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Tenth Report of the DEPARTMENT OF HEALTH AND WELFARE (HEALTH BRANCH) (Fifty-ninth Annual Report of Public… British Columbia. Legislative Assembly 1956

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 PROVINCE OF BRITISH COLUMBIA
Tenth Report of the
DEPARTMENT OF HEALTH
AND WELFARE
(HEALTH BRANCH)
(Fifty-ninth Annual Report of Public Health Services)
YEAR ENDED DECEMBER 31st
1955
'
VICTORIA, B.C.
Printed by Don McDiarmid, Printer to the Queen's Most Excellent Majesty
1956  Office of the Minister of Health and Welfare,
Victoria, B.C., January 9th, 1956.
To His Honour Frank Mackenzie Ross, C.M.G., M.C.,
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, 1955.
ERIC MARTIN,
Minister of Health and Welfare. Department of Health and Welfare (Health Branch),
Victoria, B.C., January 9th, 1956.
The Honourable Eric Martin,
Minister of Health and Welfare, Victoria, B.C.
Sir,—I have the honour to submit the Tenth Report of the Department of Health
and Welfare (Health Branch) for the year ended December 31st, 1955.
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)
The Honourable 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.,
Deputy Provincial Health Officer and Director, Bureau of
Local Health Services.
G. R. F. Elliot, M.D., CM., D.P.H.,
Assistant Provincial Health Officer and Director, Bureau of Special
Preventive and Treatment Services.
A. H. Cameron, B.A., M.P.H.,
Director, Bureau of Administration.
G. F. Kincade, M.D., CM.
Director, Division of Tuberculosis Control.
C. E. Dolman, M.B., D.P.H., Ph.D., F.R.C.P.,
Director, Division of Laboratories.
A. A. Larsen, B.A., M.D., D.P.H.,
Consultant in Epidemiology and Director, Division of
Venereal Disease Control.
J. H. Doughty, B.Com., M.A.,
Director, Division of Vital Statistics.
R. Bowering, B.Sc.(CE.), M.A.Sc,
Director, Division of Public Health Engineering.
T. H. Patterson, M.D., CM., D.P.H., M.P.H.,
Director, Division of Environmental Management.
Miss M. Frith, R.N., B.A., B.A.Sc, M.P.H.,
Director, Division of Public Health Nursing.
F. McCombie, L.D.S., R.C.S., D.D.P.H.,
Director, Division of Preventive Dentistry.
R. H. Goodacre, M.A., C.P.H.,
Director, Division of Public Health Education.
Miss D. Noble, B.Sc.(H.Ec), C.P.H.,
Consultant, Public Health Nutrition.
C. R. Stonehouse, CS.I.(C),
Senior Sanitary Inspector.
C. E. Bradbury,
Rehabilitation Co-ordinator.
E. R. Rickinson,
Departmental Comptroller.
5  TABLE OF CONTENTS
General—
The Province and Its People
Mortality and Morbidity.
Page
13
13
14
17
18
19
20
21
22
24
Community Health Centres _.     26
Details of Construction re Community Health Centres	
Resident Physician Grants	
School Health Services	
The Health of the School-child	
Table I.—Physical Status of Pupils Examined, Showing Percentage in
Each Group, 1948-49 to 1954-55.
The Organization for Public Health Services 	
Accommodations .—	
Training	
Table I.—Local Health Services (Other than Greater Vancouver or Vic-
toria-Esquimalt)	
Table II.—Offices and Divisions Providing Administrative, Consultative,
and Other Specialized Services	
Report of the Bureau of Local Health Services .	
Health-unit Organization and Development	
Administration _	
School Grade, 1954-55.
Home-care Programmes	
Nursing-care Programme..
Disease Morbidity and Statistics-
Report of the Division of Public Health Nursing-
Status of the Service	
Public Health Nursing Consultant Service	
Public Health Nursing Training	
27
29
29
31
34
34
Table II.—Physical Status of Total Pupils Examined in the Schools for
the Years Ended June 30th, 1951-55	
Table III.—Physical Status of Total Pupils Examined in Grades I, IV,
VII, and X for the Years Ended June 30th, 1951-55...     34
Table IV.—Summary of Physical Status of Pupils Examined, according
to School Grades, 1954-55     35
Table V.—Physical Status by Individual Grades of Total Schools, 1954-55    35
Table VI.—Number Employed and X-rayed amongst School Personnel,
1954-55	
Table VII.—Immunization Status of Total Pupils Enrolled according to
36
36
36
38
39
Table VIIIa.—Percentage Distribution of Children by Eligibility for and
Acceptance of Poliomyelitis Vaccine and Age, British Columbia,
July lst to November 30th, 1955     42
Table VHIb.—Percentage Distribution of Children Accepting Poliomyelitis Vaccine by Number of Injections Received and Age, British
Columbia, July lst to November 30th, 1955 .     43
Table IXa.—Paralytic Poliomyelitis Cases and Attack Rates by Age and
Vaccination Status, British Columbia, July lst to November 30th,
1955 . .     43
Table IXb.—Poliomyelitis Cases in Contact of Vaccinees with Onset
Interval, British Columbia, May 18th to November 30th, 1955     43
Table X.—Notifiable Diseases in British Columbia, 1951-55     46
Table XL—Notifiable Diseases in British Columbia by Health Units and
Specified Areas, 1955     47
48
48
49
51 N 8 ;-      BRITISIT COLUMBIA
Page
Local Public Health Nursing Service . —— 52
Maternal Health—Prenatal and Postnatal 1 —_ 53
Child Health—Infant and Pre-school .  53
Child Health—School  53
,.    Tuberculosis...  54
Other Communicable Diseases 1  54
Nursing Care ...  54
General   55
Home and Office Visits  55
Clinic Attendance ■  55
Immunizations Completed  56
Report of the Division of Environmental Management  57
A. Nutrition Services .  5 8
Consultant Service to Local Public Health Personnel... .  58
Community Health .  58
Maternal and Child Health . 1 __._, _._    __ 59
School Health  60
Consultant Service to Hospitals and Institutions .  61
General Observations  61
B. Sanitary Inspection Services  62
Milk  62
Eating and Drinking Places  63
Frozen-food Locker Plants .  63
Slaughter-houses  63
Meat Inspection  64
Industrial Camps  64
Summer Camps  64
Schools  65
Barber-shops and Beauty-parlours .  65
Vermin-control   65
Garbage-disposal . . ,  66
General _. 66
C. Civil Defence Health Services  66
Hospital Disaster Plans  66
Emergency Medical Supplies  66
Emergency Blood Service  67
Study Forums  67
Training .. .  67
General ..___  68
D. Employees' Health Service j  68
Investigation of Specific Occupational and Environmental Hazards  70
E. Health-care Research Project  70
Report of the Division of Preventive Dentistry  72
Research : 1  72
Prevention :  73
Community Preventive Dental Clinics  74
Regional Dental Consultants .... :  74
Full-time Preventive Dental Services  75
Summary of Preventive Dental Programmes in British Columbia _____ 75
Dental Personnel .  76
Dental Faculty  76 DEPARTMENT OF HEALTH AND WELFARE, 1955
N 9
Report of the Division of Preventive Dentistry-
Dental Services in Rural Areas.
-Continued Page
 :     76
British Columbia Dental Association .     77
General      77
Table Ia.—Community Preventive Dental Clinics in British Columbia,
1948-54 .     78
Table Ib.—Community Preventive Dental Clinics in British Columbia,
1954-55     78
Table II.—Clinical Services by School Grades, School-year 1954-55     78
Table III.—Full-time Preventive Dental Services in British Columbia by
Local Health Agency, Showing Services Provided in School-year
1954_55 and Comparisons with 1953-54     79
Table IV.—Full-time Preventive Clinical Dental Services Provided to
Children in Health Units in British Columbia by Age-groups for the
School-years 1951-52 to 1954-55     80
Table V.—Full-time Preventive Clinical Dental Services Provided to
Children in British Columbia by Age Groups for School-years
1953-54 and 1954-55     81
Table VI.—Summary of Preventive Dental Services in British Columbia
during School-year 1954-55 Showing Distribution of Services and
Clinical Services to Pre-school Children and Grade I Pupils     81
Report of the Division of Public Health Engineering  82
Water-supplies  82
Sewage-disposal  84
Stream Pollution  85
Shell-fish  86
Swimming and Bathing Places ... 87
Tourist Accommodation :  87
Frozen-food Locker Plants  87
General  88
Report of the Division of Vital Statistics	
Registration of Births, Deaths, and Marriages
Current Registrations	
Delayed Registration of Births	
  89
  90
 .  90
  91
Documentary Revision .  91
Revision of Indian Vital Statistics  91
Elimination of Duplicate Registrations  92
Microfilm and Photographic Services  93
Administration of the " Marriage Act "  93
Caveats  _.  94
"Marriage Act Amendment Act, 1955 " :  94
Registration of Notices of Filing a Will  94
District Registrar's Office  95
Changes in Registration Districts  95
Inspections  95
Vancouver Office  96
Statistical Section  96
Tuberculosis Statistics  97
Venereal-disease Statistics _._  97
Crippled Children's Registry  98
Dental-health Statistics  98
Mental-health Statistics  98 N 10 BRITISH COLUMBIA
Report of Division of Vital Statistics—Continued
Statistical Section—Continued Paoe
Cancer Statistics   99
Epidemiological Statistics  99
Population Estimates i_ __.  99
Poliomyelitis Cost Study  99
Special Assignments ___  100
Vital Statistics Special Reports  100
Summary of 1955 Vital Statistics . .. .  101
Population and Natural Increase  101
Birth and Stillbirth Rates.. . 1  102
Principal Causes of Mortality 1  102
Report of the Division of Public Health Education  103
Staff Education  103
Public Education . . .  104
Personnel . .  106
Report of the Bureau of Special Preventive and Treatment Services, Vancouver  107
Buildings _. I  107
General .  107
Faculty of Medicine, University of British Columbia .  109
Voluntary Health Agencies  109
Alcoholism Foundation of British Columbia  109
British Columbia Cancer Foundation  109
Canadian Arthritis and Rheumatism Society (British Columbia Division) 109
Western Society for Rehabilitation  110
Canadian Red Cross Blood Transfusion Service  110
National Health Grants  111
General  111
Administration  111
Grants Received for the Year Ended March 31st, 1955  111
Crippled Children's Grant  112
Professional Training . .... 113
Hospital Construction Grant  113
Venereal Disease Control Grant  113
Mental Health Grant  114
Tuberculosis Control Grant  115
Public Health Research Grant .  115
General Public Health Grant  115
Cancer Control Grant  116
, Laboratory and Radiological Services Grant __.  116
Medical Rehabilitation Grant  117
Child and Maternal Health Grant  117
Acknowledgment  118
Report of the Division of Laboratories  119
Tests for Diagnosis and Control of Venereal Diseases  119
Tests Relating to Tuberculosis-control .  120
Salmonella-Shigella Infections  121
Other Types of Tests  121
Bacteriological Analyses of Milk and Milk Products and Water  121
Bacterial Food Poisoning  122
Diphtheria  122
Parasitic Infestations ...  122 DEPARTMENT OF HEALTH AND WELFARE,  1955
N 11
Report of the Division of Laboratories—Continued
Other Types of Tests—Continued Page
Fungous Infections  122
Miscellaneous Tests  123
Branch Laboratories  123
General Comments  123
Table I.—Division of Laboratories, Department of Health and Welfare, Statistical Report of Examinations Done during the Year 1955   125
Table II.—Statistical Report of Examinations Done during the Year 1955,
Branch Laboratories	
126
Report of the Division of Venereal Disease Control  127
Epidemiology  127
Treatment  128
Social Service  129
Education  130
Administration  130
Report of the Division of Tuberculosis Control  132
Active Cases, 1954  133
Report of the Rehabilitation Co-ordinator  139
Acknowledgment  140
Report of the Accounting Division  141
. f' ' Tenth Report of the Department of Health and Welfare
(HEALTH BRANCH)
Fifty-ninth Annual Report of Public Health Services
YEAR ENDED DECEMBER 31st, 1955
G. F. Amyot, Deputy Minister of Health and Provincial Health Officer
During 1955 there were marked developments in the professional and administrative
fields and great improvements in the physical accommodations afforded many of the staff.
Once again it is possible to report that there was no grave outbreak of disease.
The General section, immediately following, has a twofold purpose. It describes the
chief features of the organization for public health services in British Columbia. It also
summarizes the year's major developments.
The programmes and activities of the various services are presented in greater detail
in the later sections, which have been written by the heads of those services.
All programmes and activities were planned and conducted by at least several, and
sometimes many, persons. Those concerned were representatives of other departments of
Government, professional groups, and voluntary agencies, as well as the Health Branch.
Their co-operation and contributions did much to advance the public health service. The
Deputy Minister of Health is sincerely grateful for this help.
The year 1955 was the eighth in the National health grants programme. Like the
previous years, it was noteworthy for the Department of National Health and Welfare's
assistance and understanding in administering the programme. This Annual Report contains many references to the benefits that British Columbia has derived from the grants,
and the Deputy Minister for the Province wishes to speak for all concerned in expressing
appreciation.
GENERAL
A. H. Cameron, Director, Bureau of Administration
THE PROVINCE AND ITS PEOPLE
According to the mid-year estimate, the population of British Columbia is 1,305,000.
This is an increase of 39,000 over the 1954 population. For the Province as a whole,
with its area of approximately 366,000 square miles, this gives a population density of
3.6 persons per square mile, the second lowest among the Provinces of Canada. Since
almost one-half of the total population lives in the metropolitan areas of Greater Vancouver and Victoria-Esquimalt, it follows that there are vast areas of the Province over
which the population is sparsely scattered. This feature presents a problem of great
importance in the provision of public health services. The great distances (and the
generally winding and often mountainous roads) reduce the accessibility of the people
who are to be served and tend to make the work more difficult and costly.
MORTALITY AND MORBIDITY
The Director of Vital Statistics reports that, once again, there was little change in
the crude death rate. For 1955 the preliminary figure for the population excluding
Indians was 9.6 deaths per 1,000 population.  Two-thirds of all deaths were caused by
13 N  14 BRITISH COLUMBIA
the degenerative diseases—heart disease, cancer, and cerebrovascular lesions—which
affect primarily the older population. The next three causes of death were accidents,
pneumonia, and diseases of early infancy. Although these accounted for about only one-
fifth as many deaths as did the first three, they affected the younger age-groups. Thus
they presented a more serious problem than their frequencies suggest.
The Director of Local Health Services states that there was an increase in the total
incidence of notifiable disease. The increase was due primarily to outbreaks of influenza
which occurred from January to May. Fortunately the disease was generally mild in
nature.
There was an encouragingly low incidence of streptococcal infections, particularly
those diagnosed as scarlet fever. However, there was a definite increase in the incidence
of whooping-cough. The Director of Local Health Services suggests that this disease
warrants special study to determine which age-groups are most affected and where the
emphasis in the immunization programme should be placed.
As in previous years, there were some cases of diphtheria, a fact which also points
up the importance of immunization.
The incidence of poliomyelitis for 1955 was practically the same as that for 1954
and considerably lower than that for 1953 and 1952. Although this past improvement is
not readily explained in the light of the present knowledge of the epidemiology of the
disease, there is some reason to hope for further improvements. This hope stems from
the programme of immunization with Salk vaccine. The administration of this vaccine to
children in the most susceptible age-groups was one of the most important accomplishments of British Columbia's public health services during 1955. The report of the Bureau
of Local Health Services contains more detailed information concerning the encouraging
results.
Enteric infections of the Shigella-Salmonella group continued to occur. However,
the numbers were somewhat smaller than in recent years.
Staphylococcal infection was the cause of some concern, particularly in relation to
the general hospitals of the Province. The Deputy Minister of Health appointed a committee under the chairmanship of the Senior Medical Health Officer for the Metropolitan
Health Committee of Greater Vancouver to study the matter and make recommendations.
It is anticipated that the first of these will be forthcoming early in the new year.
The Director of Venereal Disease Control states that there has been a continued
decline in the total number of venereal-disease cases reported. This reduction was due
solely to a decrease of about 250 in the number of cases of gonorrhoea reported. The
number of cases of infectious syphilis reported was practically the same as the year before.
According to the report of the Division of Tuberculosis Control, the mortality rate
from tuberculosis showed a slight increase during 1955, thereby reversing, to a small
extent, the dramatic trend which had taken place from 1946, the beginning of the streptomycin era, to 1954. The Director of Tuberculosis Control suggests that this may be in
the nature of a delayed mortality of a number of advanced cases as a result of treatment
with antimicrobials.
The demand for beds for the treatment of tuberculosis continued to decrease in
British Columbia, as it did elsewhere on this continent. New methods of treatment have
made it possible to shift the responsibility for the treatment of many of the cases from the
sanatorium to local health services.
THE ORGANIZATION FOR PUBLIC HEALTH SERVICES
Under the " Health Act," the Deputy Minister of Health, who is also the Provincial
Health Officer, is responsible for the organization and development of public health
services throughout the Province. In broad terms, this end is achieved through two
separate, although well co-ordinated, administrative methods.   First, the two metropoli- DEPARTMENT OF HEALTH AND WELFARE, 1955
N 15
tan areas of Greater Vancouver and Victoria-Esquimalt operate their own city health
departments. Although they receive substantial financial assistance from the Provincial
Government and, through the Provincial Government, from the Federal Government,
they do not come under the direct supervision of the Deputy Minister of Health. Second,
the remainder of the Province is served by public health workers who are employees of
the Provincial Government and who, because of that fact, come more directly under the
jurisdiction of the Deputy Minister of Health. The Provincial Government employees
form the staffs of the health units, which are defined as modern local health departments
staffed by full-time public-health-trained personnel serving one or more population centres
and the rural areas adjacent to them. There are seventeen such health units covering the
Province from the International Boundary north to the units whose headquarters are at
Prince Rupert and Prince George.
Although these seventeen health units are manned by Provincial Government employees, local autonomy is maintained. Each health unit director and, through him, his
staff are responsible to a union board of health consisting of elected citizens. The union
board controls the general aspects of the unit's health programme and activities. The
Health Branch, Provincial Department of Health and Welfare, provides the necessary
professional and technical guidance.
It is gratifying to be able to report, once again, that public health services are available to practically every citizen of British Columbia through either the metropolitan health
departments (Greater Vancouver and Victoria-Esquimalt) or the Provincial 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 1955
from the sources named were as follows:—
Source of Service Per Cent
City health departments of Greater Vancouver and Victoria-
Esquimalt   48.3
Provincial health units  49.2
Non-health-unit  areas   (public  health  nursing  and  sanitary
inspection districts)     1.6
Total  99.1
The seventeen Provincial health units are listed in Table I, which also gives information concerning geographical location, population served, and staff. An understanding
of the relation between the health unit and the school districts is important. When British
Columbia's system of health units was revised in 1946, each unit was made to encompass
several whole school districts. The chief purpose of this geographical relationship was to
provide a method of collecting the local contribution of 30 cents per capita per annum.
The local School Boards perform this service. However, it should be clearly understood
that the public health services provided by the health units include much more than school
health services. Although the latter are an important part of the programme, each health
unit provides a generalized service which deals with all health aspects of community life.
In Table I the information under " Positions " gives the numbers of available positions, whether occupied or vacant. The actual numbers of employees on staff were usually
less than the figures shown. Although a statement concerning the staff situation at one
particular date in the year is not necessarily significant, it is interesting to note that, at the
year's end, there were vacancies for one health unit director, three public health nurses,
six sanitary inspectors, four dental officers, and two dental assistants. There were no
vacancies in positions for clerical workers.
The fact that, at the year's end, there were only three vacancies in the 148 public
health nursing positions may give the false impression that there is no recruiting problem
in this group.   In actual fact, it has been particularly difficult to recruit nurses who have N 16 BRITISH COLUMBIA
the desired postgraduate training in public health. For this reason, approximately 18 of
the 148 nursing positions have been filled by registered nurses who lack the special postgraduate training. In accordance with a policy which has been in effect now for several
years, funds from the National health grants are used to provide small bursaries and pay
the university fees of such nurses who have proven themselves suitable to take the special
public health training.
The health units discussed above constitute the " front line " of the Provincial health
forces. In almost all cases the services reach the public through this part of the Health
Branch organization. But guidance, general direction, and specialized services are provided by other divisions and offices of the Health Branch. These other parts of the service
are listed in Table II, which gives certain other pertinent information also.
If the central office in Victoria and the branch office under the supervision of the
Assistant Provincial Health Officer in Vancouver could fill all of their positions with
adequately trained personnel, they would probably have approximately the correct number of employees to cope with the demands of the service. However, there are serious
shortages in staff. Two fully trained public health engineers resigned during the year.
Only one replacement has been obtained, and this only after a lengthy search and recruiting campaign. The Division of Public Health Education also lost two of its professionally
trained staff during 1955. This Division now has several vacancies which it is finding very
difficult to fill.
The Division of Vital Statistics faces a somewhat different situation. Although there
have been marked increases in the volume of work since 1950, the number of employees
is practically the same as it was at that time. On several occasions during 1955 the
normal production schedules could not cope with the labour load. This problem is complicated further by the fact that the Division's office space in the Parliament Buildings
could not accommodate additional employees even if these were authorized.
In the Division of Tuberculosis Control it has been possible, in two institutions, to
discontinue the use of certain groups of beds which were difficult to administer or uneconomical to operate. The establishment of employees was also reduced to some extent
during the year.
Although it is now possible to permit a greater number of tuberculosis patients to
leave sanatorium and return to their homes (if conditions there are suitable for their
care), many must still be supervised and given further treatment in their homes. This is
the responsibility of the health unit staffs, particularly the public health nurses, a fact
which has increased their labour load.
Over the past several years the Division of Venereal Disease Control has experienced
a lessening of the demands placed upon it. This has been the result of scientic improvements in case-finding and treatment. During 1955 it was possible to effect a reorganization and reduce the staff by some five employees. Further the directorship of the Division
has been reduced from a full-time to a part-time basis. (At the end of the year the Consultant in Epidemiology was also serving as Director of Venereal Disease Control with a
view to determining whether the one person could meet the needs of both positions.)
In the Division of Laboratories there was practically no change in the number of
authorized positions throughout the year. However, it has long been evident that the
Provincial laboratory services should be extended to deal with additional important public
health laboratory tests, and only lack of physical accommodations has prevented specific
action before this time. Now that the Division of Laboratories occupies much improved
quarters in the Provincial Health Building, it is hoped that the extension of services may
soon be effected.
The proper utilization of staff throughout the entire Government service, including
the Health Branch, was the object of an intensive survey conducted during 1955 under
the general direction of the Civil Service Commission. Fourteen survey groups studied
the various departments of Government.    Two groups were assigned to the Health k
DEPARTMENT OF HEALTH AND WELFARE,  1955 N 17
Branch—one to study the institutions and the other to study the remainder of the Branch.
A part of the survey was purposely postponed until the divisions and offices occupying
the Provincial Health Building had had an opportunity of becoming accustomed to their
new quarters. Thus the survey of the Health Branch had not been completed by the
year's end, and certain survey reports concerning the institutions also remained to be
submitted. However, in the already submitted report dealing with General Services,
Local Health Services, and the Division of Vital Statistics, the general conclusions were
as follows:—
" There was no evidence of any serious problem of overstaffing.
" Indeed, in the case of Local Health Services, there is evidence of understaffiing.
" In almost every office or division surveyed, it is possible to effect certain improvements in procedures and methods. Although each such improvement, by itself, may effect
only a small saving in time and energy, the total savings can either relieve the pressure in
an overburdened office (e.g., Local Health Services) or perhaps permit an actual reduction
in staff.
" The problem of space and accommodations is very serious. This is particularly
evident in the Victoria offices of the Health Branch (General Services and Division of
Vital Statistics). Lack of adequate working space and the geographical separation of
related offices reduce efficiency and make for unnecessary expenditure of labour."
ACCOMMODATIONS
For many years the Annual Reports of the Health Branch have discussed the difficulties, frustrations, and plans associated with the physical accommodations assigned to
the Division of Laboratories, the Division of Venereal Disease Control, and the Assistant
Provincial Health Officer in Vancouver. At long last it is possible, in this Report, to state
that the Provincial Health Building has become a reality. Located at 828 West Tenth
Avenue, Vancouver, it was occupied in July. In addition to providing modern accommodations and thus overcoming the difficulties and hazards under which the Division of
Laboratories, in particular, laboured, it simplifies administration by bringing together
under one roof all the Provincial health services in the Vancouver area, except the Division of Tuberculosis Control. (Even this Division has its headquarters offices connected
physically to the new building.) 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 is occupied by the Red Cross Blood Transfusion Service as a blood-
processing depot.
Another major development was the construction of the Poliomyelitis Pavilion,
which was completed early in the year. This unit was designed specially for the care of
convalescent poliomyelitis cases. It is located in Vancouver on the grounds of the Pearson Hospital, under which it comes for administrative purposes. The first patients were
admitted on March 24th, and the Pavilion is now operating to capacity. Thus it is doing
much to relieve the general hospitals of the long-term care of convalescent cases in order
that those institutions may use their facilities for the care of acute cases.
There was encouraging progress in the construction of community health centres
throughout the Province. Such buildings designed for the use of the public health staff
in the health units were completed at Revelstoke, Ladner, Keremeos, and Vancouver.
Construction was begun at North Vancouver and Prince George, and plans for construction were being made in eight other centres. The initiative of the citizens in the communities plays a most important part in these developments. Although Provincial funds
and National health grants are used to assist in construction costs, the community must
provide local funds to the extent of at least one-third of the total cost. Health Branch
officials wish to pay tribute to the Municipal Councils, service clubs, and voluntary health
agencies which have done so much to raise the local shares. N 18 BRITISH COLUMBIA
In some centres of the Province, health-unit personnel have been provided suitable
quarters in Court-houses and other Provincial Government buildings or in rented offices.
The provision of such accommodation comes under the jurisdiction of the Department of
Public Works, whose co-operation is appreciated sincerely by the Health Branch.
Health Branch officials are highly gratified with these great improvements in accommodations. However, there has developed a serious problem in respect to the offices
occupied by the Division of Vital Statistics in the Parliament Buildings. For many years
the separation of the Division's offices, one from the other, through the enforced use of
space on the second floor, in the attic, and in the basement, as well as in the vault on
Topaz Avenue, has been the cause of many unnecessary steps and motions on the part
of employees. Because of the accumulation of necessary vital records, the situation has
now become critical. There is simply no space in which additional volumes of records
can be stored.
TRAINING
The calibre of public health services is largely dependent on the professional and
technical knowledge, experience, and skills of the workers rendering the services. Every
effort must be made to keep these at a high level. British Columbia, like the other
Canadian Provinces, is fortunate in being able to draw upon the National health grants
for this purpose. During 1955 sixteen Health Branch employees completed postgraduate
training at university and nineteen embarked upon similar training. Five others attended
short courses for which the costs of tuition and travel were also defrayed by National
Health grants funds. (The above figures relate to Health Branch employees only. The
value of the training programme, made possible by the National health grants, is made
even more apparent when consideration is given to the training which has been provided
also to employees of the Mental Health Services, the metropolitan health departments, and
general hospitals.)
In-service training of employees continued to hold an important place in Health
Branch activities. Written instructions and information, personal visits to the health
units by the consultants, and staff meetings have all had continued use in this aspect of
the programme. However, the most concentrated efforts were the two meetings of the
full-time Medical Health Officers and the Annual Institute for Provincial Public Health
Workers. The 1955 sessions of the Institute were held in Vancouver from April 12th
to April 15th and were attended by health-unit personnel and senior officials of the Health
Branch. The chief speaker was Dr. G. F. Amyot, Deputy Minister of Health for British
Columbia, whose subjects were " Future Trends of Public Health in British Columbia,"
" Programme for Evaluating Health Services," and " The Health Unit as a Team." Dr.
Amyot's participation was undertaken at the request of the health-unit personnel, who
were anxious to have the views and philosophies of their own deputy and public health
leader. Other Health Branch personnel from both the health unit staff and the specialized
services took prominent parts in the remainder of the programme. DEPARTMENT OF HEALTH AND WELFARE,  1955
N 19
Table I.—Local Health Services (Other than Greater Vancouver
and Victoria-Esquimalt)
Health Unit
Headquarters
School
Districts
Included
Population (Excluding
Indians)
Staff (Positions.
i
Health
Unit
No.
oa
n
O
u
V
s
^ "9 h_
A<KZ
CO
H
It
ca r-
tn&
oo
0_
si
si
M
u
a
O
1
2
3
East Kootenay	
Selkirk	
West Kootenay
North Okanagan-
South Okanagan.
South Central	
Upper Fraser	
North Fraser.	
Boundary 	
Simon Fraser2	
Gibsons-Howe
Sound3  -
Saanich and South
Vancouver
Island
Central Vancouver Island
Upper Island	
Cariboo	
Cranbrook	
Nelson	
Trail  _  .
1, 2,  3, 4, 5,
18   	
6, 7, 8, 10	
9, 11, 12, 13-
19, 20, 21, 22,
78  	
35,890
22,590
36,390
33,795
51,135
30,425
43,385
25,345
60,700
26,270
11,250
51,100
66,450
31,220
37,970
22,855
15,450
5,800
3,900
2005
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
9
6
9
9
14
7
10
6
12
5
2
12
15
8
12
5
4
1
1
1
2
1
2
2
3
2
3
1
3
1
1
2
3
1
3
2
1
1
1
i
i
i
i
i
t
i
i
i
i
i
i
1
1
2
4
Vernon	
Kelowna 	
3
5
6
14, 15, 16, 17,
23, 77
24, 25, 26, 29,
30, 31	
32, 33, 34	
42, 75, 76
35, 36, 37
43    	
3
7
8
9
10
Chilliwack	
Mission	
Cloverdale  	
New Westminster.-	
Gibsons and Squamish
232 Burnside Road
West, Victoria-	
2
3
2
3
1
11
46, 48	
12
13
616, 62, 63, 64
65, 66, 67, 68,
69, 70, 79—
47, 71, 72
27, 28, 55, 56,
57, 58 	
50, 51, 52, 53,
54  —	
3
14
15
Courtenay 	
4
1
16
3
2
17
59, 60, 81
80
1
Kitimat*	
49  .
Telegraph Creek*	
Totals	
16
148
33
7
7
35
1 These figures show the authorized positions. There were vacancies in various places at various times during the year.
2The Simon Fraser Health Unit serves also School District No. 40 (the City of New Westminster). The Director
and certain other staff (not shown above) are employed by the city.
3 The Gibsons-Howe Sound area has not yet been organized officially as a health unit.
* Kitimat, Ocean Falls, and Telegraph Creek have not yet been included officially in health units, although a nurse is
stationed in each area.
5 Approximate.
6 In part. N 20
BRITISH COLUMBIA
Table II.—Offices and Divisions Providing Administrative,
Consultative, and Other Specialized Services
Office or Division
Location
Staff1
Central Office2	
Rrfinrh Offjre2
Victoria.  ...
28
25
Victoria	
Vancouver	
60
14
27
Division of Laboratories.	
Division of Tuberculosis Control—
Vancouver  _	
Nelson.  	
46
2
20
Willow Chest Centre                                     	
Vancouver..—	
Vancouver	
Tranquille   	
Victoria.- _ __	
New Westminster  	
Nelson  	
Vancouver  	
Tranquille	
Victoria	
168
Pearson Hospital   -	
225
289
Vancouver Island Chest Centre	
14
6
3
4
Interior Travelling Clinic	
3
3
64
1 Because of certain reductions made in staff during the year, this column shows the approximate number of persons
employed at the year's end rather than the number of positions.
2 The staffs of these offices included the Health Branch's central administrative personnel and the personnel who
provide consultant services in public health nursing, sanitation, nutrition, public health education, rehabilitation, public
health engineering, environmental management, and preventive dentistry. DEPARTMENT OF HEALTH AND WELFARE,  1955 N 21
REPORT OF THE BUREAU OF LOCAL HEALTH SERVICES
J. A. Taylor, Director
Under the authority of the " Health Act," each municipality within the Province is
required to establish a Local Board of Health " to superintend and see to the execution
of any regulations made under the Act." However, two or more Municipal Councils may
elect, under authority of the same Act, to unite their respective Local Boards of Health
into a Union Board of Health. The participating Municipal Councils may then enter into
an agreement with a number of School Boards for neighbouring school districts to transfer
to the Union Board of Health responsibilities for the provision of school health services.
The Union Board of Health then becomes the 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.
Trained public health personnel employed by the Health Branch, Department of
Health and Welfare, are seconded to the various Union Boards of Health throughout the
Province, to provide the public health services to meet the public health needs of the
communities within the health-unit areas in the larger part of the Province, In the Greater
Vancouver and Greater Victoria areas there are metropolitan types of health-unit organization, functioning under metropolitan boards, which employ their own trained staff
directly, but, nevertheless, provide the same type of public health service. These technically trained staffs, through their direct contact with the people in the communities,
become directly acquainted with the public health needs therein, and are constantly
designing new services and modifying existing services in an endeavour to cope with those
needs, while, through their channel of communication with the Bureau of Local Health
Services, they obtain supervisory and consultative advice from the various technical
divisions within that Bureau. The Health Branch, Department of Health and Welfare, is
able, through the local health units, to maintain a direct and continuous link providing
information on the health needs, health problems, and health situations of the Province;
through that link flow all the Provincial health facilities, permitting every resident of the
Province to receive adequate health services, irrespective of the location. Because of the
geography and topography of the Province, there will always remain certain isolated,
sparsely settled areas in which it is not economically practical to maintain trained personnel on a full-time basis; in those areas, basic services are provided on either a visiting
programme or through the employment of part-time personnel.
