsored by the Greater Vancouver Health League and the annual regional meeting of the
National Film Board in October.
Both meetings provided an opportunity for the main film distributing agencies and
users to discuss many of the problems encountered in the distribution, utilization, and
care of moving-picture films.
Liaison was maintained with the two Provincial Normal Schools at Vancouver and
Victoria with periodic meetings to discuss the training of teachers in the fundamentals of
health education. As in the past, a talk on Provincial health services and health-education
aids was given to the students at Victoria Normal School in the spring.
Evaluation of materials suggested for distribution to the public was continued
throughout the year. In addition to several publications prepared by divisions within the
Health Branch, a number of pamphlets and posters were evaluated at the request of the
Department of National Health and Welfare. In each case the comments of persons
representing various groups, both lay and professional, were obtained and summarized.
Mr. William Mennie, of the Research Division, Department of National Health and
Welfare, visited the Health Branch early in the year to discuss revisions in the summary
compiled from the Provincial health-survey reports describing health services and facilities as they existed in 1948. Since Mr. Mennie's trip, this Division has been obtaining
additional information for the Research Division which will enable it to bring this Province's contribution up to date, as of December, 1952.
MATERIALS
In education during the past ten or twenty years the " group " has been rediscovered
as an educational instrument. By the group is meant the association of a small number
of people capable of developing personal relationships, having some continuity of relationships and having some common concern. Educators who cannot possibly reach
every individual must work through groups and their leaders in order to economize effort.
The group is an educational agent helping the individual to adopt new ideas more readily
and, more important, encouraging him to put new ideas into practice. It must be the
responsibility of educators to create situations which will help leaders of organizations
and groups appreciate the need for more information and training and thus create a state
of receptiveness. It was with this in mind that toward the latter part of the year the
Division began work on a new booklet designed to provide local field staff with a basic
understanding of the techniques of leading group discussions and at the same time double
as a refresher for those who are already aware of and apply these principles. It was felt
that this booklet might help public health nurses, Sanitary Inspectors, and health-unit
directors not only in their staff meetings and study groups, but also in discussions which
many of them are required to lead in their programmes of community education.
The pamphlet shortage mentioned last year has become more acute during the past
twelve months, and was emphasized by the complete absence of two fundamental booklets, " The Canadian Mother and Child " and " Up the Years from One to Six." Information Services Division, Department of National Health and Welfare, producer of these
publications, has apparently been experiencing budgetary difficulties, forcing it to cut
back drastically its distribution to the Provinces. Furthermore, the pamphlet situation
has deteriorated to the point where, contrary to the recommendations made by the Provinces at the Fourth Federal-Provincial Conference on Health Education last year, at
least four of the most widely distributed publications are to be placed on general sale by
the Federal Government, effective April 1st, 1954, with no free distribution to the Provinces as in the past. DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 83
One of the main functions of the Division is that of maintaining a central registry
of information on educational programmes in the health units. One example of this
endeavour pertains to the series of classes for expectant mothers which are being organized all over the Province. It is the aim of the Division to provide some measure of
assistance to units developing maternal- and child-health programmes by producing a
basic outline relating how existing classes were organized, the educational approaches
used, content of each class in the series, publicity methods, and similar types of evaluated
information that will provide a groundwork that might otherwise be developed on a
trial-and-error basis by individual units. Although the project is now only in a formative
stage, it is hoped that within the next three or four months an information kit will be
made available to all areas contemplating parent-craft classes. In conjunction with this
programme, the existing twelve-month " baby letters " and the booklet " Feeding the
Normal Child," produced by the Health Branch, have been revised by the Consultant in
Maternal and Child Health.
There is, in the Report of the Division of Preventive Dentistry, a comprehensive
description of the fluoridation programme undertaken jointly by the Divisions of Preventive Dentistry, Public Health Engineering, and Public Health Education. To this end,
this Division issued a series of eight articles under the heading of " Fluoridation News "
to every member of the field staff and to the city health departments of Greater Vancouver and Victoria-Esquimalt. These articles condensed the mass of information that is
available from many sources and included up-to-date material that could be utilized in
a series of talks on fluoridation. In addition, an information kit was designed for use
by local health-services personnel, consisting of materials directed to three levels of
consumption. It included " Fluoridation News " for medical-dental, legal, and engineering groups; the United States Public Health Service pamphlet " Better Health through
Fluoridated Water" for such community groups as the Women's Institutes, Parent-
Teacher Associations, Farmers' Institutes; and the American Dental Association leaflet
" Drink Away Tomorrow's Tooth Decay," for general distribution. Additional information on costs of fluoridating, available films, and displays were also included. A modified version of the kit has been made available to community groups concerned with the
study of fluoridation and its effect upon tooth decay.
Realizing that visual aids help to create a state of receptiveness, the Division is in
the process of collecting a series of slides for use in talks on fluoridation by local public
health personnel. Based on topics covered by the proposed Canadian Dental Association
fluoridation pamphlet, more than thirty slides show illustrated charts, fluoridation equipment, and scenes from cities in the United States and Canada already fluoridating their
water-supplies.
Further work in this medium of education is also under way. One important function of local health units is that of bringing services to the attention of the people for
whom they are provided. As cost is the prime prohibiting factor in producing a film,
it was felt that a series of slides taken in various health units would provide a flexible
means of visual assistance to nurses, Sanitary Inspectors, and health-unit directors in
explaining the services provided in their areas. A project has been drawn up whereby
this Division will provide films and flash-bulbs to units with amateur photographers for
approved outlines of topics and activities. A similar group of slides depicting tuberculosis, venereal disease, nutrition, and other Health Branch services is also under consideration.
Although there was a marked decrease in the availability of new films during the
year, twenty new and duplicate items were added to the central film library.
Showings to more than 80,000 people reveal that mental health was the most
popular topic, followed by dental health, maternal and child care, nutrition, sanitation,
and safety. It is not possible to draw many conclusions from attendance figures, but it
is interesting to note that safety foots the list, despite the fact that accidents in British
Columbia constitute the leading cause of death between the ages of 1 and 31. Y 84 BRITISH COLUMBIA
IN-SERVICE TRAINING
During the past few years the Division has been represented on the Public Health
Institute planning committee charged with the responsibility of planning and operating the
four-day in-service training programme each year. Together with representatives from
the two metropolitan health departments, all local health-service personnel meet at this
time to hear guest speakers and members of both Provincial and local health services
discuss topics designed to broaden one's concept of public health.
This year the Annual Institute was held in Vancouver from April 7th to 10th. Dr.
Hugh Leavell, Professor of Public Health Practice at Harvard University, spoke on topics
with a range in scope from accident-prevention to the contributions of the social sciences
to public health. The talks were both interesting and valuable in that the subject-matter,
although fundamental to one's understanding of public health, is too often pushed into the
background by routine procedures.
In the latter part of the year, sole responsibility for organizing the Institute was
shifted from the committee to this Division. Members of the committee will, however,
remain as an advisory council and will therefore continue to contribute their wisdom and
guidance in the selection of both speakers and topics.
The orientation course for new members of the professional staff in the central office
and for new unit dental and medical directors was continued during the year. Orientation was arranged for one health-unit dentist, one statistician, two health educators, one
research assistant, and the new industrial nurse serving the Parliament Buildings.
PUBLICATIONS AND PUBLICITY
In 1931 the Provincial Board of Health began issuing monthly statistical bulletins
for the information of District Registrars and the medical profession. Sixteen years later,
after the establishment of the Division of Health Education, the bulletin changed its
approach, becoming an educational force directed to schools, community groups, newspapers, and to the medical and dental professions. Finally, in January, 1951, the
bulletin changed its name to " B.C.'s Health " and appeared in printed form. However,
in August of this year, along with similar publications of other departments, " B.C.'s
Health," after twenty-two years, was discontinued in accordance with Government policy.
Since then the Health Branch has been contributing monthly articles for the new Government publication, " B.C. Government News," which now replaces all publications previously issued by the various departments.
STAFF
The division continues to experience a mobility in staff due primarily to the difficulties
in both recruiting and retaining suitably qualified applicants.
Toward the end of the year the vacancy created by a candidate who resigned after six
months' service was finally filled.
Despite the problems encountered in recruiting, the Division has been able to extend
the programme designed ultimately to improve community and school health education.
More emphasis, however, must be placed upon the training of those who will be concerned with health educating. This will involve an extension of present co-operation
with the nursing and teacher-training schools, and indirectly with present teachers through
the Department of Education and local health units. DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 85
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. Also housed within this office is the
Vancouver office of the statistical section of the Division of Vital Statistics, and the usefulness of this arrangement continues to grow each year.
BUILDINGS
The summer of 1953 saw the start of construction of the new Provincial Health
Building, and this can be considered as the important development in this Bureau during
the year. The completion of this building some time early in 1955 will vastly improve the
services now given by this Bureau to the people of the Province of British Columbia.
FACULTY OF MEDICINE, UNIVERSITY OF BRITISH COLUMBIA
As mentioned in the 1952 Annual Report, the very satisfactory working relationship
with the Dean of the Faculty of Medicine, University of British Columbia, and in particular with the heads of the Departments of Paediatrics and Preventive Medicine, continues to expand. This is emphasized by the fact that the Department of Paediatrics has
been named as the official consultant to the Health Branch in child-care, and, further, two
members of this Bureau are Assistant Professors of Public Health in the Faculty of
Medicine, University of 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.
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, British Columbia Poliomyelitis Foundation, British Columbia Tuberculosis
Society, Canadian Red Cross Society, John Howard Society, Cerebral Palsy Association,
Canadian Cancer Society (British Columbia Division), Alcoholism Foundation, Multiple
Sclerosis Society, and other similar organizations related to health matters in the Province
of British Columbia. Y 86 BRITISH COLUMBIA
During the year, visits were made to many of the larger hospitals in this Province
on Departmental matters, such as 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 ten
centres in the Province.
The diagnostic and treatment centre of the British Columbia Cancer Foundation at
the Royal Jubilee Hospital in Victoria continues to provide for a needed and expanding
service.
Western Society for Rehabilitation
This voluntary health organization in the field of rehabilitation continues to give
leadership to all of Canada in this field. The increasing responsibilities of this agency
have necessitated the assistant medical director appointed in 1952 being employed three-
quarter time instead of half time, as well as the appointment of a second assistant medical
director on a full-time basis.