While there were modifications, extensions, and improvements in the public health
services during the past year, the outstanding accomplishment is probably the administration of Salk poliomyelitis vaccine to the children in the most susceptible age-groups.
Results of that programme would indicate that, in so far as the 1955 poliomyelitis was
concerned, an appreciable decrease in the attack rate among the vaccinated children
occurred.
The administration of this vaccine was handled effectively and efficiently because
of the well-organized local health units throughout the Province, which permitted coordinated planning of the programme from its inception to its completion.
The progress that can be recorded in this and other fields in public health has in a
large measure been aided by the National health grants programme. In past years new
health units became developed and additional personnel were added where required, while
new programmes were introduced and extensions of existing programmes became possible; all of this has been continued while further services have been developed, one of
these being the poliomyelitis vaccination programme. Local Health Services in British
Columbia is much further ahead to-day as a result of the stimulation that was, and is
continued to be, given through the National health grants. N 22 BRITISH COLUMBIA
HEALTH-UNIT ORGANIZATION AND DEVELOPMENT
The industrial and population growth that has been occurring creates a need for
some expansion of Local Health Services. The planning for health units and the development of those units have meant, however, that the expansion could be coped with through
the addition of staff personnel within the existing units; the inclusion of an additional
public health nurse or sanitary inspector, with the assistance of National health grants,
sufficed to meet the need within the framework of the health unit. Under such a programme, additional public health nursing positions became established in the South
Okanagan, Boundary, Saanich and South Vancouver Island, and Upper Fraser Valley
Health Units, while sanitary inspector trainee positions were retained in the South Okanagan, Boundary, Saanich and South Vancouver Island, Upper Fraser Valley, and West
Kootenay Health Units.
For some time there had been requests for establishment of a public health nursing
service within School District No. 49 (Ocean Falls), but, because of a shortage of nurses,
it had not been possible to fulfil that request. During this year, however, it was possible
to open up that public health nursing district to permit a qualified public health nurse to
organize public health services for the communities and schools in Ocean Falls, Bella
Bella, Bella Coola, and the numerous smaller communities within the school district. The
public health nurse is receiving the support and assistance of the resident physicians in
those areas who are serving in a part-time capacity as Medical Health Officers and school
health physicians.
The newly established community of Kitimat, arising out of the industrial development there, reached a stage where it was indicated that public health services, in addition
to the part-time Medical Health Officer, were found necessary. In the initial planning for
this community, it had been proposed that public health services would be initiated with
the introduction of public health nursing services and increased step by step as population
growth warranted. During the year the first step was taken in the commencement of a
public health nursing service again with the support and assistance of a part-time Medical
Health Officer and School Medical Inspector. At the same time, provision was made for
part-time sanitary inspection services through periodic visits by a sanitary inspector from
the Skeena Health Unit. At the same time, part-time clerical assistance was introduced
for the organization and maintenance of records. The industrial growth within this community is on a planned basis, which will produce a rapidly increasing population, requiring
a gradual increase in the public health services there. The original planning calls for
complete public health services under the direction of a public health physician which
will be correlated with the other community health services in medical care and hospitalization programmes. That planning is being continued in the hope that a model type of
service for a community can be developed in a new community in which the treatment
and preventive health services are established in step with the community growth from
its initial phases.
The Central Vancouver Island Health Unit, because of its population growth, has
become an exceedingly heavy administrative load for one public health physician, expected
to handle the total administration as well as the responsibilities of Medical Health Officer
and School Medical Inspector; examination of this situation, therefore, led to the decision
that it would be advisable to add a physician to its full-time staff, which was done during
the past year. The original appointee, after some six months of service, was forced to
decide, for personal reasons, that he would have to forego a career in public health to
return to the United Kingdom; following his departure, another physician was appointed
to carry on those duties. Resignations of other health-unit directors occurred during the
year. The Director of the East Kootenay Health Unit, who had served so capably for the
past five years, accepted an appointment in the Province of Ontario; as his decision
occurred rather suddenly, it was not possible to effect an immediate replacement, so that DEPARTMENT OF HEALTH AND WELFARE,  1955 N 23
the unit was left without an administrative head for approximately three months until a
qualified public health physician was recruited from the Province of Saskatchewan.
The promotion of the Director of the North Fraser Health Unit to a position as
Director of a Division (Epidemiology) resulted in a vacancy in that health-unit area.
Following the posting of the vacancy, the decision was made to offer the appointment to
the Director of the West Kootenay Health Unit, who, however, will remain in his present
post until such time as a replacement can be found for that health unit. In the meantime,
administration of the North Fraser Health Unit will be carried on in a supervisory basis
by the former director from his headquarters in his new position in Vancouver. The
Skeena Health Unit, which had been without the services of a full-time director since
September, 1954, was finally restored to full complement early in the spring of 1955
through the appointment of a young physician from Scotland.
At present the Peace River Health Unit is again without the services of a health-unit
director, as the previous physician departed in September for postgraduate training in
public health at the School of Hygiene, University of Toronto. Negotiations are proceeding toward replacement there, and it is hoped that may be effected without too much
further delay.
Within the Victoria-Esquimalt Health Department, a major administrative change
occurred during 1954, when the Senior Medical Health Officer resigned to accept an
appointment as Assistant Senior Medical Health Officer within the Metropolitan Health
Department in Vancouver. A lengthy period of indecision occurred in relation to his
replacement, while certain negotiations were proceeding toward amalgamation of public
health services in the Greater Victoria area. As a result of requests from the Victoria-
Esquimalt Union Board of Health, a report on reorganization of the existing health services included in the Victoria-Esquimalt Health Unit, the Saanich and South Vancouver
Island Health Unit, and the Oak Bay Health Department was prepared in detail by the
Health Branch, Department of Health and Welfare, to serve as a basis of discussion
toward a metropolitan health department. While the Victoria-Esquimalt Union Board of
Health displayed considerable interest in the development of such a body, there were
certain objections on the part of the Municipalities of Saanich and Oak Bay which could
not be reconciled; as a result, the three separate administrations continued. With that
decision, the appointment of the former Assistant Medical Health Officer to the position
of Director of the Victoria-Esquimalt Health Department was then effected.
During the past years, efforts have been directed toward the development of more
efficient public health education services within health units. Two public health educators
have been employed—one in the Central Vancouver Island Health Unit and one in the
Victoria-Esquimalt Health Department. These appointments capably demonstrated the
value of public health education as an organized service within a health unit, more
effectively co-ordinating the public health educational endeavours of the various staff
members. It was proposed that appointments to other units should be made, but unfortunately it was impossible to recruit suitably interested candidates. Recently resignations
have depleted the previously organized services, and progress in public health education
is stalemated.
Certain changes have occurred in the field of public health dentistry as more and
more emphasis became placed on the services that could be administered through community dental clinics, supervised to a large degree by regional dental consultants who
could provide supervision over a number of health units. This plan seems to offer greater
opportunity for preventive dental services to a greater number of children, and the plan
is being followed with a considerable amount of interest and study. In order to provide
it for the whole Province, certain reorganization in the dental personnel within health
units has taken place, and is recorded within the report of the Division of Preventive
Dentistry. N 24 BRITISH COLUMBIA
The major problem within the health-unit areas in so far as personnel is concerned
seems to be in connection with the provision of sufficient clerical assistance. While the
Health Branch, Department of Health and Welfare, has endeavoured to maintain a
formula of one clerical worker to each four professional personnel, it has become evident
that the field demands and number of records are creating need for more clerical workers
than that formula allows. While certain clerical additions have occurred, there is very
definite need for further study of the entire situation, since all health units find themselves
becoming unable to cope with the record requirements. Some study of the whole system of
records is therefore proposed, while the clerical needs of the health units are also surveyed.
Within the report for 1954 an analysis of the growth of Local Health Services was
recorded, indicating the stimulation that had been brought about by the National health
grants. At this time it is interesting to note further that Naional health grants continue
to carry a large share of the financing of Local Health Services to the degree that they
permit employment of eight public health physicians, thirty-five public health nurses,
nineteen sanitary inspectors, five public health dentists, and fifteen clerical workers, as
well as much of the equipment required by them.
ADMINISTRATION
Administratively the Bureau of Local Health Services is expected to direct liaison
between the local health units, on the one hand, and the technical divisions comprising
the Bureau, on the other hand. To assist in this role, the Bureau has been guided by two
advisory groups, namely, the Local Health Services Council, composed of divisional
directors meeting weekly, and the Medical Health Officers' Council, composed of all the
full-time Medical Health Officers throughout the Province, meeting bi-annually. The
Local Health Services Council has continued to function as a clearing-house of information. Each division is kept informed on Departmental policies and development and, in
turn, supplies information with respect to the consultative and supervisory services being
channelled to the various health units. The participating divisions are thus able to keep
abreast of developments in the field of local health services and, during field visits throughout the Province, are in a position to correlate the plans being made in their respective
technical field with the plans that are being negotiated in other technical fields. There
is then a degree of integration of services rather than undue emphasis on one particular
phase of public health.
The Medical Health Officers' Council met twice during the year, a one-day meeting
being convened in April and a two-day meeting in September. The spring meeting, as
usual, convened during the Annual Public Health Institute, at which the guest speaker
was Dr. G. F. Amyot, Deputy Minister of Health, who very ably reviewed the field of
public health administration in relation to Local Health Services. The fall meeting of
the Medical Health Officers' Council was, for the first time, convened outside the Province, preceding the annual meeting of the Canadian Public Health Association, which
was, this year, convened in Edmonton, Alta. This arrangement provided an opportunity
for the participants to attend a National convention and to hear discussions by the leaders
in public health in Canada, while, at the same time, permitting them to become acquainted
with some of the public health personnel in the other Provinces.
As the spring meeting of the Health Officers occurred at the same time as the Salk
poliomyelitis vaccine was becoming publicized, an opportunity presented itself for a very
thorough discussion on the planning of a poliomyelitis vaccination programme for British
Columbia. From that discussion there stemmed some definite decisions on which there
was complete agreement, adding materially to the success of the vaccination programme,
which commenced throughout the Province immediately upon the return of the health-
unit personnel to their respective areas.
Arising from the Health Officers' Council meeting, there have been a number of
sub-committees established to deal with specific phases of the service in which there DEPARTMENT OF HEALTH AND WELFARE,  1955 N 25
seems to be need for constant review in an endeavour to promote policy changes in keeping with the needs of the service. The School Health Services Committee, for example,
which became established a year ago to deal with a revision of the school health services
programme, has become a standing committee, continuing to study the programme in
school health services, and to examine critically the policies while recommending modifications as required. During the year the Committee had several meetings to deal with
the type of report form that was presented annually as an assessment of the results of the
school medical services; arising from those gatherings has come a complete revision
of the assessment classification of the medical examinations of school pupils, which, it is
hoped, will provide more detailed information on the health of the school-child. The proposals of the Committee were presented to the Health Officers' Council during its fall session, and have been accepted for trial to determine their value. A second standing committee dealing with communicable-disease control continued to function during the year.
Representation on this sub-committee was increased to permit Dr. W. S. Barclay, Regional
Superintendent, Indian Health Services, to become an active member, thereby correlating
Provincial regulations with those relating to the health of Indians. Recommendations
had been presented by the Department of National Health and Welfare toward more
uniform handling of notifiable diseases across Canada, in which suggestions were being
advanced toward changes in the Communicable Disease Regulations, in which lesser
emphasis would be attached to the minor communicable infections than heretofore. Each
Province had had an opportunity to review these recommendations prior to a Federal-
Provincial conference on communicable disease convened in Ottawa in May of this year.
Arising from those deliberations were a number of recommendations which were brought
to the attention of the Health Officers' Council by this sub-committee; a revision of the
Regulations for the Control of Communicable Disease has thus become necessary, and
work is going forward on this through subsequent sub-committee meetings.
The sub-committee on tuberculosis practices held a number of meetings, at which
questions relating to tuberculosis infectivity and interpretation of bacteriological cultures
and smears were reviewed. As the sub-committee was composed of representatives from
the Health Officers' Council, the Division of Tuberculosis Control, and administrative
officials within the two bureaux concerned, correlation of programmes within the Division
and the Local Health Services field became possible. As a result of the clarification that
occurred, definite recommendations were developed which, it is hoped, will promote
greater effectiveness in continuity of the service provided the tuberculosis patient from
his home to the sanatorium and back. Following the report of the sub-committee to the
Health Officers' Council, it was definitely recommended that this committee continue
also as a standing committee for the future.
Definite interest on the part of a number of Health Officers toward obtaining their
certification as specialists in public health led to some inquiries being presented to the
Royal College of Physicians and Surgeons relative to the possibility of the examinations
being held in Western Canada rather than in the East, as heretofore. It was indicated
that if there would be a sufficient number of applicants from the West, there would be a
likelihood of the examinations being held in Vancouver during 1956. The Health Officers' Council decided, therefore, to strike another sub-committee to deal with this situation to ensure that every aid was provided toward encouraging a group to seek certification while providing such assistance as might be necessary in study toward those examinations. That sub-committee has drawn up a list of reference texts which is being circulated on a planned basis to the interested candidates, and is working on a proposal toward
a short in-service training course for those candidates prior to the examination.
During the previous year some discussions had been prompted by individual Health
Officers into the question of milk legislation. During this past year an inquiry by a Royal
Commission had brought forth a report on the milk industry, which criticized the sanitation on some of the dairy-farms.    Arising from that Royal Commission report, the N 26 BRITISH COLUMBIA
Department of Agriculture appointed a committee for the specific purpose of recommending procedures and regulations which appear necessary to ensure that milk to be
used for human consumption is produced under conditions of buildings, sanitation, and
live-stock health which would help to safeguard the health of the people, and which do
not place an unreasonable financial burden on the dairy-farmer. The Health Branch,
Department of Health and Welfare, had representation on that committee, on which there
were farmer representatives and Department of Agriculture representatives, under the
chairmanship of Dr. Duncan Mackenzie, Assistant Dean of Agriculture in the Faculty of
Agriculture at the University of British Columbia. As the year drew to a close, certain
recommendations were being presented from that committee to the Minister of Agriculture for his consideration as a future approach in dairy-farm inspection, regulations, and
methods. It was further being planned that a revision of the legislation in respect to the
whole milk industry would be reviewed in an endeavour to consolidate the various pieces
of legislation.
There had been a suggestion last year that some approach be made through the
Union of British Columbia Municipalities to establish a committee which would meet at
the same time as the Union of British Columbia Municipalities to discuss interrelated
health matters. The proposal was given very careful consideration by the executive of
the Union of British Columbia Municipalities, who, however, felt that it was not in the
best interests of the Union of British Columbia Municipalities to permit sub-committees
to become established, since, then, matters would be dealt with in sub-committee rather
than discussed openly on the floor of the convention. The suggestion, therefore, became
shelved in the hope that any points relating to health would be brought up during the full
convention, when all interested parties could be given an opportunity to participate in the
discussion toward reaching a conclusive decision.
COMMUNITY HEALTH CENTRES
The plan designed to encourage the construction of more suitable office accommodation for local health services is now entering its fourth year of operation and is continuing
to prove its effectiveness as more community health centres come into being. Community
health centres in four more communities were constructed this year, to bring to thirteen
the number that have been constructed under this plan during the past four years. There
are ten more in the planning stage, two of which are entering the initial construction phase,
while the others are being planned for construction within the next year or two, depending
upon the degree of success in raising the local portion of the financing.
While the Provincial grant and the National health grant contribute toward a considerable part of the financing, it is, nevertheless, not always easy for the community to
raise the local share, which is often more than one-third of the total cost, since the Senior
Government grants are fixed. A very major contribution to the local share has been forthcoming from the voluntary health agencies, notably the British Columbia Tuberculosis
Society, the British Columbia Cancer Society, and the British Columbia Branch of the
Canadian Red Cross. Their participation in the programme has aided materially in the
total plan, and has ensured that the community health centre becomes an institution
totally communal in which all community health agencies, both official and voluntary,
work together in the interests of community health.
As an indication of the progress that has been made in the construction of community health centres since the introduction of the proposal in 1951, the following table
may be of interest. From it can be gathered information on the location of the community
health centres and the costs that have been involved in relation to the grants that have been
forthcoming from Provincial and Federal sources. DEPARTMENT OF HEALTH AND WELFARE,  1955
Details of Construction re Community Health Centres
N 27
Health Centre
Cost of
Construction
(Excluding
Equipment)
Federal
Participation
Provincial
Participation
Victoria Health and Welfare Centre-
Coquitlam sub-office..
Kamloops Health and Welfare Centre-
Enderby sub-office .
South Okanagan Community Health Centre-
Maple Ridge Health Centre .
Nanaimo Community Health Centre-
Simon Fraser Health Unit	
Armstrong-Spallumcheen Health Centre-
Oliver Community Health Centre-
Health and Welfare Building, Vancouver	
Health Unit No. 2, Kerrisdale, Marpole, and Richmond .
Similkameen Health Centre _ -	
Revelstoke Health Centre  	
Ladner Community Health Centre	
Health Unit No. 5, Grandview District.
Port Alberni Health Centre	
Totals..
$113,541.98
8,656.96
86,030.65
8,400.15
46,846.12
20,446.00
82,144.70
90,775.00
8,370.00
12,163.69
114,446.00
60,311.00
11,761.57
17,900.00
13,304.58
145,000.00
$840,098.40
$11,250.00
2,769.12
11,743.18
2,600.00
14,260.00
4,923.33
15,000.00
15,000.00
2,790.00
4,126.66
11,250.00
9,750.00
2,923.33
3,640.00
3,570.00
11,250.00
$126,845.62
$11,250.00
3,118.73
50,801.10
2,600.00
16,015.41
4,923.33
15,000.00
15,000.00
2,790.00
4,126.66
11,250.00
9,750.00
2,923.33
3,640.00
3,570.00
11,250.00
1,000.00
$169,008.65
Early in the year the Minister of Health and Welfare officiated at the official opening
of the very fine community health centre recently constructed in Ladner as a sub-office
for the Boundary Health Unit to provide office accommodation for the public health nurse
and clinic space for the various clinical services. This building became an actuality
through the efforts of the Ladner Kinsmen's Club, who undertook its construction as their
community endeavour at a total cost of $14,800. There was a very fine spirit of joint
community action displayed throughout all the negotiations towards its construction,
which resulted in a very commendable health centre, providing for the housing of all
community health agencies under the one roof. The project is a credit to the Ladner
Kinsmen's Club for their foresight and initiative in undertaking its construction; it will
serve the community well for many years to come.
In Revelstoke another fine community health centre attained construction during
the year at a total cost of $12,500, being financed through grants from the three branches
of government, assisted by contributions from the voluntary health agencies already mentioned. This building was occupied during November when the Minister of Health and
Welfare again officiated at its official opening. It provides very suitably appointed
accommodation for the public health nurse, visiting officials of the health unit, and for
conduct of the clinics, setting a plane for the calibre of the quality of municipal interest
in its public health services. The City of Revelstoke is to be congratulated for its leadership in sponsoring such a project.
A third community health centre was completed in Keremeos, at a cost of $10,624,
and was officially opened in mid-September. It is interesting to note that the Similkameen
Public Health Society, which had its origin when the Victorian Order of Nursing services
were introduced into that area more than twenty-five years ago, sponsored the construction of this community health centre, disposing of its interests in some property already
owned by it to do so. During all those years this same society has maintained its interest
in community health services from its early introduction as a visiting nursing service to
its wider ramifications as a community public health service; realizing the need for more
satisfactory clinic accommodation, they worked tirelessly to achieve that goal. The difficulties that arose in the financing arrangements were numerous, particularly those involved
relating to its ownership of certain existing properties. In spite of these difficulties, however, they maintained their interest and their enthusiasm to achieve their goal, with the
official opening of a very fine health centre in mid-September.   Here again joint endeavour N 28 BRITISH COLUMBIA
was noted in the assistance that had been given by the local branches of the voluntary
agencies, through which financial assistance by the Provincial organizations funnelled.
An additional feature of the Similkameen Health Centre was the inclusion of office accommodation for the visiting physician from Penticton to accommodate him and his
patients during his regular weekly visits to the area.
The Metropolitan Health Service in the City of Vancouver has also benefited from
this programme, with the construction of an additional community health centre in the
Grandview area this year; this brings to three the number of such centres provided in
the City of Vancouver during the past two years. The present project provides for an
expenditure of $161,000 to provide office accommodation for physicians, nurses, sanitarians, statistical clerks, mental hygienists, and dentists. This building is a definite improvement over the previous accommodation provided and will be a distinct advantage
in the conduct of the clinics operating for the convenience of the citizens in that area,
providing a much more efficient operation for the future.
Definite advantages have accrued from the community health grant programme
sufficient to warrant its continuation in future years. As the year drew to a close, there
were indications from a number of communities that they would like to participate in the
programme. The need for such centres in certain communities within the Province is
quite apparent in view of the cramped quarters in which many of the staffs now operate.
It is suggested, further, that the amount of money available annually should be increased
to provide for a greater number of community projects to be started in any one fiscal year.
At present the number of projects must be given a priority number, since the moneys
available in Provincial budgets cannot permit all requests in a single fiscal year to be met.
At the close of the year, plans had been completed and excavations commenced for
community health centres in North Vancouver and Prince George, while negotiations
are going forward for other health centres in Burnaby, Richmond, Trail, Cloverdale,
Penticton, Mission City, Lillooet, and Kitimat.
Apart from the community health centre construction programmes, certain other
office accommodation has become available to local health services in certain areas. In
the headquarters of the East Kootenay Health Unit at Cranbrook, construction of a new
Court-house is rapidly drawing to a close, which will provide complete office accommodation for the central staff of the health unit. This has been one of the areas in which the
accommodation has been most unsatisfactory, and it is a distinct advantage to have new
quarters becoming available. This accommodation is more centrally located in so far as
the community is concerned and will therefore be an advantage in so far as clinic attendance is concerned in the future. It is well planned, not only for present requirements,
but also for the future, and should take care of the needs of that local health service for
many years to come. Also in the East Kootenay Health Unit sub-office at Invermere,
certain changes have taken place to provide more suitable accommodation for the resident
public health nurse on the ground floor of the Masonic Building; here also the offices
previously provided fell far short of desirability, being cramped, unattractive, and cold
in the winter months. The new space will overcome many of those objections while
providing excellent facilities for office routines and clinic operations. Changes in the
Forestry Service, Department of Lands and Forests, left the old Forestry Building vacant
in the heart of the City of Duncan; complete remodelling of the interior of that building
provided a complete new office for the Duncan sub-office in the Central Vancouver Island
Health Unit. The remodelled quarters were officially opened by the Minister of Health
and Welfare early in the year; during those functions, tribute was paid to the Cowichan
Health Centre Committee, which supervised the public health nursing programme in that
area for a quarter of a century prior to its amalgamation into the Central Vancouver
Island Health Unit in 1946. That Cowichan Health Centre was the pioneer for the present
full-scale community public health services, and due recognition to its leaders is seen in
the plaques in the clinic quarters. DEPARTMENT OF HEALTH AND WELFARE,  1955 N 29
There were also some changes noted in improvement in housing for public health
services in certain communities where rental space is provided. Probably the most
notable advance in this direction was in the Village of Squamish, where the Board of
Commissioners included accommodation for the public health nurse, sanitary inspector,
and clinics in the newly constructed Municipal Hall. This has provided a very excellent
set of offices, designed not only for the present, but also for future needs. Another
example of this type of accommodation is taking place at Gibsons, where private interests
are constructing a block in which space is being provided for the resident public health
nurse and sanitary inspector, as well as for clinic operations. This space was designed to
meet the needs of the service and will be rented for that purpose on a lease basis. Certain
changes also occurred at the Williams Lake sub-office of the Cariboo Health Unit, where
the provision of an additional public health nurse made the need for more space necessary.
This space was provided through an addition to the present building, to permit office
accommodation for the two resident nurses and their clinic operations.
Probably the most needful areas in the matter of accommodation are in the headquarters of the Saanich and South Vancouver Island Health Unit in Saanich, and the
headquarters of the West Kootenay Health Unit at Trail. There is some hope that the
situation at Trail may be improved, as plans are being negotiated toward a community
health centre to be constructed at Warfield, on land donated by the Consolidated Mining
and Smelting Company. There is not, however, the same hopeful trend in Saanich, where
discussions toward community health centres seem to be fraught with failure. While
investigations have been made to determine whether new space could not be located on
a rental basis, even that seems to be impossible, and the solution to the space problem
is none too clear.
RESIDENT PHYSICIAN GRANTS
This programme is designed primarily to assist small communities in the provision
of medical care through local resident physicians or through visits from a physician
resident in a near-by community. The grant in itself is not large, merely serving to
reimburse the physician to some extent for the out-of-pocket expenses incurred by him
in providing the necessary medical supervision of the ill members of the community.
The community itself is expected to assume some responsibility to ensure that necessary
office space and facilities are provided to the physician to meet his needs. The physician
is expected to present a report on a quarterly basis of the services provided, following
which a quarterly payment of the grant is rendered. During the year, grants were paid
on behalf of thirty rural locations in the Province to some twenty-one physicians.
Negotiations were conducted with physicians in Queen Charlotte City toward
provision of periodic medical-care service to other communities on the Queen Charlotte
Islands, notably Masset. With the coming of a second physician and the provision of
increased grants, it was possible to provide service to those outlying communities and that
the hospitalized patients in the Queen Charlotte City itself were assured of continuous
medical care by a physician.
One area of the Province which has been most anxiously seeking a solution to its
medical-care needs is the Village of Zeballos, on the west coast of Vancouver Island.
It has been impossible to attract a physician to take up residency there, although a hospital is available, but at present non-operative. At the close of the year the matter was
being referred to the Commissioner, British Columbia Division, Canadian Red Cross
Society, in the hope that that association could take over operation of the hospital as a
Red Cross outpost, in much the same way as was recently done at Atlin and other
communities in remote areas of the Province.
SCHOOL HEALTH SERVICES
A major programme within the field of Local Health Services is the provision of
school health services to the various schools throughout the Province.   The programme N 30 BRITISH COLUMBIA
concerns itself with the promotion of health, the protection of health, and the detection
and correction of deviations from normal health. In fulfilling these requirements, 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. During the previous year the School Health Services Sub-committee of
the Health Officers' Council critically examined the whole programme of school health
services and made a complete revision in recommending that routine medical examinations
of all the pupils should be done away with, in favour of concentration upon selected children, particularly those in Grade I and those referred through the medium of a teacher-
nurse conference. Considerable emphasis was placed on the value of the teacher-nurse
conference, since it was felt that the teacher, through her day-to-day observations of the
school-child, was in a particularly advantageous position to detect deviations from normal
which would seem to require medical attention. Heretofore, the concentration had been
on the physical examination of the school-child, whereas attention should also have
been focused on the mental and emotional development of the pupil, from which might
stem so much of the later adult difficulties.
The revised school health programme, which came into being in the middle of an
academic year, has not had an opportunity to function throughout an entire school-year.
However, the revised programme has been introduced in the schools of the Province and
would seem to be working satisfactorily. The results of that programme may be more
definitely assessed in the next Annual Report, when comparisons with the results from
previous years may become possible.
The School Health Services Sub-committee of the Health Officers' Council, which
had been appointed as a standing committee, has continued to meet to review the school
health services. During this year, as a result of representations made to it by psychiatrists attached to the school health services in the metropolitan health services in
Vancouver, some considerable study was given to the categorization of the mentality of
the school pupil as seen by the medical personnel. The early concentration had been
upon the physical condition of the school-child, with some estimation of the emotional
status. It was argued that no system of categorization that included only " P " (physical)
and " E " (emotional) and left out " M " (mentality) was complete, and that if an
assessment of the total child was to be considered, then all three categories should be
assessed and recorded. It was indicated that an outline could be utilized by physicians
as a guide to assist them in assessing a child's intelligence. Further aids might include
any group tests which had been done at the school, observations of the teacher and parent,
further inquiry by the public health nurse, or individual testing by psychometric means.
Continued scrutiny with reassessment in six months would often prove helpful.
A proposal was presented to the Health Officers' Council and finally adopted on a
trial basis. Previously the symbols " A," " B," " C," and " D " had been the designations,
with " p " or " e " following them, classifying the child into one of four major groups
with two sub-classifications, depending upon whether the child had a physical defect or
some emotional disurbance. It is now proposed to discard this classification in favour of
a categorization of "P," "E," and "M." Symbol "P" is to be used to indicate all
physical defects, while the symbols " E " and " M " be assigned to indicate the medical
examiner's opinion that problems exist in emotional difficulties or mental defects. If this
is followed, the degree of defect must then be recorded, and it is proposed to do this by
using numbers 1, 2, 3, 4 to state the seriousness of the defects, as follows:—
1—No defect, or a minor defect only which will, in the opinion of the examiner,
not affect the child's ability to progress normally in school (e.g., minor
dental caries or mild visual defects).
2—A defect observed which has, or may have, effect on the child's ability to
to carry on normally at school. DEPARTMENT OF HEALTH AND WELFARE,  1955 N 31
3—A defect observed which has, or may have, a marked effect on the child's
ability to carry on normally at school.
4—A defect observed which is so marked that the child is unable to continue
in the standard classroom.
It was decided to bring this categorization into effect with the commencement of
the 1955-56 academic year; a revision of the Annual Report form " Medical Inspection
of Schools " to provide for the reclassification of school examinations was completed in
order that the school medical examiners could record their examinations in keeping with
the new system. The first report on this type of categorization of the health of the
school-child will be forthcoming in the next Annual Report.
In addition to the revision of the categorization of the examination, the School
Health Services Sub-committee gave some consideration to the school athletic and
physical education programme, with particular consideration to the form of athletics
and types of physical education that should be advised for each age-group within the
school system. This subject is being further considered and opinions are being sought
from school athletic directors and pediatric consultants to determine if definite recommendations can be made as a guide for both the teaching and health personnel.
Continued interest has been maintained in the question of testing of visual acuity of
the school pupils, utilizing the Snellen Chart as a screening method. Further representations were presented by the British Columbia Optometrists' Association to the Department of Education, with a suggestion that a pilot study might be undertaken in some of
the schools in the Province to determine if vision training might not promote improved
learning ability. As this pertained essentially to the teaching methods in the school, the
matter was solely a decision of the Department of Education, outside the province of
the Health Branch, Department of Health and Welfare. However, the question in respect
to the Snellen Chart awaits the results of the study being undertaken by the Ophthalmo-
logical Section of the British Columbia Medical Association into their investigations
within the Vancouver schools, on which a report has still to be presented.
As has been indicated in previous reports, the relationship between the school health
services and the community health services cannot be entirely separated, since the school-
child participates in the community environment for a somewhat longer period than he
does in the school environment. There are, therefore, numerous references within this
Annual Report in which community health services reflect upon the health of the
school-child; these will be found especially in the sections dealing with public health
nursing services, dental health services, nutrition services, sanitation services, and health
education.
THE HEALTH OF THE SCHOOL-CHILD
Each year an endeavour is made to assess the health of the school-children in British
Columbia, as revealed through the medium of the annual reports submitted by the School
Medical Inspectors. Attempts have been made from time to time to discover a measuring
rule that could be utilized to adequately assess the health status of the school pupils, but
each year it has been evident that 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 deficiency. Changes in
community and school environment do occur, but the values stemming from those changes
are difficult to measure quantitatively. As the reports are compared from year to year,
certain generalizations in respect to the over-all health picture of the school pupils does
become possible, based upon the physical examinations, the immunization status, and the
disease morbidity statistics. For the academic year September, 1954, to June, 1955,
the school health programme was operative in the eighty large school districts and the
twenty-five small school districts. There were a considerably greater number of pupils
enrolled in the grades examined, a consistent upward trend being shown each year.   This N 32 BRITISH COLUMBIA
becomes evident in a glance at Table II, where the total pupils enrolled in grades
examined for 1954-55 were recorded as 215,945 pupils, representing a 10.7-per-cent
increase over that of the previous year and a 39.7-per-cent increase over that of
five years ago. Of the 215,945 school-children enrolled in the grades examined, only
48,781 (22.6 per cent) received medical examinations. This represents a further
decrease in the number of pupils examined, but is not surprising in view of the emphasis
in the school health programme on examinations of preferred groups and referred pupils
rather than routine examination of all pupils. This is borne out in a study of Table IV,
in which the results of the medical examinations by grade reveal that 84.5 per cent of
the pupils in Grade I were examined, a slightly higher number than that done the previous
year. In this grade every endeavour is made to make the physical examination of the
pupil as effective as possible in the eyes of both the pupil and the parent, particularly the
parent on whom endeavours are bent in the interest of adequate protection of the child's
health as he commences school life. »
While various statistical tables are presented in an analysis of the school medical
services performed, a most significant feature is reflected in Table I in the indication that
the physical status of the school-children remains clinically good. While there has been
some decrease in the number categorized as Group A, there is still 91 per cent within
that group, with 8.3 per cent in Group B, 0.5 per cent in Group C, and 0.1 per cent
in Group D. This is the first year, however, within the last five years in which there have
been any pupils shown in Group D, while there have also been increases in the number
occurring in Group C and the number appearing in Group B. This may be the direct
result of the revised programme in which referred pupils are being given the major
attention, and, if so, is a direct reflection on the increased value of that programme in
which concentration on pupils with deviations from the normal is being directed.
Probably another year's experience will have to be analysed to determine whether this is
actuality or not.