During the year a highly qualified person in the field of logopaedics was added to the
staff of the Cerebral Palsy Association, which is housed in the Western Society for Rehabilitation, and his services are available to all agencies housed at the Western Society for
Rehabilitation.
Early in 1954 there will be an additional twenty beds and 15,062 square feet of
diagnostic, treatment, and out-patient facilities completed at the Western Society for
Rehabilitation. This will aid materially in increasing the services now available to the
people of the Province of British Columbia through the Western Society for Rehabilitation, Canadian Arthritis and Rheumatism Society (British Columbia Division), and the
Cerebral Palsy Association.
Canadian Arthritis and Rheumatism Society (British Columbia Division)
Further expansion has taken place during 1953 in this voluntary health agency. In
addition to the main diagnostic clinics established in the large centres, a travelling consultant service is now extended to physicians outside Vancouver.
Mobile physiotherapy service is given from the treatment centres listed in the 1952
Report as well as from new centres in Port Alberni, Courtenay, Abbotsford, Chilliwack,
Langley, and Burnaby. At least seventy-three communities have the advantage of home
care.   In all areas medical and lay committees give practical and financial support.
Intensive care by the team consisting of the doctor, physiotherapist, occupational
therapist, social worker, and nurse is given to in-patients at the treatment centre operated
by the Canadian Arthritis and Rheumatism Society and located in the Western Society
for Rehabilitation Building in Vancouver. The Canadian Arthritis and Rheumatism
Society is renting increased space in the addition to this building nearing completion in
order to provide for the establishment of an occupational-therapy department as well as
expansion of existing services. Patients from all over British Columbia are referred to
this treatment centre.
The staff now totals forty-three, including a medical director and three consultants,
two nurses, one occupational therapist, twenty-two physiotherapists, one driver, and three
J DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 87
research and records stenographers.   A shortage of physiotherapists delays and increases
the cost of the programme.
Three research projects are being conducted under the auspices of the Canadian
Arthritis and Rheumatism Society—one at the Department of Biochemistry at the University of British Columbia on the basic aspects of rheumatism and arthritis, one on
rheumatic fever and heart-disease, and one on rheumatoid arthritis. Some assistance
toward this research is being received from the National Public Health Research Grant.
CIVIL DEFENCE
Lectures to various groups, including schools of nursing, the Vancouver Civil Defence
School, and other interested groups, still continue as a responsibility of this Bureau.
GENERAL
The regulations under the "Practical Nurses Act" passed in 1951 were finalized
during the year, but up until the present time these regulations have not become law in
this Province.
Considerable time was spent in the development of a research programme related
to narcotic addiction as mentioned in the 1952 Report. The fall of 1953 saw the culmination of these efforts with the appointment by the University of British Columbia of
a highly qualified psychiatrist to head up this research programme. The Mental Health
Services under the Provincial Secretary's Department, the Attorney-General's Department, and this Health Branch will continue to be closely associated with the University
in the planning and completion of this research project. The research is being financed
under the National health grants and the Attorney-General's Department, with technical
and professional advice and guidance being supplied by the University of British
Columbia.
The year saw the birth of the Alcoholism Foundation. It does appear that finally
the efforts of all those interested in the problem of alcohol have been co-ordinated, and
progress in the solution of this problem can be hoped for as the Foundation develops its
programme. The Attorney-General's Department, the Mental Health Services of the
Provincial Secretary's Department, and both the Health Branch and Welfare Branch of
the Department of Health and Welfare have representatives on the board of trustees of
this Foundation.
Poliomyelitis was once again a problem in this Province, and although it will be
covered in greater detail elsewhere in this Annual Report, several facts are worthy of
mention.
The responsibility for the development of a more satisfactory method than that
which has existed in previous years for reporting, possible transportation, and hospitalization, including treatment, was given this Bureau by the Deputy Minister of Health.
The recommended procedure for management of cases of poliomyelitis was developed
with the valuable assistance and guidance given by the Poliomyelitis Committee of the
Vancouver General Hospital. As a result of these recommendations, a poliomyelitis
treatment centre for more severe cases was established at the Vancouver General Hospital, and later at the Royal Jubilee Hospital, Victoria. Details of these procedures in
the management of poliomyelitis in this Province are available if desired.
The people of the Province of British Columbia, and in particular this Health
Branch, are once again deeply indebted to the Royal Canadian Air Force for its splendid
co-operation in carrying out mercy flights in the evacuation of poliomyelitis patients to
Vancouver. In the first eleven months of this year the Royal Canadian Air Force has
flown approximately 25,000 miles in carrying out some twenty-two mercy flights. It is
not possible to express in writing what this has meant to the people of the Province of
British Columbia, not only in dollars and cents, but above all in the safety factor due to
the presence of trained and experienced medical and nursing personnel on these flights. Y 88 BRITISH COLUMBIA
The British Columbia Poliomyelitis Foundation has also given yeoman service in
the management of poliomyelitis in this Province this year. Its funds have matched
Government funds in the purchase of equipment, and over $100,000 has been spent on
equipment alone in 1953. The British Columbia Poliomyelitis Foundation also assisted
greatly in expediting the delivery of respirators to this Province when urgently required.
Funds from this voluntary health agency have also assisted greatly in those fields for
which the Health Branch has no funds. These include payment of special nurses, housekeeper services, and transportation, to mention a few.
Gamma globulin was made available to this Province during the summer and is
distributed through this Bureau to local health services for use on a restricted formula
due to the shortage of supply of this product. It is distributed free, to be administered
by the family physician to those contacts who meet the criteria as laid down by the
Poliomyelitis Committee of the Vancouver General Hospital.
During the year a consultant in nutrition from the Bureau of Local Health Services
was attached to this office. This has been a most useful development, and her advice
and guidance in the field of nutrition to the Division of Tuberculosis Control and voluntary health agencies related to this Bureau have been most valuable.
NATIONAL HEALTH GRANTS
General
The total amount of funds available to British Columbia for the fiscal year 1953-54
is $3,849,447, excluding the Public Health Research Grant, which is allocated in Ottawa.
The decrease of approximately $600,000 from the previous year is due to a decrease in
the Hospital Construction Grant of approximately $1,000,000, which is only partially
offset by the amount of $437,126 allocated to this Province in the three new grants
introduced this year for laboratory and radiological services, medical rehabilitation, and
child and maternal health. The amounts of the other grants remain essentially unchanged.
The Health Survey Grant was discontinued this year, as the survey and report, for which
this grant was provided, were completed in 1952.
Four transfers of funds were made in order to meet the need for additional funds.
From the Cancer Control Grant, $29,000 was transferred to the Professional Training
Grant and $60,000 to the General Public Health Grant. From the Tuberculosis Control
Grant, $20,000 was transferred to the General Public Health Grant, and from the Laboratory and Radiological Services Grant $20,000 was also transferred to the General Public
Health Grant.
Administration
The administration of the National health-grants programme has continued to be
quite satisfactory, and is no doubt due in large part to personal discussion of problems,
the opportunity for which was provided by the visit of officials from the Department of
National Health and Welfare and the Treasury Department to this Province in September.
The policy of having the Assistant Provincial Health Officer in Ottawa at the time
consideration is given to continuing projects has been accepted. As a result, approval of
the majority of these submissions was received this year from the Department of National
Health and Welfare before April 1st, 1953. This was of assistance, particularly to the
non-government agencies, as it was then possible to inform them of the funds available
for their services before the new fiscal year actually began.
Grants Received for the Year Ended March 31st, 1953
Total expenditures for the year ended March 31st, 1953, were $1,986,279 or 45
per cent of the total available, as compared with $2,481,398, or 85 per cent of the total
grants available, in the year ended March 31st, 1952.   The decrease in total expenditures DEPARTMENT OF HEALTH AND WELFARE,  1953
Y 89
is due primarily to the decrease in expenditures under the Hospital Construction Grant.
These expenditures may be expected to fluctuate considerably due to the delays which
occur in the construction of hospitals and health centres. The total amounts approved
under the Mental Health and Tuberculosis Control Grants were less than in the previous
year, when large amounts were used for furnishings for newly completed buildings. As
a result, the total expenditures under these two grants also decreased. Detailed figures
are given in the following table:—
Comparison of Amounts Approved and Actual Expenditures with Total Grants
for the Year Ended March 31st, 1953
Grant
Total Grant
Approved
Actual Expenditures
Amount
Per Cent
Amount
Per Cent
$43,599
48,599
2,478,153
43,599
518,616
370,329
17,585
33,320
588,060
293,682
$18,125
47,665
1,576,561
43,599
394,252
301,090
17,585
800
571,199
195,324
42
98
64
100
76
81
100
2
97
67
$15,990
44,587
598,751
43,599
357,339
239,438
13,381
680
494,355
178,159
37
92
24
100
Mental Health        	
69
65
76
2
84
61
Totals   	
$4,435,542
$3,166,200
71
$1,986,279
45
The decrease in amounts approved and expended, as previously noted, also affected
the position of British Columbia in relation to all Provinces. Excluding the Public Health
Research and Health Survey Grants, the percentage of funds allocated was 72 per cent
in British Columbia, as compared with 75 per cent for all Provinces. Similarly, the
amount expended in British Columbia was 45 per cent of the total available, as compared
with 51 per cent for all Provinces.
Crippled Children's Grant
A new development under this grant is assistance to the Cerebral Palsy Association
of British Columbia. This made possible in October the appointment of a person well
qualified in the field of logopaedics. As a result, an expert speech-therapy programme
is being developed for children in the Lower Mainland area, and consideration is being
given to the establishment of a training programme in logopaedics at the University of
British Columbia.
A detailed outline of the Crippled Children's Registry, which is financed under this
grant, is given in the report of the Division of Vital Statistics which appears earlier in this
Health Branch Report.
Professional Training Grant
The number of persons completing training under all projects during the calendar
year 1953 was thirty-nine, and total expenditures made in regard to this training were
$69,672.99. In addition, fifty-eight persons have taken short courses, varying in length
from a few days to two or three weeks. Funds for this training have been provided by
other grants in addition to the Professional Training Grant.
Included in the short-course group are five health-unit directors who attended a
mental-health workshop arranged by Washington State Health Officers' Association and
twenty-four public health nurses who attended a short course in mental health arranged
by the University of Washington. Expenditures for these two courses were charged to
the Mental Health Grant. Y 90 BRITISH COLUMBIA
Assistance is being continued this year toward the training of public health staff and
the staff of general hospitals, as well as training in specialized fields such as medical
rehabilitation, tuberculosis, and mental health.