Some comment would seem to be warranted in regard to Table VI, which analyses
the X-ray programme amongst school personnel for the past academic year. The
numbers seem to be definitely lower in this school-year than in any previous school-
years, and is indicative of the emphasis that must be placed toward intensification of the
X-ray programme amongst school personnel. While there is some justification for the
small numbers that are done in the unorganized areas where X-ray facilities are not
readily available, nevertheless in organized areas there would seem to be no excuse when
adequate X-ray facilities are readily available.
The immunization status of the school pupils, as exhibited in Table VII, would
indicate that the majority of the 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. While this may be considered a
satisfactory trend, nevertheless there would seem to be no reason why more schoolchildren should not be completely immunized against these illnesses, as diphtheria cases
continue to be recorded annually; for this year a rate of 0.6 per 100,000 population
emphasizes the need that exists for continued vigilance in the matter of immunization to
diphtheria. There is also a sad note in the fact that the immunization status seems to
decrease with age, indicating that possibly some further emphasis is needed to encourage
the high-school pupils to maintain the immunization status obtained in their elementary-
school life.
An encouraging trend is the marked increase that has become evident in the
numbers immunized to tetanus, which principally is due to the combined antigens being
administered in the diphtheria-tetanus toxoid, for, this academic year, the number
immunized against tetanus is practically double the number immunized in previous years.
The school population immunized against typhoid fever continues significantly low,
as is to be expected, since administration of typhoid fever vaccine is restricted to areas DEPARTMENT OF HEALTH AND WELFARE,  1955
N 33
where a low standard of sanitation prevails. Increases in population bring with them
increased demands in sanitation standards, so that the areas of low standard are becoming
lessened each year. There always remains the possibility of spread of typhoid fever, even
in areas of high sanitation standard, through carriers, but the numbers that would be
affected would be restricted to the contacts to that carrier rather than to a large popula-
ion; hence the immunization clinics for vaccination against typhoid fever are becoming
less prevalent; this is reflected in the decreased numbers of school-children maintaining
a typhoid fever immunization.
A significant addition to the health of the school-child through immunization was
the inclusion this year, for the first time, of recorded immunization against poliomyelitis.
As this product was available only in restricted quantities, administration was provided
only to the most susceptible age-groups, being those who would enter school in September,
1955 (5-year-olds) and those already enrolled in Grade I; consequently, immunization
toward poliomyelitis, as shown in Table VII, indicates only the one grade being involved
to any extent.   Future reports will show the further addition to this programme.
The communicable-disease incidence is a third factor affecting the health of the
school-child, since a considerable portion of the notifiable diseases are childhood infections. The results of these are shown in Table X, indicating that, with the exception of
influenza, the communicable-disease picture practically paralleled that of the previous
year. The minor communicable diseases, such as chicken-pox, measles, mumps, and
rubella, displayed their usual incidence, with peaks during the winter and spring months
and lessened incidence during the summer and early fall. It would seem to indicate that
there is a continual reservoir of infection of these childhood diseases which becomes
spread when the children are congregated again in the classrooms, taking its toll among
the non-immune pupils throughout the schools. Influenza exhibited its highest incidence
of the last five years with an attack rate of 1,195.4 per 100,000 population; while a
considerable portion of this affected adults, there was, nevertheless, a very high incidence
recorded amongst school pupils, as was evidenced by the absenteeism occurring in the
schools in the early spring months. Increased cases began to be reported in January,
increasing in number during February and reaching a peak in March and April, following
which there was a rapid cut-off in the spread of the infection. Fortunately the type of
infection was mild and did not create any particular complications so that no particular
lasting effects of the outbreak are evidenced. Streptococcal infections, as seen in the
scarlet fever and septic sore throat notifications displayed some decrease in a rate of
85.0 per 100,000 population, as compared to a rate of 121.1 for the previous year.
Here, also, the type of infection was mild, and no particular after-effects are recorded;
the latest treatments with chemo-therapeutic or antibiotic drugs have decreased the
number of severe complications that previously followed streptococcal infections. In so
far as poliomyelitis was concerned, there was practically the same incidence this year as
in the previous year, with a rate of 17.2 per 100,000 population, as compared to that of
16.7 per 100,000 in 1954. N 34
BRITISH COLUMBIA
Table I.—Physical Status of Pupils Examined, Showing Percentage
in Each Group, 1948-49 to 1954-55
Academic Group
Percentage of
Pupils in
Group A1
Percentage of
Pupils in
Group B2
Percentage of
Pupils in
Group C3
Percentage of
Pupils in
Group D4
1948 49                             	
93.3
93.4
93.1
93.5
93.0
92.6
91.1
6.4
6.5
6.8
6.4
6.8
7.3
8.3
0.3
0.1
0.1
0.1
0.2
1949 50                                                                   	
1950-51      	
1951-52                      _	
1952-53                         	
1953-54                	
0.1
1954-55         _ _	
0.5                        0.1
3 Group A: A, Ap, Ae, and Ape categories.
2 Group B:  Bp, Be, and Bpe categories.
3 Group C:  Cp, Ce, and Cpe categories.
4 Group D appearing for first time;  1954-55 includes Dp, De, Dpe.
Table II.—Physical Status of Total Pupils Examined in the Schools
for the Years Ended June 30th, 1951-55
1950-51
1951-52
1952-53
1953-54
1954-55
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
23.6
57.2
0.6
1.6
5.8
0.1
0.9
0.1
194,920
52,814
27.1
36.2
53.6
0.7
2.1
6.1
0.1
1.1
0.1
215,945
Total pupils examined  _        . ..
48,781
22.6
Physical status—percentage of pupils examined—
A                                                                 	
38.9
Ap                                                                                       	
48.1
Ae
1.6
2.5
Bp -._	
Be                                   	
6.6
0.5
Bpe.  _ _  	
Cp  	
Ce... '          	
1.2
0.3
Cpe   _  _
0.1
0.2
Dp _   _	
0.1
De -  	
Dpe    	
(*>
1 Percentage of cases (5) recorded is less than 0.1 per cent.
Table III.—Physical Status of Total Pupils Examined in Grades I, IV, VII,
and X for the Years Ended June 30th, 1951-55
1950-51
1951-52
1952-53
1053-54
1954-55
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
34.9
57.1
0.5
1.4
5.1
0.1
0.7
0.1
73,616
39,995
54.3
37.7
53.1
0.7
2.1
5.3
0.1
0.9
0.1
78,062
38,122
Physical status—percentage of pupils examined—
A                	
38.8
48.7
1 6
Ap                       — :  	
Ae _	
Bp—  	
Be _ _ _	
6.4
0.5
Bpe           	
Cp _   	
Ce                 _ _
0.2
Cpe  _	
0.1
0.1
	
Dp    	
C1)
De   	
Dpe	
(2)
1 Number of cases (29) is less than 0.1 per cent of total cases examined.
2 Number of cases (5) is less than 0.1 per cent of total cases examined. DEPARTMENT OF HEALTH AND WELFARE, 1955
N 35
Table IV.—Summary of Physical Status of Pupils Examined,
ACCORDING TO SCHOOL GRADES, 1954-55
Total
Pupils,
AH
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-
A_
Ap-
Ae—
Ape-
Bp-
Be—
Bpe-
Cp -
Ce-
Cpe.
Dp_.
De.„.
Dpe
215,945
48,781
22.6
38.9
48.1
1.6
2.5
6.6
0.5
1.2
0.3
26,776
22,636
84.5
36.9
48.2
2.0
2.8
7.8
0.7
1.3
0.2
110,787
10,357
9.4
39.2
46.8
1.6
2.1
7.4
0.5
1.2
0.4
50,887
9,964
19.6
40.8
48.9
1.0
2.7
4.7
0.4
1.2
0.2
27,495
5,824
21.2
43.3
48.6
0.8
2.4
3.8
0.2
0.7
0.2
0.2
0.1
O)
0.1
71)
0.8
0.1
1 Number of cases (5) is less than 0.1 per cent of total cases examined.
Table V.—Physical Status by Individual Grades of Total Schools, 1954-55
1 Number of cases (5) is less than 0.1 per cent of total cases examined.
2 Number of cases (1) is less than 0.1 per cent of total cases examined.
All
Schools
Grade
I
Grade
II
Grade
III
Grade
IV
Grade
V
Grade
VI
215,945
48,781
22.6
38.9
48.1
1.6
2.5
6.6
0.5
1.2
0.3
26,776
22,636
84.5
36.9
48.2
2.0
2.8
7.8
0.1
1.3
0.2
26,440
2,341
8.9
35.9
49.3
1.3
2.8
8.5
0.6
1.0
0.5
23,532
3,127
13.3
33.0
50.1
1.6
1.7
8.8
0.3
1.5
0.4
2.6
20,406
2,365
11.6
45.0
43.6
2.0
1.5
6.1
0.5
1.1
0.2
20,425
1,296
6.4
41.5
46.4
1.5
2.4
5.9
0.5
1.3
0.5
19,984
1,228
6 1
Physical status—percentage of pupils examined—
A 	
47.5
Ap                                	
40 6
Ae —       - -
Ape  _	
Bp       	
Be _.    .....
Bpe   -	
Cp   .      	
Ce	
1.4
2.4
5.7
0.8
0.7
0.7
0.1
Cpe     _  	
0.2
0.1
	
0 1
Dp _   _.
0.1
0)
0.1
0 1
De  — .  _ _	
Dpe  _ _ _	
i1)
Grade
VII
Grade
VIII
Grade
IX
Grade
X
Grade
XI
Grade
XII
Grade
XIII
Total pupils enrolled in grades examined  	
19,317
8,045
41.6
40.5
50.2
0.8
2.7
4.2
0.4
1.0
0.1
17,018
1,044
6.1
43.8
43.4
1.2
2.1
6.3
0.5
2.2
0.5
14,552
875
6.0
40.7
43.8
1.5
3.1
7.4
1.0
2.2
0.3
11,563
5,076
43.9
41.4
50.5
0.9
2.5
3.8
0.1
0.7
0.1
8,711
420
4.8
51.2
40.2
1.0
1.0
5.2
0.5
6,445
297
4.6
62.4
30.3
1.0
3.0
3.0
0.3
776
Physical status—percentage of pupils examined—
A                                                                  _	
61.3
29.0
Ap                                                      	
Ae     .                     	
Ape    ~
Bp	
6.5
3.2
Be  	
Bpe   	
Cp _	
0.7
Ce  _ _ —
	
Cpe- _ _	
	
Dp 	
0.1
	
(2)
	
De   	
	
Dpe  	
	 N 36 BRITISH COLUMBIA
Table VI.—Number Employed and X-rayed amongst School Personnel, 1954-55
Table VII.—Immunization Status of Total Pupils Enrolled,
according to School Grade, 1954-55
Total
Pupils
Enrolled
by Grades
Percentage Immunized
Smallpox
Diphtheria
Tetanus
Typhoid
B.CG.
Polio1
215,945
26,776
26,440
23,532
20,406
20,425
19,984
19,317
17,018
14,552
11,563
8,711
6,445
776
61.7
63.5
66.2
64.9
62.4
65.5
67.2
48.5
55.1
51.9
57.1
52.9
52.7
46.1
68.7
76.4
77.3
74.6
71.1
72.6
72.5
66.5
57.7
55.1
60.8
55.2
51.2
46.4
44.9
70.7
61.8
52.7
43.7
45.2
43.8
37.0
29.5
26.4
26.1
22.4
20.8
22.8
1.2
1.3
1.5
1.5
1.1
1.3
1.5
0.9
1.0
1.1
1.0
0.7
1.8
0.9
0.1
0.1
0.1
0.1
0.1
0.1
0.1
0.1
0.4
0.7
Grade 1 	
Grade II _	
85.5
Grade III    	
Grade IV __ - -
Grade V     	
Grade VI -
Grade VII    	
Grade VIII   	
Grade IX	
Grade X	
Grade XI       	
Grade XII	
Grade XIII    	
	
-  i Percentage applies to 6-year-old children only.
Under the section of this Report dealing with dental health services, certain information can be gathered in relation to the dental health of the school-child. In consideration
of the total health of the pupil, certain emphasis must be devoted to the dental-health
status as an additional factor. Community dental clinics have become organized throughout the Province, in which the major efforts have been directed toward the Grade I pupils,
and encouragement of remedial treatment as indicated. All of this is coincident with
a dental-health education campaign to inform parents and children on preventive dental
factors.
The general health of the school-child during the 1954-55 period would seem to
have been satisfactory. There are trends evident, however, which would indicate that
continual vigilance in school health services is desirable to promote further improvement
and maintenance of the health of the school-child. In particular, probably greater
emphasis must be placed on the immunization programmes to promote a higher immunity
status for the school population as a whole. The communicable-disease picture has
remained fairly static, with the exception of the experience occasioned with influenza,
which seems to be unpredictable and uncontrollable. Dentally, progress is being made
in remedial dental clinics for the younger school-aged and pre-school child, while information is being provided in the aspects of preventive dentistry. It must also be recorded
that in order to maintain and promote a healthy school population, emphasis in public
health must continue to be concentrated in the maternal and child health programme to
ensure that the child entering school is already in as healthy condition as possible.
HOME-CARE PROGRAMMES
The number of requests received from communities would indicate that there is
a definite interest in the provision of home nursing-care programmes, sufficient to warrant
full consideration on the part of local health departments toward inclusion of the service
as an integral part of the community health service.   The pilot study that was commenced DEPARTMENT OF HEALTH AND WELFARE,  1955 N 37
in Vernon three years ago under the supervision of an advisory committee, with guidance
by the North Okanagan Health Unit, was given considerable publicity and has created
an increased interest on the part of a number of other communities in a similar service.
However, the Vernon plan was designed primarily to determine if home care for convalescent patients discharged from hospital early might thereby release hospital beds for
more acute cases. This would then effect an economic saving to the community in permitting a more frequent turnover of beds, decreasing the construction of additional hospital
accommodation. In addition to the nursing care that might be needed, it was argued that
the provision of housekeeping service would also be a distinct advantage to patients
requiring home help. For both nursing and housekeeping service, a small daily charge
was to be made. In order to integrate these services with the hospital-care services, it was
decided that no patient should be discharged to the home-care service without the approval
of the attending physician.
It became evident early in the programme that the success of the service was
dependent upon a co-operative interest on the part of physicians and hospital nurses.
When their interest lagged, there was a definite decrease in the demands on the service,
but as soon as the matter was brought to their attention, there was an immediate case-load
increase. As the area in which the service would be provided was extended and the
demands increased, there was an additional public health nurse added to the staff of the
North Okanagan Health Unit in January to assist in the home-care case load, as well as
the general public health service case load. Here, again, National health grants were of
material assistance, since the pilot study was set up under a National health grant project,
and has been observed with considerable interest as a programme which might be extended
to other areas.
As there is a definite lag in the compilation of the statistics, it is preferable to compare
three similar periods in so far as this service is concerned. Last year it was possible to
compare January-August, 1953, with the same period for 1954, and now to add the
figures for a similar period for 1955.
There has been a further increase in the number of patients receiving this service
in its various phases, to provide a total increase of 54.7 per cent over the previous year.
There was, however, a marked decrease in the number of nursing visits per patient, as
each patient on nursing care received an average of 3.0 visits to save 11.5 hospital-days.
For the same period in 1954, each patient had 6.6 visits to save 14.7 hospital-days.
It would tend to indicate that a somewhat less acute type of nursing care has been required
during 1955, since patients required a lesser number of nursing visits per patient, on the
average.
Although there may have been a lesser number of visits, it is interesting to note that
the average time per visit has remained fairly constant, at 22.2 minutes, of which 10.2
were in travel, although there has been some change in the ratio between service and
travel.
In so far as the housekeeper service is concerned, there was an increased number
of patients receiving housekeeper care during the comparable eight months' period in
1955, but there were a lesser number of hospital-days saved by this service. Thus,
in 1955, each patient receiving housekeeper services averaged 39.5 hours of housekeeping
care to save 6.6 hospital days or 4.0 hours of care per hospital-day saved, as compared
to 51.4 hours of care to save 14.5 days in 1954 or 3.5 hours of care per hospital-day sayed.
The total benefits in so far as the hospital is concerned would indicate that there
were, on the average, a lesser number of days saved per patient, being 10.9 in 1955, as
compared to 14.8 in 1954 and 14.0 in 1953. This may be a direct reflection in relation
to the type of case that is being referred to the service as being somewhat less acute,
requiring a lesser number of nursing visits per patient, and a lesser amount of time for
nursing treatment. It would appear, therefore, that patients are not being discharged
from the hospital as early as in previous years. Comparative tables for the three annual
periods are shown as follows:— N 38
BRITISH COLUMBIA
Nursing-care Programme
Jan.-Aug., 1953      Jan.-Aug., 1954      Jan.-Aug., 1955
Number of patients—
Receiving nursing care only-
Receiving housekeeping service only-
Receiving both nursing care and housekeeping service-
Total receiving services- 	
Number nursing visits-
54
7
12
60
17
7
76
29
25
Number of visits per patient-
Number of housekeeping visits-
Hospital-days saved—
By nursing-
By housekeeping.
By both 	
Totals	
Time of public health nurses (total)—
Average time per public health nurse visit—
73
84
130
370
5.6
196
439
6.6
257
349
3.0
364
773
69
177
881
246
119
882
192
337
1,019
1,246
1,411
3,863
5,274
3,651
5,391
3,560
4,213
9,137
9,642
7,773
10.4
14.3
8.3
13.7
10.2
12.0
24.7
22.0
22.2
Housekeeping hours	
Hospital-days saved per patient-
Receiving nursing care only-
Receiving housekeeping only-
Receiving nursing care and housekeeping-
Average per patient	
807.5
14.3
10.0
14.8
14.0
1,234.75
14.7
14.5
17.0
14.8
2,138
11.5
6.6
13.4
10.9
Costs (Six Months, January to end of August)
Total cost, January to August-
Hospital-days saved	
Cost per day 	
$2,034.04
1,246
$1.63
$2,082.42
1,411
$1.47
It is evident from the table that, while there have been a considerably greater number
of patients receiving the service and a greater total number of hospital-days saved, the
average days saved per patient are less than in similar periods in previous years. This,
however, should not be a discouraging factor, since the over-all benefits to the patients,
hospital, and community are sound. This is borne out further by a comparative study
of the costs for the corresponding periods in each of the three years in which the service
has been operative, indicating that the cost per day has shown a gradual downward trend.
These figures are significant when compared with the hospital per diem cost of $11.35.
Significant is the fact that the service has increased the facilities of the Vernon Jubilee
Hospital to the extent of 5.8 beds in continuous use during 1955, as compared to an
increase in 1954 of 5.2 beds and in 1953 of 4.3 beds.
In addition to this special home-care programme, mention was made in the last
Annual Report of the home-care service that was being introduced in the Municipality of
Saanich, through the Saanich and South Vancouver Island Health Unit. This service is
not particularly related to convalescent nursing care of the discharged hospital patient,
but is accepting patients referred to it by private physicians. While the service has been
in operation for about a year, the demands made upon it have not appeared onerous, and
it has been able to meet satisfactorily all the requests referred to it. The system of records
which were set up to provide information on this service have had to be revised to yield
more definite information; because of this revision, it is not possible to collate the records
for analysis at this time; further study of the record-keeping is under way to set up a more
effective system which will yield the information as required, since it is evident that the
type of record is going to be utilized in other areas of the Province where similar demands
for home-care programmes are originating. DEPARTMENT OF HEALTH AND WELFARE,  1955 N 39
One of the latest areas to decide upon introduction of this service was in the Upper
Island He'alth Unit, where the Municipalities of Courtenay, Comox, and Cumberland
have agreed to the additional local assessment of 10 cents per capita to provide for a
home-care nursing programme under the official local health agency. This service will
be somewhat more difficult in administration, since the three municipalities are separated
by fairly extensive settled unorganized areas. Therefore, while the service can be provided within the boundaries of the municipality, those living on the fringe of the municipality will not receive the service because it is not possible to tax those unorganized areas
for the service. Studies are going forward to determine what can be done to bring the
unorganized areas into the system, since there is a definite desire to have the same
programme uniform throughout the whole area.
The investigation into a visiting-nurse programme for the City of Penticton, under
the sponsorship of the Hospital Board, has been continued during the year. Several
meetings have been held, at which representatives from the Vernon Jubilee Hospital
Board and Home Care Advising Committee have recounted their experiences with the
service there. There is still a definite optimism toward the introduction of the service in
the City of Penticton. Similarly, discussions have been going forward in the Powell River
area toward introduction of this service, and it seems evident that it will be requested by
the citizens of that area during the forthcoming year. In the meantime the same quietly
effective programme of home nursing and housekeeping care is progressing in the City of
Kelowna to satisfy the needs of that community.
In the field of home-nursing services, the Victorian Order of Nurses has continued
to fulfil a need, particularly in the larger cities of Victoria and Vancouver, and also in
areas such as Trail, Cloverdale, Gibsons, and, latterly, Nanaimo. In all of these areas
there has been definite rapport between the public health agency and the Victorian Order
of Nurses agency, so that they function side by side in the same community without overlapping in essential services. It must still be argued, however, that duplication will arise
to some degree in respect to direction of travel, and even visits in the same home for
different purposes. It is questioned whether this is economically sound community
planning.
DISEASE MORBIDITY AND STATISTICS
The Canadian Sickness Survey, which was carried out during a twelve-month period
commencing in the autumn of 1950 as a joint undertaking of the Department of National
Health and Welfare and the ten Provincial health departments, under grants made available through the National health grant programme, has continued to yield reports. Three
further reports were published during 1955, the first dealing with permanent physical
disabilities, the second with incidence and prevalence of illness, and the third with volume
of health care. This brings to eight the number of reports that have resulted from the
Canadian Sickness Survey, but by no means are the complete results of that survey
available as yet, since additional reports will be forthcoming as the material collected
becomes analysed.
The report dealing with incidence and prevalence of illness indicated that over
three-quarters (77.6 per cent) of the Canadian population reported new illness during the
survey year. The incidence of new illness was highest among children and was lowest
amongst persons over 65, which may be explained by the fact that much of the illness
suffered by persons in this age-group is of a chronic long-term or recurring nature. Of the
total population, well over half (56.0 per cent) suffered disabling new illnesses during
the survey year.
In the report dealing with the volume of health care, it was shown that two-fifths
(43.2 per cent) of the surveyed Canadian population of 13,540,000 persons reported
doctors' calls or clinic visits during the survey year. Well over half of the population
(56.8 per cent) reported no doctors' calls or clinic visits during the survey year. Persons
reporting one call or visit amounted to 15.1 per cent of the population, persons reporting N 40 BRITISH COLUMBIA
two calls or visits amounted to 8.1 per cent of the population, and successively smaller
proportions reported larger numbers of doctors' calls or clinic visits. One-tenth (10.2
per cent) of the survey population reported hospital care during the year 1950-51, while
just over 1 per cent reported home-nursing care during that period. One in twenty-seven
of the population (3.7 per cent) reported operations during the survey period, and one
in every seven of the population (14.7 per cent) reported dental care. One in every
thirty of the population (3.3 per cent) reported examinations for glasses (other than by
physicians) during that period, and one in every 106 of the population (0.9 per cent)
reported chiropractic treatment. Other miscellaneous health care was reported by 0.6
per cent of the population.
As the reports become available from the National Sickness Survey, it becomes
evident that that survey did build up a mass of medical-care information, and that much
more data are yet available as the study continues. It is possible to relate more and more
of this directly to British Columbia so that factual data can become available on the
medical-care needs of the Province as a whole.
It was recorded in the last Annual Report that the Consultant in Epidemiology would
be expected to present a specific report dealing with disease morbidity and epidemiology
during this year; however, changes which took place within that service, which resulted
in a new appointee assuming the position toward the close of the year, made the plan
impracticable. Although some investigations had been conducted in epidemiology,
particularly into shigellosis and poliomyelitis, the exact investigative programme did not
become fully organized. Until the newly appointed Consultant in Epidemiology becomes
acquainted with his duties, a continuation of the former type of morbidity reporting will
have to suffice. For 1955 British Columbia showed an increase in the total incidence of
notifiable diseases, with a rate of 3,462.0 per 100,000 population, to record the second
highest incidence of the past five years, as evidenced in Table X. Only 1951 exhibited
a higher rate, due primarily to the heavy incidence of influenza, as seen in a rate of 956.9
per 100,000; this past year also the increased rate was due primarily to the heavy
incidence of influenza, which showed a rate of 1,195.4 per 100,000 population.
Explosive outbreaks of this illness commenced to appear in various communities of the
Province during January, increasing in volume through February to a peak in March,
with a slight downward trend in April, and a final fall-off in incidence during early May.
The clinical severity remained mild, with ultimate recovery for the great majority of
patients within a few days, and consequently there was not a concomitant increase in
mortality from influenza, there being comparatively few deaths, confined for the most
part to the aged, in whom associated complicated factors were responsible.
Plans had been laid this year, as in previous years, for special studies of epidemic
influenza. The Department of National Health and Welfare sought to have all reporting
done promptly, while opportunity was provided for the typing of submitted specimens in
the Laboratory of Hygiene at Ottawa. Some specimens were forwarded to the laboratory
and subsequently reported upon as influenza, Type A virus being the causative organism.
Contributing to the high rate of notifiable diseases was the usual incidence of childhood infections — chicken-pox, measles, mumps, pertussis, rubella, and streptococcal
infections — which occur among the non-immune persons, particularly children in the
community. The incidence in many of these follows the pattern in relation to opening
and closing of schools, with a gradually increasing incidence after the schools reopen in
the fall, and a gradual decrease to a small residual incidence during the summer months
when the schools are closed. Chicken-pox, this year, with a rate of 379.0 per 100,000
population, was at the lowest ebb in the last five years, apparently attacking a lesser
number of patients. However, it must be mentioned that the reporting of this infection
is not complete, and there are admittedly hundreds of cases that are never reported, so
that the actual attack rate is only an index of the volume of infection. DEPARTMENT OF HEALTH AND WELFARE, 1955 N 41
Mumps, on the other hand, showed a somewhat increasing volume of infection over
that recorded the past year, with a rate of 223.9 per 100,000 for 1955, as compared to a
rate of 280.3 per 100,000 for 1954. The rate this year does compare with the high rate
in 1953 and 1950, and merely emphasizes the fact that this infection does occur cyclically
in epidemic proportions.
Rubella, on the other hand, recorded a very low figure with a rate of 58.9, compared
with that of 65.7 last year and 89.0 in 1953 and 165.8 in 1952. Actually the rate for
rubella has been showing a consistent decrease from a peak in 1950, exhibiting a trend
in the cyclic occurrence of this illness, indicating that an increase can be expected shortly,
as a very considerable non-immune group is becoming established throughout the
Province.
It is encouraging to record the very low incidence of streptococcal infections during
1955, particularly in those diagnosed as scarlet fever, in which the rate was 58.0, as
compared to 107.0 for 1954. Here, again, the rate is the lowest in the past five years.
It is difficult to determine to what this decrease can be attributable, since no particular
changes have occurred in control measures for these infections. Actually they do not
hold the same seriousness from a point of view of complications as pertained in former
years, since the addition of newer forms of treatment have overcome the development of
such complications. There does remain, however, the potential threat of streptococcal
infections creating rheumatic fever, particularly among children. The Health Officers'
Council took this problem under advisement during one of its meetings and recommended
the establishment of a pilot study in one of the health-unit areas to determine what might
be done in control of rheumatic fever and in prevention of that condition. The South
Okanagan Health Unit undertook the task of conducting a pilot study in its area, and is
drafting proposals toward that end, working with its hospitals and its local medical
societies. Particularly they are interested in development of actual reporting of all cases
of rheumatic fever, prior to analysing what prophylactic measures may be adopted toward
prevention of recurrence and of complications. That study will be continued into the
future and will be reported on in more detail as the pilot plan gets further organized.
It would appear that some specific attention should be devoted to the matter of
whooping-cough (pertussis), in which the rate of 129.0 per 100,000 population is the
highest in the past five years. Specifically, some analysis of the age specific attack rate
seemed to be warranted to determine whether the increased volume of cases is occurring
among older pre-school and school-age children rather than among infants and young
pre-school groups. Pertussis immunization has rendered protection for infants and
young pre-school children definitely possible, for whom pertussis vaccine provides a fairly
solid immunity. The mortality for this illness in previous years was greatest among the
very young, in whom protection by immunization is therefore of most value and most
necessary. However, it is not desirable to protect a child against pertussis through passive
immunization for his entire life. Artificial immunity must ultimately be replaced by the
more secure natural immunity through the medium of disease experience. It is therefore
likely that infection will occur among older non-immune children where an immunization
programme is protecting the younger children. This seems to be borne out in a study of
cases occurring during 1955; in an examination of 1,597 cases reported, 119 were under
1 year of age, 674 in the age-group 1 to 4 years, 768 in the age-group 5 to 14 years, 14
in the age-group 15 to 19 years, 22 in the age-group 20 years and over, and 20 in an
age-group unspecified. From this can be gathered the impression that the major number
of cases occur in the age-groups beyond infancy, but that some further assessment is
desirable to ensure no infection in the group under 1 year of age. Emphasis would still
seem to be desirable to bring all infants into the security of immunity.
During the year the usual number of cases of infectious hepatitis was recorded, with
a rate of 64.4, paralleling the rate that has been occurring during recent years. Here,
again, the rate may be only an indication of the total volume of infection, but is an index N 42
BRITISH COLUMBIA
of an increasing infection. This matter was given some very definite consideration during
the year, as the Health Officers' Council reiterated their desire to see immune serum
globulin used as a prophylactic. Following discussions on the subject in relation to the
incidence, it was decided to provide immune serum globulin for contacts in close groups;
during the year a considerable amount (651 cc.) was distributed for that purpose.
However, there was an indication that it was not promoting the desired control, and,
toward the end of the year, consideration was being given to provision of immune serum
globulin to all intimate contacts to infectious hepatitis, in the hope that it would prevent
a large number of cases and thereby reduce the community incidence.
In the section of this Report dealing with school health services, mention was made
of the amount of diphtheria that continues to occur, and the table of notifiable diseases
reflects this, at a rate of 0.6 per 100,000 population. This indicates only too clearly the
vigilance that must be exercised toward production of an immune population; this
requires immunization in the early childhood years with repeat immunizations to maintain
that initial immunity for life. Clinics are therefore not only desirable to accommodate
the infants, pre-school and school population, but also to include the adult population.
Poliomyelitis during 1955 exhibited an incidence practically parallel to that of 1954,
considerably less than the numbers that had appeared for the two previous years. With
the appearance of 224 cases, the case rate per 100,000 population was 17.2, as compared
to that of 16.7 in 1954, 64.0 in 1953, and 49.6 in 1952. The cause for the lowered incidence in the past two years is unexplainable, being one of those enigmas common to this
particular type of infection, in which the epidemiology of the disease is still somewhat
obscure. The outlook for the future shows some hope in the success that seems to have
occurred with the Salk immunization programme, as evidenced by the trials in the United
States during 1954, as recorded in the Francis Report, and in the analysis of the results
of the immunization programme in British Columbia during the past year. The very
efficient programme of administration of vaccine to some 49,000 children was conducted
by local health services throughout the Province in the early spring between April and
June. The whole programme was very well co-ordinated from the manufacturer's level,
through the Federal and Provincial health departments, to the local health level, and
resulted in a very efficient and effective administration of the vaccine without any complications or serious reactions. Records were very carefully maintained on all the children
who participated in the programme to compare those unvaccinated in the specific age-
groups with those vaccinated in the same age-groups. An analysis of those results is
shown for 45,067 children in the following tables, which contrast the attack rates in the
unvaccinated and the vaccinated groups.
Table VIIIa.—Percentage Distribution of Children by Eligibility for and
Acceptance of Poliomyelitis Vaccine and Age, British Columbia, July 1st
to November 30th, 1955.
5 Years
6 Years
7 Years
Total
Number
Per Cent
Number    Per Cent
Number
Per Cent
Number
Per Cent
Children accepting vaccine	
Children not accepting vaccine	
14,865
5,856
71.7
28.3
22,951
3,445
86.9
13.1
7,826
3,187
71.1
28.9
45,642
12,488
78.5
21.5
Total children eligible for
vaccine 	
20,721
100.0
26,396
100.0
11,013
100.0
58,130
100.0 DEPARTMENT OF HEALTH AND WELFARE, 1955
N 43
Table VIIIb.—Percentage Distribution of Children Accepting Poliomyelitis
Vaccine by Number of Injections Received and Age, British Columbia,
July 1st to November 30th, 1955.
Number of Injections Received
5 Years
6 Years
7 Years
Total
Number
Per Cent
Number
Per Cent
Number
Per Cent
Number
Per Cent
190
586
14,089
1.3
3.9
94.8
266
878
21,807
1.2
3.8
95.0
119
353
7,354
1.5
4.5
94.0
575
1,817
43,250
1.2
4.0
94.8
pro-
Total    commencing
14,865
100.0
22,951
100.0
7,826
100.0
45,642
100.0
Table IXa.—Paralytic Poliomyelitis Cases and Attack Rates by Age and Vaccination Status, British Columbia, July 1st to November 30th, 1955
Age
Number
Vaccinated
(2 and 3
Injections
Only)
Number
Developed
Paralytic
Polio
Paralytic
A.R./1.000
Number
Not
Vaccinated
Number
Developed
Paralytic
Polio
Paralytic
A.R./1.000
5 years..