Hospital Construction Grant
The Hospital Construction Grant was reduced this year, and, in addition, a smaller
proportion of the accumulated unexpended funds from previous years was revoted, so
lhat the total amount available this year is approximately $1,000,000 less than ,in
1952-53. The reason for these reductions is that a large proportion of the hospital construction which had accumulated during the war years has been completed or is well
under way, and, therefore, a smaller amount should be sufficient for current new projects
and the completion of those under construction. The number of hospital-construction
projects initiated during the current fiscal year is comparatively small, but there are still
a large number of projects to be completed.
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 is being 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, which appears in a
later section of this Health Branch Report, constitutes the report made on the use 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. In general, all
phases of the Provincial mental-health programme have improved through the additional
staff and facilities provided under this grant, but reference is made here only to some of
the newer developments.
The Department of National Health and Welfare has agreed that the Homes for the
Aged, which are under the jurisdiction of the Mental Health Services, may be classed as
mental institutions for purposes of this grant. As a result, therefore, it has been possible
to improve facilities for the care of these patients.
A more active programme to combat tuberculosis in the patients of the Provincial
Mental Hospitals is being developed, assisted by additional staff provided under this
grant. Additional staff has also been provided to assist in the new formal reactivation
programme, which has been introduced into the wards for regressed patients in the
continued-treatment units and which is showing valuable results.
Mentally defective children are now admitted directly to The Woodlands School,
New Westminster, without the necessity of first passing through the Provincial Mental
Hospital, Essondale. This advance has been made possible by the provision of proper
admission facilities in one of the three new 100-bed units. The Mental Health Grant
has been of great assistance in providing surgical, laboratory, and X-ray equipment for
the admission unit. The additional staff which has also been provided has assisted in the
improvement and expansion of the programme at this unit.
Assistance is being continued to the University of British Columbia, the psychiatric
services in the Vancouver General Hospital and Royal Jubilee Hospital, Victoria, and
the mental-health programmes in the Cities of Victoria and Vancouver. In the latter
area, a nursing consultant with postgraduate training in mental health has been appointed DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 91
to indoctrinate new staff members and to assist the present staff in relation to the mental-
health programme.
Tuberculosis Control Grant
This grant is similar to those for mental health and venereal-disease control in that
the majority of the tuberculosis services are provided by the Provincial Government, and
the largest proportion of this grant, therefore, is used by this Government department.
Detailed information regarding these services is given in the report of the Division of
Tuberculosis Control, which appears in a later section of this Health Branch Report.
Public Health Research Grant
Four new research projects have been approved this year for assistance under this
grant, in addition to the continuation of three projects from previous years.
An analysis is to be made of all phases of hospitalized illness as shown by the records
of the British Columbia Hospital Insurance Service and the relationship of hospitalized
illness to certain other factors, such as prepaid medical plans and co-insurance, as well
as studies of certain administrative problems in connection with hospital insurance which
may have a bearing on the quality and quantity of health-care available to the population.
The purpose of this research is to obtain information essential in planning for the most
efficient programme of health-care and the optimum utilization of hospital facilities and
other health resources. This project is under the supervision of the Director, Division
of Environmental Management, Provincial Health Branch.
In co-operation with the Vancouver Chapter, Multiple Sclerosis Society of Canada,
research is being carried on in regard to the causation, prevention, and cure of multiple
sclerosis. Two projects initiated by the Canadian Arthritis and Rheumatism Society
(British Columbia Division) and approved are concerned with the assessment of cortisone in the prevention of permanent rheumatic heart-disease and with the determination
of human blood patterns and levels of the adrenal steroid hormones.
Health Survey Grant
As noted in the Annual Report for 1952, the Survey of the Health Services and
Facilities in British Columbia, December 31st, 1948, was tabled in the House of Commons
on July 2nd, 1952.
This report, early in 1953, became the subject of much discussion, particularly by
the British Columbia Division of the Canadian Medical Association. These discussions
were naturally focused on Section VII of this report, which dealt with suggestions relative
to the introduction of health insurance in specific specialties in the practice of medicine.
Committees have been set up by the British Columbia Division of the Canadian Medical
Association to study these recommendations, and in particular that recommendation
pertaining to the diagnostic services, since a National health grant for laboratory and
radiological services was made by the Federal Government in May, 1953. Details of this
grant are found later in this Report.
General Public Health Grant
All phases of the general public health programme carried on by the local health-unit
staff continued to receive assistance from this grant. The additional staff required in the
local areas to meet the demands for public health services was an important factor in
the request, which was approved, that the Public Health Grant be increased by the transfer
of $60,000 to this grant from the Cancer Control Grant. Detailed information in regard
to these services is given earlier in this Report, in the report of the Bureau of Local
Health Services.
A new project approved this year provides for the establishment of an industrial
nursing service which, besides providing actual health services to the 1,700 Provincial Y 92 BRITISH COLUMBIA
Government employees in Victoria, will serve as a study project for the promotion and
development of this type of service in industry. The service is under the direction of the
Director, Provincial Division of Environmental Management.
A second new development made possible through an approved project was the
employment during the summer months this year of three third-year medical students in
health units, where they were given specific responsibilities. This plan has been most
successful, with advantages to both the students and the health units.
Approximately $40,000 from this grant is being expended this year for the purchase
of equipment for the care and treatment of poliomyelitis. While the larger proportion of
funds has been allocated toward the purchase of respirators, other equipment, such as
rocking-beds, polio pack machines, and positive-pressure apparatus, has also been
purchased.
Funds for the above purchases were transferred to this grant from the Radiological
Services Grant and the Tuberculosis Control Grant.
This equipment is located almost entirely in the Vancouver General Hospital and the
Royal Jubilee Hospital, Victoria, with the larger share being in the former. Treatment
centres have been established at these two hospitals, and patients requiring specialized
care are brought in from other areas of the Province.
Cancer Control Grant
The operations of the British Columbia Cancer Foundation, which are financed
under this grant, are outlined earlier in this report in the section " Voluntary Health
Agencies."
The number of examinations done under the Provincial Biopsy Service has steadily
increased since the inception of the service. The average number of tissue examinations
per quarter referred under the Biopsy Request Form was 2,792 in 1951, 3,265 in 1952,
and 3,995 each quarter in the first nine months of 1953. These figures do not include
biopsy examinations originating in the hospitals having pathologists on their staff, but
the number of these examinations has also increased. The quarterly average number of
all biopsy examinations was 8,968 in 1952 and 9,633 in the first nine months of 1953.
Laboratory and Radiological Services Grant
The Laboratory and Radiological Services Grant is one of the three grants made
available for the first time in 1953. The purpose of this grant is threefold—the improvement of the quality and the extension of diagnostic services and thus the improvement
of medical care in general, the better distribution of medical man-power by providing
diagnostic facilities to areas not already served and thus encouraging physicians to practise
in these areas, and the reduction of personal expenditures for diagnostic services.
The grant is distributed on the basis of 30 cents per capita of population and
increases 5 cents per capita annually until a maximum of 50 cents per capita is reached.
British Columbia's share this year is $359,400.
Expenditures for equipment and professional training may be charged entirely to
this grant, but expenditures for services must be matched by Provincial expenditures on
such services of at least an equal amount. This provision should not delay expenditures
for services under this grant, as it is expected the Department of National Health and
Welfare will accept as matching funds the cost of such services provided under the British
Columbia Hospital Insurance Service and a large proportion of the cost of the Provincial
Division of Laboratories. The total of these two items is considerably in excess of the
amount required.
A Provincial programme for the utilization of these funds is now under consideration, and in this connection liaison is being maintained with the British Columbia Division
of the Canadian Medical Association. In the meantime it has been agreed that, providing the need is established, funds for the purchase of radiological equipment will be DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 93
provided on the basis of 40 per cent from this grant, 20 per cent from the British Columbia Hospital Insurance Service, and the remaining 40 per cent from the local area; funds
for the purchase of laboratory equipment will be provided entirely from this grant.
A survey has been made of all laboratory and radiological facilities in general hospitals,
but it is not expected that plans will be sufficiently far advanced to enable very large
expenditures to be made this year.
Medical Rehabilitation Grant
This grant, which is available for the first time this year, is to make funds available
to the Provinces for those areas of rehabilitation and for those groups of disabled persons
with respect to which no grant funds have been available hitherto. Rehabilitation projects
which relate to tuberculosis, mental health, and crippled children programmes will continue to be dealt with under existing relevant grants.
Distribution of the grant is on the basis of $ 10,000 to each Province and the balance
according to population.   The amount allocated to British Columbia this year is $42,877.
This grant is also partially a matching one; expenditures for equipment and professional training may be charged in full, but expenditures for services are on a matching
basis. No difficulty is expected in regard to the provision of matching funds, as it is
understood Provincial Government grants now being made to the Western Society for
Rehabilitation and the Canadian Arthritis and Rheumatism Society (British Columbia
Division) will be accepted by the Department of National Health and Welfare for this
purpose.
Rehabilitation is a problem which concerns several Government departments and
voluntary agencies. Funds for rehabilitation are also available from various Government
and private sources. Close co-operation is being maintained with all agencies concerned
in order that a well-co-ordinated Provincial programme may be developed.
Under these circumstances it is likely that projects submitted this year will be
limited almost entirely to additional equipment for established services, while those to
initiate or expand services are delayed until the Provincial programme is finalized.
Child and Maternal Health Grant
The purpose of the Child and Maternal Health Grant, which is the third new grant
this year, is to assist in an accelerated and intensified programme for the improvement of
maternity, infant, and child care.
The grant is distributed on the basis of $10,000 to each Province, 50 per cent of
the balance on the basis of the average number of births over the previous five years and
the other 50 per cent on the basis of the average number of infant deaths over the previous
five years. Total expenditures for approved services, equipment, or professional training
may be charged to this grant. The amount available to British Columbia this year is
$34,849.
The child and maternal health services in this Province are an integral and important
part of the general public health programme carried on by the staff of the local health
departments, and it is planned to use this grant to strengthen and expand this phase of
the general programme.