6 years-
7 years-
TotalS-
14,675
22,685
7,707
5,856
3,445
3,187
45,067
12,488
0.7
0.9
0.9
0.8
Table IXb.—Poliomyelitis Cases in Contacts of Vaccinees with Onset
Interval, British Columbia, May 18th to November 30th, 1955
Paralytic   28
Non-paralytic (confirmed1)      4
Non-paralytic (unconfirmed)  i     6
Total cases  38
Interval between inoculation of vaccine and onset in contact—
Less than 1 month  5
More than 1 month  33
Total  3 8
1 On basis of C.S.F. findings.
It becomes evident from a study of these tables that if the paralytic attack rate 0.8
per 1,000 were applied to the vaccinated children, there would have been an additional
36 cases of paralytic poliomyelitis. This, therefore, tends to indicate that the vaccination
programme was a success in so far as the 1955 experience in British Columbia was concerned and is justification for the immunization of further groups of children as vaccine
becomes available.
There are indications that there will be larger quantities of vaccine available during
1956, and plans are under way toward the immunization of more children in the higher
age-groups, while continuing the immunization of the previous age-groups; that is to say
that children from age 5 upward into their teens may be expected to receive Salk vaccine
in the forthcoming year.
Another forward step which occurred in relation to poliomyelitis during 1955 was
the opening of the Poliomyelitis Pavilion on the grounds of the Pearson Tuberculosis N 44
BRITISH COLUMBIA
Hospital to provide for the lengthy specialized treatment of paralytic poliomyelitis
patients, thus relieving the load on the acute hospitals to permit them to assume responsibility for acute care in the early stages of the illness. Considerable admiration must be
expressed for the exceptionally high quality of medical and nursing skill provided these
patients in the larger hospitals in Vancouver and Victoria, particularly the Vancouver
General Hospital and the Royal Jubilee Hospital. They have accepted seriously paralysed, acutely ill patients at any hour of the day or night, and have provided them with
maximum care to the degree that many of the patients have been restored to complete
health without residual paralysis. Without the assistance of these institutions, the demand
placed upon the Poliomyelitis Pavilion might be more than it could justifiably handle;
as the year ended, some thirty-six patients were receiving treatment in the Poliomyelitis
Pavilion.
It is encouraging to note that there has been a reduction in the case fatality rate of
1.3 for 1955, the lowest rate to date. This is no doubt due to the excellent evacuation
services provided, as in the past, by the Royal Canadian Air Force, coupled with the high
quality of medical care provided by both practising physicians and the two hospitals mentioned previously. As a basis of comparison, the table that follows shows the trend that
has occurred in the case fatality rates and reflects the credit that is due these various teams.
Year
Cases
Deaths
Case
Fatality
Rate
1927   .  ._        _	
182
102
43
34
42
313
584
787
211
224
37
19
13
8
11
12
37
26
6
3
20.3
1928    _ _
18.6
1929                                	
30.2
1930           _ -	
23.5
1931  _    _	
1947                            	
26.2
3.8
1952
6.3
1953 _ -	
3.3
1954                       -	
2.8
1955    -     	
1.3
Credit must also be acknowledged from the British Columbia Foundation for Poliomyelitis, a voluntary agency supported mainly through the efforts of the Kinsmen's Clubs
throughout the Province. They have conducted annual campaigns for funds which have
received wide support and have assisted in many ways in the poliomyelitis programmes,
both in immunization and in treatment. The funds for the purchase of the vaccine were
provided through matching moneys from National health grants, and a Provincial grant,
but additional sums were earmarked by the British Columbia Foundation for Poliomyelitis
for the purchase of any additional vaccine that might become available during the year.
Unfortunately manufacturing outputs could not be increased to provide any such additions. However, the Foundation did assist further in the purchase of additional equipment, particularly syringes and needles, to assist in the intensified immunization programme which was carried on in a concentrated period by the public health nurses and
health officers.
In addition to this voluntary agency, recognition must also be given to the Western
Society for Rehabilitation for the part which they have played in the ultimate rehabilitation of the patient with residual paralysis. Those patients have been accepted in increasing numbers in the Western Society for Rehabilitation and have received exceedingly
efficient service in re-education of muscle to permit restoration to useful function, either
naturally or aided by supports.
There has continued to occur a number of cases of enteric infection of the Shigella-
Salmonella group, although in somewhat lesser numbers than in recent years. Bacillary
dysentery, mostly Shigella, was reported in 293 cases for a rate of 22.5 per 100,000
population, which is considerably less than the rate of 47.8 of 1954.   The majority of
J DEPARTMENT OF HEALTH AND WELFARE,  1955 N 45
these infections were due to Shigella sonnei, which is indigenous to the Province, being
reported from all areas. It is sufficient to indicate that it is prevalent and that epidemics
from this can be anticipated from year to year, from carriers harbouring the organism.
Salmonellosis showed an even more remarkable decrease, with the exception of that due
to Salmonella typhi, which had a rate of 0.6, and Salmonella paratyphi, with a rate of 3.1.
These two showed trends similar to the incidence in previous years and continued to
serve as a warning that precautionary control measures are needed, specifically in certain
areas of the Province where the disease seems to be endemic. There does seem to be a
fairly high proportion occurring in the Skeena Health Unit, and studies are going forward
in that area to determine what may be done to control some of the infection that is being
recorded annually. The large unqualified group of Salmonella, in which is incorporated
the various types, showed a fairly considerable decrease, with a rate of 7.0, as compared
to a rate of 13.7 the year previous. The reasons for such a decrease are not self-evident,
since there is a considerable residual volume of infection prevalent throughout the
Province at all times, and consequently there will likely be a man-to-man spread wherever
there is a breakdown in personal hygiene and food-handling methods. Sporadic epidemics
will likely continue to occur from time to time.
While no human cases of rabies were reported during the year, there was evidence
of rabies occurring among domestic animals, particularly dogs, in the Rossland area.
There, two humans were bitten by a dog which was subsequently proven to be suffering
from rabies, and only prompt attention by the physician and the Medical Health Officer
prevented the possibility of a human victim of the disease. Co-operation was immediately forthcoming from the Federal Diseases and Animals Branch, which quickly adopted
measures for the inoculation of all domesticated canines in the area, while the municipal
authorities and police took steps to rid the community of stray animals. These prompt
measures have probably aided in control of the situation in that community, but are
indicative of the need that must be exercised to watch for rabies occurring among community animals, spreading from the wild game in the area.
One condition, not shown in the table of notifiable diseases—namely, staphylococcal
infection—created interest during the year. Reports were prevalent that this condition
was on the increase throughout the hospitals of the Province, and a spot survey of the
hospital incidence was taken for one day late in November. From that it was evident
there was something of a problem, although it was not solely a hospital problem, but
more a community problem. While some cases were occurring in the hospitals, there
were cases being admitted from the community, and it was probably unjust to concentrate the publicity on the hospital situation. It was felt that some basis would have to
be established if any determinations were to be made of the extent of the problem, and
that notification of the cases would seem to be most desirable. A committee established
by the Deputy Minister of Health under the chairmanship of the Senior Medical Health
Officer for the Metropolitan Health Committee took the situation under advisement and
is working toward recommendations for the reporting procedures that will come into
being shortly. There will have to be some interpretation of what is to be reported in the
matter of degrees of staphylococcal infection, which responsibility also rests with this
same committee. Once notification becomes established, determinations of the extent
of the situation will then be possible and studies can then be undertaken to determine
whether control can be exercised.
The table of notifiable diseases lists also the incidence of tuberculosis and venereal
disease, which are reported on in separate sections of this Report by the divisions dealing
with those particular communicable infections.
Cancer continued to display its usual annual toll in a rate of 272.5, which is practically analogous to the incidence over the past five years. The British Columbia Cancer
Institute has been recognized as the agency of the Province dealing with this particular N 46
BRITISH COLUMBIA
health problem.    The report of the Bureau of Specialized and Preventive Treatment
Services contains information relative to the work going on in that field.
The notifiable diseases continue to be reported weekly by the Medical Health Officers
to the Division of Vital Statistics, which collates the material and prepares the various
tables, charts, and diagrams to provide an analysis of the situation for the public health
physicians, Provincially and locally. The statistical tables that follow, showing the total
number of cases and case rates for the past five years, and listing the incidence by health
units throughout the year, display the year's effect of these conditions on the health of the
people of British Columbia.
Table X.—Notifiable Diseases in British Columbia, 1951-55
(Including Indians)
(Rate per 100,000 population.)
Notifiable Disease
1951
Number
of
Cases
Rate
1952
Number
of
Cases
Rate
1953
Number
of
Cases
Rate
1954
Number
of
Cases
Rate
1955
Number
of
Cases
Rate
Actinomycosis..
Botulism	
Brucellosis.-	
Cancer-
Chicken-pox	
Conjunctivitis.
Diphtheria	
Dysentery—
Amoebic-
Bacillary (Shigella) —
Encephalitis, infectious
Hepatitis, epidemic	
Influenza, epidemic	
Leprosy 	
Malaria. —
Measles   	
Meningitis 	
Mumps.
Pertussis	
Poliomyelitis _
Rubella.
Salmonellosis—
Typhoid fever
Paratyphoid fever-
Unqualified
Streptococcal infections—
Erysipelas _
Scarlet fever-
Septic sore throat	
Puerperal septicjemia..
Tetanus  	
Trachoma 	
Tuberculosis 	
Tularemia
Venereal disease—
Gonorrhoea _
Syphilis (includes nonspecific urethritis—
venereal) 	
Chancroid
Vincent's angina-
18
2,850
6,671
374
5
253
90
11,033
2
6,269
30
5,835 |
1,134 |
92 j
2,288 |
I
18
7
149
38
4,146
300
8
1,662
3,301
568
48
Totals..
1.6
247.2
578.5
32.4
0.4
21.9
7.8
956.9
0.2
543.7
2.6
506.1
98.4
8.0
198.4
1.6
0.6
12.9
3.3
359.6
26.0
0.7
144.1
286.3
49.3
4.2
12
3,366
6,266
346
11
1
102
2
212
548
2
8,227
33
7,088
976
594
1,986
30
8
109
26
4,163
536
2
3
1,411
3,057
541
19
47,189  4,092.7  39,677
1.0
281.0
523.0
28.9
0.9
0.1
8.5
0.2
17.7
45.7
0.2
686.7
2.7
591.6
81.4
49.6
165.8
2.5
0.7
9.1
2.2
347.5
44.7
0.2
0.3
117.8
255.2
45.2
1.6
3,312.0
1
~ 5
2,785
6,869
193
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
13
1,494
1
2,969
691
11
26
38,185
0.1
0.4
226.4
558.4
15.8
0.6
0.1
47.8
0.3
64.1
65.7
0.1
0.1
621.6
3.4
656.2
58.3
64.0
89.0
0.8
1.8
6.7
1.9
180.5
16.7
0.1
0.2
1.1
121.5
0.1
241.4
56.2
0.9
2.1
1
3
7
3,600
6,085
64
7
605
1
1,220
78
6,572
47
3,548
1,096
211
832
11
36
173
21
1,355
179
1
4
1,434
1
2,668
784
36
12
0.1
0.2
0.5
284.4
480.6
5.1
0.5
47.8
0.1
96.4
6.2
519.1
3.7
280.3
86.6
16.7
65.7
0.9
2.8
13.7
1.7
107.0
14.1
0.1
0.3
113.3
0.1
210.7
61.9
2.8
0.9
3,104.4
30,692
13
3,556
4,947
134
2
293
2
841
15,601
1
8,160
48
2,922
1,683
224
768
40
92
12
757
352
4
6
1,414
2,508
765
7
11
45,179
1.0
272.5
379.0
10.3
0.6
0.2
22.5
0.2
64.4
1,195.4
~b.i
625.2
3.7
223.9
129.0
17.2
58.9
0.6
3.1
7.0
0.9
58.0
27.0
0.3
0.5
108.4
192.2
58.6
0.5
0.8
3,462.0 DEPARTMENT OF HEALTH AND WELFARE,  1955
N 47
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C
h N 48 BRITISH COLUMBIA
REPORT OF THE DIVISION OF PUBLIC HEALTH NURSING
Monica M. Frith, Director
The public health nursing service continued its steady development throughout the
year 1955 in spite of many difficulties. Through the Division of Public Health Nursing,
which forms part of the Bureau of Local Health Services, the local health units receive
consultative service, as well as technical supervision of the public health nursing programme. The Division of Public Health Nursing maintains responsibility for recruiting,
placing, and transferring of nursing personnel in order to provide the highest possible
quality of public health nursing service to the people of British Columbia. Every effort
is made to keep the quality of service as high in standard in the remote rural districts as
the service available to people in the more populated parts of the Province.
STATUS OF THE SERVICE
During the year eleven new positions were established for public health nursing
field staff, to bring the total number of public health nursing positions to 151. This total
includes positions for 125 staff nurses, 15 senior nurses, 6 supervisors, 1 resident nurse,
2 consultants, an assistant director, and director. In addition, an epidemiology-worker
from the Division of Venereal Disease Control serves on the staff of the Cariboo Health
Unit. In June of this year the Public Health Nursing Co-ordinator position at the Division of Tuberculosis Control in Vancouver was discontinued.
In February the Ocean Falls Public Health Nursing Service (School District No. 49),
which embraces a large area including Bella Bella, Bella Coola, Namu, South Bentinck,
was established. This district requested public health nursing service some time ago, but
it was not possible to open up the district until this year because of the shortage of qualified public health nursing personnel. In August, Kitimat Public Health Nursing Service
(School District No. 80) was established on a full-time basis. Previously some public
health nursing service was available to the community on a part-time basis. However,
the increase of population justified the placement of a full-time public health nurse at
this centre this year. It appears that this service will need to be expanded before long
due to the heavy industrial expansion with the resultant development of a new municipal
area.
New positions to take care of the population increases were established in the South
Okanagan Health Unit at Kelowna and Penticton, the North Okanagan Health Unit at
Vernon, the North Fraser Health Unit at Mission, the Upper Fraser Valley Health Unit
at Chilliwack, the Boundary Health Unit at Cloverdale, the East Kootenay Health Unit
at Cranbrook, the West Kootenay Health Unit at Trail, and in the Saanich and South
Vancouver Island Health Unit. Zeballos, on the west coast of Vancouver Island, commenced a part-time public health nursing service, utilizing the assistance of a resident
married nurse. In all, a total of thirty-five public health nursing positions have been
made possible through National health grants. These grants provide for the salary and
operating expenses, as well as basic nursing equipment, such as nursing-bag, baby-scales,
and vision-testing boxes.
The gradual increase in numbers of public health nurses in local health units has
necessitated some change in the organization of the public health nursing structure in
health units which formerly had senior nurses who carried district responsibilities as well
as supervisory duties. The senior nurses in the Upper Fraser Valley Health Unit, the
East Kootenay Health Unit, West Kootenay Health Unit, and the Upper Island Health
Unit now devote full time to public health nursing supervision and administration.
During the year sixty-four placements were made to fill public health nursing vacancies. Of the nurses placed in these positions, fourteen returned from university following the completion of the public health nursing course, fifteen were nurses without public DEPARTMENT OF HEALTH AND WELFARE,  1955 N 49
health nursing qualifications, and the balance were recruited in the Province and elsewhere in Canada, Scotland, and California.
The Department was fortunate to be able to fill such a large number of positions
with qualified public health nurses when it is realized that only three qualified public
health nurses were recruited following the completion of the university year at the University of British Columbia. This year six British-trained health visitors joined the staff
as public health nurses. This is the largest number to date, and local health services
have benefited from the experience of this new group of qualified public health nurses.
Of the total group of new recruits, only four were resident outside the Province at the
time of appointment to the staff. Therefore, it appears that continued efforts must be
directed toward training and recruiting public health nurses in British Columbia in order
to keep up with the need for trained personnel.
The fourteen nurses who returned to the staff as qualified and experienced public
health nurses following university training taken with the help of financial assistance
from National health grants have been the dependable nucleus of trained public health
nursing staff around which the less mobile members of the public health nursing staff
have been placed. Without this group of public health nurses it would not have been
possible to maintain the service in the outlying centres of the Province. In all, 30 per
cent of the present public health nursing field staff have been trained with the assistance
of National health grant bursaries. It was possible to reopen Burns Lake and Greenwood districts following the return of public health nursing trainees to the staff.
There were twenty-nine resignations from the staff, which is one less than last year.
Of this number, eighteen left for marriage and family reasons, eight to accept new positions, and three trainees left the service rather than go on to university. Two Public
Health Nursing Consultants resigned to join the World Health Organization. In addition, sixteen nurses are on leave of absence attending university to further their education
in public health nursing.
PUBLIC HEALTH NURSING CONSULTANT SERVICE
The Public Health Nursing Consultant service functions under the direction of the
Bureau of Local Health Services in an advisory capacity to local health units in order
to assist with the development of local public health nursing programmes to fit in with
accepted standards of service.
The Public Health Nursing Consultants visit health units and nursing districts at
least twice a year to assist the senior or supervisory public health nurse to deal with the
local situation. Through an annual study of the case loads carried by each public health
nurse, time analysis, and statistical service reports, data are obtained which may substantiate the need for additional public health nursing personnel. The Consultant helps
the senior nurse to analyse the various types of services given by the public health nurses
on her staff to determine whether the nurses are using their time in the most efficient
manner. As a result, many adjustments have been made to local health programmes in
order to provide better service to the public.
The Public Health Nursing Consultants have been working toward the establishment of definite Provincial policies with regard to public health nursing activities in such
matters as school health, child health conferences, home-visiting, etc., which will eventually go forward to the public health nursing staff in manual form. The Consultants
have made a substantial contribution to Policy Manual material during this year. They
assisted with the revision of the booklet " Feeding the Normal Child," which is used by
the field staff in the infant-care teaching programme. The post-natal letters which are
sent out each month to the mother following her return home from hospital with her
baby were completely rewritten by one of the Consultants, in fine with the latest pediatric
information from the University of British Columbia. N 50 BRITISH COLUMBIA
The Public Health Records Committee, which was made up of senior nurse representatives from the Fraser Valley, with a Consultant Public Health Nurse as secretary,
and a representative of the Division of Vital Statistics, met at regular intervals. The
major work of this Committee this year has been the development of the family folder
procedure manual of instructions for the proper use of the new filing system. With the
completion of this work, members of the Records Committee resigned, as it was felt that
many of the decisions with regard to record usage should be the prerogative of a more
representative group of health-unit and central-office advisers. They recommended that
the Provincial Records Committee consist of (1) health-unit director, (2) member of
the Division of Vital Statistics, (3) a health-unit clerk, (4) two public health nurses,
(5) a Public Health Nursing Consultant, and (6) the central-office clerical consultant.
It was further recommended that sub-committees be set up to advise on revisions of records of specific records used by select groups only, such as nursing and sanitation.
The position of Public Health Nursing Co-ordinator with the Division of Tuberculosis Control in Vancouver was discontinued in June of this year. Miss Fern Primeau,
who had been in this position, had made an excellent contribution in the capacity of
Co-ordinator, but it was agreed that the time had now come for local health units and
the Division of Tuberculosis Control to accept complete responsibility for their own part
of the tuberculosis-control programme. The direct exchange of tuberculosis records,
P.H. 7, was initiated, as it was believed that this would be a good time to bring this
change into effect, when many of the health units were setting up the family folders.
Many adjustments have been made as the result of the change, and the new programme
seems to be running quite smoothly. The Public Health Nursing Consultant in Vancouver now acts in a liaison capacity with the Division of Tuberculosis Control. Revisions have been started on the Tuberculosis Policy Manual, incorporating the procedure
changes.
The Division of Venereal Disease Control has seconded a member of its epidemiology staff to the Cariboo Health Unit, to assist with the development of an adequate
venereal-disease control programme in this unit which has a special problem. It has
continued to offer consultative services to the field staff requiring special assistance with
venereal-disease control.
The Division of Public Health Nursing suffered a severe loss with the departure of
two Nursing Consultants to the World Health Organization. Miss Margaret Cammaert
left in June for Mexico and Miss Lucille Giovando left in August for San Salvador. Both
Consultants had served for a number of years in staff, supervisory, and Consultant positions. As Miss Giovando had special training in mental health and Miss Cammaert had
special preparation in maternal and child health, it has not been possible to find public
health nurses with similar training and experience for replacements. However, the Division was most fortunate in securing the services of Mrs. Dorothy Slaughter as Public
Health Nursing Consultant, with headquarters in the new Provincial Health Building in
Vancouver. As former Director of Public Health Nursing, Mrs. Slaughter brings a
wealth of experience to the position, which she assumed in September. The position of
Assistant Director of Public Health Nursing has not yet been filled.
During the year the Division has worked closely with allied public health agencies,
including the Greater Vancouver Metropolitan Health Committee, the Victoria-Esquimalt
Health Department, The Indian Health Services, and the Victorian Order of Nurses.
Members of the Division have been on a number of Provincial committees. These
include the Provincial Junior Red Cross, Junior Red Cross Crippled and Handicapped
Committee, the Red Cross Nursing, the St. John Ambulance Nursing Committee, the
Public Health Nursing Labour Relations and Educational Committee of the Registered
Nurses' Association of British Columbia, the Advisory Committee to the University of
British Columbia School of Nursing, the Provincial Crippled Children's Registry, and
the Provincial Mental Health Association Committee. DEPARTMENT OF HEALTH AND WELFARE, 1955 N 51
PUBLIC HEALTH NURSING TRAINING
The in-service training of nurses without public health nursing qualifications was
continued again this year in order to meet service needs in local health units. During
the year fifteen nurses without public health nursing qualifications were taken on staff
as public health nursing trainees. This year less than one-third of the new appointees
lacked public health nursing training, in contrast to two-thirds one year ago. Nurses
without public health qualifications are placed as public health nursing trainees in selected
health-unit centres and sub-centres, where an adequate orientation programme and continued public health nursing supervision are available. Only nurses who are eligible and
interested in obtaining public health nursing qualifications at an early date are taken on
staff for this training. The orientation programme is carried out by the local senior
public health nurse and includes an opportunity to observe qualified public health nursing staff at work and a period of study in order to obtain a working knowledge of basic
programmes and procedures in public health nursing. At the end of the orientation
experience, the public health nursing trainee assumes responsibility for her own nursing
district. Placement of public health nursing trainees in local health services has created
an additional load for the supervisory staff, but the experience has proved to be most
valuable to the nurses when they attend university. The training programme has made
a good contribution to the over-all provision of qualified public health nurses for local
health services, as the trainees returning to the service can assume greater responsibilities
than the nurse who has just completed the public health nursing course at university
with a minimum of practical experience. During the year fourteen public health nursing
trainees returned to the field staff and another fourteen nurses were given leave of absence
to complete the certificate course in public health nursing. Thirteen are in receipt of
National health grant bursaries. These bursaries are most generous, as the trainees
receive $100 per month while attending university and completing field work, plus tuition
fees and a small book allowance. In return the trainee agrees to work for two years
following the completion of the public health nursing course. Public health nursing
trainees this year are enrolled in nursing schools at tfffe University of British Columbia,
McGill University, Western Ontario, and the University of Saskatchewan.
In line with the policy of providing adequately trained staff for all types of public
health nursing positions, two senior nurses were given leave of absence on National health
grant bursaries in order to take university courses in public health nursing supervision
and administration. Miss Norah Wood is enrolled in McGill School for Graduate Nurses,
while Miss Joan Russell is taking the course at the University of Toronto School of
Nursing. It is hoped that all senior nurses can eventually take advantage of similar educational opportunities.
During the past year the field training programme for university students was exceptionally heavy due to an increased enrolment of students in the School of Nursing at the
University of British Columbia. A total of thirty-four students from the University of
British Columbia received basic public health nursing experience in local health services.
Each student was assigned for a four-, five-, or six-week placement to an experienced
public health nursing field adviser for supervised public health nursing activities. Students
were placed in the field in January, May, and June. A number of the students placed for
field work were enrolled in the new nursing programme which prepares the nurse for
either public health nursing or hospital administration. Students in this programme are
not necessarily interested in public health nursing as a career. However, the experience
gives them a better understanding of the functions of a public health service. In addition,
six students from the University of Saskatchewan received a month's experience in the
field during May. The field staff on the whole enjoy working with nursing students and
are prepared to give them the best possible experience in their health service.
The Saanich and South Vancouver Island Health Unit continued to provide two- or
three-day periods of orientation for undergraduate students from the Royal Jubilee and N 52 BRITISH COLUMBIA
St. Joseph's Hospitals Schools of Nursing in Victoria. A total of forty-three students had
experience with this unit. The South Central Health Unit has also offered similar experience to the Royal Inland Hospital at Kamloops, but only a limited number of nurses were
able to take advantage of this opportunity.
Continuous in-service education programmes are carried on in each health unit by
means of regular nursing study-group meetings. These meetings are planned to keep the
members of the staff up to date with newer developments in public health nursing. The
health-unit staff usually select their own topics for study, based on the need of the group.
One health unit developed material for pre-natal classes this year, while another has been
studying the school-age child in order to prepare the staff to do a better job with teacher-
nurse conferences. The public health nursing study groups carried through with a detailed
study of the material made available through the psediatric refresher course given one year
ago. Public health nursing staff took advantage of the course in rehabilitation nursing
(body mechanics), made available on a local level by an instructor on the staff of the
Registered Nurses' Association of British Columbia. Ten public health nurses were
selected locally to attend the annual meeting of the C.P.H.A. at Edmonton this fall. As a
number of new health programmes were discussed, the public health nurses derived a
considerable amount of benefit from the opportunity of attending the sessions and meeting
public health workers from other Provinces.
This year a nurse was able to take advantage of a plan for the exchange of public
health nurses, and is having one year's experience at Beverley, Hull, England. It is hoped
that the experience gained with this type of health agency will justify the extension of an
exchange plan for public health nurses to other countries.
The Public Health Institute provides another excellent opportunity for in-service
education. During the Public Health Nursing Section programme, two excellent symposia were presented on " The Teacher-Nurse Conference " and " The Use of Interviewing Techniques in a Child Health Conference." The public health nurses meet as
a group at the Institute, and through their organization, the Public Health Nursing Council, make recommendations regarding matters of concern to the nurses as a whole. As a
result of a resolution from this group, more visual-aid material, films, and books have
been made available to local health units for prenatal classes. The Council asked the
Personnel and Salary Committee to continue its activities rather than affiliate for negotiation purposes with the Registered Nurses' Association of British Columbia. A committee
was set up to advise the Director of Public Health Nursing concerning the public health
nursing uniform.
LOCAL PUBLIC HEALTH NURSING SERVICE*
Public health nurses make up the largest number of health-workers serving on the
public health unit team. Therefore, they are in a position to make a significant contribution to the health-unit programme. Because their work brings them into contact with
many individuals and groups, they are in a strategic position to promote public health
activities.
Each public health nurse carries out a generalized health programme, providing
health services to the people in her assigned district. The size of the district and the
population depend to some extent on the concentration of the people and the travel distances involved. Where travel distances are great, the public health nurse has a smaller
population to serve. In December of this year each public health nurse on the average
served 4,500 people. The services provided by the generalized public health nursing
programme have been arbitrarily divided into the broad categories of service described
later.
* Figures shown in this section apply to the seventeen local health units but do not include the metropolitan health
departments of Vancouver, Victoria-Esquimalt, and Oak Bay. DEPARTMENT OF HEALTH AND WELFARE,  1955 N 53
Maternal Health—Prenatal and Postnatal
The public health nurse offers an education programme for expectant mothers to
assist them in making the best possible preparation for the safe delivery of a healthy
child. Classes for expectant mothers are given at many of the larger centres. Usually
six classes form the series, which deals with the hygiene of pregnancy, breast feeding,
nutrition, the baby's layette and bath, and the early care of the baby. A visit to the
maternity ward of the local hospital may be included. Relaxation exercises are given as
part of the programme in a number of centres. This year, lecture series with exercises
were given at twelve centres, while an additional five centres gave classes without the
exercises. During the year basic equipment was obtained through National health grants
to provide health units with such items as a demonstration layette, teaching-films, posters,
basic reference text-books, and mattresses for the exercise classes. Prenatal classes
showed an attendance of 1,915. During the year 1,453 home and office visits were made
to expectant mothers. There were 13,949 postnatal visits to mothers following their
return home from hospital with the new baby.
Child Health—Infant and Pre-school
The public health nurse endeavours to visit the mother during the first week home
from hospital with her new baby. At this time she is most receptive to teaching, and the
nurse is able to assist her in planning and caring for the new baby. Procedures such as a
baby bath may be demonstrated. Further visits are given on the basis of need. Mothers
are encouraged to continue with medical supervision and advised that supplementary
health teaching is available at child health conferences.
Child health conferences are held throughout the public health nurse's district in
locations where there are a sufficient number of children to justify the setting-up of a
clinic. They may be held in private homes, halls, or schools. Many of the locations are
not too satisfactory, but the public health nurse endeavours to provide service as conveniently as possible for the mothers. At the child health conference the mother receives
anticipatory guidance on growth and development and specific information concerning
problems such as diet and emotional upsets. Immunizations are available to protect the
child from communicable diseases. During the year 52,584 infants and 46,830 preschool children were in attendance at child health conferences. Public health nurses
made 26,882 visits regarding infants and 27,698 regarding pre-school children.
Child Health—School
The public health nurse supervises the health of the school-children in her district.
She makes regular visits to the schools to give service and provide consultative help to
members of the school system. The new school health programme was put into effect
in all schools this year. Service includes teacher-nurse conferences for all children, completion of immunizations, referral of children requiring special attention, assistance with
medical examinations on selected children, X-ray examinations, with home-visiting as
indicated. The public health nurse visits the homes of school-children to talk with parents regarding such things as the need for medical care for the correction of specific
defects, improved dietary habits, and health regime. While visiting in the home, the
public health nurse interprets health matters to the parents to assist them to understand the need for recommended action. Children needing financial aid for medical care
are referred to suitable agencies. Local organizations may help by providing financial
assistance. When this is not available, children may be referred to organizations such
as the Canadian National Institute for the Blind, the Junior Red Cross, the Crippled
Children's Hospital, the Health Centre for Children, the Queen Alexandra Solarium, and
the Preventorium. N 54 BRITISH COLUMBIA
During the year the public health nurses assisted with 23,994 medical examinations
and, in addition, made 73,379 examinations and inspections. The public health nurses
held 50,476 conferences with school staff, 37,083 with pupils, and 10,032 with parents.
Health problems concerning 40,518 pupils were discussed. A total of 24,963 visits were
made to the homes of school-children, while 3,029 conferences were held with the parents in the office.
Tuberculosis
The public health nurse supervises tuberculosis patients in the community and
arranges for examinations of contacts to cases. Tuberculosis cases continue to be discharged earlier from tuberculosis institutions to their homes. The amount of follow-up of
patients, therefore, continues to increase. There were 7,230 health supervisory visits
made to patients with tuberculosis and 5,988 to contacts of tuberculosis cases. In addition, streptomycin injections may be given by public health nurses to patients on medication. Although every effort is made to have patients attend clinic or come into the
office for treatments, more than one-half of the treatments were given at home. A total
of 10,645 injections were given in the home and 41,896 were given at the office.
Other Communicable Diseases
The public health nurse assists with the communicable-disease control programme
by making immunizations available at the various clinics and schools throughout her
district. During May and June an intensive poliomyelitis vaccination programme for
the protection of Grade I and pre-school children eligible to enter school in the fall was
carried out. A total of 24,972 children* received three doses of Salk vaccine. There
were 8,960 children who completed the series of injections for protection against whooping-cough; 12,095 for diphtheria; 12,835 for tetanus; 30,211 were vaccinated against
smallpox; and 1,708 received protection against typhoid fever. In all, a total of 325,298
individual doses were given by field staff during the year. In addition, 2,570 prophylactic injections, such as anti-measles serum and gamma globulin, were given for protection from other communicable diseases by field staff during the year. Public health
nurses made a total of 6,103 visits to homes and had 387 office consultations for the
purpose of communicable-disease control.
The venereal-disease control programme continues to be emphasized in the Cariboo
and Skeena Health Units. The epidemiology-worker on loan to the Cariboo Health
Unit from the Division of Venereal Disease Control has been most effective in stimulating the programme. A total of 874 home visits were made for venereal-disease control
purposes, while 431 office consultations took place for this same purpose.
Nursing Care
Nursing care in the home is provided routinely by the public health nurse on a
short-term basis. This care includes nursing procedures such as hypodermic injections,
enemas, treatments, dressings. In an emergency the public health nurse will give more
extensive care and teach someone else to carry on the nursing on the daily routine. The
amount of nursing care in the home has varied considerably throughout the Province.
There were 4,550 home visits and 888 visits by patients to the office for nursing care.
This number is exclusive of the 7,964 injections given in the home and 1,256 injections
given patients in the office.
Certain health units have made provision for more complete home nursing service.
These include Kelowna in the South Okanagan Health Unit and Saanich Municipality in
the Saanich and South Vancouver Island Health Unit, which give a complete nursing-
care service as part of the generalized health programme. Vernon, in the North Okanagan Health Unit, continues to carry the home-care programme as described in the
'Applies only to the seventeen local health units, and does not include the metropolitan health departments of
Greater Vancouver, Victoria-Esquimalt, and Oak Bay. DEPARTMENT OF HEALTH AND WELFARE,  1955 N 55
report of the Bureau of Local Health Services. The Courtenay-Comox district of the
Upper Island Health Unit will set up a complete bedside nursing service in the new year.
It is encouraging to see more consideration being directed toward housekeeping
services for persons who are sick at home. These services are available at Kelowna,
Kamloops, and Chilliwack. This type of service, along with part-time nursing in the
home, is often sufficient to permit a sick person to remain at home rather than occupy
a hospital bed.
GENERAL
In all, family health service was given in 71,534 homes by public health nurses this
year. In order to provide needed diagnosis and treatment, referrals were made to local
medical practitioners as well as to a variety of health agencies. The public health nurses
have utilized travelling health clinics for referral of appropriate cases. The clinics include
the tuberculosis travelling clinic, the Children's Hospital Clinic, the Cancer Consultative
Clinic, and Child Guidance Clinic. Many referrals to other health agencies in Vancouver, such as the Children's Centre, Canadian National Institute for the Blind, etc., were
made possible with the assistance of the Junior Red Cross funds for transportation. In
addition to the types of service mentioned, public health nurses made 2,176 visits and
held 186 office conferences concerning individuals with mental-health problems. A total
of 47,198 home visits and 12,155 were made for adult health.
Seven health units continued to provide public health nursing service to a number
of Indian reservations. This year the Penticton reserve was added to the South Okanagan Health Unit.
The scope of the public health nurse has continued to extend, and with increasing
demands for service, public health nurses continue to work under a considerable amount
of pressure in order to provide good public health nursing service in their districts.
Tribute should be paid to the public health nurse who continues to give service in rural
communities and often lives and works under adverse conditions and at the same time
receives less financial recompense than her counterpart in other public health services
in British Columbia.
The following statistical summary shows the volume of work completed in certain
Public Health Nursing services during the year.
Home and Office Visits
Infant   26,882
Pre-school   27,698
School   27,992
Adult  60,353
Expectant mothers   1,453
Streptomycin injections for tuberculosis cases  15,541
Tuberculosis cases and contacts  13,218
Venereal-disease contacts and cases  1,305
Other communicable diseases  6,490
Prophylactic injections for communicable disease  2,570
Nursing-care injections   9,220
Other nursing-care treatments  5,438
Clinic Attendance
Prenatal classes       1,915
Child health conferences—
Infant      52,584
Pre-school      46,830 N 56 BRITISH COLUMBIA
Immunizations Completed
B.C.G  25,000
Diphtheria  12,095
Poliomyelitis   24,972
Smallpox   30,211
Tetanus   12,837
Typhoid  1,708
Whooping-cough   8,960
Total immunization treatments  324,989 DEPARTMENT OF HEALTH AND WELFARE,  1955 N 57
REPORT OF THE DIVISION OF ENVIRONMENTAL MANAGEMENT
Thomas H. Patterson, Director
In order to clarify the functions of this Division within the Bureau of Local Health
Services, separate reports are submitted for each section.
Occupational health continues to be of major interest to this Division, but it has not
yet been possible to establish facilities and employ personnel to provide an adequate
service in this regard.
Each year there is evidence of increased industrialization of this Province, and with
the development of new industries, new occupational hazards face the working population.
The larger industries and those industries which have their head offices in larger
centres elsewhere in Canada and the United States usually are aware of the importance of
occupational health services and have undertaken to provide some service of this nature
to their employees in British Columbia. Unfortunately even among this select group
there is very little uniformity of opinion as to how much service and what type of service
should be considered.
Over 95 per cent of industries in British Columbia are too small to provide complete
occupational health services without combined planning among the industries. It will be
necessary for the Government to assist in the organization of these services by offering
advice and technical assistance.
Management of companies in British Columbia are beginning to request advice from
this Division concerning the establishment of health services for their employees. Several
physicians have found themselves called upon to give services designed toward the
prevention of illness and injury and maintaining the health of employees rather than
providing treatment for industrial conditions. It is obvious that a way will have to be
found to bring management, physicians, nurses, first aid, safety, and public health personnel together to work out the means of providing the best type of health service for
industrial workers.
The first step toward such planning has been taken with the initiation of an industrial health survey of plants in one area representing a cross-section of industry in this
Province. The survey will be completed with the assistance and co-operation of the
Occupational Health Division of the Department of National Health and Welfare and the
Metropolitan Health Committee in Vancouver. The results of the survey will indicate the
present status of health of workers in British Columbia and the type of health services
which are now utilized by industry. The survey will also reveal the potential hazards
which may be found in the various types of industries operating in British Columbia.
Specific studies and investigations were carried out during the year with regard to
lead exposure of workers in the printing industry, toxic exposures to asbestos fibres in
manufacturing and mining, dermatitis in the metal industry, humidity and temperature
ranges in coal mines.
Through the kind assistance of the laboratory of the Department of Mines, it was
possible to carry out analyses of various substances, such as solvents, welding fumes, and
metals, suspected of causing deleterious effects to health.
The use of electrical vaporizing equipment for the control of insects continued to
pose a problem both in households and institutions, although no known cases of poisoning
were revealed. The potential danger associated with the use of this equipment is, however, recognized and must not be ignored.
All shipments of radioactive isotopes for medical or industrial use are reported to
this Division, and records of users are maintained, along with reports of exposures to
radiation. In cases where high exposures are reported, the matter is discussed with the
persons concerned. Industrial use of radioactive substances and X-ray are continuing to
increase, and it is necessary to follow this development carefully in order to protect the
health of workers and the general public. N 58 BRITISH COLUMBIA
A. NUTRITION SERVICES
The programme of the Nutrition Services has as its prime objective the improvement of health through improving the food habits of individuals and families. Significant
progress toward this objective can be reported in reviewing the nutrition services provided
during 1955.
Continued study of the variety of foods eaten by families in this Province has
provided ample evidence of the common nutrition problems toward which the nutrition
programme must be directed. Inadequate family meals, due to lack of knowledge, indifference, or economic reasons, the excessive consumption of sweet foods, overweight, and
the wide prevalence of food fads and misinformation are some of the problems on which
programme planning has been based. Emphasis has been given during the year to the
further development of consultant services and reference materials to assist local public
health personnel to deal more effectively with these problems, particularly in the fields of
maternal and child health and school health.
Due to a staff shortage for six months of the year, it was necessary to curtail the
nutrition services provided to hospitals and institutions. Since the procurement of a
second Nutrition Consultant late in the year, plans have been made to increase the services provided in this field.
Consultant Service to Local Public Health Personnel
The local public health team is most advantageously situated to advise families on
food selection during such activities as prenatal classes, child health conferences, home
and school visits. For this reason, the provision of Nutrition Consultant services to local
public health personnel is of prime importance. The increased attention given to nutrition
education in the local health programme is apparent from the numerous requests for
assistance received from public health personnel during the year. Through the consultant
programme, every effort has been made to keep public health personnel well informed on
the latest nutrition information and to provide technical data, educational materials, and
direct service with local projects and problems. Some of this service has been provided
directly during visits made to six health units during the year.
To exemplify the areas in which consultant services have been directed during 1955,
the programme is described under the broad headings of Community Health, Maternal
and Child Health, and School Health, as follows:—
Community Health
In addition to the continual programme of nutrition education directed at improving
food habits in the community, several problems have been given particular attention this
year. One of these is the problem of food faddism, characterized by misinformation
or misinterpretation of nutrition facts. In co-operation with public health personnel,
teachers, and physicians, a study has been made of the nature and prevalence of food
misinformation in the Province. It is very apparent from the data obtained in this study
that the health of a significant number of individuals is being endangered by unsound
dietary practices based on various food fads. The study has served to exemplify the need
for exposing and offsetting food faddism with sound nutrition facts. The information
obtained in the Province has been made available to a National committee of the Canadian Home Economics Association who are currently studying this problem throughout
Canada.
A second problem that has continued to receive attention in community nutrition
programmes is overweight. Considerable time has been devoted to studying methods and
compiling materials to assist public health personnel with their educational efforts to
inform people of the dangers of overweight and of a rational approach to lasting weight-
control.   From a long-term view-point it is recognized that a programme directed at the DEPARTMENT OF HEALTH AND WELFARE,  1955 N 59
prevention of overweight at all age levels is the soundest, most effective method of dealing
with this widespread problem. Although group classes for weight-control have been
conducted by public health personnel in several areas, it is noted that these projects are
time-consuming in view of the limited successful results achieved. Therefore, while
assistance with group projects has been provided, the greatest emphasis has been given
to the methods of preventing overweight.
The preparation and selection of up-to-date educational material for the use of public
health personnel has continued during the year. The booklet, " Family Meals," which has
been distributed through local health services during the past three years, is now under
revision by the Vancouver Nutrition Group. Due to the widespread use of this booklet,
the need for periodic revision is recognized, so that the latest practical information about
British Columbia foods and family meal-planning is provided.
Maternal and Child Health
This year there has been a considerable increase in the service provided to assist
public health personnel with nutrition education in the maternal and child health programme. Public health nurses are now conducting regular series of prenatal classes in
seventeen districts of the Province. Since at least one class in each series is devoted to
a discussion of prenatal nutrition, there have been numerous requests from public health
nurses for information and references to assist in advising mothers on food selection.
In view of this and because of the importance of nutrition during pregnancy to the health
of the mother and infant, considerable attention has been given to developing services in
this field.
In co-operation with the Professor and Head of the Department of Paediatrics,
University of British Columbia, and members of the Vancouver Nutrition Group, a leaflet
has been prepared outlining the foods recommended during pregnancy and suggestions
for family meal-planning. When printed this publication will be made available to physicians and public health personnel throughout the Province to assist them in providing
nutrition information to expectant mothers.
The Nutrition Consultant has served as a discussion leader for the nutrition classes
provided during three series of prenatal classes in the Greater Victoria area. This has
provided a valuable opportunity to assess various teaching methods and nutrition education materials for prenatal classes. Methods and materials that have proven effective in
this series are now being outlined for the reference of public health nurses who are
conducting classes in other areas of the Province.
In co-operation with the Public Health Nursing Consultants and the Professor and
Head of the Department of Paediatrics of the University of British Columbia, a complete
revision has been made this year of the booklet "Feeding the Normal Child." This
booklet has been used extensively for the guidance of parents throughout the Province
during the past ten years. The revised edition will provide up-to-date information on
infant-feeding and a new section on meal-planning for the pre-school child. The inclusion
of a chapter on pre-school nutrition is a significant achievement, since there is a most
apparent need for practical guidance on meal-planning for parents of young children.
Because food habits are formed during the early years, it is recognized that this is an area
where specific attention to nutrition education is most profitable.
Through the kind co-operation of the Nutrition Consultants with the Metropolitan
Health Committee of Vancouver, the list and description of Vitamin D supplements
issued in 1954 has been revised to include the latest products on the market. This material
is distributed for reference by public health nurses during child health conferences. N 60 BRITISH COLUMBIA
School Health
The growing awareness by parents, teachers, and school administrators of the
importance of nutrition to the health of the school-child is apparent from the increased
requests from public health personnel for service in this field. The development, during
the past few years, of improved teaching methods, such as dietary studies and animal-
feeding demonstrations, and well-planned school-lunch programmes are specific examples
of the progress being made in programmes to improve the food habits of school-children
and their families. The problems revealed from dietary studies among several thousand
school-children during the past six years continue to show the needs toward which nutrition education must be directed. The chief dietary deficiencies in children's meals
revealed by these studies are milk and cheese, a Vitamin D supplement, and foods rich
in Vitamin C. An additional problem clearly indicated in the studies is the excessive
consumption of sweet foods, such as candy, cake, and soft drinks, by many schoolchildren. Therefore, the foremost objective in the Nutrition Consultant programme for
school health services has been to continue to draw attention to these problems and to
assist with the various educational methods designed to improve food habits.
Rat-feeding demonstrations in schools are continuing to prove one of the most
effective methods yet undertaken to illustrate the importance of adequate meals and to
induce children to change their food habits. This year, assistance was provided in
arranging these demonstrations in fifty-five schools excluding the Greater Vancouver area.
It is interesting to note that over 300 schools have conducted rat-feeding experiments since
this project was introduced five years ago. It is apparent from the reports of public health
nurses and teachers that the demonstrations not only arouse interest in food selection, but
also iduce improvement in food habits among an appreciable number of children. The
difference in weight, appearance, and disposition of the pair of rats receiving a good
variety of food as contrasted to the pair receiving a poor variety is clearly illustrated to
the children during the four-week demonstration.
Again, sincere appreciation is expressed to the staff of the Animal Nutrition Laboratory at the University of British Columbia for their continued interest and co-operation in
providing experimental rats for demonstrations throughout the Province.
During field-trips, visits were made to nine schools to observe the operation of the
lunch programmes. In the majority of these schools, children who must remain at school
over the noon hour are receiving well planned and prepared lunches at a very reasonable
cost. Following observation in each school, recommendations concerning food-purchasing, menu-planning, and equipment were forwarded to the local health unit director.
Assistance with planning the layout and equipment for lunchrooms in new school buildings was provided to School Boards in several districts.
In view of the requests related to lunch programmes in larger schools, there is a
very evident need for a reference manual dealing with general organization, menu-
planning, food preparation and service for supervisors of complete meal programmes.
Although work has commenced on the preparation of such a manual, time has permitted
the completion of only a portion of this material during the year. It is hoped that it will
be possible to devote considerable attention to this project during the coming year.
At the request of the Provincial Director of Home Economics, Department of
Education, and in co-operation with members of the Vancouver Nutrition Group, a
complete revision has been made this year of the nutrition sections of the Foods, Nutrition, and Home Management Manual. This publication is used as a standard reference
text in Home Economics classes and in many homes in this Province.
During the year the Nutrition Consultant spoke to the Home Economics teachers
who attended summer school in Victoria and to the Home Economics section of the
Okanagan Teachers' Convention. Through these discussions it was possible to emphasize current nutrition problems and to draw attention to various methods of dealing with
these problems in the Home Economics programme. DEPARTMENT OF HEALTH AND WELFARE,  1955 N 61
Consultant Service to Hospitals and Institutions
It has already been noted that it was necessary this year to curtail the amount of
service provided to hospitals and institutions due to the resignation in April of Mrs.
Lorraine Arseneault, the Nutrition Consultant responsible for this phase of the programme. This position was vacant until the appointment of Miss Joan Groves in late
September.
Assistance with food-cost control, menu-planning, and quantity recipes was provided
to three hospitals in co-operation with the British Columbia Hospital Insurance Service.
Visits to hospitals, as requested by hospital administrators, will be resumed during the
coming year so that more detailed assistance may be provided with problems of the dietary
department.
The institutions receiving consultant service have included the New Haven Borstal,
Oakalla Prison Farm, Queen Elizabeth Hall (the home for the blind in Vancouver), and
the Western Society for Rehabilitation. For each institution, detailed reports of observations and recommendations for improvement in the food service have been provided to
the administrator concerned. Routine visits to Oakalla Prison Farm, as requested by the
Warden, were continued until the resignation of the Nutrition Consultant in April.
During these visits, assistance was provided with the over-all supervision of the food
service and with studies on staff requirements for the new kitchen. It is gratifying to note
that the programme which was recommended in the 1952 report of the Nutrition Consultant has been developed almost fully in this institution. The new kitchen has been
constructed and numerous improvements have been made in the general organization of
the food service.
At the request of the Personnel Officer, Bureau of Special Preventive and Treatment
Services, the Nutrition Consultant assisted with a comprehensive study at Pearson
Tuberculosis Hospital to determine the personnel requirements of ward kitchens under
the revised forty-hour-week schedule. Following the survey, recommendations were
made for modifications of routines in the ward kitchens in lieu of personnel changes.
Recommendations were also made to the Personnel Officer regarding changes in the
organization of the Tranquille dietary department, required as a result of the reduced
number of dieticians now at this hospital.
Early in the year, assistance was provided to the Department of Public Works in
planning the layout and equipment for the lunchroom of the new Provincial Health
Building in Vancouver.
At the request of the Purchasing Commission, assistance has been provided with
testing numerous samples of food products to determine their suitability for use in
government institutions.
An active interest has been continued in plans for group feeding in time of disaster.
Following an emergency feeding course in Arnprior in 1954, the Nutrition Consultant has
helped to organize Civil Defence courses for dieticians of the Lower Mainland Dietetic
Association and with outlines for emergency feeding courses in local areas of this
Province.
The need has been recognized for the extension of Nutrition Consultant services to
private hospitals and boarding homes where elderly persons reside on a long-term basis.
During the year, requests for this service have been received from administrators of these
institutions and from health and welfare personnel. Although limited assistance has been
provided to several nursing homes this year, it is hoped that this service may be further
developed during 1956.
General Observations
It will be noted that co-operative activities with the Vancouver Nutrition Group have
been mentioned in several sections of this report. This group is comprised of nutritionists
from the University of British Columbia, the Greater Vancouver Metropolitan Health N 62
BRITISH COLUMBIA
Committee, the Vancouver General Hospital, this Department, and other agencies. Meetings of the group are held each month for the purpose of planning and working together
on nutrition problems of common interest. Through the close co-operation of the nutritionists in this group, much has been accomplished of benefit to the over-all nutrition
programme in this Province.
Within this report, reference has been made to various problems and needs that
must still be met. Additional services to assist with prenatal classes and problems of
food budgeting, the preparation of a reference manual for school-lunch administrators,
and assistance to administrators of private hospitals and boarding homes for the aged
are needs that have been noted. It is hoped that many of these will be met through the
programme during the coming year. While much remains to be accomplished, nevertheless the year 1955 has been one in which significant progress has been made in the
development and extension of nutrition services to assist with the improvement of food
habits and thereby the health of the people in this Province.
B. SANITARY INSPECTION SERVICES
The Chief Sanitary Inspector acts as consultant to Medical Health Officers and
sanitary inspectors. The actual inspection service is carried out under the administrative
policy of the individual Union Board of Health. This Division offers advisory services
on technical matters, assists in evaluating programmes, and acts as liaison between other
government agencies, trade organizations, and the local health unit. Special investigations are conducted in co-operation with local health services.
The continued improvement noted in food sanitation, industrial- and summer-camp
sanitation, private water-supplies, private sewage-disposal, rodent and insect control, and
related community sanitation matters is attributed to the diligent efforts of the Medical
Health Officers and sanitary inspectors under the direction of their Union Boards of
Health.
Milk
For the fifth consecutive year an evaluation has been made on the bacteriological
quality of pasteurized milk as supplied by vendors throughout the Province. An average
plate count of 10,000 colonies per cubic centimetre was obtained on 1,930 samples of
pasteurized milk from seventy-four vendors. The comparatively low plate count indicates
that a bacteriologically good quality of pasteurized milk continues to be delivered to the
consumer's doorstep. Sixty-five of the seventy-four vendors on which estimations were
made were within the allowable limit of 50,000 colonies per cubic centimetre. Comparative figures for five years are summarized as follows:—    •
Average Plate Counts on Pasteurized Milk, 1950-54
Year
Number of
Vendors
Number of
Milk Samples
Average Plate
Count per CC.
1950                                                     	
56
45
56
68
74
586
728
1,021
1,386
1,930
22,000
1951                                    _         	
13,000
1952           --
13,700
1953                                                  	
10,300
1954      _ _	
10,000
Municipal milk by-laws for the Village of Warfield, Village of Dawson Creek, and
the district Municipality of Kent were reviewed prior to submission for approval by the
Lieutenant-Governor in Council.
At the request of local health services, a comprehensive review was prepared on
the interpretation of laboratory reports in the field of milk-control. DEPARTMENT OF HEALTH AND WELFARE, 1955 N 63
For some years this Department has viewed with concern the duplication of
inspection of premises supplying fresh fluid milk, and, as a result, reviewed past Statutes
related to milk legislation. It was found that prior to 1913 the policing of milk production was vested in municipal by-laws by authority of the " Municipal Act." In 1913 a
Milk Act was passed. The " Milk Act" was, basically, enabling legislation for a
municipal by-law and again placed the enforcement authority with municipal governments. In 1927 a new Milk Act was passed, and it is interpreted to have a twofold
purpose. Firstly, in the interest of promoting milk production as a part of the agricultural
industry, it was designed to provide a Crown service to the dairy farmer-producer in the
form of an annual inspection of the milk cattle—a set of standards on premises and
methods of milk production. The second part of the Statute was similar to the 1913
Statute, which vested the police power in a municipal by-law. A few municipalities
apparently did not see fit to exercise their authority and never passed milk by-laws.
During the past year a Royal Commission on Milk revealed some conditions which
implied that a new approach to policing milk production should be investigated.
Eating and Drinking Places
Emphasis in the supervision of restaurants continues to be in the educational field
of food-handling classes as opposed to enforcement techniques. Cooks, waiters, and
waitresses are instructed in hygiene practices as a means of maintaining clean premises
and preventing outbreaks of food poisoning. Food-handling classes of outstanding
success were conducted in the South Central and Simon Fraser Health Units. Throughout the Province the effectiveness of restaurant supervision was reflected in fewer complaints to this office than in past years. Enforcement is, however, necessary at times.
Two health units reported successful prosecutions due to infractions of the Regulations
Governing the Sanitation of Eating and Drinking Places.
Frozen-food Locker Plants
By invitation a representative of the Division attended the annual meeting of the
Frozen Food Locker Plant Association to review the regulations governing construction
and operation of frozen-food locker plants. It was explained that the regulations were
designed for two purposes. Firstly, plans of proposed premises required the approval of
the Deputy Minister of Health as a means of assisting the operator to erect and equip
the proposed premises in a manner conducive to successful operation with a minimum
of difficulty. Secondly, routine inspection and records of such inspections were the
direct responsibility of the Union Board of Health. Appreciation was expressed by the
association for a more rigid enforcement of the regulations in the course of routine
inspection since 1952.
Slaughter-houses
On behalf of local health services, this Division maintains liaison with the Recorder
of Brands of the Department of Agriculture with respect to the licensing and sanitary
conduct of slaughter-houses. This procedure continues to operate to the complete satisfaction of both Departments. Premises on which cattle are slaughtered are required to
have a licence to operate under the " Stock-brands Act." The structural requirements
and sanitary conduct must be in accordance with the " Health Act." By arrangement,
the applicant for renewal of the annual licence must attach a certificate of approval
completed by the Medical Health Officer to his application form.
Eighty-one slaughter-house licences were issued this year, compared to seventy-five
for 1954.
The Food and Drugs Division, Department of National Health and Welfare, in the
course of a National survey of slaughter-houses, found cattle-slaughtering premises in this
Province to their complete satisfaction.   However, unsatisfactory conditions were found N 64 BRITISH COLUMBIA
in two hog-slaughtering premises, and corrective action was taken by the Medical Health
Officer.
Meat Inspection
In previous Reports, examples of interest in routine meat inspection have been cited.
In May, 1955, the Regulations Providing for the Control of Slaughtering of Animals and
the Inspection, Storage, Handling, and Operation of Meat and Meat Products were passed.
Several Union Boards of Health have since requested that the Department of Agriculture
provide the staff to do the actual inspection as a service to the local areas. Since the
passing of the regulations, The Corporation of the City of Victoria is the only municipality
which has passed a by-law to prevent the sale or exposure of meat unless the carcass bears
a " B.C. Passed " or " Canada Approved " stamp. Prior to the recent legislation, the
Cities of Vancouver, Kelowna, Penticton, Vernon, Salmon Arm, and Kamloops had meat
inspection by-laws providing for inspection within the particular municipality.
Industrial Camps
Inquiries for information and complaints were above average in number during
the year.
The special sanitation project of the Cariboo Health Unit for 1955 was to make as
complete a coverage as possible of the large number of logging and sawmill camps in
that area.
Trailer accommodation introduced in 1952 continued to be used as bunk-houses.
Three construction projects reported using this type of accommodation for five persons.
One permit was granted for the use of the conventional-sized trailer for six persons. In all
instances the use of double-tier bunks has been discontinued.
With the active co-operation of health units, a comprehensive survey was conducted
on accommodation provided by the Department of Highways at the request of that
Department.
On behalf of the Aluminum Company of Canada, the Director of the Division,
assisted by the Skeena Health Unit, made a special survey of construction-workers'
accommodation at Kitimat.
Summer Camps
Licensed under the "Welfare Institutions Licensing Act," recreational camps are
operated by welfare organizations, churches, service clubs, fraternal organizations, and
include the Boy Scout and Girl Guide camps. The health-unit sanitary inspector appraises
the environment and mass feeding factilities and reports his impressions to the Chief
Inspector of Institutions on a prescribed form. The sanitary inspector also reports his
findings to the organization operating the camp and is thereby in a position to co-operate
with the organization. Explanations, advice, and assistance are offered in order that
when sufficient funds become available, they will be spent to the best advantage in the
elevation of the standards of the particular camp. Inspections this year indicate a steady
and continued improvement.
Reports were submitted on eighty camps this year, compared to seventy-six in 1954.
In an evaluation, forty-four camps were rated as good, twenty-eight as fair, five as poor,
and three as unsatisfactory. Comparative ratings for the years 1951 to 1955, inclusive,
are presented in the following table:— DEPARTMENT OF HEALTH AND WELFARE,  1955
N 65
1951
1952
1953
1954
1955
Number
of
Camps
Per
Cent
Number
of
Camps
Per
Cent
Number
of
Camps
Per
Cent
Number
of
Camps
Per
Cent
Number
of
Camps
Per
Cent
Good	
Fair	
22
18
6
3
46.0
36.0
12.0
6.0
1
35      |    62.0
13      |    23.0
4            7.5
4      |      7.5
29
13
61.5
27.5
48
24
3
1
63.0
32.0
4.0
1.0
44
28
5
3
55.0
35.0
Poor..      	
Unsatisfactory 	
3            6.5
2      |      4.5
6.5
3.5
Totals  	
49
56      |     ......
1
47      |     ......
1
76
80
Schools
For many years when School Medical Inspectors were practising physicians on
a fee-for-service basis, it was a requirement that a copy of the annual report to the School
Trustees be submitted to the Provincial Health Branch. At that time this Branch acted
in a consultant capacity directly with the Board of School Trustees. With the advent of
full-time health units, in which the health-unit director is also the School Medical Inspector
and is trained in school environmental practices, it is not considered necessary to submit
reports to this Branch. Henceforth the advisory services of the School Medical Inspector
will be given directly to the Boards of School Trustees.
Barber-shops and Beauty-parlours
Regulations of the Provincial Board of Health respecting Barber-shops, Barber
Schools or Colleges, 1936, were rescinded on August 15th, 1955, and replaced with the
Regulations Governing the Sanitation of Barber-shops and Beauty-parlours. Regulations
were revised at the request of the Barbers' Association of British Columbia and were
thoroughly reviewed by that organization, the Hairdressers' Association of British Columbia, and the Medical Health Officers prior to their adoption. The policy governing routine
inspections was thoroughly reviewed by the Medical Health Officers at their semi-annual
meeting in September, 1955. Distribution of copies of the revised regulations to the trade
was made through the co-operation of the secretaries of the respective associations.
Vermin-control
Inquiries continue to be received for advice on the extermination of fleas, bedbugs,
cockroaches, and silverfish. These inquiries are routinely referred to the health unit as
the qualified agency to give a personal service in this regard.
Those mosquitoes that are transmitters of disease in tropical and near-tropical
countries are fortunately not a problem in British Columbia. Mosquitoes are, however,
a nuisance factor in many communities, and considerable interest has been displayed in
control and eradication measures particularly in the North Okanagan and South Central
Health Unit areas. Requests have been received soliciting Health Branch support toward
the enactment of legislation similar to the "Mosquito-control Act" of 1919, which was
repealed in 1921.
The dissemination of information and advice on minimizing rat infestations is a
minor, yet important, function of many health units. Information is available to householders, storekeepers, and community groups interested in infestation as an individual
or a community problem. The information available covers methods of extermination,
including trapping, poisoning, fumigation, and methods of rat-proofing.
This Division continues to stimulate health-unit personnel to contribute specimens
to the Laboratory of Hygiene, Ottawa, in the interests of the study of plague incidence
in the rodent and its parasite, the" flea. The Victoria-Esquimalt Health Department
routinely collect and ship specimens of rats, whereas the South Okanagan Health Unit
contributes ground-squirrels and marmots for laboratory examination. N 66 BRITISH COLUMBIA
Garbage-disposal
More than average interest has been expressed in refuse-disposal this year. Municipally operated disposal-sites are gradually changing from the ravine and open-face dumps
in which garbage is left exposed, and sanitary fill methods are being adopted, with a daily
covering of all deposits. The sanitary fill method raises the ground-level of low-lying
areas and eliminates the nuisance of the open type of disposal. This enables the municipality or community to employ rat-extermination measures to advantage. The operation
of the sanitary fill method requires more constant care, and only municipal collectors are
permitted to use these facilities. Therefore, in many instances, residents in unorganized
territory are denied the privilege of using the municipal disposal-grounds. Individuals,
Union Boards of Health, and other groups have with increasing frequency made requests
that the Provincial Government establish and maintain disposal-grounds in unorganized
territory.
General
Advice on investigating causes of odours and discoloration in water, interpretation
of building-condemnation procedures, disseminating information on the provision of
toilet facilities as public conveniences, and the investigation of complaints, particularly
on sewage-disposal, is a time-consuming process, yet an important function in a sanitation
programme.
C. CIVIL DEFENCE HEALTH SERVICES
The need for increasing our efforts in organization for Civil Defence has received
further emphasis with the occurrence of several major civilian disasters in Canada this
year. It would appear that in disaster areas where Civil Defence had already been
established that this organization proved of great value toward minimizing the havoc and
human discomfort arising from such mishaps.
Due to increasing potentials of war weapons, there has been some change in the
over-all planning for Civil Defence, but the aims and objectives of Civil Defence health
services must remain essentially the same. This service must save lives, through the
provision of first aid and medical and surgical care, and must continue to protect health
and prevent disease by providing public health services before, during, and after disaster.
Progress in developing an emergency service of this magnitude is slow, but there
is evidence of some success each year.
Hospital Disaster Plans
One more Hospital Disaster Institute was held in British Columbia during the year.
This one was at St. Paul's Hospital, Vancouver, as St. Paul's was one of the hospitals that
had sent representatives to attend the previous Institute held at the Royal Jubilee Hospital
in Victoria in 1954, and had then undertaken to develop and demonstrate a disaster plan
for representatives of all hospitals located in the Vancouver target area. The development of such plans in a busy hospital is by no means a simple task, but the recognition
of the value of these plans upon their completion is spontaneous.
Hospitals throughout the country will become rallying points for all emergency health
services, and they must be prepared to carry the responsibility which will fall upon them.
Three more Institutes of this nature are planned for other areas of the Province and will
be carried out during the forthcoming years as the selected hospitals complete their plans.
Emergency Medical Supplies
The Federal Government programme of purchasing, packaging, and stock-piling
surgical and medical supplies across Canada is continuing, and should near completion
in 1956. There will then be approximately $12,000,000 worth of these supplies available
for disaster, but it will also be necessary for Provincial and Municipal Civil Defence
officers to be prepared to supplement the supplies from local sources. DEPARTMENT OF HEALTH AND WELFARE,  1955 N 67
The Federal Government has also launched upon a programme of packaging and
stock-piling supplies and equipment for improvised hospitals. These hospital units are
intended to supplement existing hospital services or even supply hospital services where
none exist in an emergency. It is the problem of the Civil Defence organization to staff
and operate these units.
In addition to the above, emergency public health and clinical laboratory kits are
also being stock-piled across Canada.
Emergency Blood Service
With the transfer of the former Director of the Red Cross Blood Transfusion Service
in British Columbia, the development of emergency bleeding centres has been retarded.
However, some steps have been taken at the National level which will facilitate the future
development of these centres in British Columbia. The Federal Government, in consultation with the National Red Cross, has agreed upon the type of equipment, including
disposable plastic blood-collection bottles, which would be required for equipping these
centres, and they are now proceeding with the purchase of enough supplies for thirty-four
centres in Canada. It is proposed that three of these centres be located in British
Columbia in sites remote from the presently established Red Cross centres.
Study Forums
Five separate Civil Defence exercises were carried on throughout British Columbia,
attended by representatives of Provincial and local Civil Defence health service personnel.
In each of these study forums the local health service officers presented specific plans for
taking care of large numbers of casualties in their areas.
In addition to these special studies, specific plans for the organization of Civil
Defence health services have been presented for the Fraser Valley mutual-aid area and
the Central and Northern Vancouver Island area. Each of these latter plans will be given
a trial period before recommendations go forward for their adoption in other areas of
the Province.
Training
During the year two training courses for physicians were presented by the Civil
Defence College at Arnprior, Ont. Ten physicians were selected in British Columbia
and were able to attend these courses. Emphasis was placed on the part that can be
played by industrial physicians, during the first course, for the purpose of interesting and
stimulating industry to prepare for emergency.
The nurses' A.B.C. indoctrination courses continued at the Civil Defence College at
Arnprior, and ten British Columbia nurses were in attendance this year. A special effort
was made to have nurse instructors from the nursing-schools of the Province attend for
this type of training, as it is now included in the curricula of the nursing-schools in
British Columbia.
The first Civil Defence course for pharmacists was also held at the Civil Defence
College, and six candidates were sent from British Columbia. At this course the pharmacists learned the important part they were expected to play as emergency supply officers,
laboratory technicians, blood transfusion and haematology technicians, as well as assistants
for treatment of casualties. In November a special conference of pharmacists was held
in Ottawa for the purpose of discussing the regional stock-piling and control of emergency
medical and surgical supplies. The Chief Supply Officer of British Columbia was present
at this conference and assisted with the plans for this Province.
Training in first aid and home nursing has continued throughout the year, both in
special Civil Defence classes and in the regular teaching programmes of our schools, with
the result that a very large proportion of our population has now at least had some train- N 68 BRITISH COLUMBIA
ing in this field and will be of considerable assistance in dealing with any type of
emergency.
The training and organization programme drawn up for Government employees in
the Parliament Buildings has continued, and initial steps were taken to locate and establish first-aid stations and one large casualty-dispersal station within these buildings.
General
The Federal Government has striven to give the leadership and assistance which is
so needed in developing Civil Defence health services. During the year several visitors
from the Federal Civil Defence Office in Ottawa and from the Civil Defence College in
Arnprior have attended local meetings and discussions in British Columbia. The calibre
of all the training courses presented at the new Civil Defence College at Arnprior has
been excellent and has in every case convinced the candidates of the sincere need for
action in Civil Defence.