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. Y 94
BRITISH COLUMBIA
REPORT OF THE DIVISION OF LABORATORIES
C. E. Dolman, Director
The year under review has been no less difficult than its predecessors. Staffing
problems, which tend to become more acute as the number employed and the work-load
increase, have been aggravated by these inefficient quarters, which discourage even the
keenest new-comers. Such circumstances have made it virtually impossible to build
up any reserves of trained staff, so that a few seniors find themselves continually training
fresh recruits. Fortunately, some respite is in sight. In the autumn the contract was
let for construction of the Provincial Health Building. It is hoped that the three floors
assigned to the Division of Laboratories in this modern fire-proof structure will be ready
for occupancy by the early summer of 1955.
Table I.
-Statistical Report of Examinations Done during the Year 1953,
Main Laboratory
Out of Town
Metropolitan
Health Area
Total in 1953
Total in 1952
208
4,590
1,812
1,040
53
8,097
3,470
1,133
786
256
6,622
5,259
1,897
35
9,379
6,338
13,784
2,225
6,516
1,457
20,719
6,858
3,362
204
175
796
1,178
103,157
15,069
1,507
18,346
21,644
1,821
68
360
1,319
1,853
1,684
1,662
1,311
918
1,684
140
140
124
72
85
464
11,212
7,071
2,937
88
17,476
9,808
14,917
3,011
6,516
2,350
25,221
15,765
4,912
234
225
978
1,867
139,947
21,868
2,057
26,734
27,938
2,727
87
710
2,063
2,775
3,732
3,707
2,568
931
7,168
140
140
124
72
210
284
Blood serum agglutination tests—
12,124
Brucella group -— —	
6,621
2,511
Miscellaneous 	
Cultures—
M. tuberculosis 	
120
15,919
8,026
C. diphtheria; -   -	
17,793
3,517
N. gonorrhoea;	
6,054
1,959
893
4,502
8,907
1,550
30
50
182
689
36,790
6,799
550
8,388
6,294
906
19
350
744
922
2,048
2,045
1,257
13
5,484
Direct microscopic examination—
26,758
12,993
4,288
Treponema pallidum.  — -	
278
225
757
Miscellaneous  — -	
Serological tests for syphilis—
Blood-
1,740
142,071
25,324
2,842
Complement fixation,     __
v.d.r.l	
26,368
188
Cerebrospinal fluid—
2,845
131
Cerebrospinal fluid—
827
Protein   	
2,171
2,936
Milk—
3,225
Coli-aerogenes    —	
Phosphatase...	
Water—
3,225
2,394
857
Coli-aerogenes 	
Ice-cream—
7,015
152
152
152
63
125
117
110,726
260,024
370,750
345,022 DEPARTMENT OF HEALTH AND WELFARE, 1953
Y 95
At the central laboratories the total number of tests performed and the actual
work-load in terms of " unit values " showed an increase of about 8 per cent. The fairest
way of computing and comparing laboratory work-loads appears to involve the " unit
value " system rather than totals of " specimens received " or " tests performed." Under
this system, each type of test is assigned a specific unit value, ranging from 1 to 10, based
on the estimated comparative time taken to perform the test. Thus an agglutination test
using a single antigen rates 1 unit, whereas a guinea-pig inoculation for tuberculosis rates
10 units. In a later section of this report, further reference will be made to work-loads
and unit values. For present purposes, the work of the central laboratories in 1953
is shown in Table I under the customary headings, the corresponding figures for 1952
being also given.
The branch laboratories at Victoria and Prince George showed increased activity
during the year, while the number of specimens received at Nelson declined. Examinations made at these three laboratories in 1953 have been set forth in Table II. Addition
of the nearly 70,000 tests carried out in the branch laboratories to the corresponding
figure of 370,000 for the main laboratories gives the impressive total of 440,000 tests
relating to communicable-disease control in British Columbia. This represents an
increase of about 30,000 tests, or roughly 7 per cent, over the Division's 1952 total—the
largest annual increment for several years.
Table II.—Statistical Report of Examinations Done during the Year 1953,
Branch Laboratories
Nelson
Prince George
Victoria
48
Blood agglutination—
420
87
596
95
63
Cultures—
2,711
537
32
135
169
1,784
1,784
564
	
133
258
667
2
Direct microscopic examination—
1,132
738
6,143
111
23
5
39
69
271
Serological tests for syphilis—
Blood—
21,489
1,564
2,205
6,367
58
18
82
84
1,128
1,107
408
56
977
231
484
Cerebrospinal fluid—
494
486
543
Milk-
642
642
259
573
823
1,341
1,341
1,341
1,359
1,359
Water—
718
Totals 	
12,232
4,071
50,492
Grand total, 66,795. Y 96 BRITISH COLUMBIA
TESTS FOR DIAGNOSIS AND CONTROL OF VENEREAL DISEASES
The continuing fall in the incidence of syphilis is reflected in a small reduction in
the number of blood specimens received for sero-diagnostic tests. Cerebrospinal-fluid
specimens also slightly declined. However, this trend was more than counterbalanced
by a comparison, involving some 30,000 blood specimens, of the sensitivity and specificity
of the so-called V.D.R.L. slide test and the presumptive Kahn test. This commitment
arose out of the increasing concern about the accuracy of the latter test expressed at the
last few annual meetings in Ottawa of the Technical Advisory Committee on Public
Health Laboratory Services. In addition, several thousand blood and cerebrospinal-fluid
specimens were subjected to complement-fixation tests, using lipoidal and the newer
cardiolipin antigens in parallel. The senior bacteriologist in charge of the syphilis
serology section carefully supervised these surveys and analysed the findings. The
results, which were presented by the Director to the Technical Advisory Committee meeting early in December, seemed to indicate that V.D.R.L. slide test would be an efficient and
desirable substitute for the presumptive Kahn test, and that the cardiolipin antigen was
somewhat superior in the complement-fixation test.
During the year the main laboratories participated, with very satisfactory results,
in the sixth sero-diagnostic survey arranged by the Laboratory of Hygiene, Department
of National Health and Welfare. Each of the Provincial laboratories in Canada examined
portions of the same group of about 100 selected blood specimens, their respective findings being tabulated and compared. Unfortunately, the available amounts of these
specimens were insufficient to permit inclusion of our branch laboratories in this survey.
Mistakes in the performance of these sero-diagnostic tests are, on the whole, more liable
to occur when the turnover of specimens is small. However, every effort has been made,
by supplying standardized reagents, by refresher courses, and by personal visits, to ensure
high standards of accuracy in our branch laboratories.
Although the incidence of gonorrhoea has not declined to the same degree as that of
syphilis, current methods of treatment often add to diagnostic difficulties, and consequently to increased dependence upon laboratory findings. Hence, perhaps the small
reduction in the number of smears examined microscopically for N. gonorrhoea; and
the increased requests from the Division of Venereal Disease Control for cultural
examinations.
In an effort to improve and simplify the procedures used in gonococcus culture work,
a senior bacteriologist conducted an investigation into a new method, involving the
so-called " transport medium " technique, developed by Dr. R. D. Stuart, Director of
the Provincial Laboratory, Department of Health of Alberta. The established practice
necessitated our maintaining at the V.D. clinic a supply of freshly made plates of special
nutrient medium, the streaking of specimen swabs on to these plates, and the prompt
shipping of the inoculated plates to the laboratories. The method under trial was based
on the fact that gonococci (which soon die when exposed to oxygen and drying) will
survive for several hours on carbon-impregnated swabs held in a buffered, semi-solid
agar containing a reducing agent, thus permitting these swabs to be returned to the
laboratories for plating on to nutrient media. A substantial number of specimens from
the Division of Venereal Disease Control, subjected to both methods of culture, showed
a distinctly higher gonococcus recovery rate from the transport medium, even when
plating of the swabs was delayed for twenty-four hours. In October it was therefore
agreed by the two Divisions concerned that the new method should be at once adopted.
Apart from an immediate improvement in efficiency, it is now possible to envisage
extension of this facility (when our staff and accommodation permit) to private physicians and health units operating within a twenty-four-hour delivery radius of the central
laboratories. DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 97
TESTS RELATING TO TUBERCULOSIS CONTROL
All types of tests for M. tuberculosis increased during the year. Direct microscopic
examinations of sputum and other specimens increased by roughly 20 per cent, reversing
last year's trend, and presumably reflecting in part greater case-finding and follow-up
activity on the part of the Division of Tuberculosis Control. Another contributory factor
is that rapid changes may be induced in patients by modern methods of treatment of
tuberculosis (as also of syphilis), which entail more frequent laboratory checks. An
increase of about 6 per cent in the complex and time-consuming cultural examinations
would have been considerably greater if the Division had not found itself compelled to
impose some restraint on requisitions of this type. This section of the Division is especially under pressure to enlarge its services, and is the least able to respond because of
the difficulties and dangers inherent in such work carried out in overcrowded quarters.
For many years a warning has been sounded in these annual reports about hazards
of accidental infection faced by the staff, particularly by those engaged in handling
tuberculous material. In March a laboratory assistant accidentally inoculated the
palm of her hand while injecting a guinea-pig with a culture for virulence test. Prompt
first-aid measures failed to prevent development of a palpable local lesion. This was
excised, and an intensive course of streptomycin and P.A.S. instituted under the supervision of the Division of Tuberculosis Control, whose co-operative interest in this episode
is appreciated. The patient developed no further evidence of tuberculosis, though the
outcome might have been otherwise before the era of specific therapy. The fortunate
infrequency of such accidents is largely due to the extreme vigilance and careful technique
displayed and enforced by the senior bacteriologist in charge of this section.
Animal inoculations for tuberculosis increased from 284 in 1951 to around 500.
We are indebted to Dr. F. O. R. Garner and Dr. Evelyn M. Gee at Tranquille for keeping
us regularly supplied with healthy guinea-pigs throughout the first ten months of the year.
Signs of incipient trouble (possibly pseudo-tuberculosis) showed in shipments received
throughout the year. Trouble due to pseudo-tuberculosis developed in the animal colony
toward the year's end. The supply and care of guinea-pigs entails perennial problems,
even when the best of accommodation is available. In our parlous circumstances, it is
indeed regrettable that these animals cannot be dispensed with altogether for diagnostic
and virulence tests in tuberculosis-control.
SALMONELLA-SHIGELLA INFECTIONS
The section concerned with specimens relating to excreta-borne infections was
again very, overworked, especially since early October, when the senior bacteriologist in
charge broke her leg and was off duty for many weeks. Agglutination tests for organisms
of the typhoid-paratyphoid group underwent a slight decline, possibly reflecting the
lowered incidence of S. typhi and S. paratyphi B infections, which was unusually high
in 1952.