During the year Miss Marjorie Hazlewood, who was the liaison officer for Civil
Defence health services, found it necessary to resign, and this position has not been filled.
The Director of this Division has continued to act as adviser to the Provincial Civil
Defence Officer concerning planning and organization of health services. Throughout
the Province, the Provincial Civil Defence Co-ordinator and members of his staff have
continued to guide and aid in the development of health services. The study forums
prepared by this staff have again proved of great value in stimulating local action and
thinking toward organizing Civil Defence services.
Most of the leaders in Civil Defence throughout the Province give their time voluntarily because they recognize the urgency and need for this service, and it is to these
people that so much credit is due for the progress that has been made to date. There is,
however, a great deal more to be done in developing emergency plans for all our hospitals,
for training key people for emergency jobs, for developing first-aid stations and improvised hospitals, for planning the distribution of emergency supplies, and for the innumerable other phases of our defence if we are to survive the type of disaster which faces us
with increasing frequency.
D. EMPLOYEES' HEALTH SERVICE
The service of the Employees' Health Centre is designed to meet the needs of the
employee in all health matters requiring counselling service, minor treatment or first aid,
and preventive measures. This programme of positive health maintenance is accomplished through the application of preventive measures, such as health counselling, circulation of relevant literature, the recognition of early symptoms with referral of the
employee to the family doctor, and consultation with departmental officers and employees.
Thus the major role of the employees' health service is one of education, early case-
finding, and liaison.
During the year the Health Centre has made available advisory and emergency
medical services to approximately 2,500 Government employees in and adjacent to the
Parliament Buildings, Victoria. A study of the following tables gives a detailed analysis
of the activities and services rendered by the Health Centre:— DEPARTMENT OF HEALTH AND WELFARE,  1955 N 69
Number of visits—
Total  2,714
First visit of occupational or non-occupational disease or
injury  914
Repeat visit  939
Follow-up  351
Consultation, doctor or nurse  403
Visitors to health centre  39
Civil Defence  8
Return to work  8
Miscellaneous  62
Visits by sex—
Male  1,570
Female  1,144
Classification—
All new diseases  485
Occupational  14
Non-occupational  471
All new injuries  429
Occupational  181
Non-occupational  238
All repeat visits  939
Occupational  149
Non-occupational  770
Disposal—
Sent to hospital  11
To physician, dentist, specialist  122
Sent home  35
Returned to work  2,040
The classification of visits markedly points out the predominance of non-occupational conditions for which employees request service. This observation is in line with
the experience of other occupational health services and is recognized as one of the most
valuable steps in improving the morale and working interest of employees. Early treatment of non-occupational illness or injury results in a minimum of lost time from work
and diminishes disability.
As employees continue to learn of the existence and nature of this centre, it will
be possible to better determine where the greatest emphasis should be placed to give the
best and most effective service. For instance, by the early detection and recognition of
emotional disturbances, alcoholism, and minor disturbances before they become major
problems, the Employees' Health Service can reduce to a minimum the employee's lost
time from work, increase his efficiency and happiness, and thus raise the morale of the
total work group.
Those cases which were sent to hospital, to their own physician, or sent home were
also likely to have made a much faster recovery from their condition than if they had
neglected to receive proper early treatment.
During the year 121 reports on accidents were submitted to the Workmen's Compensation Board, but, of these, only thirty-eight cases required the attention of a private
practitioner, and only fourteen lost any working-time as a result of their condition. One
hundred and six persons used the bed facilities of the centre for the purpose of recovery
or convalescent rests. The fact that these facilities are under the supervision of the
nurse permits an accurate evaluation of the condition of the employee requesting and
requiring the use of brief rest periods. In other instances where beds are not supervised,
employees may neglect to seek proper medical care while using these facilities. N 70 BRITISH COLUMBIA
During January an X-ray survey was conducted throughout the Parliament Buildings. The effectiveness of the periodic free chest X-rays as case-finding and a preventive
medium is seen in the fact that there were thirty-four referrals to the chest clinic for large
diagnostic films. Three new cases of active tuberculosis were discovered and brought
under treatment, while twenty-one others of differing clinical status will receive close
supervision and observation. The remaining cases were abnormalities of the chest. All
cases were referred to the individual's family doctor. Participation was gratifying, but
13 per cent of the employees did not avail themselves of the free chest X-ray, a majority
of which were at supervisory level.
A blood donor clinic was held at the Parliament Buildings at the request of the
Canadian Red Cross Blood Transfusion Service in June and December of this year. The
total response of the Government employees was 638.
Investigation of Specific Occupational and Environmental Hazards
One of these studies concerned the follow-up of certain complaints among the
employees of a Government office. A lighting survey was conducted, using differing
conditions of natural and artificial lighting. This comparative study revealed that the
lighting intensities of the working areas fell well below the minimum recommended for
good working conditions and the avoidance of eye strain. A combination of inadequate
lighting fixtures and low reflection factors of the walls and ceiling in these offices contributed substantially to the existing conditions.
Recommendations for the correction of these conditions were forwarded to the head
of the department concerned, and steps are being taken to implement these recommendations. The provision of a proper working environment will undoubtedly promote better
morale, improve efficiency, and decrease fatigue among the workers of these particular
offices.
Other instances of poor working environment have been noted and are under study.
A special problem exists in these buildings with respect to dust-control and ventilation
in storage vaults, but because of the physical aspects of these vaults there is considerable
difficulty in correcting these conditions. It is recognized, however, that as long as the
working environment remains unimproved, there will be a continuing problem of employee
turnover and absenteeism.
A mental-hygiene programme has been directed toward better job adjustment for
employees and better placement of employees and is concerned with the fitting together
of emotional demands of the job and the emotional assets of the employee. This has
been done through education and supervision and carried out with the collaboration and
co-operation of the personnel staff of the department concerned.
During the year, inquiries were made to the Employees' Health Centre by occupational health nurses for information relative to salary schedule, duties and responsibilities
of occupational health nurses, standing procedures, records and record-keeping, reference
material, and the availability of institutes and refresher courses at university level. These
inquiries express the need of the occupational health group for consultant services directed
to interpret and promote good nursing services in occupational health throughout the
Province of British Columbia.
E. HEALTH-CARE RESEARCH PROJECT
This project was established in December, 1953, under a Federal health grant for
the purpose of studying and analysing hospital admission-discharge records.
The analysis of these records was expected to reveal the experience of hospitals
relative to admissions for diagnosis, abnormal lengths of stay, admissions of chronic
cases, types of cases that could benefit from rehabilitation programmes, and conditions DEPARTMENT OF HEALTH AND WELFARE,  1955 N 71
which could be reduced by preventive programmes. These statistics were then to be
related to the cost of hospitalization in this Province.
Due to several factors, including reorganization of the administrative set-up of the
British Columbia Hospital Insurance Service and the extensive checking of data required
to establish the reliability of the statistics accumulated during 1953, it was decided that
only data for the year 1953 would be suitable for study. As there then appeared to be
some difficulty in having these data tabulated, it was decided that study should be
initiated on statistics concerning maternal and infant cases, as these could be made
available at an early date.
The statistical tables on maternal admission-discharge have now been completed and
are being analysed. Tabulation of infant statistics has also been completed and is being
organized in table form.
The selection of maternal and infant statistics for study was not the most desirable
from the standpoint of reaching the original objectives of this project, for it can be
realized that very few, if any, maternal or infant admissions can be reasonably reduced
nor would the length of stay be likely to be excessive. However, these particular statistics
were recognized as being the most reliable for the period under study, as they had undergone the most extensive scrutiny during this year.
It was anticipated at the time that this decision was made that the handling of
maternal and infant data would provide an opportunity to study the methods of handling
all the hospital admission-discharge record data for future studies, as well as reveal specific
information concerning complications of maternity cases and infant morbidity.
The experience of dealing with these hospital statistics and the close association with
members of the British Columbia Hospital Insurance Services provided the opportunity
to assist with review of the record forms and the methods of tabulating and handling the
information contained on them. The present admission-discharge record now contains
information concerning the patient's membership in pre-payment medical plans, specific
information concerning the cause and type of accidents, and a more detailed age-group
breakdown for children under 1 year of age. These three items alone provide much
information which will be of value to future studies of these data.
Early in the study it was realized that a very serious defect existed in the data under
study, for it was not possible to determine or identify the cases which had been in hospital
more than once during the year. A great deal of investigation followed to determine
a means of identifying future readmissions, but plans to institute a technique which would
bring about this identification were not adopted, and information on readmissions is not
available.
Sincere appreciation is expressed for the co-operation, advice, and assistance received
from the staff of the British Columbia Hospital Insurance Service, the Division of Vital
Statistics of the British Columbia Department of Health and Welfare, and from the
teaching staff of the Department of Paediatrics and from the Department of Obstetrics
and Gynaecology of the University of British Columbia. N 72 BRITISH COLUMBIA
REPORT OF THE DIVISION OF PREVENTIVE DENTISTRY
F. McCombie, Director
Any endeavour to improve the dental health of the people has been compared to
a three-legged stool. The three legs of the stool are represented by research, prevention,
and treatment. Thus a successful dental-health programme has been said to depend
on progress of each of these three fields. In British Columbia, during 1955, most
significant progress in each of these three activities can be reported.
In the field of research, a methodology has been established which will permit for
the first time in British Columbia an evaluation of the Province-wide preventive dental
services. The results of this evaluation will be statistically valid, and, by the use of
scientific sampling methods and mechanical punch-card equipment, they will also be
obtained by the very minimum of time and effort by all concerned.
In the field of prevention, two communities—namely, Smithers and Prince George—
have commenced the fluoridation of their water-supplies during the past year and will
thereby ensure for themselves a considerable improvement in the dental health of their
children in future years. During the 1954-55 school-year, 42.5 per cent more children
than in the previous school-year received complete dental treatment through the preventive dental clinics organized in the rural areas of this Province. These children, and in
many cases their parents, were personally instructed as to how disease, especially dental
caries, could be prevented in future. In areas of the Province where full-time preventive
dental services have been in operation, there was a definite trend during the past school-
year for all age-groups to require slightly less dental treatment than in previous years.
In the field of treatment, it is most pleasing to be able to report that during the past
year most active progress has been made toward the establishment of a School of Dentistry
at the University of British Columbia. A careful and comprehensive survey has now
been completed which clearly defines the physical and monetary requirements and staff
necessary for the establishment of a Faculty of Dentistry.
Nevertheless, it remains a sad fact that during the school-year 1954-55, of some
12,500 Grade I pupils in the public schools of British Columbia who received a dental
examination, seven of every ten were in need of dental treatment. Of these children
receiving treatment through full-time preventive dental services, the 6-year-olds required
an average of eight tooth surfaces to be restored, and for every ten children of this
age-group six teeth were so badly decayed that they had to be extracted.
RESEARCH
During the past seven years the preventive dental services of British Columbia have
expanded more than threefold and, it is believed, have operated at an ever-increasing level
of efficiency.
Records so far developed have demonstrated clearly the total extent of dental
treatment provided and, to a very considerable degree, the amount of treatment which
was found to be necessary for various age-groups. This information is now organized
in a manner so as to be comparable for various regions of the Province and so that
comparisons throughout the years may be made. A significant contribution to Canadian
national statistics has thus been made. Records to date have also given some indication
of the dental-health educational activities carried out as a primary purpose of these
services.
However, up to this time, evidence as to the success and efficiency of these preventive
dental services has been largely presumptive. Accurate and reliable information has not
been available concerning any decrease in the dental-caries attack rates at various age
levels, any improvement in the status of oral hygiene, or the level of dental care attained
by all age-groups of the child population.   Nor as yet has even rudimentary information DEPARTMENT OF HEALTH AND WELFARE,  1955 N 73
been ascertained regarding the two large groups of dental disorders yet to be seriously
assailed on a dental public health basis, namely, malocclusions and periodontal disease.
During the month of November a methodology was prepared to provide this information each year on a statistically accurate basis. These procedures were designed with
the assistance of the Division of Vital Statistics and with the consultative advice of R. M.
Grainger, D.D.S., M.Sc.D., D.D.P.H., Chief, Dental Statistics and Research Section,
Division of Medical Statistics, Ontario Department of Health, whose services for this
purpose were kindly made available by the Ontario Health Department. Financial
assistance was provided by a National health grant.
The survey methods which have been developed are thought to be the most accurate
and efficient available in this field to date. The procedures are based on earlier work by
the United States Public Health Service, the Canadian Department of National Health
and Welfare, and the Department of Health of Ontario.
These procedures have been achieved by following four basic principles. Firstly,
by the use of multiple examiners diagnostic bias between regions and between the findings
of successive years is reduced to a practical minimum. Secondly, by the careful choice
and definition of indices designed to portray accurately the dental-health status of each
age specific group of children, the recording by examiners is minimized and the accuracy
of results ensured. Thirdly, by the careful application of statistical methods of sampling,
the total number of children to be examined is reduced to the minimum necessary to
obtain statistically valid results. Fourthly, by the use of mechanical punch-card equipment, the time of those responsible for computing, tabulating, and arranging the results
of the survey is also reduced to a minimum.
The information so obtained will be used in at least two important ways. It will,
when returned to the local health departments, allow them for the first time to have a
base-line truly indicative of the dental-health status of the child population of their region.
Comparisons with future years will, it is hoped, reflect the results of their programme
and also indicate specific areas where greater emphasis should be placed. Secondly, since
dental-health programmes within this Province are rightfully varied to meet the needs of
each area, it is hoped that it will be possible to compare and evaluate the programmes
to the mutual benefit of all areas.
The introduction of these dental indices in British Columbia on a Province-wide
basis, and the subsequent evaluation of the various extensive preventive dental services
in future years, is considered second in importance only to the establishment of the basic
policies and relationships of the Division of Preventive Dentistry in 1949. It is anticipated
that the first survey of this nature will be carried out in the spring of 1956 in the Greater
Victoria, Greater Vancouver, and Fraser Valley regions. Thereafter, it is planned that
this survey will continue on an annual basis, embracing other regions of the Province as
organization and personnel permit, until eventually the survey is carried out on a Province-
wide basis.
With the helpful co-operation of all concerned, including public health personnel,
the dental profession, and the teaching profession, it is believed that these procedures
will contribute greatly to our mutual endeavours to improve the dental health of the
people of British Columbia, and also perhaps make a significant contribution to Canadian
dental public health.
PREVENTION
It has been repeatedly stated by highly qualified dental research-workers that to-day
the vast majority of dental disease is preventable. To bring this information to the people
of British Columbia is one of the primary purposes of the Division of Preventive Dentistry.
Material available to local health departments for this purpose now includes no less
than fifteen different booklets and pamphlets, seventeen different posters, and fifteen films N 74 BRITISH COLUMBIA
and filmstrips on loan from the central library of the Health Branch. This material has
been carefully chosen so as to provide dental-health educational aids suitable to all age-
groups, from pre-school children to parents. Throughout the year it has been stressed
that always these educational aids should be carefully chosen so that maximum benefits
may be obtained therefrom.
COMMUNITY PREVENTIVE DENTAL CLINICS
It will be seen from Table Ib that during the school-year 1954-55 community
preventive dental clinics operated within fifteen of the total seventeen health units of this
Province, and their activities took place in thirty-five of the eighty school districts. During
the school-year fifty-five out of the sixty-two organized clinics were able to provide service
to the children. Sixty-four dentists were employed part time in these clinics. The
remaining seven clinics were non-operative, since they were in communities without
a resident dentist and were unable to obtain the services of a visiting dentist during the
year. In total, during this school-year, 5,777 children received complete dental treatment
through community preventive dental clinics, which represents an increase of 42.5 per
cent over the number of children treated by these clinics the previous school-year. These
children included 1,553 pre-school children who, on an average, required one hour and
thirty-seven minutes of dental time for their complete dental treatment, and also included
2,601 Grade I pupils who, on an average, required one hour and fifty-four minutes
(Table II). Within the schools served by these clinics, 5,166 Grade I pupils were
enrolled, and those receiving dental treatment represented 50.3 per cent of this total
Grade I enrolment. In addition, 649 Grade II pupils and 356 Grade III pupils, of whom
it is believed the majority received dental treatment the previous year, required, on an
average, approximately one hour and thirty minutes of dental time for their complete
dental treatment.
It is estimated that if all these services provided by the community preventive dental
clinics had been undertaken by full-time personnel, a further fourteen full-time dental
officers would have been required. The dental-health educational activities carried out
by the lay committees sponsoring and administering these clinics, and by the dentists
participating therein, have improved even further during the past year. It is believed
that these activities over a span of years cannot but contribute significantly to the improvement of the dental-health status of the community. National health grants have assisted
greatly in making possible financial assistance to these programmes.
For the school-year commencing September, 1955, six more clinics have been
organized to provide preventive dental clinics in four more school districts. Many
other communities and school districts are hopeful of inaugurating such services in the
fall of 1956.
REGIONAL DENTAL CONSULTANTS
At the commencement of the past year two regional dental consultants were serving
the health units of the Fraser Valley. Subsequent to the appointment this spring of one
of these dental officers, Dr. D. I. Yeo, as Director, Dental Health Services, Greater Vancouver Metropolitan Health Committee, an experiment was tried to ascertain if one
regional dental consultant could at this time provide an adequate service to the four health
units of the Fraser Valley. Owing to the concentration of population within this region,
and the availability and willingness of the private dental practitioners therein to
co-operate in the community preventive dental clinics, this arrangement appears to be
working very satisfactorily. After a trial period of some fifteen months of this type of
service, the senior officials of the Health Branch are rather impressed with its efficiency
and effectiveness in conjunction with community preventive dental clinics in providing
and maintaining a high standard of preventive dental services within rural health units. DEPARTMENT OF HEALTH AND WELFARE,  1955 N 75
FULL-TIME PREVENTIVE DENTAL SERVICES
The preventive dental services provided by full-time personnel in this Province
during the school-year 1954-55 are shown in Table III. Comparisons with the previous
year are also recorded.
It will be noted that full-time preventive dental services were provided within three
of the Provincial health units, and that through these services 981 pre-school children
and 1,114 Grade I pupils were dentally examined. Of the pre-school children inspected,
only 23.8 per cent were not in need of dental treatment at that time, and of the 680 preschool children receiving complete treatment, 52.8 per cent had never before visited a
dentist. Of Grade I pupils enrolled in the schools served by these clinics, 98.2 per cent
received a dental examination and only 15.3 per cent were not in need of dental treatment
at that time. Of the Grade I pupils enrolled in these schools, 57.2 per cent were treated
by these clinics and a further 12.3 per cent were treated by their family dentist. In total,
of the Grade I pupils enrolled in these schools, 84.8 per cent did not require treatment
at the time of their examination or were subsequently treated by the clinics or by their
family dentist.
Table IV shows that in all age-groups of children receiving treatment through full-
time preventive dental services in health units, the treatment required by these children
was less than in the previous three years. The costs of these programmes were borne by
National health grants and contributions by the Boards of Trustees of school districts
receiving these services.
Full-time preventive dental services were also provided during the past school-year
by the Greater Vancouver Metropolitan Health Committee, the Board of Trustees of
the New Westminster School District, the Powell River and District Preventive Dental
Clinic, and the Board of Trustees of the Greater Victoria School District.
As shown in Table III, full-time preventive dental services were provided during the
past school-year within a total of nineteen school districts. A total of 3,923 pre-school
children were examined by these clinics. Of these children, 36.0 per cent did not require
treatment at that time. Pre-school children who received complete dental treatment
totalled 1,853, and 3,048 parents of pre-school children also received individual chairside
dental-health instruction through these clinics.
During the 1954-55 school-year, 13,506 Grade I pupils were enrolled in the schools
in British Columbia in which full-time preventive dental services were available. Of
these, 92.4 per cent were dentally examined, and only 29.2 per cent of the children
enrolled in these schools were not in need of dental treatment at the time of the examination. A total of 4,213 Grade I pupils, representing 31.1 per cent of the school Grade I
enrolment, received treatment through these clinics. A further 12.9 per cent received
dental treatment through their family dentist.
In summary, in the public schools of British Columbia which are in receipt of
full-time preventive dental services, 73.4 per cent of the children enrolled in the Grade
1 classes either did not require treatment at the time of the dental examination or
subsequently received this treatment during the school-year.
Table V demonstrates that children of all age-groups receiving dental treatment
through these services in British Columbia for the past school-year required slightly less
dental treatment than was necessary for the previous year.
SUMMARY OF PREVENTIVE DENTAL PROGRAMMES
IN BRITISH COLUMBIA
Preventive dental services provided by full-time personnel or by community dental
clinics were available during the past school-year within sixteen of the seventeen Provincial health units of this Province, and operated within fifty-three of the eighty school
districts (Table VI).   Within thirty-five school districts, dental services were available N 76 BRITISH COLUMBIA
to children of all schools within the school district. A total of 3,406 pre-school children
received complete dental treatment during the past school-year. There were approximately 29,000 Grade I pupils enrolled in the public schools in this Province during the
past school-year, and preventive dental services were available to 18,672 of these
children. A total of 15,086 pupils were dentally examined. Of the Grade I pupils of
these schools, 10,759 either did not require treatment at the time of their examination or
received complete dental treatment from the clinics. A further 1,749 Grade I pupils
were treated by family dentists. In total, 12,508 either did not require treatment at the
time of their examination or subsequently received treatment from the clinics or their
family dentist. These 12,508 children represent 66.9 per cent of the total enrolment of
Grade I pupils in the schools to whom preventive dental services were available and
82.9 per cent of the Grade I pupils in these schools who received a dental examination.
DENTAL PERSONNEL
The ratio of dentists to population within this Province deteriorated during the past
year. As at September 30th, 1955, the ratio stood at one dentist to every 2.033 persons.
At the same time the previous year, the ratio was 1:2,009. The disparity between the
concentration of dentists in the metropolitan areas and in the remainder of the Province
remains approximately as heretofore, with one dentist to every 1,537 persons in the
metropolitan areas and one dentist to every 3,108 persons in the remainder of the Province. However, it should be explained that as of January, 1955 (the latest National
statistics available), it was reported that British Columbia had a better ratio of dentists
to population than any other Province in Canada. The National ratio at that time was
one dentist to every 2,838 persons.
DENTAL FACULTY
In view of the above, it is therefore most pleasing to be able to report that during
the summer of this year J. B. Macdonald, D.D.S., M.S., Ph.D., Division of Dental
Research, Faculty of Dentistry, University of Toronto, was appointed as Consultant in
Dental Education to the University of British Columbia. During the latter half of the
year he prepared a comprehensive and detailed report which outlines the procedures
required whereby, as and when moneys are made available, the first dental students may
be accepted by the University. However, the population of British Columbia is increasing
rapidly, and there is an increasing demand for dental treatment. Thus it should be quite
clearly understood that even if forty dental students are graduated each year by the dental
school, this will do little more than meet the demand for dental services to the same degree
as at the present time. Nevertheless, it is of course equally to be understood that without
the establishment of a Dental Faculty within British Columbia it is forecast that the
situation would very rapidly worsen during the coming years.
This Division has been able to be of some assistance in the provision of material for
the above report and looks forward to the closest possible co-operation with the Faculty
in the years to come, so that by their mutual endeavours the status of the dental health
of the people of British Columbia may consistently be improved.
DENTAL SERVICES IN RURAL AREAS
During the past five years the shortage of dentists practising in communities of
sufficient size to warrant the residence of an active dentist has improved very considerably.
There now remain in the Province few, if any, such communities without a resident
dentist. However, it is well recognized that many communities with one or more resident
dentists could be served advantageously by a further dentist. So that this problem may
be clearly understood, the Dental Health Committee of the British Columbia Dental
Association have kindly agreed to carry out a survey which will indicate in which com- DEPARTMENT OF HEALTH AND WELFARE,  1955 N 77
munities of this Province the demand for dental treatment outweighs the dental services
available. It is believed that this information will be helpful in encouraging newly
graduated dentists, and dentists newly registering in this Province, to locate in these
communities.
For communities too small as yet to warrant a resident dentist, arrangements have
continued during the past year, as far as possible, for a dentist to visit such communities
either regularly or for a definite period during the year. In all such cases, community
preventive dental clinics for the younger children have been organized and transportable
dental equipment provided on free loan. During the coming year it is hoped, with some
degree of assurance, that two younger dentists will be interested in providing such a
service on a continuing basis for a ten- or twelve-month period commencing in June,
1956.
BRITISH COLUMBIA DENTAL ASSOCIATION
In May, 1955, a Dental Health Conference was convened by the Dental Health
Committee of the British Columbia Dental Association. This was the first time in this
Province, and, as far as known, the first time in Canada, that such a conference included
not only dentists engaged either part time or full time in preventive dental services, but
also lay representatives from official and voluntary agencies sponsoring these services.
During the day's proceedings, lectures were arranged of interest to the whole Conference,
and others of interest specifically to the lay representatives or to the dentists. It is
believed that as a result of this Conference the dentists learned not only something of the
basic principles underlying the preventive dental services of this Province, but also some
of the latest techniques of children's dentistry. The representatives of the agencies
sponsoring either full-time preventive dental services or community dental clinics achieved
a clearer understanding of the purposes of these programmes, and also of the possibilities
and results of dental-health education. It is considered that the Dental Health Committee
of the British Columbia Dental Association made a significant contribution to the future
dental health of the people of this Province by sponsoring and organizing this Dental
Health Conference. Such was the success of this Conference this past year, at which 120
persons were present, that the British Columbia Dental Association plans to make this
an annual event in the future.
Early in 1956 the British Columbia Dental Association plans to conduct a Dental
Health Week. During this week they will endeavour, throughout the Province, to concentrate public attention upon the problem of dental ill health and how dental disease
may be prevented. Plans include radio and television broadcasts, window displays, talks
by local practising dentists to community groups, and poster contests within the schools.
GENERAL
From the foregoing it may be seen that significant progress has been attained in the
planning toward the improvement of the dental-health status of the people of British
Columbia. Furthermore, it will be possible to measure statistically the success of the
preventive dental programmes of this Province in subsequent years from the base-line
data derived from the first annual survey to be carried out in the spring of 1956.
The magnitude of the problem of dental disease occurring to-day in British Columbia
is formidable. Nevertheless, the dental-health programmes in this Province and the
activities of the Division of Preventive Dentistry are designed to attack this problem
from as many different angles as possible. Furthermore, with the careful appraisal of
these programmes in the years to come, and with their modification and improvement
as revealed necessary by continuing evaluation, it is believed that this problem will
undoubtedly be minimized until finally overcome. N 78
BRITISH COLUMBIA
Table Ia.—Community Preventive Dental Clinics in British
Columbia, 1948-54
School-year
Number of
Clinics
Number of
Dentists
Number of
Children
Receiving
Complete
Dental
Treatment
Average
Total Cost
per Child1
1948-49    _	
2
6
9
IS
20
43
2
8
12
22
25
47
141
381
1,052
1,858
2,121
3,084
1949-50              _
$18.46
1950-51                        	
15 76
1951-52..   _	
1952-53  	
1953-54.            _	
13.26
12.78
15.45
Table Ib.—Community Preventive Dental Clinics in British
Columbia, 1954-55
School-year
Health Units
in Which
Clinics
Operated
(Total, 17)
School
Districts
in Which
Clinics
Operated
(Total, 80)
Number of
Clinics
Organized
during
School-year
Number of
Clinics
Operated
during
School-year
Number of
Dentists
Providing
Services
Number of
Children
Receiving
Complete
Dental
Treatment
Average
Grant
per Child1
1954-55	
15
35
62
55
64
5,777
$7.78
1 The average grant per child closely approximates 50 per cent of the average total cost per child.
Table II.-
-Clinical Services
by School Grades, School-year 1954-55
School Grade
Enrolment of
Pupils in Schools
Served by Clinics
(1)
Number of Children
Receiving Complete
Dental Treatment
(2)
Column (2)
as per Cent of
Column (1)
(3)
Average Time per
Child for Complete
Treatment
C1)
5,166
(2)
(2)
(!)
1,553
2,601
649
356
618
C1)
50.3%
C1)
C>
C1)
Hr.    Min.
1        37
1        54
Grade 11 pupils	
1        32
1        29
C1)
Totals	
5,777
C1)
O)
1 Not applicable.
2 Not computed, since service in these grades not available in all clinics. r
DEPARTMENT OF HEALTH AND WELFARE,  1955
N 79
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BRITISH COLUMBIA
Table IV.—Full-time Preventive Clinical Dental Services Provided to Children in Health Units in British Columbia by Age-groups for the School-
years 1951-52 to 1954-55.
School-year
Total
Children
Completed
Treatment
Averages per Child
Restored
Tooth
Surfaces
Extractions,
Deciduous
Teeth
Extractions,
Permanent
Teeth
Clinical
Time
1951-52...	
Age 3 Years
1952-53	
1953-54	
1954-55.  	
1951-52-
Age 4 Years
1952-53
1953-54 _.
1954-55 ___.                           .    	
1951-52	
Age 5 Years
1952-53- _	
1953-54 _  	
1954-55                            '              	
1951-52	
Age 6 Years
1952-53 „	
1953-54 	
1954-55 ...
1951-52	
Age 7 Years
1952-53     _	
1953-54	
1954-55  	
1951-52	
Age 8 Years
1952-53 __ _ _	
1953-54  „             __     .
1954-55.        	
82
43
220
185
204
82
185
176
251
142
234
275
813
736
938
557
233
78
156
131
5
4
13
5
3.0
4.1
1.9
1.5
5.9
6.8
5.2
4.6
5.5
6.4
5.4
5.6
7.6
7.2
7.6
6.4
9.0
10.3
8.9
5.8
0.06
0.05
0.00
0.01
0.19
0.22
0.19
0.03
0.19
0.38
0.24
0.17
0.52
0.72
0.27
0.13
0.77
1.00
0.47
0.41
(*)
C1)
C1)
C1)
C1)
C1)
(!)
0)
0.000
0.007
0.000
0.004
0.000
0.000
0.000
0.000
Hr.    Min.
1 4
1        12
50
33
1 48
1 51
1 32
1 12
Totals too small for average to be meaningful.
42
44
47
22
5
3
42
39
3 13
2 6
1 48
1 32
1 Not applicable. DEPARTMENT OF HEALTH AND WELFARE,  1955
N 81
Table V.—Full-time Preventive Clinical Dental Services Provided to Children
in British Columbia by Age-groups for School-years 1953-54 and 1954-55
School-year
Total
Children
Completed
Treatment
Averages per Child
Restored
Tooth
Surfaces
Extractions,
Deciduous
Teeth
Extractions,
Permanent
Teeth
Clinical
Time
1953   54
Age 3 Years
1954   55                                                           	
1953-54   _____
Age 4 Years
1954-55       ___                                     	
1953-54
Age 5 Years
1954-55  _.._      __	
1953-54    ....
Age 6 Years
1954-55                	
1953-54   _____
Age 7 Years
1954  55
1953-54   ....
Age 8 Years
1954-55   	
262
256
442
418
783
884
4,293
3,606
770
638
55
42
2.5
2.4
6.4
5.7
6.6
9.2
8.2
7.0
6.8
0.04
0.06
0.27
0.14
0.40
0.34
0.65
0.60
0.32
0.67
C1)
0)
C1)
I1)
0.007
0.004
0.003
0.017
Hr.     Min.
56
38
1        42
1        10
1        57
1       28
2       34
2       26
2        34
1        47
) Totals too small for averages to be meaningful.
i
1 Not applicable.
Table VI.—Summary of Preventive Dental Services in British Columbia during School-year 1954-55 Showing Distribution of Services and Clinical
Services to Pre-school Children and Grade I Pupils.
Full-time
Preventive
Dental
Services
Community
Preventive
Dental
Clinics
Totals
Distribution
Provincial health units in which operated (total, 17)_.
School districts in which operated (total, 80)..
School districts in which service available to all schools_____	
Pre-schooi Children
Number of children receiving complete dental treatment at clinics-.
Grade I Pupils
Total children enrolled in schools served by clinics   	
Total children inspected _     _— —
Total not requiring treatment-
Total received complete dental treatment from clinics..
Total received treatment from family dentist 	
Total not requiring treatment or receiving treatment from clinics or family
dentists  _____           ___
Percentage of enrolled children not requiring treatment or treated  ___
Percentage of inspected children not requiring treatment or treated	
4
19
19
1,853
13,506
12,485
3,945
4,213
1,749
9,907
73.4
79.4
15
35
16
1,553
5,166
2,601
2,601
(*)
2,601
50.3
100.0
16
53
35
3,406
18,672
15,086
10,759
1,749
12,508
66.9
82.9
1 Not recorded. N 82 BRITISH COLUMBIA
REPORT OF THE DIVISION OF PUBLIC HEALTH ENGINEERING
R. Bowering, Director
The Division of Public Health Engineering functions within the framework of the
Health Branch as part of the Bureau of Local Health Services. The aim of professional
public health engineering is to control the physical environment, either directly or indirectly, so that the health and comfort of man may be protected or improved.
Engineering in public health involves the planning of procedures and policies; the
review of the design of structures, equipment, and facilities; the investigation of conditions; and the control of natural forces—all for the purposes of affecting the physical
environment for the protection and improvement of the public health. The Division of
Public Health Engineering employs registered professional engineers who are trained for
that part of public health work which is directed toward the solution of problems in
water-supply, sewerage, waste collection and disposal, and the control of the environment in the prevention of communicable diseases.