The much more exacting but more conclusive cultural examinations of faeces
increased by over 20 per cent, to a total approaching 10,000. The actual number of
Salmonella organisms isolated from individual patients or carriers was 131, the lowest
total since 1948. On the other hand, this year yielded a large number of Salmonella types
hitherto unknown in British Columbia, including S. bovismorbificans (the first isolation
from human sources in Canada), 5". wichita, S. javiana, S. enteritidis, and S. brandenburg.
This Province has the dubious distinction of apparently harbouring the widest range of
Salmonella types in Canada, no fewer than thirty-eight types having been identified from
human sources during the last decade. A rather surprising feature of this situation is that
although many of these types are known to be potentially associated with animal reservoirs,
no actual instance of animal-to-man conveyance has locally come to light. Y 98 BRITISH COLUMBIA
Another single intsance of a Canadian rarity, S. paratyphi A, was encountered.
S. kentucky, which was isolated once in each of the years 1949, 1950, and 1952, was
isolated from six persons in 1953. Again, S. heidelberg, which made its first appearance
in this Province last year, with seven persons infected, was identified in eleven individuals
this year. Our bacteriological and epidemiological records suggest that these two Salmonella types are likely to have joined the ranks of some eight to twelve strains which must
be regarded as more or less indigenous to British Columbia.
The lower than average incidence of salmonellosis was unhappily overshadowed by
extremely widespread and persistent outbreaks of shigellosis due to Shigella sonnei. In
last year's Report it was stated that " the reservoir of unidentified carriers of Sh. sonnei
may well have been enlarged " as a result of outbreaks of bacillary dysentery at girls'
camps in Howe Sound, in the summers of 1950 and 1952. This prophecy has been rather
strikingly borne out during 1953 by the total of 638 different persons yielding Sh. sonnei
by stool culture. The lowest monthly number of persons infected was fifteen in October,
and the highest was 129 in March, a month not generally associated with a heavy incidence
of excreta-borne infection.
OTHER TYPES OF TESTS
Bacteriological Analyses of Foodstuffs, Milk and
Milk Products, and Water
The Division's responsibility for the bacteriological examination of foodstuffs has
been restricted to materials which have either been implicated in outbreaks of suspected
bacterial food poisoning or are deemed dangerous to public health because of faulty
methods of manufacture, preparation, or storage. Problems of quality and adulteration
fall within the purview of the Federal "Food and Drugs Act," and are dealt with by the
Food and Drug Laboratory, Department of National Health and Welfare. Suspected
food-borne chemical poisoning and kindred toxicological problems are referred to the
Provincial Analyst, Department of Mines, or to the City of Vancouver analyst. Sometimes the dividing lines have to be rather arbitrarily drawn, but obviously the Division
could not follow a policy of having to determine the edibility of any sample foodstuff,
whether submitted by professional or lay persons. A few minor gaps in the services
offered in this field seem a preferable alternative, in present circumstances, to a swamping
of the Division by irrelevant demands for tests which would be neither conclusive nor
scientific.
The usual numbers and types of staphylococcal food-poisoning episodes were
investigated during the year.   No case of botulism was encountered.
Bacteriological tests of milk and phosphatase tests for proper pasteurization increased
by over 10 per cent. The senior bacteriologist in charge of milk and water testing
arranges shipping-days with the Sanitary Inspectors, who collect the samples in the
various health units, and the schedule is, on the whole, adhered to co-operatively.
A special series of tests was conducted in the last quarter of the year, at the request of
Dr. J. L. Gayton, Medical Health Officer for the City of Victoria, on raw-milk samples
shipped in bulk from Vancouver to Victoria. Remarkably wide fluctuations in bacterial
counts were noted. The Division continued to examine ice-cream and cottage-cheese
samples collected from the Greater Vancouver area.
Bacterial counts and coli-aerogenes tests on water samples increased slightly in
number. Although some of these samples reach us after undue delay, so that results are
not very reliable, there seems little doubt that water-supplies of dubious quality are being
consumed in many parts of the Province. The Division adhered as firmly as possible to
the agreed policy of referring to the local health unit all requests from private parties for
examinations of well or spring water. The Sechelt Peninsula area presented some
difficulties in this connection, since it is not yet organized under a health unit, while
a high proportion of its permanent and temporary residents seem to depend on private
sources of water-supply. DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 99
Diphtheria
Cultural examinations for C. diphtheria; again dropped considerably. However, the
Division's findings indicate that the carrier incidence in this Province is too high to justify
any complacency, a belief borne out by the occurrence of several cases of diphtheria
during the year.
Intestinal Parasites
Microscopic examinations for intestinal parasites increased by over 20 per cent, and
revealed an unusually high incidence and wide range of infestations.
By arrangement with the Laboratory of Hygiene, Department of National Health and
Welfare, a series of specimens was forwarded to all Provincial Laboratories by Mr. J. B.
Poole from the Institute of Parasitology at Macdonald College, Quebec. Our findings
were listed, and in due course the control laboratory's version was returned for comparison. The results were satisfactory enough to inspire reasonable confidence, and
though the survey was unfortunately timed to coincide with some of the busiest months
of the year, it certainly provided a helpful training opportunity.
BRANCH LABORATORIES
An increase of about 10 per cent in tests done at the Victoria branch laboratory was
largely due to heavy demands for cultural and microscopic examinations for M. tuberculosis, stemming from the Victoria clinic of the Division of Tuberculosis Control. Sero-
diagnostic tests for syphilis also increased, and would have mounted further had not some
requested surveys of naval personnel been diverted to the central laboratories. A sizable
expansion is also evident in the milk- and water-testing programme. Certain items of
equipment being procured under a National health grant will relieve some bottle-necks.
We are glad to acknowledge the cheerful and co-operative manner in which Dr. R. G. D.
McNeely, director of pathology at the Royal Jubilee Hospital, and his staff have met the
staffing and financial problems involved in the added work.
The decline of about 16 per cent apparent in the Nelson branch laboratory is believed
only temporary. The reduced number of Kahn tests, for instance, is partly due to a
lowered employment rate at the Trail smelter, where new employees are routinely tested.
Again, the smaller number of milk samples has resulted from Sanitary Inspector's illness
or from poor coverage during vacation periods. When industrial activity in the Kootenay
area is restored, the Nelson branch turnover of specimens will undoubtedly expand.
The staff comprised an assistant bacteriologist in charge, a laboratory assistant, and a part-
time cleaner, whose salaries have been covered by a National health grant.
The success of this project has been due mainly to the fine qualities of the successive
staff members posted to Nelson from the central laboratories, but owes much also to the
generous co-operation of the Kootenay Lake General Hospital authorities in supplying
accommodation.
The Prince George branch laboratory, housed in the Cariboo Health Unit headquarters, has experienced many difficulties, which seem inseparable from operation on
a one-person basis. The assistant bacteriologist has done her best to cope with store-
keeping, media-making, cleaning glassware, and typing reports, in addition to actual
technical procedures. She has conscientiously tried to overcome certain difficulties by
adjusting her own programme of work. Although total tests increased by about 30 per
cent, and notwithstanding the considerable benefits which have accrued to the sanitation
of the area served, it seems that equally good services could be offered at less cost from
the central laboratories, especially since there are now fast bus and aeroplane schedules
between Prince George and Vancouver.
Close contact was maintained with the branch laboratories by frequent correspondence, and by personal visits whenever opportunity permitted.   In an attempt to bridge Y  100 BRITISH COLUMBIA
distances and to stimulate our staff members in isolated areas, a laboratory bulletin was
launched early in the year. Seven numbers were issued during 1953. At the Health
Officers' meeting in April, distribution of the bulletin to all health units was advocated,
and this practice has since been adopted.   The Director is responsible for final editing.
GENERAL COMMENTS
The year was marked by greater than usual difficulty in recruiting staff with university training. Competition from local hospitals, university departments, and research
organizations, as well as from the National Research Council, Defence Research Board,
and the Laboratory of Hygiene, has become intense. Even if the salary ranges offered
by our Civil Service Commission were higher than for corresponding positions elsewhere—and in some instances they are lower—this Division's working conditions would
remain a serious deterrent. We have therefore been obliged to fill several vacancies for
university graduates with matriculants, thus replacing a number of assistant bacteriologists with laboratory assistants. This step will result in a reduction of the average salary
prevailing in the Division as a whole and in remarkably low operating costs.
Figures compiled by a sub-committee of the Technical Advisory Committee on
Public Health Laboratory Procedures showed that this Division's cost of performing
1 unit of communicable-diseases control work is the lowest in Canada. In 1952 our
figure was 20.7 cents per unit, compared with 22.6 cents per unit in Quebec, our nearest
competitor, where the prevailing salaries for non-professional staff averaged several
hundred dollars less. In Ontario the per unit cost was 31.2 cents, or 50 per cent higher
than our figure. Much of this disparity is due to our expenditures on supplies and
equipment, and more particularly on housing and maintenance, being unduly low in
relation to output. Apart from this, however, the work-load per staff member has been
considerably higher than in other Provincial laboratories in Canada. For instance, the
work-load per person in British Columbia in 1952 was 17,732 units against 10,609
units in Ontario; in other words, on the average each person on our establishment carries
a 68-per-cent higher load than his or her counterpart in Ontario. A considerable increase
in the size of the staff is obviously warranted, although we would have difficulty in
recruiting suitable persons, even if we had room to accommodate them. This dilemma
can only be solved when new quarters make a staff reorganization feasible.
During August and part of September the Director had an opportunity, under a
National health-grant project, to visit public health and research laboratories in the
British Isles and certain countries of Western Europe. Some twenty-eight institutions
were visited, and discussions held with a large number of laboratory and public health
authorities. Data and impressions gathered during the seven weeks' trip confirm the
heaviness of the work-load being borne in this Division. In one laboratory in England,
for example, with a staff of about one-third our number (the majority being male) only
about one-tenth our number of work units was done. It was also apparent that for
a given population the number of specimens sent to public health laboratories in Canada,
and especially in British Columbia, is very much greater than in the British Isles and
Europe. The Director also attended the Sixth International Microbiological Congress,
held in Rome early in September, where he served as a member of a committee on
anaerobe classification, and presented a paper entitled " Clostridium botulinum type E."
Miss D. E. Kerr, Assistant Director, managed the affairs of the Division with her
customary competence during the Director's absence. Miss Kerr's efficiency and devotion
to duty are well known to all who have occasion to deal with her, but it is none the less
a pleasurable obligation to acknowledge these qualities once again. Under less conscientious leadership, the fine spirit animating the Division, which alone has enabled it
to circumvent and endure so many handicaps, could not have been maintained. DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 101
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 was
3,671, which total includes 462 cases of non-specific urethritis, compared with 3,914
in 1952. Infectious syphilis has now become a clinical rarity; there were only twenty
cases reported as of December 31st, 1953. Late syphilis and prenatal syphilis, as
reported to this Division, have also shown a marked decline.
TREATMENT
This Division continued, as in the past, to overtreat gonorrhoea patients with massive
doses of penicillin, and the results to date have shown that such treatment has been most
successful in preventing concomitantly acquired syphilis. This overtreatment schedule,
as developed within the Division, has now been accepted by other Provinces as routine
therapy.
We are pleased to report that this Division has continued to receive excellent
co-operation from private physicians and other agencies within the Province in regard
to the matter of reporting clinical cases of venereal disease.
Prenatal syphilis has shown a notable decrease in the number of new cases
reported—three new cases during 1953, as compared with eight new cases in 1952. This
trend is indeed encouraging because prenatal syphilis for a number of years did not
decrease with the same rapidity as did new cases of acquired syphilis as reported to this
Division.
Due to the decreasing patient case-load, it was deemed advisable during the course
of the past year to avail ourselves of consultative service available from other agencies,
and we thereby have been able to terminate two consultant appointments within the
professional establishment of the Division. It should be emphasized that the calibre
and availability of this consultative service to all physicians within the Province have been
maintained at their usual high level.
The treatment schedule was again completely revised by members of this Division
and made available to all physicians practising in the Province. This new schedule was
drawn up with the following intentions: To simplify and standardize treatment and
follow-up procedures, and to present this material in a readily available manner.
Free drugs were again made available to all private physicians for the treatment of
patients with venereal disease. The newer types of antibiotics have also been made
available for treatment of those patients who have demonstrated previous penicillin
allergic manifestations. This Division has continued to supply all health units with the
necessary drugs in order that they can be dispensed locally to the private physicians.
Because of the increasing problem that non-specific urethritis presents, it was considered wise to retain the services of a genito-urinary consultant. During the forthcoming year it is hoped that the Division will be able to devise a more satisfactory
schedule of diagnostic criteria" and treatment for the management of this troublesome
condition.
During the past year several new developments have taken place within this Division.
A limited clinical assay was performed to determine whether or not the newer long-acting
penicillins would be of assistance for the treatment of female repeaters who make up
a goodly percentage of our problem. The consultant in epidemiology has advised that
females be treated after one naming as a contact, in order that a modified type of speed-
zone epidemiology could be instituted within this Division. The results of this change
and of several others, although it is too early to report any accurate figures, have shown
a very encouraging trend.
189399 Y  102 BRITISH COLUMBIA
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; Juvenile Detention Home;
and New Westminster clinic. The Vancouver clinic no longer remains open on Saturday
morning because of the marked decrease in clinic attendance.
Other forms of venereal disease, such as chancroid and lymphogranuloma venoreum,
encountered during the year were mainly found among mariners entering the port of
Vancouver. There was no evidence of increased spread of these infections among the
general population.
EPIDEMIOLOGY
It has continued to remain our belief that the key to the control of venereal disease
lies in the vigorous and enthusiastic application of epidemiological methods. With our
goal thus defined, it has been a constant and ever-increasing challenge to uncover new
productive avenues of approach which might help us more rapidly to eradicate our
reservoir of infection.
During this past year special studies have brought to our attention the part played
by the female in the transmission of gonorrhoea from the reservoir of infection to the
fresh male host. In order to deal with this, we have adopted the policy that all female
contacts to gonorrhoea be treated on their first visit to the clinic. The immediate problem
of bringing the contact to treatment more rapidly has resulted in a modified programme
of speed-zone epidemiology aimed at bringing a high percentage of our female contacts
to treatment within twenty-four or seventy-two hours following receipt of information.
The Vancouver City Gaol examination centre continued to function as a very
important part of the epidemiology programme. The number of newly diagnosed
gonorrhoea infections has decreased to an all-time low, and it is felt that this changing
index accurately reflects the prevalence of gonorrhoea in Vancouver. Treatment in the
centre is offered to all patients on epidemiological grounds or clinical evidence of
infection.
The clinic at Health Unit No. 1, Metropolitan Health Committee, now operates
twice weekly, 11 a.m. to 1 p.m. A public health nurse is in attendance, 2 to 4 p.m. daily,
to undertake serological testing for the U.S. Immigration, down-town cafes, and industries. Persons reporting here during the above hours may receive tests for gonorrhoea,
and treatment if indicated.
This year the Indian Health Services assumed almost full responsibility for the
epidemiological follow-up of all Indians. Health units have established policy on a local
level whereby the agency which is able to do the most rapid follow-up of the Indian
handles the referred case.
The epidemiological section continued to have a very satisfactory liaison with the
private physicians throughout the Province. The adequacy of contact information
obtained by the physician has improved so that we have been able to investigate many
more of these contacts.
New approaches to the suppression of facilitators and facilitating premises has
required continuous study. Where misdemeanours occur, a greater effort has been made
to pin-point responsibility on one individual. Three meetings were held during the
year—one with other interested departments and agencies, and two meetings with the
managers of hotels and rooming-houses which have been community trouble-spots over
a period of several years.
The American Social Hygiene Association again sent a representative to survey the
facilitating processes operating in Vancouver City. These objective reports have proved
helpful in giving us specific information regarding certain activities within the city.
eeEeii DEPARTMENT OF HEALTH AND WELFARE,  1953 Y 103
Senior members of the Division made a total of six visits to the field staff to discuss
epidemiology techniques and assist with problem cases.
This has been a year of changing emphasis for the epidemiological section of the
Division. It is hoped a wise choice of activities on which to place emphasis will strengthen
our programme and eliminate unproductive case-finding and case-holding effort.
SOCIAL SERVICE
For a three-month period during the year there was no case-worker at the Vancouver
clinic, and service on a part-time basis was provided by Social Service staff from the
Division of Tuberculosis Control. In spite of this staff difficulty, counselling service was
continued for the patients reporting to the Vancouver clinic for treatment, and there were
805 patient-interviews carried out by the Social Service Section during the year.
In addition, this Section participated in the educational programme for student-
nurses, public health workers, and professional staff in allied fields undertaken by the
Division of Venereal Disease Control.
In our work with the patient-group, at the termination of each interview the clinic
social worker recorded her assessment of the patient and his capacity to utilize this
counselling service, and the following criteria were taken as a guide: —
Group I. — This person is capable of taking responsibility for himself;  he is
functioning adequately in his life situation and his infection has been
acquired as the result of an episode that is out of character with his
behaviour pattern.
Group II.—This person has capacity to take responsibility for himself but he
needs help in defining this;  he also lacks knowledge about the venereal
diseases and about sexual behaviour in general.
Group III.—This person manifests real conflict in some area of his life, and his
promiscuous behaviour is symptomatic of this stress.    The pressure may
be external because of the life situation in which he finds himself, or it
may be within the personality structure of the individual.
Group IV.~In all of his personal relationships this individual functions on
a casual level, and his sexual behaviour follows the same pattern.    His
roots are shallow, and he does not want to or is not capable of assuming
personal responsibilities.    His goal in life is ill-defined, but he is not in
conflict about himself or his situation.
Group V.—This is the chronic-problem person whose life is disordered and
whose promiscuous behaviour is part of that way of living.   He exists on
the fringe of crime, and authority is his natural enemy.
In the twelve-month period under review, out of the total 805 patient-interviews,
rating of the patient by the social worker was recorded in 660 cases.   Of the remainder,
70 had been rated in a previous interview, 42 required no service other than referral to
some other medical resource, 14 were not venereal-disease patients, and 19 were not
given a rating.
Of the 660 who were rated, 104 were considered to come within Group I. For these
patients the counselling interview was an opportunity for the patient to review his
behaviour in the light of his goal in life, and thus the total treatment process became sex
education with real meaning for the patient as a person.
There were 163 patients classified as Group II, and here again the social worker's
interview was geared to make the learning process a personal experience which would
enhance the patient's capacity to meet future situations in his life.
Among the 148 rated in Group III were most of the social ills, including marital
conflict, personality disorders, alcoholism, adolescent revolt against parental authority,
illegitimate pregnancy.    With some, the basic problem was too deep-rooted for any Y  104 BRITISH COLUMBIA
effective help to be given in one interview, but most of these people derived some comfort
from sharing their problems with the case-worker. The interview was a sorting-out
process, and the patient was encouraged to utilize the resources available in the community
for meeting his particular kind of need. Some of these patients continued their relationship with the clinic social worker after medical treatment was completed. It is from this
group of patients that most of the referrals were made from the Social Service Section
to the psychiatric consultant.
The 208 patients considered to come within the Group IV classification represented
almost one-third of the total number rated. While these people represent a continuing
problem in venereal-disease control because of their way of living, they can be helped to
assume more responsibility in the epidemiological control of these diseases. For these
patients the counselling interview was directed toward emphasizing the importance of the
infected person in the control process, since he alone has the vital information about his
sex partners that starts the epidemiological investigation. With this positive approach
to the patient, the control programme became a combined operation of patient and staff,
and this gave the patient some status. For many of them this is a rare and satisfying
experience.
There were thirty-seven patients considered to fall in Group V. This number was
small because most of the chronic-problem patients report to the treatment centre at the
city gaol rather than to the Vancouver clinic. There is very little that counselling can do
for this group, except to give these people the experience of courtesy and acceptance.
Like children, they respond to kindness by co-operating to the maximum of their limited
ability.
In summary, the twelve months' experience in the use of this rating scale indicates
that about two-thirds of the patient-group derive benefit from the counselling service.
The other one-third corresponds roughly to the proportion of the patient-group who have
repeated venereal infection.
EDUCATION
The Division of Health Education is primarily responsible for the health-education
programme to lay groups, while the Division of Venereal Disease Control has accepted
the responsibility for professional and staff education.