Public health engineering problems seemed to increase greatly during 1955, as one
might expect when one considers the increasing population density and increasing industrialization of the Province. In addition to the increasing wealth of the Province,
improved living standards have resulted in an increased demand for water and sewerage
services in many of our communities. In order to cope with the numerous diversified
problems involved in public health engineering, a full staff of fully trained public health
engineers, with postgraduate training, is required for the Division. Unfortunately, in
1955, two fully trained public health engineers left the field of government service for
other types of employment. This has meant that many of the things which the Division
had hoped to accomplish in 1955 were not accomplished.
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 waterworks systems be
submitted for approval. A careful study of these plans, together with inspections on the
site in many cases, is one of the major duties of the Division. The Division also keeps
a check on new materials used in waterworks construction. During the year forty plans
in connection with waterworks construction were approved and twelve plans were provisionally approved. As well as approving plans, engineers from the Division visit various
waterworks systems in the Province from time to time for the purpose of checking on
sanitary hazards and to give advice and assistance generally in their improvement.
There are very few complete water-treatment plants in British Columbia, owing to
the fact that in British Columbia most sources of water provide satisfactory water for
domestic consumption without expensive treatment. In many cases only bactericidal
treatment is required. There are now sixty waterworks systems in the Province that use
chlorination for protecting the bacteriological quality of the water. It is estimated that
almost three-quarters of the population of the Province uses water protected by chlorination. Another type of treatment of water was introduced in British Columbia this year,
when two communities installed fluoridation equipment. In both cases a public health
engineer was present at the time the equipment was installed, and great care was taken
to see that the local operator knew how to operate the equipment and how to see to it
that the fluoride added to the water was within the proper limits of tolerance. Reports
have been received regularly from the places where fluoridation is being used, which
indicate that the chemical is being added properly.
With the large number of chlorination plants in the Province and now with the
addition of fluoridation plants, it is felt that there is need for better training of operators DEPARTMENT OF HEALTH AND WELFARE,  1955 N 83
of waterworks equipment, particularly water-treatment equipment. While no course for
waterworks operators was established in British Columbia, contacts were made with the
training section of the United States Public Health Service and the State of Washington,
and several of our waterworks operators attended a short course in Washington State.
It was hoped that more could have been done toward the establishing of a training course
in British Columbia, but this was not possible with the reduction of staff.
The regular frequent sampling of water from public water-supply systems is the
responsibility of the local health unit. The Division of Laboratories performs the bacteriological examinations of the samples. Copies of the results of all laboratory examinations of water are sent to the Division of Public Health Engineering, where they are
recorded for easy reference under the proper place-name. In this way a constant check is
kept on the bacteriological quality of the water served in British Columbia.
In addition to the bacteriological examination of water, there is some need for
chemical examination of water. Up to this year the Public Health Engineering Division
of the Department of National Health and Welfare operated a laboratory for chemical
analysis of water. This laboratory ceased operation during the year. Although the
Health Branch does not yet operate a laboratory for doing routine chemical analyses, it
is pleasing to note that the Division of Laboratories is proposing to take on this work as
soon as a suitable employee is available.
The Division receives a number of inquiries each year concerning private water-
supplies. These are referred to the local health unit. A considerable amount of advice
is given by mail and occasionally by visit.
There seems to be a new trend in the Province toward the creation of small water-
distribution systems. Some of these serve as few as ten homes, and others serve up to
a hundred. These have, in the past year or so, been built by subdividers, who find it
necessary to provide a water-supply system in order to sell lots. Many of these, particularly in the Lower Fraser Valley, provide well-water, using a hydropneumatic tank for
control of the pump. These types of systems, which were originally designed for individual homes, have met a need in the small water-distribution system, but it is felt that
some research by the Division is necessary to see that, when plans for this type of water-
distribution system are approved, the public will receive a reasonable supply of good
water.   There is indication that there will be more of this next year.
During the year, in co-operation with the Natural Resources Conference, a questionnaire was sent to all the waterworks operators in the Province asking for information
regarding the water-supply system. Replies were received with reference to 173 waterworks systems. These systems serve a population of 953,113 people through 216,680
connections. The population represented is, therefore, 79 per cent of the population of
the Province.
When adding the numbers served by waterworks systems that did not reply, it is
estimated that approximately 83 per cent of the population of British Columbia is served
by public water-supply systems.
Another changing trend in water-supply in British Columbia is the increasing use of
pumped water. At one time there were very few water-supply systems in the Province
that pumped the water. At present about 60 per cent of the water-supply systems in the
Province use gravity water exclusively, about 25 per cent use pumped water exclusively,
and about 15 per cent use both gravity and pumped water. However, the larger communities in general use gravity water, so that a high percentage of the population served
by water uses gravity water.
Another interesting feature of water-supply in British Columbia is that most of the
water used is very soft water. There are very few supplies that have extremely hard
water.
It is gratifying to note that, in keeping with the normal trend, there have been no
known water-borne epidemics resulting from the use of public water-supplies in British N 84 BRITISH COLUMBIA
Columbia this year. The fact that there has been no evidence of water-borne illness in
our Province over the past several years indicates, to a certain extent, the care being
taken by the various water authorities to provide a safe water for the citizens of British
Columbia. This record, however, should not be allowed to bring about a feeling of
complacency because the bacteriological quality of a number of water-supplies could be
improved by more efficient operation of the chlorinating equipment. There is also need
for revision of our laws regarding watershed protection. The Division is always ready
to assist any water-supply authority with respect to water-supply problems that may have
an effect on the public health.
SEWAGE-DISPOSAL
The Division of Public Health Engineering 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 before construction
may commence. During the year twenty-two approvals were given in connection with
sewerage-works and thirteen plans were approved provisionally.
Study of the 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. One of the villages of the Province which built an
entirely new sewerage system this year was the Village of Westview. However, the work
was not quite complete as the year ended. A number of other villages have had reports
from consulting engineers concerning their sewerage problems.
The sewage-treatment plant for Colquitz Mental Home was completed this year and
placed in operation late in the year. This has removed one of the large sources of
contamination from the Gorge watershed in the Greater Victoria area. The Gorge water
still receives some contamination from unorganized territory, such as the View Royal
area and portions of the Colquitz River drainage-basin in the Municipality of Saanich.
It was mentioned in the 1953 and 1954 reports that the Vancouver and Districts
Joint Sewerage and Drainage Board had published a report on the ultimate disposal of
sewage from the Greater Vancouver area. The implementation of this report required
the acceptance by the municipalities in the Greater Vancouver area which are not now
members of the Board. It does not now appear that these municipalities will accept the
recommendations of the report. During the year the Municipality of Richmond employed
a consulting engineering firm to study and report upon their sewerage needs. The Council
of the municipality did not go so far as to carry out any of the recommendations of the
report up to the present time. Other municipalities in the Greater Vancouver area are
in need of similar types of reports.
Perhaps the most important happening with respect to sewerage in British Columbia
during the year 1955 was the change in policy by the Central Mortgage and Housing
Corporation, which required that whenever a subdivider was developing a subdivision
containing a large number of homes, complete sewerage services had to be installed if
the houses were to receive " National Housing Act" loans. The charges for these
sewerage systems are paid by the subdivider and, of course, are ultimately paid by the
person who purchases the home. This development caused a considerable amount of
study by a new group of consulting engineers in the Province, and the Director of Public
Health Engineering spent a lot of time discussing the sewage-disposal requirements.
Studies were made in connection with six large subdivisions, some of them having as
many as 600 building lots. In addition to the studies concerning sewage treatment, limits
had to be placed on the permissible gradients of sewers. None of the sewerage-system
plants for large subdivisions was in operation by the end of the year. It is expected that
a number of these will be built in 1956. DEPARTMENT OF HEALTH AND WELFARE,  1955 N 85
One questions the wisdom of the construction of so many temporary facilities for
the disposal of sewage. In the Municipality of Richmond alone, our estimate is that
$500,000 will be spent on temporary disposal. This $500,000, if spent on an over-all
system of mains and sub-mains for the municipality, would go a long way toward assisting
with the cost of an adequate system of mains and sub-mains for the municipality as
a whole.
The problem of the unorganized urbanized area is still a major one as far as lack of
sewerage is concerned. A further study of the problem of View Royal was made during
the year by the employment of a retired sanitary engineer living in the district. His report
seemed to indicate that the cost of sewering the area was prohibitive, and his report did
point the way to alleviate some of the more pressing problems.
The question of sewage-disposal for private homes comes generally under the direction of local health services. However, the plans and specifications are provided by the
Division of Public Health Engineering. Also advice is given to local health services
regarding private sewage-disposal problems. In 1954 considerable study was made by
the Division toward the redesign of our standard septic-tank plan. Owing to the fact that
the engineer who was doing the work on this project resigned in early 1955, the work
was not brought to a final conclusion.
The Division also gives advice and reviews plans of sewage-disposal systems for
schools and hospitals. There is still need for research in order to determine the discharge
characteristics of sewage from school on a per pupil basis. The Division also provides
consultative service regarding sewage-disposal problems for the government institutions.
A questionnaire was sent during the year to all the municipalities operating sewerage
systems. This questionnaire indicated that a large amount of sewerage work needed to
be done. The continued growth of the Province will necessitate the building of sewage-
treatment plants in communities which formerly disposed of sewage by dilution. Also
the growth of some municipalities has caused the need for expansion of some existing
treatment facilities. Constant education of the public is necessary in order to have them
realize the need for essential sewerage services.
There is a need also for better training of sewage-treatment plant operators. Some
of the operators in the Province attended a short school at the University of Washington
early in the year 1955. It is felt that the time is coming when such short schools should
be established in British Columbia.
STREAM POLLUTION
Stream pollution is one of the items that has been dealt with by the Division of
Public Health Engineering. Although stream pollution may be a part of the sewage-
disposal problem and a part of the water-supply problem, it is felt that it is important
enough to discuss it under a separate heading.
Stream pollution is caused by the discharge of sewage and industrial wastes into
surface water. These discharges may have quite diverse effects on the receiving body of
water because of the extreme variations in the type and strength of the wastes and the
quality and volume of the receiving bodies of water. The net result of such discharges,
however, may make the water less desirable and less useful.
The extent of stream pollution in the Province is not extensive at present as there
are only a few instances where waste discharges have affected down-stream water-users.
However, it is recognized 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 of streams
and rivers.    In addition to the Health Branch, other departments of government have N 86 BRITISH COLUMBIA
legislation for the control of industrial wastes. Legislation is of a very general nature,
and it is utilized by each department to protect its special interest. As these interests
involve such diverse things as fish, navigation, public water-supplies, and irrigation, it is
not surprising that different interpretations of the general Acts or 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 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. An industry is not required
to have its wastes facilities approved prior to construction; consequently, if a problem
arises after operations commence, the solution involves a more difficult matter of alteration rather than prevention. 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 the discharge of wastes into streams from becoming
a major health problem. Representatives from the Division have attended a number of
conferences on individual stream-pollution problems during the year. The control of
pollution depends to a great extent on co-operative effort and public interest.
There has been a growing demand for one pollution-control agency in the Province.
This agency could be set up by the creation of a pollution-control agency separate from
all present agencies of government which have to do with pollution-control. Another
way, which has been quite widely adopted in other jurisdictions, has been the making of
the Health Branch responsible for execution of the pollution-prevention programme,
considering not only the public health aspects, but the aspects which protect fish, irrigation, navigation, and other fields of interest. In such cases a board is usually appointed,
composed of representatives from the various interested agencies.
There are still no large pulp-mills located on our Interior streams. If any are built
on such locations, great care will have to be taken to see that the best possible means of
waste treatment is used.
In British Columbia generally, stream pollution has not become a serious problem,
except in a few isolated instances. With the increasing industrialization of the Province,
stream pollution could become a very serious problem, unless sufficient steps are taken
now to prevent it. It appears that the placing of all classes of stream pollution under one
jurisdiction might be the best way of achieving this result.
SHELL-FISH
The Division of Public Health Engineering has the responsibility of enforcing the
shell-fish regulations. The inspection of shucking plants and handling procedures now
comes under the jurisdiction of local health units. There are six local health units that
have one or more shucking plants under their jurisdiction. 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 certificates for export purposes.
The Provincial regulations are such that any shell-fish produced in the Province in conformity with the regulations will conform with the requirements of the Department of
National Health and Welfare.
Oysters produced commercially in British Columbia are grown on leased ground.
Copies of all applications for new leases and for renewal of existing leases are forwarded
to this Department for approval. Any ground found unsuitable for production of shellfish for public health reasons will not be leased. In some areas the pollution survey of
a proposed oyster lease can be made relatively easily, but in other a considerable amount
of survey work is necessary. There were twenty-eight certified shucking plants in operation in 1955, of which twenty were family operations.   Certification must be renewed DEPARTMENT OF HEALTH AND WELFARE,  1955 N 87
annually. There are fourteen shell-stock shippers certified as well. Lists of certified
shucking plants and shell-stock shippers are forwarded to the Department of National
Health and Welfare, which, in turn, forward these to the United States Public Health
Service. This makes it possible for American importers to know if shell-fish come from
certified plants and shippers.
One problem of interest that arose during the year was the proposed renewal of the
use of Pedder Bay on Vancouver Island for the production of oysters. A former lease
had expired many years ago. Between the time of expiry of the former lease and the
renewed intention to produce shell-fish in Pedder Bay, some additional sources of contamination came into existence. It is proposed that in 1956 a thorough sanitary survey
of this area be made. The matter relating to shell-fish toxicity is one that is still under
consideration. 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 1955. There have been no deaths due to the eating of toxic shell-fish in
British Columbia since 1942. The west coast of Vancouver Island is now open for the
taking of clams and mussels.
SWIMMING AND BATHING PLACES
It was mentioned in the 1954 report that a considerable amount of time was spent
during the summer in consultation work on swimming-pools. A swimming-pool regulation committee was set up in 1954. This committee drafted a proposed set of swimming-
pool regulations. These regulations were not adopted in 1955, principally because of
shortage of staff to see them through. There still is a good demand for the paper that was
prepared several years ago on suggested requirements for swimming-pools.
TOURIST ACCOMMODATION
The Regulations Governing Tourist Accommodation are administered by the
Commissioner, British Columbia Government Travel Bureau, Department of Trade and
Industry. For many years a licensing authority operated, consisting of five members, one
of whom was the Director of the Division of Public Health Engineering. These regulations were rescinded in December, 1954, and were therefore not operative during 1955.
Studies were made at two meetings with representatives of the other three Western Provinces toward unification of requirements for tourist accommodation. It is expected that
greater uniformity will result.
With the removal from the regulations administered by the Department of Trade
and Industry of any reference to the sanitary provisions for tourist accommodation, it will
now become necessary for the Health Branch to have regulations prepared pursuant to
the " Health Act" for the enforcement of good sanitation in tourist accommodation.
There are over 1,300 tourist accommodations in the Province, and these will still be
rated for standard of excellency by the Travel Bureau. The inspection of tourist accommodation for health and sanitation reasons will still be done by the local health unit.
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 studies the plans and
recommends approval where such is indicated. Approvals were given to six locker plants
during 1955.
In the 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. N 88 BRITISH COLUMBIA
Periodic inspection of the locker plants is made by the local sanitary inspector. One set
of locker plans was turned down during the year. It does not appear that there will be
many new locker plants built each year from now on.
GENERAL
The Division of Public Health Engineering provides a consultation service to other
divisions of the Health Branch and to local health units on any matter dealing with engineering in public health. This entails a considerable amount of work and travel. During
the year most 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 Director of Public Health Engineering gave a series of lectures to architecture
students at the University of British Columbia in the fall of 1955 under the auspices of
the Department of Public Health of the Faculty of Medicine. The position of chairman
of the British Columbia Examining Board for sanitary inspectors was again filled by the
Director of the Division.
The annual convention of the Pacific Northwest Sewage and Industrial Wastes
Association was held in Victoria in October, 1955, and invitations were sent to all persons
known to be interested in the problem living in British Columbia, whether or not they
were members of the association. The Director of the Division was the chairman of the
local arrangements committee. A meeting of the Pacific Northwest Pollution Control
Council was also held in Victoria.
As mentioned previously, the work of the Division was considerably hampered in
1955 due to the loss of two fully trained members of the staff. Only one of these persons
has been replaced. 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. DEPARTMENT OF HEALTH AND WELFARE, 1955 N 89
REPORT OF THE DIVISION OF VITAL STATISTICS
J. H. Doughty, Director
The Division continued to perform its twofold function of civil registration and
statistical service. Its registration responsibilities include the administration of the
" Vital Statistics Act," the " Marriage Act," the " Change of Name Act," and certain
sections of the " Wills Act." Its statistical services include the provision of a wide range
of public health statistics, the carrying-out of statistical analyses, the provision of consultant service to other divisions of the Health Branch and associated health agencies,
as well as the preparation of conventional vital statistics regarding births, deaths, marriages, stillbirths, adoptions, and divorces.
Continuing the trend of recent years, there has been an over-all increase in all
branches of the Division's activities. The increase in registration and in certification
work appears to be due to the increased population and to a further increase in the use
of birth, death, and marriage certificates for legal and commercial purposes.
The statistical activities of the Division have been intensified in line with the developing health programmes of the Department. This report will concern itself with a
brief description of the more important services rendered during the year in both the
statistical and the registration fields.
Certifications issued by the central office of the Division continued to increase in
number during 1955, and new records were set with respect to all series of certificates.
Over 60,000 certificates of all types were issued by the Victoria office during the year,
representing a 7-per-cent increase over the number issued during the previous year and
almost a 90-per-cent increase over the number issued only five years ago. Birth certificates issued increased by 8 per cent from 1954 to 1955, death certificates by 6 per
cent, and marriage certificates by 6 per cent.
Revenue-producing searches increased by 5 per cent and non-revenue searches of
current registrations by 7 per cent. Over 66,000 searches were made during the year,
a figure which is 53 per cent higher than that recorded in 1950.
Revenue collected by the central office amounted to almost $58,000, 6 per cent
above the 1954 collections and 51 per cent above those for 1950.
Despite the marked increases in the volume of work referred to above since 1950,
the staff of the Division has been kept at virtually the same size as it was at that time.
However, it appears impossible for the existing staff to absorb still further work increases,
and on several occasions during the year the volume of business was greater than could
be dealt with in the usual production schedule.
No alleviation was gained in respect of the serious space problem which continues
to grow with each passing year. Certain administrative difficulties were also suffered in
a continuation of staff turnover, often complicated by lengthy delays in securing replacements. At least several months are required to train the replacements in even the more
junior positions, and the frequency of changes in personnel has had a further adverse
effect upon the efficient operation of the Division.
Owing to the large and increasing volume of correspondence handled, there has
been a growing problem in the amount of time and effort required to sort and transfer
files at the end of each year. Steps have been taken to overcome this annual peak load
by segregating correspondence currently into two groups—one group containing completed transactions and the other containing items for which a further exchange of correspondence can be anticipated. In this way a part or all of the files can be transferred
at any time in the year with a minimum of labour. A change was also made in the
method of filing correspondence relating to delayed registrations of birth, so as to reduce
the difficulty of locating files, presently experienced, when several persons write to the
Division independently concerning the same delayed-registration application. N 90 BRITISH COLUMBIA
In order to assist the searchers and to further expedite the issuance of certificates,
a consolidated index of the current year's registrations was prepared on a semi-annual
basis in addition to the preliminary weekly and monthly indexes. Each week well over
1,000 new registrations are received and must be immediately indexed in order to be
available for any certifications which may be required from them. Hence one of the
important functions of the Mechanical Tabulation Section of the Division is the continuous preparation of up-to-date indexes and of consolidated indexes of all registrations filed with the Division.
One of the ancillary functions of the Division is to maintain a form register of all
printed forms used throughout the Health Branch. Moreover, it is the duty of the Division to give technical advice on all new forms that are proposed and to screen all orders
for the printing of forms with a view to improving their utility and uniformity.
REGISTRATION OF BIRTHS, DEATHS, AND MARRIAGES
Current Registrations
In the eighty-three years since the inception of civil registration in this Province,
many changes have taken place, including improvements in transportation, hospital
utilization, changes in the customs of the people, and changes in legislation. Together
these have resulted in a greater awareness of the value of complete and accurate recording of vital statistics, with the result that the Province to-day enjoys a high level of civil
registration. Investigations have shown that delays or omissions in registration usually
occur now only where illegitimacy or marital difficulties involving separation or divorce
are factors. The number of births which do not become registered is small, although
some delinquent registrations are obtained only after considerable efforts on the part of
the Division. It is believed that the number of unregistered births would be further
reduced if Family Allowance payments could be made contingent upon the registration
of the birth. Representations to this effect have been made to the Family Allowance
administration of the Department of National Health and Welfare by the Vital Statistics
Council for Canada. However, the Federal authorities have rejected this proposal, even
though the Provincial birth registrations continue to be used as the main source of eligibility verification.
Registration of deaths and of marriages presents only minor problems, since the
mechanics of filing such records are well known to the undertakers and to the clergy
respectively, who are by law responsible for filing these documents.
The content of registration forms is constantly under review in an effort to simplify
their completion by the public and to retain only such questions as are considered essential from the legal or statistical point of view. This is being done both at the Provincial
level within the Division and on an interprovincial level through discussions at the annual
meetings of the Vital Statistics Council for Canada. Studies are being made at the present time on the value of information derived from questions relating to racial origin and
to occupation and industry as appearing on the registration forms. These questions
appear to be the most difficult for which to obtain accurate replies, as well as being
questions to which the public most frequently object.
The wide and ever-increasing use of ball-point pens has been a matter of deep
concern to the Division for a number of years. It is most desirable that vital-statistics
registrations should retain their qualities of legibility for a great length of time, particularly in the birth series where registrations 80 or more years old are often required.
Unfortunately most persons do not understand the importance and value of the records
they are creating. Despite the fact that all registration forms bear printed instructions
in both red and black bold-face type, the proportion of records completed with ballpoint pen is now so great that the Division has been forced to discontinue the practice
of requesting the resubmission of such registrations with unfading ink.   Fortunately the DEPARTMENT OF HEALTH AND WELFARE,  1955 N 91
Division has microfilm copies of all registrations, and the preservation of these copies
has now become a matter of paramount importance.
Grateful acknowledgment is made to the hospital staffs for the splendid co-operation they have rendered the Division in obtaining prompt and accurate registration of
births occurring within their respective institutions.
Delayed Registration of Births
It would appear that there are still many unregistered births of persons born prior
to 1920. These unregistered births are nearly all discovered as the need arises for proof
of age for the persons concerned. Each year the births of many persons are registered
following routine applications and upon compliance with delayed-registration requirements. Experience over the years has shown that strong supporting evidence is essential
in order to maintain a high standard of delayed registration. To this end the verification
standards are frequently subjected to critical review.
Efforts to assist applicants for delayed registration were continued and extended
in several ways during the year. A tabulated index of sixty-one volumes of Physicians'
and Nurses' Notices of Birth covering the early part of the century was completed in
1955. In addition, many records of baptisms were microfilmed and transcribed to punch-
cards. A tabulated index of baptisms was likewise prepared and placed in use. These
indexes are proving to be most valuable additions to the verification material the Division has accumulated.
Gains were likewise made in reducing the number of unregistered births of Indians
through the co-operation of the Indian Commissioner for British Columbia and the Indian
Superintendents. As the frequency of contact between the Indian and the white population has increased, the problems associated with the obtaining of registrations for Indians
has decreased.
DOCUMENTARY REVISION
Vital-statistics records are continually receiving amendments to accommodate new
information resulting from adoptions, legitimations, changes of name, alterations of
Christian name, and corrections of errors made at the time of registration. These changes
are handled by the Documentary Revision Section of the Division. This Section is also
charged with registering orders of adoption and divorce transmitted from the Supreme
Court Registries and with the processing of applications for legal changes of name.
The number of adoption orders received during the year increased slightly to 1,185
from 1,154 in 1954, while the number of divorce orders increased to 1,754 from 1,525
in 1954. Legal changes of name and alterations of Christian name showed increases of
approximately 8 per cent over the previous year. Legitimations of birth accepted after
due investigation decreased slightly in number to 203 in 1955, compared to 215 accepted
in the previous year.
Revision of Indian Vital Statistics
The review of Indian vital-statistics registrations continued during the year, and
again many hundreds of registrations were amended. As has been pointed out in previous
years' reports, the accuracy of the earlier Indian records left much to be desired, largely
because registration for Indians was on a voluntary basis until 1943. While this deficiency
was overcome in that year by making the registration of Indian vital statistics mandatory,
there has remained the long tedious work of reviewing this series of registrations, eliminating duplicate records, amending spellings of names, and adding personal details where
these had been omitted. By so doing, it is hoped that the standard of Indian registration
will eventually equal that of the white population.
To supplement the above programme, steps were taken to educate the Indians
respecting the importance of accurate vital-statistics recording. This is being accomplished N 92 BRITISH COLUMBIA
gradually through the co-operation of the Indian Commissioner for British Columbia, the
Indian Superintendents, the Indian schools and hospitals. During tours of inspection, the
Inspector of Vital Statistics visits the Indian Superintendents for the purpose of explaining
policies and procedures. These contacts have proven to be very valuable in improving the
quality of registrations and in other matters, such as encouraging the use of laminated
birth certificates by the Indians.
In 1954 an experiment was made in a number of Indian Agencies whereby production of a birth certificate of a child was requested upon enrolment in school. The purpose
of this experiment was twofold—namely, to ensure that the child's personal record in
school would agree with the details shown on his birth certificate, and also to determine
whether the report of new enrolments presently required by the Division could be discontinued. The results in the first year appeared to be encouraging. However, a spot
check was made in 1955, with the following results: Of 30 schools contacted, 1 was
closed and 9 reported no new pupils; in the remaining 20 schools it was shown that
although 129 new pupils had enrolled, only 19 had submitted birth certificates and the
births of 4 more were found to be unregistered; in 93 of the 110 cases where birth certificates were not submitted upon enrolment, it was found that discrepancies existed
between enrolment records and birth records. Steps were then taken to amend the faulty
information. This points to a very serious and undesirable situation, since it means in
effect that in the majority of those 93 cases the children would have continued to use
wrong information regarding dates of birth, spellings of names, and even entirely different
names. Subsequent identification of the individual with his birth certificate and his school
record would become difficult or even impossible. Indications are that much has yet to
be done respecting Indians to ensure continuity of information from one source to another.
Efforts will be made to continue this educational programme so that the value of the
revision of the Indian vital-statistics records will not be lost.
Elimination of Duplicate Registrations
Reference has been made in the Annual Reports in recent years to the new system
of consolidated indexes for all series of registrations on file with the Division. These
indexes are now complete for all vital-statistics registrations ever filed in this Province
since its inception in 1872. The indexes have been compiled in volumes according to the
year in which the event occurred, regardless of the year in which registration was filed.
Within each volume the names are listed in strictly alphabetical order for the entire Province, regardless of the place within the Province in which the event occurred. However,
the indexes do show the place of event, the exact date of occurrence, and the exact date
of registration. The old indexes had, of necessity, been built up according to date of
registration and were alphabetical for each separate registration district. Furthermore,
many of the old indexes were hand-written. The use of mechanical punch-card equipment
has made possible the new stream-lined index arrangements which the Division now
enjoys.
One of the inherent weaknesses of the former system was that it permitted duplicate
registrations to be filed and to go unnoticed. A child registered in one registration district
was sometimes registered again, at a later date, in another registration district. The new
index system provides a means of discovering such duplicate registrations because similar
names now appear in sequence in the index of the year of event. However, in order to
ascertain that duplication does in fact exist, it is necessary to turn up the two original
registrations in question and to compare all the details. A surprising number of similar
entries with respect to names and dates do prove upon examination to relate to different
individuals.
The task of scrutinizing all the indexes with a view to discovering and eliminating
duplicate registrations has been in progress for several years and is carried out when other
work is less pressing.   By the end of 1955 all birth indexes from 1872 up to and including DEPARTMENT OF HEALTH AND WELFARE,  1955 N 93
1919 had been checked and all proven duplicates cancelled. Duplicate registration is
unlikely to occur in the present registration system because of the automatic checks which
have been incorporated.
MICROFILM AND PHOTOGRAPHIC SERVICES
The Division continued to forward microfilm copies of all registrations of births,
deaths, stillbirths, and marriages on a weekly basis to the Dominion Bureau of Statistics.
This is a contract arrangement and enables the Dominion Bureau of Statistics to compile
national vital statistics and the national indexes of births and deaths.
The project of microfilming all Physicians' Notices of Birth on file with the Division
was completed during the year, and new records in this series are now being microfilmed
on a current basis. Baptism, marriage, and burial records submitted by church authorities and by certain District Registrars continue to be microfilmed for the verification
library used in connection with applications for delayed registration of birth. The cooperation of church authorities in making these old church records available for preservation in this fashion is greatly appreciated.
The microfilming of a number of files dealing with delayed registrations of birth and
death, " Marriage Act" orders, correction declarations, and legitimations was completed
during the year. In addition, all registrations upon which notations or amendments had
been made were refilmed. In this connection, a change was made in the method of
splicing amendments on to the appropriate rolls of film. Occasionally all amendments
were spliced into the end of the roll, but experience has shown that it is more practical
and considerably faster in locating amendments to have them appear at the beginning of
the rolls. Changes were made in several hundred rolls during the year in order to gain
this advantage.
New equipment for the production of photographic copies was installed during
1955, replacing an obsolete photostat machine. The new process makes possible the
production of a photo copy from any document in a matter of minutes and increases the
volume of work which may be handled.
ADMINISTRATION OF THE "MARRIAGE ACT"
The administration of the "Marriage Act" is another major responsibility of the
Division of Vital Statistics. The Act covers all phases of the Province's jurisdiction over
the solemnization of marriage and the legal preliminaries thereto. The main duties of
the Division under this Act relate to the issuance of marriage licences and the vesting of
individual ministers and clergymen with the authority to solemnize marriage in British
Columbia. The Division also appoints Marriage Commissions for the purpose of solemnizing the civil marriage ceremony.
The Act contains provisions respecting the registration of ministers and clergymen
for the purpose of solemnizing marriage in this Province. These provisions are intended
as a protection for the public against the performance of marriages by fraudulent or
unauthorized individuals. The Act provides that, before registration is granted, the
denomination to which the clergyman belongs must fulfil certain requirements regarding
continuity of existence, and it must also have established rites and usages respecting the
solemnization of marriage.
By Statute, a list of all clergymen authorized to solemnize marriage must be published in The British Columbia Gazette annually. In addition, a monthly supplement is
issued, indicating the particulars of those persons newly registered, as well as those whose
registrations have been cancelled. As many hundreds of such changes occur each year,
the preparation of the annual list is an effective means of reconciling the records of the
different church groups with those of this Division. Each year it has been found that
through oversight or misunderstanding various church officials have omitted to advise N 94 BRITISH COLUMBIA
the Division currently of changes in personnel. In the absence of the above-mentioned
reconciliation, it is likely that many marriages would be performed by unregistered
clergymen.
Five new religious groups were recognized within the terms of the " Marriage Act"
during 1955, while inquiries as to the qualifications for recognition were made by eight
others. Eighteen orders permitting remarriage pursuant to section 47 of the " Marriage
Act" were issued. It is interesting to note that in all of these cases the couples had
previously been married to each other, were subsequently divorced, and were intending
to marry each other again.   In some instances there had been an intervening marriage.
The policy of checking all current marriage registrations against the roll of clergymen
authorized to solemnize marriage has been discontinued. No marriages performed by
unauthorized clergymen have been discovered for over two years. This appears to indicate that the method of registering clergymen for the solemnization of marriage and of
the recognition of new denominations is quite satisfactory.
Caveats
Persons having a reasonable objection to an intended marriage may lodge a caveat
with any Marriage Commissioner or Issuer of Marriage Licences, whereupon no civil
marriage may be performed nor any licence issued until the grounds for the objection
have been investigated. In practice the local official refers the objection to the Director,
who, upon the receipt of the statutory fee of $2.50, advises all Marriage Commissioners
and Issuers of Marriage Licences throughout the Province of the particulars of the
objection. The central office issues a revised list of outstanding caveats twice yearly to
local officials, so that only in those instances where objections have not been withdrawn
will the names appear on the caveat list. Only three caveats were lodged during 1955, a
much smaller number than usual. However, each case involves a relatively large amount
of clerical work, and since time is of the essence each caveat must be given top priority.
" Marriage Act Amendment Act, 1955 "
Administrative difficulties in connection with the issuance of permits for immediate
marriages were being encountered by the Marriage Commissioners and Issuers of Marriage Licences in increasing frequency throughout the Province. The " Marriage Act"
authorized such appointees to issue a permit for immediate marriage if it could be shown
that such action was " expedient and in the interests of the parties." This rather indefinite direction often placed the responsible officials in a most difficult position if, indeed,
they were to carry out the intent of the " Marriage Act." An amendment was therefore
obtained, by which the Marriage Commissioners and Issuers were given precise instructions respecting the circumstances in which they may authorize immediate marriages.
In order to guard against injustices and extreme hardship in cases not provided for by
the situations specifically outlined in the amendment, provision was made whereby applications could be referred to the Minister of Health and Welfare for final adjudication.
This amendment has now been in operation almost a full year, and it appears to be serving its intended purpose in a very satisfactory manner.
REGISTRATION OF NOTICES OF FILING OF A WILL
By the end of 1955 approximately 28,000 Notices of Filing of a Will had been
received by the Division in accordance with the provisions of the " Wills Act." These
notices indicate that a will has been drawn up and state the location of it. This service
was instituted by amendment to the " Wills Act" in 1945 and is available to testators
at no cost. There is, however, a fee of 50 cents for searching the records prior to probate of a will. DEPARTMENT OF HEALTH AND WELFARE, 1955 N 95
Experience in administration of these sections of the " Wills Act " has revealed two
important problems which increase in magnitude each year. There is an increasing repetition of similar names, with virtually no means of identifying the persons concerned,
either from the original notice or from the application for search made by an executor
following the death of a testator. Furthermore, there is at present no machinery whereby
entries may be deleted from the index following the receipt of revised notices or upon
probate of the wills concerned. It is hoped that this situation may be rectified by suitable amendment to the " Wills Act."