Lectures were given to student-nurses in all nursing-schools on the methods of
control and the facilities available throughout the Province. The regular course of
instruction was given to the students from the Vancouver General Hospital who come to
the Division for a two-week period during their training. Besides lectures, they receive
a thorough grounding in the clinical aspects of venereal-disease control and also take
part in the epidemiology programme. Students taking their course in public health
nursing at the University also came for a one-week period, to participate in all phases of
our work. Lectures were given to the psychiatric nurses at Essondale, practical nurses
at the Vocational School, second- and third-year medical students at the University of
British Columbia, and to various other groups.
Youth groups have requested speakers on several occasions.
Fortnightly staff meetings were held at the Division headquarters. Lectures on
various aspects of syphilis and gonorrhoea were given, also a very interesting panel discussion, with the consulting specialists giving interpretations from their special fields. These
were attended by the consulting staff and members of the Division.
An exhibit was again presented at the Kiwanis Annual Fair and Trade Exhibition
in North Vancouver. " Corkie, the Killer " was the subject theme. Blood tests were
offered to the public and literature distributed.
At the annual meeting of the Health League of Canada a small display was put on
to show professional groups the continued need of an active programme for venereal-
disease control.   Pamphlets were obtainable and much interest was shown. DEPARTMENT OF HEALTH AND WELFARE,  1953
Y 105
The manuals " Venereal Disease Information for Nurses " and " V.D. Control
Program of the Health Branch " were revised and reprinted during the year. These
manuals are widely distributed to student-nurses and other interested persons in the
Province. A new pamphlet has been obtained which gives an excellent interpretation
of the part played by the student-nurse in venereal-disease control during her hospital
training.
The following is a list of papers given or published by members of the Division in
the course of the year:—
(1) " Challenging Trends in V.D. Control," by Dr. A. John Nelson and Dr.
Ben Kanee, presented before the American Academy of Dermatology and
Syphilology in December, 1953.
(2) " Police and Health Department Co-operation in V.D. Control," by A.
John Nelson, M.D., D.P.H., was accepted for publication in the Journal of
Social Hygiene.
(3) In the January, 1953, issue of the Vancouver Medical Association bulletin
a paper entitled " Prophylaxis of Ophthalmia Neonatorum," by G. R. F.
Elliot, M.D.C.M., D.P.H., and A. John Nelson, M.D., D.P.H., was published.
(4) " Recent Advances in Venereal Disease Control," by A. John Nelson,
M.D., D.P.H., was accepted for publication in the Canadian Nurse.
GENERAL
National health grants continued to prove most 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.
Funds from these grants were made available to assist in the development and
operation of the Bio-Medical Library, University of British Columbia. In the library,
up-to-date literature on venereal diseases is maintained, and the senior consultant to the
Division is an active member of the management committee.
The Division is most appreciative of the co-operation and help extended by various
other groups and agencies with an interest in the promotion of social hygiene and control
of venereal disease. Special mention must be made of the Vancouver City Police, the
Royal Canadian Mounted Police, the British Columbia Hotels' Association, the Liquor
Control Board, the Indian Affairs Branch of the Department of Citizenship and Immigration, the Armed Forces Disciplinary Control Board of the United States 13th Naval
District, and the American Social Hygiene Association.
In addition, special appreciation is expressed to the Division of Laboratories, without
whose ever-willing services and co-operation this Division would find it difficult to
function, and also to the Division of Vital Statistics for its helpful advice and assistance
so freely given at all times. Y 106 BRITISH COLUMBIA
REPORT OF THE DIVISION OF TUBERCULOSIS CONTROL
Dr. G. F. Kincade, Director
In the following report an attempt will be made to analyse trends in the basic
elements of tuberculosis-control and to emphasize those important changes which influence planning and indicate the lines of future development. There can be no doubt that
with the important changes in treatment and case-finding that have occurred in recent
years, the problem of tuberculosis-control has changed dramatically. We have now
reached a critical stage in our development and must carefully analyse our position in
an attempt to forecast the future.
Experience in recent years, since the advent of antimicrobials and recent developments in chest surgery, has shown that tuberculosis can now be cured. Hence our whole
concept in the approach to treatment has changed in that we now attempt to achieve
a cure, whereas formerly we had to be satisfied to bring the disease under control with
stabilization of the lesion, and through careful control of the patient to hope that the
disease would remain arrested. Our present objective is the eradication of the lesion
from the body. This has had many and varied effects on the programme of hospitalization, although the future bed utilization and needs are not too clearly indicated as the
result of our changing treatment practices.
Even though our practices have undoubtedly changed in the treatment of various
types and stages of disease, the average length of treatment of the cases admitted to
institutions over the past ten years has not varied greatly. The largest group of patients,
according to length of stay, is the one treated four to eight months, representing 202
patients out of 890 discharges in 1952. Another 129 cases were treated one to four
months, and 156 cases treated less than one month. All told, 666 cases, or 75 per cent
of the total, were treated under one year.
Actually it is surprising that the average length of treatment has not increased
considerably. The death rates will show that many people with advanced disease are no
longer dying of tuberculosis. These people are recovering through antimicrobials, but
usually after prolonged hospitalization. Surgery has also increased markedly, in line with
the present conception of removing dangerous foci which might later reactivate. This
policy applies not only to the new cases who have an incomplete result from medical
treatment and are left with a dangerous focus, which must be removed, but also to many
other cases, of which there is a considerable backlog, who had their treatment in the
pre-streptomycin era and pre-resection era and are now being readmitted for resectional
surgery.   These major chest surgical cases necessitate long periods of institutionalization.
In view of the obvious increase in hospitalization of the above two groups, it must
be indicated that medical cures through antibiotics in the less advanced cases must have
been achieved in shorter periods of time. Moreover, those cases in which the definitive
treatment is obviously surgical are more quickly brought into condition to undertake this
surgery. One would therefore expect with fewer far-advanced cases being discovered
and the backlog of surgical cases being gradually overcome that the periods of hospitalization should soon see a definite reduction.
In this connection it is interesting to note that in 1952, 41.7 per cent of the first
admissions to institutions were minimal, 33.2 per cent moderately advanced, and only
16.1 per cent were far advanced. Over the past ten years this has shown an encouraging
trend, with the far-advanced first-admission cases reduced by almost 50 per cent while
the minimals have increased by 50 per cent.
BED SITUATION
During recent months an unusual situation has been experienced in the Division of
Tuberculosis Control in that there have been empty beds, and all cases, except for elective DEPARTMENT OF HEALTH AND WELFARE,   1953 Y  107
surgical cases, could be admitted immediately. At the present time there are twenty-one
empty beds and twenty-eight patients on the waiting-list. The waiting-list is composed
of surgical cases or of those who will not go to institutions where beds are available. This
enviable situation has been achieved mostly by the addition of new beds in the past year.
At the present time there are approximately 925 beds within the units of the Division,
as compared with 772 before the opening of Pearson Hospital. The number of applications for the first ten months of this year was 799, as compared with 804 in the first
ten months of 1952, which would indicate that the reduction of the waiting-list is due to
increased facilities and not to any reduction of persons needing treatment.
Due to the nursing shortage there are forty beds in that complement at Tranquille
which are not occupied. However, in view of the fact that there are fifteen empty beds
at Tranquille in the limited complement now in use, the advisability of endeavouring to
operate these extra forty beds under existing conditions is questionable.
Notwithstanding the present favourable position, other factors which could affect
the bed situation must be taken into account. It is well known that there are numerous
cases needing treatment who refuse hospitalization. If these were forced into institutions, with effective legislation, a great many more beds would be needed. Similarly,
if Provincial responsibility for chronic care is extended to non-pulmonary tuberculosis,
present facilities could not meet these needs.
A census of sanatorium patients taken on September 30th of this year indicates
an increasing trend of occupancy of beds by male patients over 50 years of age. Out of
a total occupancy of 843 beds, 562 were males, of whom 271 or 48.2 per cent were over
50 years of age. Out of 281 female patients, only 25 or 8.9 per cent were over 50 years
of age. In all, 296 or 35.1 per cent of total beds were occupied by persons over 50 years
of age. This has increased from 28.3 per cent a year ago. The ratio of male to female
bed patients is at present exactly two to one, and in view of the fact that the distribution
of males and females in the total population is almost equal, these figures would indicate
that tuberculosis in the male is a much greater problem than tuberculosis in the female.
Also the male over 50 years of age is one of our greatest institutional-care problems,
and this appears to be definitely increasing rather than decreasing.
MORTALITY
The trends in mortality from tuberculosis are very well known and most striking.
In 1946 there was a death rate in British Columbia of 57.4, with 576 deaths per annum.
This year is chosen because it was about the beginning of the streptomycin era. The
rate has declined steadily each year, until the present rate is less than one-quarter of that
in 1946. In spite of an increasing population, only 214 deaths were recorded in 1952,
giving a rate of 17.9. The preliminary figures for 1953 show 140 deaths, giving a rate
of 11.4. Undoubtedly, most will agree that this dramatic decline in deaths has come
about chiefly as a result of the antimicrobials.
In the other-than-Indian group the proportion of deaths in age-groups 50 and over
is very striking. The preliminary figures for 1953 indicate that only six deaths occurred
in persons under 20 years of age, mainly in the 1-4 age-group. Eighty-three out of 123
deaths occurred in persons 50 and over, representing 67 per cent of all deaths from
tuberculosis.   The ratio of deaths in males to females in this group was five to one.
MORBIDITY
The reduction in morbidity from tuberculosis admittedly has not been so marked
as in mortality, but, in spite of what is written elsewhere to trie contrary, there has been
a striking decline in the number of new cases of tuberculosis discovered in recent years.
This is of even greater significance in view of the increased tempo of our case-finding
activities. Y  108 BRITISH COLUMBIA
In 1943, at the beginning of community survey work, approximately 46,000 examinations were done, with 1,688 new cases being discovered. As this programme gained
momentum, in 1947 approximately 180,000 examinations were done, and the peak in
morbidity was reached with 2,616 new cases being reported. Since then case-finding
efforts have been further expanded to include admission X-ray surveys and continuing
community surveys, with 282,000 chest X-rays being taken in 1952. In spite of this
there was a marked decline in new cases found to 1,383 for the year. In other words,
while the case-finding effort increased over 50 per cent, the morbidity rate was reduced
almost by the same degree. It is not suggested that present morbidity rates should give
rise to complacency, nor should there be a reduction in efforts to seek out the undiagnosed
case of tuberculosis, but it is felt that those engaged in the work should realize the true
state of affairs and take satisfaction in the results achieved so far.
An analysis of morbidity rates in the various age-groups over the past ten years
proves interesting and shows that in all age-groups up to 14 years of age very little
change has taken place. However, this group has had a low morbidity rate, now ranging
from 25.5 to 34.0 per 100,000. In the age-groups above 20 years this rate ranged
between 197.4 and 387.4 in the peak years of 1946 and 1947. In all groups over
15 years of age there has been a very decided decrease in the morbidity rates, now
ranging between 100 and 150 per 100,000. Up to 39 years of age the female morbidity
rate is slightly higher than the male, but over 50 years of age the male morbidity rate is
twice as high as the female morbidity rate. Tuberculosis is truly becoming a disease of
the male patient over 50 years of age.
During 1953, 1,494 notifications of tuberculosis were received.
MINIATURE X-RAY PROGRAMME
For some time now every effort has been made toward getting a higher percentage
of patients X-rayed on admission to hospital. During the year 1952 a marked improvement was obtained, and these percentages were raised from 35 per cent in the first quarter
to approximately 50 per cent in the last quarter. On a yearly basis this represented
56,457 admission X-rays taken, which was approximately 40 per cent of all admissions
in those hospitals where photoroentgen units were available.
In the first quarter of 1953, 17,560 admission X-rays were taken, which represented
a 50.10-per-cent average for hospitals having miniature X-ray equipment. However, in
the second quarter of this year this fell very definitely, when out of 42,617 admissions
only 17,314 persons were X-rayed, making a percentage of 40.6. This improved during
the third quarter, and for the first nine months of 1953 the average was 47.78. During
the year 1953, 68,198 miniature X-rays were taken in admission surveys. Although the
total number is approximately 22,000 greater in 1953 than in the previous year, it does
not represent a good effort in the over-all picture, although some hospitals are doing
very well.
Out of thirty-four hospitals operating miniature equipment at the present time, only
nine or 26.4 per cent are averaging over 70 per cent of their admissions X-rayed, with
only one over 90 per cent. Eleven other hospitals or 35.4 per cent are operating between
40 and 70 per cent, while ten hospitals or 29.4 per cent operate between 10 and 30 per
cent. Four hospitals or 11.8 per cent operate below 10 per cent. It would therefore
appear that twenty-five out of the thirty-four hospitals are not doing a satisfactory job,
and obviously in a few hospitals only lip service is being given to the principles underlying
this programme. However, in fairness to the hospitals it should be pointed out that
through counting the over-all admissions to the hospitals, they were put in an unfavourable light because some of the buildings could not be serviced and in other instances some
account should have been taken of those admissions that were covered by large X-rays.
For this reason, the system of collecting figures has been changed, and it will now be done
directly from the Division of Tuberculosis Control central office to the hospital concerned. DEPARTMENT OF HEALTH AND WELFARE,  1953 Y  109
We feel that this will show a truer picture and put the hospitals in a more favourable
position. However, even when these corrections are made, it is obvious that constant
supervision of the programme will be necessary to stimulate hospitals to achieve satisfactory results.
It is pleasing that it was possible to extend the admission X-ray programme to the
smaller hospitals at the beginning of this year, paying the hospital a per capita rate for
X-rays taken on their own equipment. During the third quarter of this year 39.90 per
cent of admissions to these hospitals had chest X-rays. During the twelve-month period
9,642 admission films were taken as part of this programme. When we consider that
this is only in the organizing stage, the results look very encouraging.
The over-all X-ray admission rate, including miniature and large plates, was 58.72
per cent for the first nine months, with 80,759 X-ray films being taken during the year.
That a chest X-ray is now available to any person admitted to hospital in British
Columbia is indeed a very satisfactory state of affairs, and has rounded out our case-
finding programme in this Province.
In assessing the value of the hospital installations throughout the Province, the
principle of continuing community X-ray surveys, which has also been instituted through
the use of these machines, must also be kept in mind.
During the year 31,785 out-patients had chest X-rays taken on this equipment, which
would indicate that this utilization was somewhat greater than in previous years. In some
hospitals the number of out-patients X-rayed is greater than the number of in-patients.
Thus, aside from their importance in the admission X-ray programme, these installations
play an important role in the total case-finding programme.
With the large amount of X-ray equipment committed to the case-finding programme,
together with the large expense involved in conducting such a programme, it must be
constantly considered how long this can be justified by case-finding results. It has long
been recognized that this would be a case of diminishing returns, with fewer cases discovered as surveys were repeated throughout the Province.
In 1944, when 40,441 patients were examined, 371 cases of pulmonary tuberculosis
were diagnosed, making a case-finding rate of 9.2 per 1,000. This was only slightly
lower in 1945, while in 1947, with 162,912 examinations, 699 cases of pulmonary
tuberculosis were discovered, giving a rate of 4.2 per 1,000. In 1952, with 229,317
examinations, 802 cases of pulmonary tuberculosis were discovered, giving a rate of 3.5
per 1,000.
It would therefore appear that after a drastic reduction in the first two years the case-
finding rate since then has not fallen too markedly.
In the matter of active pulmonary tuberculosis, the 93 cases discovered in 1944
represented a rate of 2.5 per 1,000, which fell to 0.55 per 1,000 in 1945, and in 1952,
155 active cases of tuberculosis represented a rate of 0.68 per 1,000. Again, this rate
has not changed greatly over the past five years, and it would therefore seem that this is
still an effective case-finding method.
For some time now the examination of high-school students through X-rays on
a mass X-ray survey basis has been discouraged. However, on occasions these surveys
have been done. In 1952, 10,000 high-school students in Greater Vancouver were
examined in this manner. An analysis of findings shows that only one case of tuberculosis was discovered. This definitely confirms the previous conviction that, as a case-
finding method, results in this group are not fruitful, and it would indicate that the
equipment can be used to better advantage in other age-groups.
NATIONAL HEALTH GRANTS
The total grant for tuberculosis-control for the present fiscal year is somewhat lower
than previously. In 1952-53 it was $370,329. The original grant for 1953-54 was
$367,585, and this has been reduced by $20,000 which was taken into another grant. Y   110 BRITISH COLUMBIA
Of the $347,585 left, $338,431 has already been allocated for projects, most of
which have been approved. Only $12,000 of this total has not yet been approved.
For the first time since the grants were established, the Division was in a position to
overexpend the amount allocated. In fact, to meet those projects at present proposed,
it was necessary to delete projects already approved where it was obvious that the
equipment could not be obtained nor the services utilized to the total extent of the money
provided. It will be recalled that in the past the total amount of money available in the
Tuberculosis Control Grant was not utilized, mostly as a result of non-delivery of
equipment. The percentage utilization in previous years was as follows: 1948-49,
77 per cent; 1949-50, 77 per cent; 1950-51, 90 per cent; 1951-52, 76 per cent;
1952-53, 65 per cent.
At the present time it looks as though the grant for this fiscal year will come much
nearer total utilization. This, of course, depends on accounts being submitted in time
and equipment now on order being delivered before the end of the fiscal year. However,
there is not a great deal of equipment outstanding, and practically all the orders should
be filled in time.
A breakdown of the expenditures for tuberculosis under National health grants will
show that $91,008, about 25 per cent of the total, is allocated to staff and equipment in
the various units of the Division, which does not include a further $27,900 for a rehabilitation programme. This latter makes provision for extra rehabilitation services and the
tripling of the existing staff. It is hoped that these new positions will be filled in the
near future so that the rehabilitation programme may be properly developed in all of the
institutions. At the present time there are twenty-four positions within the Division of
Tuberculosis Control in which the salaries are provided through National health grants.
Through these grants a considerable amount of money is spent on the case-finding
programme. This represents over one-third of the total grant. The X-ray pool, which
provides new photoroentgen units and replacements for the existing machines, is in the
amount of $20,750. In this amount is provided new equipment for the Kimberley
Hospital and the Salmon Arm General Hospital. For assistance in community survey
work, $35,000 is allocated, while the payment for both miniature and large admission
X-rays is in the amount of $75,000.
Another large item in National health-grant expenditures is that for the antimicrobials, where $70,500 is allocated. Ten thousand five hundred dollars is spent for postgraduate training of doctors and nurses, while $8,500 of the National health-grant money
is used in the educational programme for professional student-nurses and practical-nurse
students.
From these figures it will be seen that most of the money in this grant is committed
to continuing projects. This amounts to over two-thirds of the total grant and leaves
only about $100,000 a year for new projects and the purchasing of equipment.
GENERAL
No major changes have taken place in the planning and operation of the Division
during the past year. Remodelling at Tranquille Sanatorium has continued and is nearing
completion. The new laundry has been in operation since early in the year, and the
conversion of the power plant from coal to oil, which took place last year, is now completed with the installation of storage-tanks and pumps. Conversion of the ground floor
of the Infirmary Building to provide a library, central supply-room, pharmacy, dental
offices, and X-ray department is just about finished.
The last ward at Pearson Hospital was opened early in the year, and the institution
has been running to capacity since then. The usual problems of setting up an institution
have been encountered, but the hospital is operating very satisfactorily. The development
of the grounds is well under way, with the planting of lawns and improvement of the
lighting. DEPARTMENT OF HEALTH AND WELFARE,  1953
Y  111
Renovations in the Vancouver Island Chest Centre are about completed, to provide
a separate X-ray survey clinic in this unit. The New Westminster Stationary Clinic is
being provided with new and enlarged quarters in the Gyro Health Centre. This was
made possible by the addition of a new wing to the building, financed in part by the
British Columbia Tuberculosis Society.
The tuberculosis-control programme in the Province involves many agencies whose
close co-operation and sympathetic understanding are essential to successful operation.
The harmonious relations and willing assistance from all departments of the Government—local, Provincial, and Federal—is sincerely appreciated.
To the many voluntary agencies who assist in the programme, the Division is deeply
indebted for the success of the work. The Vancouver Preventorium Board continues
to provide facilities for the treatment of children with tuberculosis and is planning for
an extension of their present facilities to accommodate a larger number of patients.
As it has for almost fifty years, the British Columbia Tuberculosis Society continues
to play a major role in the fight against tuberculosis. Always alert to the unmet needs in
the fields of prevention, case-finding, and treatment, this group lends a great support to
the public agencies.
VICTORIA, B.C.
Printed by Don McDmrmid, Printer to the Queen's Most Excellent Majesty
1954
635-154-7140 

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