Each year, as the availability of this service has become more widely known, an
increasing number of notices has been filed. Over 4,700 were received in 1955, compared to 4,100 in the previous year. Applications for searches of these wills notices
have also increased, now averaging about 500 per month, compared to 400 per month
in 1954.
DISTRICT REGISTRARS' OFFICES
Changes in Registration Districts
The Government Agency at Barkerville was closed temporarily, and it was necessary to transfer the vital-statistics duties to a private individual. However, the closure
was of a short duration, and when the Agency was reopened the Government Sub-Agent
was again appointed as District Registrar of Births, Deaths, and Marriages.
A new Government Sub-Agency was established at Fort Nelson during the year to
cater to the residents living in that area. Accordingly the responsibility of collecting
vital-statistics registrations and the issuing of marriage licences and the performance of
civil marriages was transferred from the Royal Canadian Mounted Police Detachment
to the new Sub-Agency.
Inspections
The Inspector of Vital Statistics visited fifty-four offices and sub-offices during the
year. These visits covered offices located on Vancouver Island, the Sechelt Peninsula,
the Fraser Valley, the East and West Kootenays, and the coastal area including Bella
Bella, Bella Coola, and Ocean Falls. Certain of these smaller and less accessible offices
had not been visited by a representative of the Division for seven or eight years. Periodic
visits were also made to Vancouver, New Westminster, and North Vancouver.
The purpose of these inspectional visits is to check the procedures being carried
out in the local offices and to ensure that the registration system is working satisfactorily
in the field. The Inspector usually finds it expedient to make contact with the doctors,
clergymen, undertakers, hospital administrators, and health-unit personnel in the areas
visited.
The Inspector was able to report that the standard of work in the district offices
visited is generally very satisfactory, and that the District Registrars are doing an excellent job of collecting and transmitting vital-statistics returns to the central office. Once
again it is a pleasure to express appreciation for the diligence of the District Registrars
in carrying out their vital-statistics responsibilities.
At the close of the year there were ninety offices and sub-offices operating in seventy-
one registration districts. Thirty-nine of the offices are served by Government Agents
and Sub-Agents, while Royal Canadian Mounted Police personnel hold the Registrar's
appointment in twenty-two other districts. Eight offices are served by other Provincial
Government employees, seven offices by Municipal Clerks, and fourteen by private individuals, including Game Wardens, a Postmaster, Stipendiary Magistrates, business-men,
and a Customs Officer. In addition, there are seventeen Indian Agencies throughout
the Province from which registrations are received, and a Marine Registrar located in
Vancouver. N 96 BRITISH COLUMBIA
Vancouver Office
Because of the large volume of vital-statistics business conducted in Vancouver, the
District Registrar's office in that city is operated by full-time employees of the Division.
In other centres of the Province, vital-statistics registration work is carried out on a
shared-time basis by Government Agents, Royal Canadian Mounted Police personnel,
and commission agents. Approximately 40 per cent of all registrations in the Province
are received through the Vancouver office, over one-half of all marriage licences are
issued at that point, and over 60 per cent of all civil marriages are conducted there.
In August of this year the District Registrar's office was moved from its former
location at 636 Burrard Street to a street-level suite in the new Provincial Health Building at 828 West Tenth Avenue. The move was accomplished without interruption in
the service to the public. A special feature of the new accommodation is a room set
aside for the performance of civil marriages. In the design and furnishing of the building, this room was afforded special consideration, so that it provides a pleasant and dignified setting for the conduct of civil ceremonies.
The problems of staff turnover and of staff shortages which were mentioned earlier
with respect to the central office were even more severe in Vancouver. For a period of
several months fully half of the District Registrar's staff had had less than six months'
service and, in addition, several staff members were absent for protracted periods due to
major illnesses. These staff shortages and the high proportion of untrained help made
the provision of adequate service and accurate advice to the public a matter of grave
concern to the Registrar. However, despite these difficulties the operation of the Vancouver office was maintained in a most commendable fashion.
After careful study and in consultation with the Department of Finance-, important
changes were made in accounting procedures in the Vancouver office. As a result of
the simplifications effected, daily accounting is largely done in summary form and certain
repetitive routines have been eliminated.
The volume of registrations received in the Vancouver office showed an increase
over the previous year. This increase amounted to 10 per cent in the birth series, somewhat more with respect to death registrations, and about 5 per cent in the case of marriage registrations. There was likewise a rise in the number of certificates issued in each
series, the average now being about 1,000 per month. An increase of approximately 10
per cent was noted in the number of civil marriages performed and in the number of
marriage licences issued. There was a corresponding increase in the number of letters
received and dispatched.
STATISTICAL SECTION
The Division is now equipped to provide a complete statistical service to the Health
Branch and to a number of associated health agencies. This service includes the processing and analysis of the conventional vital statistics relating to births, deaths, marriages,
stillbirths, divorces, and adoption; the processing and analysis of a wide range of public
health statistics, including the statistics derived from the operation of other divisions of
the Health Branch; and the provision of consultant statistical service to those divisions.
In addition, extensive indexing assignments are carried out each year. This integrated
statistical service is possible by virtue of the fact that the facilities of the Division include
all the essential components of a public health statistical organization. These components
are civil and medical coders, public health statisticians, statistical clerks, and a self-
contained mechanical tabulation system specifically oriented to the production of public
health statistics.
The statistical output of the Division has been developing and expanding during
recent years, and further progress was made during 1955. However, the work was
impeded this year by the loss of several trained members of the statistical staff and by the
difficulties of finding suitable replacements.   Because of the specialized nature of public DEPARTMENT OF HEALTH AND WELFARE,  1955 N 97
health statistical work, new employees require a considerable amount of in-service training. Nevertheless, all routine commitments were met and a number of special priority
assignments were successfully concluded. Additional reports were published in the series
of Vital Statistics Special Reports, and extensive work was done in preparing statistical
data related to health care and costs for the Federal-Provincial Conference which convened in October.
While the bulk of the statistical work in the Division is centralized in the Victoria
office, the Division maintains a small statistical unit in Vancouver. The primary function
of the Vancouver statistical office is to provide direct service to the divisions of the Health
Branch and to allied health agencies in and around Vancouver. To this end, the largest
proportion of the time of the Vancouver statistical staff was spent in liaison and consultant
duties. In addition to these duties, special statistical studies were undertaken and statistical information was supplied to community health groups and to students. With the
housing of the Crippled Children's Registry in the Vancouver office, one research assistant
devoted much time to supervision and development of this Registry.
The statistical services of the Division, in the main, were extended to the Division of
Tuberculosis Control, the Division of Venereal Disease Control, the Provincial Mental
Health Services, the British Columbia Cancer Institute, the British Columbia Government
Employees' Medical Services, the Division of Preventive Dentistry, and the Provincial
Epidemiologist.
Tuberculosis Statistics
As well as the routine processing of statistics relative to all tuberculosis cases
examined and to admissions and discharges from tuberculosis sanatoria, several special
assignments were carried out. A study of new cases of tuberculosis in conjunction with
miniature X-ray surveys according to school districts was completed, with a view to determining areas within the Province where there was an indication of high prevalence of
tuberculosis. Another study initiated during the year for the Division of Tuberculosis
Control was designed to determine the cost of finding by miniature X-ray surveys a case
of active tuberculosis in comparison with the cost of treating a case. This study is now
in progress, and it is anticipated that results will be available early in 1956.
The supervision of the development and ordering of tuberculosis record forms was
continued by the Vancouver statistical office. One of the research assistants remained
a member of the Central Medical Records Committee of the Division of Tuberculosis
Control in a liaison capacity, attending all meetings of this Committee. No major changes
were made during the year in the record system. Earlier in the year a statistical study
was set up on punch-cards, covering tuberculosis cases receiving surgery at Willow Chest
Centre. The objective of this study is to provide an analysis of the type and the amount
of therapy being carried out and the results thereof. In addition, much discussion has
taken place with the medical staff in developing a more useful code applicable to non-
tuberculosis pulmonary diagnoses.
Venereal-disease Statistics
The Division was actively engaged in providing statistics for the Division of Venereal
Disease Control. The routine handling of the statistics of new notifications of venereal
infection was continued, as was the production of statistics stemming from the contact
investigation work of the Division of Venereal Disease Control. The Division of Venereal
Disease Control maintains a high degree of confidentiality with respect to persons having
venereal infection, and in the data which they transmit to the Division of Vital Statistics
for statistical processing, cases are identified by number only, with no names whatsoever
appearing.
Data on contact investigations of reported cases of gonorrhoea were tabulated from
the punch-cards for the calculation of gonorrhoea epidemiologic and brought-to-treatment N 98 BRITISH COLUMBIA
indices. These two indices are a further development of the contact index which was
introduced in 1953 as a measure of evaluating the results of the case-finding activities of
the Division of Venereal Disease Control. It has now been arranged that the Division of
Vital Statistics will prepare all three indices quarterly and plot them on a chart for quick
visual evaluation of the contact investigation programme. Further to the above, the
research assistants in the Vancouver office were called upon by the Division of Venereal
Disease Control for consultations upon such items as record revisions, coding procedures,
and the presentation of statistical data.
Crippled Children's Registry
The Crippled Children's Registry has now been in operation for several years, and
as the pattern of registration appears to have become stabilized, the time was considered
to be opportune to revise the reporting forms and recording procedures of the Registry.
In the light of the experience gained during the initial stage of the Registry's operation, it
has been decided to simplify the present registration form and to print it on card stock.
These registration cards will now be filed in such a way as to constitute a card index and
thereby expedite the work of the Registry. Further work has been done on the development of statistics on rehabilitation aspects of Registry cases. New codes, punch-cards,
and procedures are being designed in this connection. Detailed tabulations and statistics
were prepared by the Division for the Annual Report of the Crippled Children's Registry.
Dental-health Statistics
Assistance was given to the Division of Preventive Dentistry in the setting-up of a
continuing survey of community dental health. Details of this project appear in the
report of the Director of Preventive Dentistry.
Mental-health Statistics
The Division continued to process the admission and separation reports of patients
moving in and out of the Mental Health Services. The extensive statistical tabulations
required for the Annual Report of the Mental Health Services were again prepared, and
considerable time was devoted to stream-lining and improving the statistical tables published in that Report.
Further work was done on developing statistics covering the resident population
of the mental-health institutions, and punch-cards were set up covering each resident.
These punch-cards have now been double-checked with the census of the in-patient population, and it is anticipated that tabulations on this phase of mental-health statistics will
be run off for the first time early in 1956.
The Division continued to act as a clearing-house for the statistical data which are
required by the Dominion Bureau of Statistics from the British Columbia Mental Health
Services and from the psychiatric wards of general hospitals.
Also in the field of mental-health statistics, a short analysis was completed on admissions, discharges, and readmissions. The purpose of this analysis was to attempt to
explain why British Columbia had the apparently highest readmission rate to mental
institutions of any Province in Canada. When the admission and discharge rates were
examined along with other information, it was evident that they were influenced by the
type of service the mental institutions extended to the public. With this in mind, and
basing the readmission rates on the number of people discharged from mental institutions,
it was found that the readmission experience for the British Columbia Mental Health
Services was actually better than the average experience of the rest of Canada. This
analysis was published in full in the current Annual Report of the Provincial Mental
Health Services. DEPARTMENT OF HEALTH AND WELFARE,  1955 N 99
Cancer Statistics
The Province continued to operate the Province-wide cancer reporting system which
was established in 1932. The statistics stemming from this registration system were
published in a release in the series " Division of Vital Statistics Special Reports."
For the first time the Division was able to supply the British Columbia Cancer
Institute with tabulations covering a complete year of statistical data on cancer cases
treated by the Institute. Because this service was only recently extended to the Institute,
minor adjustments in procedure were necessary in order to assure a smooth flow of the
statistical material. It is anticipated that in future years the statistical service extended
will prove a most valuable aid in cancer research work.
Epidemiological Statistics
The Division continued to operate the Province-wide notifiable-disease reporting
system and to compile the statistics and reports required by the Health Branch in this
connection. Several special studies and services were provided by the Division respecting
these statistics during the year, including work on the Typhoid Fever Carrier Registry.
The Division provided assistance in the planning of the poliomyelitis vaccination
programme and in analysing the results obtained. During the course of the poliomyelitis
epidemic, up-to-the-minute records were maintained so that the exact progress of the
epidemic could be known at any time and comparisons made with the situation existing
on corresponding dates of previous years.
Population Estimates
Another important activity of the Statistical Section is the preparation of population
estimates for Departmental use. These estimates are necessary for administrative purposes and as the basis for the rates of illness and mortality by age-groups and by geographical areas of the Province. Although there is a continuing demand from private
individuals and from business firms for a variety of population estimates, the Division
does not have the facilities to provide this type of service to outside agencies.
In compiling the population breakdowns which are necessary to the work of the
Division, the annual estimates of the total population of the Province by age-groups and
sex which are made by the Dominion Bureau of Statistics are accepted and used without
change. These estimates have proven to be very reliable over a period of years. The
Division also leans heavily upon the estimates of the population of the separate municipalities of the Province as submitted annually to the Department of Municipal Affairs by
the municipalities themselves.
Poliomyelitis Cost Study
The study of the cost of the 1953 poliomyelitis epidemic which was mentioned in
last year's report was completed in 1955. As far as possible, the exact hospitalization
cost for each person afflicted was traced in the records of the British Columbia Hospital
Insurance Service. Estimates of the average cost of medical care were made by a study
of those poliomyelitis cases which were covered by the Medical Services Association. The
British Columbia Poliomyelitis Foundation and the Western Society for Rehabilitation
supplied data regarding expenditures on the cases which came under their activities. An
estimate was also made of the cost of the air transportation services which were made
available through the generous co-operation of the Royal Canadian Air Force. From
all of these sources it was possible to estimate the average cost of a case of poliomyelitis
in this Province. The data showed this cost to be at least $1,110 per patient. This is
considered to be a conservative estimate, and it does not include the cost of lost wages,
the cost of diminished earning capacity for those suffering permanent disability, nor the N  100 BRITISH COLUMBIA
variety of incidental costs which occur in the average home when normal routine is
dislocated by serious illness of this type.
Special Assignments
The Division also engaged in a number of special studies and assignments of varying
importance. At relatively short notice the entire statistical resources of the Division were
diverted to the preparation of statistical data on health and hospital care and on the costs
thereof for the benefit of the British Columbia delegation to the Federal-Provincial
Conference. Several sources of information were explored, and special tabulations were
run from punch-cards wherever this was found to be expedient. Analyses were made
from extensive tabulations made available by the British Columbia Hospital Insurance
Service and by the Social Assistance Medical Services.
Assistance was also rendered to the Bureau of Economics and Statistics in the
preparation of the Province's brief to the Royal Commission investigating Canada's
economic prospects. The work of the Division in this connection extended only to
advising on those sections of the brief dealing with health matters.
Consultant service in the evaluation of statistical data was given to research projects
being conducted by the Vancouver General Hospital and by the University of British
Columbia. The former dealt with the study of staphylococcus infections and the latter
with the survey on factors contributing to narcotic addiction in British Columbia.
Certain items of special interest were extracted from the birth and death registrations
as they were being processed in the central office. Details of all deaths due to poisonings
and details of all infant deaths from asphyxia due to smothering were noted and made
available to the Director of Environmental Management. Infants having birth injuries
or malformations reported at the time of birth were automatically registered by the
Division with the Crippled Children's Registry.
A member of the research staff served on the Nurses' Record Committee during the
year and devoted time to the development and revision of public health record forms.
Consequent to the new method of grading the health of school-children which was adopted
by the Health Branch in 1955, a revised Medical Inspection of Schools Report was drawn
up and placed in operation.
Four papers dealing with the statistical aspects of various public health topics were
prepared and presented at the Public Health Institute held in Vancouver in April of 1955.
One paper reviewed the morbidity data stemming from the British Columbia Government
Employees' Medical Services, the second presented data on pregnancy wastage and infant
mortality in this Province, the third outlined recent applications of statistics to health
programmes in British Columbia, and the fourth presented a review of certain measures
of the health status of this Province.
Vital Statistics Special Reports
The series of Vital Statistics Special Reports which was commenced in 1954 was
augmented by the release of seven additional reports during 1955. The prime purpose of
these reports is to provide for the dissemination of statistical information not routinely
appearing in annual or other reports to public health personnel, to the Medical School
of the University of British Columbia, and to interested groups of the medical profession.
The information appearing in the reports issued during 1955 is synopsized below.
Report No. 6 was the first of a series dealing with statistics derived from the Physician's Notice of Live Birth and Stillbirth. This report contained general information
dealing with such classifications as place of birth, kind of birth, legitimacy status, birth
weight, need for resuscitation, and a variety of other single and multiple classifications.
Report No. 7, entitled " Complications of Pregnancy and Delivery," analysed
the data stemming from responses to the questions " Describe operative procedure " and DEPARTMENT OF HEALTH AND WELFARE,  1955 N  101
" Describe complications of pregnancy and delivery " on the Physician's Notice form.
The tables covered the 6,069 live births occurring during 1953 for which a morbid condition in the mother or an operative procedure was reported as being present. Rates of
occurrence of morbid conditions and operative procedures were shown to be greater for
immature infants than for those which were full term, greater for first pregnancies than
for subsequent pregnancies, and greater for infants of smaller birth weight.
Report No. 8, entitled " Resuscitation, Anaesthetics, and Sedations," was based upon
the responses to the questions " Was resuscitation necessary " and " Name of anaesthetic
agent and (or) sedation used " appearing on the Physician's Notice form. Resuscitation
was noted to be necessary in one birth out of every fourteen and to be required more
frequently in the case of births with malformations or injuries. Likewise, the need for
resuscitation was shown to be great in the case of immature births, one out of every three
immature births requiring resuscitation procedure. Infants born by Caesarean section
and infants born following induced labour were also shown to be more frequently in
need of resuscitation. For first pregnancies, one out of every ten births required resuscitation, whereas in the case of second and succeeding pregnancies resuscitation was
required only half as frequently.
Report No. 9, entitled " Stillbirths," presented a series of informative tables also
derived from the Physician's Notice. The data pointed up the high incidence of unfavourable maternal conditions associated with stillbirths. The data likewise revealed that not
only is there a higher incidence of conditions complicating pregnancy and delivery in the
case of stillbirths, but also that these conditions are more severe. The incidence of stillbirths was shown to increase as maternal age increased.
Report No. 10, entitled "Health Unit Statistics, 1954," presented certain basic
statistical information respecting births, stillbirths, deaths, tuberculosis, cancer, and
venereal disease according to health unit of residence. The tables were produced in the
same format used in earlier years to facilitate comparisons.
Report No. 11, entitled " Pregnancy Wastage," was also derived from the Physician's
Notice of Birth form. The report pointed out the difficulties of obtaining an accurate
picture of the pregnancy loss problem and indicated that the statistics contained in the
report could be considered as minimum figures only. Nevertheless, these data showed
that in this Province a definite loss of 70 pregnancies out of every 1,000 could be counted.
At least 11.7 per cent of mothers who delivered live-born infants during the year reported
a previous lost pregnancy, while 22.3 per cent of the mothers who delivered stillbirths
during the year acknowledged a previous pregnancy loss.
Report No. 12, entitled " Cancer Morbidity and Mortality in British Columbia,
1954," set forth data on cancer cases reported to the Division during 1954 and on cancer
deaths registered during that year.
SUMMARY OF 1955 VITAL STATISTICS
Population and Natural Increase
The estimate of the population of the Province for 1955 as provided by the Dominion
Bureau of Statistics was 1,305,000, an increase of 39,000 over the 1954 estimate. This
was the largest increase since 1947 and the fourth largest on record.
Only four times between 1872 and 1948 did the annual population increase in the
Province attributable to the excess of births over deaths exceed that due to immigration,
the immigration figure generally being considerably higher than the natural increase.
However, from 1949 to 1955, the reverse situation has existed, and the natural increase
has exceeded the increase due to immigration in each of these years by an average of over
4,500. In 1955 the rate of natural increase was the highest yet recorded—namely, 16.4
per 1,000 population—the rate in 1954 was 16.2. N  102 BRITISH COLUMBIA
Birth and Stillbirth Rates
The birth rate in 1955 was 25.4 per 1,000 population. While this was a decline
from the 1954 rate, it was higher than any rate recorded prior to 1953. The stillbirth
rate was 13.5 per 1,000 live births, the first increase since 1950 and the highest rate since
that year.
Principal Causes of Mortality
For quite a number of years little variation has occurred in the crude death rate,
although during the last few years a slight downward trend appears to have been evident.
This year the preliminary death rate for the population excluding Indians was down to
9.5 deaths per 1,000 population. This is the lowest rate recorded since 1939. The
final rate for 1954 was 9.7.
The great bulk of deaths now occur as a result of the three degenerative diseases,
namely, heart disease, cancer, and cerebrovascular lesions. These are deaths which are
mostly unpreventable in our present stage of medical knowledge. Thus even notable
successes in decreasing the mortality from other causes has only a small net effect upon
the total mortality rate. For example, had the mortality from other causes remained
constant, even the dramatic decline in tuberculosis mortality during the last decade would
have reduced the mortality rate over that period by only 45 deaths per 100,000
population.
The three degenerative conditions named above continued to exact a heavy toll of
life among the population during 1955. Two-thirds of all deaths resulted from these
causes. The specific death rates during 1955 were 368.9 per 100,000 population for
heart disease, 161.8 for cancer, and 101.7 for cerebrovascular lesions.
While the first three leading causes of death primarily affect the older population,
the same is not the case with respect to the three next most important causes, namely,
accidents, pneumonia, and diseases of early infancy. Together these causes accounted
for about one-fifth as many deaths as did the first three, but with the important difference
that they strike the younger age-groups and thereby constitute a more serious problem
than their frequencies suggest. A discussion of the effect of the different causes of death
in shortening the life-span was presented in the 1952 and 1953 Health Branch Reports
under the heading " Mortality in Terms of Life-years Lost."
It is gratifying to note that a fairly substantial decline was recorded in the number
of deaths from accidents in 1955, the rate being 60.3 per 100,000 population, compared
to rates of 66.7 in 1954 and 76.4 in 1953. Reductions were noted in the mortality from
motor-vehicle accidents and from falls, but an increase occurred in death due to drowning.
The foregoing three types of accidents were responsible for over half of all accidental
deaths occurring during the year.
Pneumonia caused 34.0 deaths per 100,000 population in 1955, as compared with
37.0 in 1954.
Diseases of the arteries, another of the degenerative conditions, caused slightly more
deaths in 1955 than in 1954, the rate being 22.3 per 100,000 population this year, compared with 20.7 in 1954. The rate of suicides declined to 11.5 per 100,000 population
in 1955, an improvement over the rates of 14.3 recorded in 1954 and of 16.4 recorded
in 1953.
The infant mortality rate in 1955 was 21.0 per 1,000 live births, the lowest rate on
record. This rate represented the fourth consecutive decline. The maternal mortality
rate in 1955 was 0.4 per 1,000 live births, a slight increase from the rate of 0.3 recorded
in 1954. DEPARTMENT OF HEALTH AND WELFARE,  1955 N 103
REPORT OF THE DIVISION OF PUBLIC HEALTH EDUCATION
Raymond H. Goodacre, Director
An analysis of a service usually begins with the fundamental questions, " Why? "
" What? " " To whom? " " By whom? " and " How? " Of these, perhaps the most difficult for public health administrators to answer is how the services of a Division of Public
Health Education can be provided to result in efficient utilization by the persons to whom
the service is directed.
It is becoming increasingly evident that the programme of this Division must depart
from the somewhat vague concept of public health education currently accepted by many
Provincial and State health departments. Present thinking by the staff of this Division is
turning toward a greater emphasis on in-service training, for although empirically, in-
service training or staff education is only one function of public health education, practically it is perhaps the most effectual and economical method by which the quality of
public health education throughout the Province can be improved. In its broadest sense,
staff education is not restricted to classroom teaching, but involves the utilization of
existing facilities which are educational by nature.
STAFF EDUCATION
One of these facilities is the Health Branch library administered by the Division of
Public Health Education. On numerous occasions, attempts have been made by this
Division to reorganize the library on a more productive basis in order that the books,
serials, and other references might be better utilized by staff on both the Provincial and
local level. Each attempt, however, failed, for the simple reason that no member of the
Division is trained in library science. Renewed efforts were directed during the year
toward the Provincial Library for assistance in devising a suitable classification and cataloguing system which would result in a rejuvenation of the existing somewhat inactive
depository of information.
As a result of this request, the Provincial Librarian was able to secure the services of
Miss E. Doreen Fraser, University of British Columbia, Bio-medical Librarian, who was
kind enough to visit the Health Branch library to suggest recommendations for a complete
reorganization of the facilities based upon the most pertinent applications of the Dewey
Decimal, Library of Congress, and Armed Forces Medical Library procedures. The
question now remains as to whether the Provincial Librarian will be able to secure the
services of an additional reference librarian who would be available to this department on
a loan basis, and who would be in a position not only to undertake the classification of
materials maintained and acquired by the Health Branch, but also to integrate listings
with those of other departments and the Provincial Library.
Four years ago this Division instituted a procedure whereby selected medical and
sanitation journals were to be circulated to health-unit personnel as an economical method
of supplementing the journals and books provided on a regular basis to health-unit basic
libraries. This system of providing journals that would otherwise be unavailable on a
systematic basis has been well received. Furthermore, it has been utilized on many
occasions for single copies of items that are deemed sufficiently important for consumption
by local health services personnel. Its most recent application has been with a group of
reference texts recommended to health officers sitting for their certification in public
health next fall. To avoid the anticipated confusion arising from the requests of eleven
persons for twenty-nine references, this Division devised a circulation schedule whereby
a proportion of these items would be shared by each candidate on a ten-day basis in such
a manner that no health officer received more than one book at a time. The remaining
references were divided into two categories; namely, those already provided to health
units as part of their basic library, and six additional titles held only by the University of
British Columbia's Bio-medical Library, available through this Division. N  104 BRITISH COLUMBIA
When it became known a year ago that poliomyelitis vaccine would be available
through local health services, reference was made to the wide range of parental acceptance
rates which had been obtained in areas where the vaccine had previously been made
available. Parental acceptance was imperative, since it was necessary for all eligible
children to obtain this consent in order to receive vaccine. As a result, this Division outlined a programme for local health services to use as a basis for local education, directing
their activity specifically to parents of Grade I children and pre-schoolers entering Grade
I in the fall of 1955. The outline prepared emphasized the necessity of not only educating
the parents directly, but also of securing the understanding and approval of the medical
profession, pharmacists, and educational authorities.
As in past years, the most highly organized in-service training project during the
year was the Annual Public Health Institute, held in Vancouver from April 11th to 15th.
The 1955 Institute featured a series of three talks by Dr. G. F. Amyot, Deputy Minister
of Health, who was this year's choice of the Institute Planning Committee, in keeping with
the wishes of field staff for a Canadian public health authority. In addition to the Deputy
Minister's discussions of the role of local health services in the changing public health
picture, the four-day intensive agenda included lectures and discussions on rehabilitation,
the role of local health units in the prevention and treatment of alcoholism, tuberculosis-
control in the community, the care of handicapped children, and similar topics designed
to keep staff informed on current trends and advances in public health.
PUBLIC EDUCATION
It was indeed a privilege to have Mr. Harvey Adams, Director of Information
Services Division, Department of National Health and Welfare, visit this office on two
occasions during the year. On both occasions Mr. Adams was able to clarify the distribution policy of certain National Health and Welfare publications which have been
relatively unavailable over the past three years. It has now been determined that this
Province will receive 75 per cent of its annual quota for the Canadian Mother and Child,
Up the Years from One to Six, The Dental Health Manual, and the Backward Child, free
of charge. Additional supplies, however, must be purchased from Provincial funds. This
policy was agreed upon by the Deputy Ministers at the Dominion Council of Health
meeting in the spring and was a most welcome solution to the problem of supplying these
popular items to the Provinces on an equitable basis.
On June 28th the Minister of Health and Welfare officially opened the Poliomyelitis
Pavilion in Vancouver. Adjoining the Pearson Tuberculosis Hospital, this Pavilion is
designed as a convalescent centre for poliomyelitis patients who have passed the acute
stage of the disease, but who are not yet ready for more-advanced rehabilitation. This
Division was privileged to act as a co-ordinating agency between the Minister, Deputy
Minister of Health, and Bureau of Special Preventive and Treatment Services in developing the opening ceremony, and produced, in co-operation with the Photographic Branch,
Department of Trade and Industry, a film depicting the role of the Pavilion in the total
picture of the care and management of poliomyelitis patients in this Province. The intent
of this film was twofold. In the first place it was designed to show both the purpose of
the Pavilion and its facilities in order to provide the guests at the opening with an understanding of the building, which they could not obtain during the tour since they were not
permitted to mingle with the patients. Secondly, there is no adequate visual presentation
dealing with poliomyelitis available for showing to lay audiences, and it was felt that once
the original purpose of the film had been fulfilled, it could be revised and augmented with
scenes depicting the role of vaccine as a preventive measure.
In addition, this Division co-ordinated the opening of the Provincial Health Building
in Vancouver, for which the official ceremony was conducted on September 26th.
Among the talks given during the year were three of particular note. The first was
presented before the fourth-year medical students at the University of British Columbia, DEPARTMENT OF HEALTH AND WELFARE,  1955 N 105
in which the over-all field of health education was highlighted with specific reference
directed toward the role of the practising physician in the health education of his patients.
The second talk consisted of a brief presentation to a health educators' sectional meeting
during the annual meeting of the Canadian Public Health Association, on the principles
of dental-health education as exemplified by a regional dental consultant in this Province.
The purpose of this paper was to demonstrate that the approach to dental-health education is fundamentally simple and should include the utilization of practising dentists and
physicians as well as public health nurses and teachers, as they, too, are key health
educators. A similar talk was given to lay representatives of agencies sponsoring full-
time preventive dental services or community preventive dental clinics at a dental-health
conference convened in May by the British Columbia Dental Association.
For the past three years this Department has been fortunate in being able to reprint
selected dental-health posters through the courtesy of the New Zealand Department of
Health. However, neither this nor any other suitable source has been able to offer a
poster depicting a topic that has heretofore been neglected, namely, that of the importance of maintaining foundation teeth. In co-operation with the Division of Preventive
Dentistry, this Division contracted with a commercial artist to design a simple presentation based upon this topic, with artwork capitalizing on the still current popularity of
Davey Crockett, for use primarily in child health conferences.
In 1954 the Government completed plans designed to allow each department to
include a display of its services at the British Columbia Building located on the Pacific
National Exhibition grounds in Vancouver. In conjunction with a Vancouver display
firm the Division developed an exhibit illustrating the many preventive health services
that are organized on a health-unit basis for mothers, school-children, and the community
in general.
Although this display was well received, it became quite apparent that several modifications were necessary in order to increase its attraction value. Several minor changes
were made in the existing display, and for the opening of the Pacific National Exhibition
this year a series of show-cases were placed to illustrate one particular phase of this
Department's work. In view of the current interest in the availability of poliomyelitis
vaccine through local health services, it was decided that a visual presentation of both
the vaccine and the recently opened pavilion would be both timely and educational.
Despite this added feature, it appeared that the display did not completely fulfil its
objective during the P.N.E. week, when the public was understandably more interested
in entertainment than in education. However, perhaps the main purpose of the display
is fulfilled not during this week, but throughout the year, when groups of visitors are
conducted through the British Columbia Building and therefore have a better opportunity
to absorb the content of each exhibit.
At the February, 1954, session of the British Columbia Natural Resources Conference, the subject of people as a resource was dealt with for the first time. Two papers—
one a discussion of the waste of human resources and the other on conservation—were
presented, together with an outline of the history and origin of British Columbia's population. For the 1955 conference the executive suggested that the story of people be presented from the view-point of public health. As a result a committee chaired by the
Director organized a programme placing two major topics demonstrating the relationship between public health and the ability to develop other natural resources. The committee was fortunate in securing Dr. Lawrence E. Ranta, Medical Director of the Vancouver General Hospital, who discussed " The Balance Sheet of Health and Disease,"
and Dr. A. John Nelson, former Consultant in Epidemiology with the Health Branch,
who spoke on the relationship between public health and natural resources. The session
which included these two papers was chaired by the Director on behalf of the Health
Branch. N  106 BRITISH COLUMBIA
During each school-year the Department of Education's Director of School Radio
Broadcasts arranges, in co-operation with the Canadian Broadcasting Corporation, for
numerous programmes designed for transmission at a time during which school-children
can listen to, and discuss in class, topics related to the curriculum. It is encouraging to
note that among these a series of health broadcasts was utilized not only in the school,
but also by Parent-Teacher Associations throughout the Province. In co-operation with
the Director of School Radio Broadcasts, this Division planned discussion outlines for
each of these broadcasts and forwarded them, together with suitable reading material,
to the Parent-Teacher Association of British Columbia for distribution to some sixty
local P.-T.A. groups.
PERSONNEL
Franklin Delano Roosevelt once commented, " The test of our progress is not
whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little."
These thoughts expressed by Mr. Roosevelt apply not only to foreign policy, but
also to the objectives of this Division, since it is far easier and less painful to concentrate
effort upon those who readily accept and appreciate services rendered. Nevertheless,
the problem remains that in too many cases services are not being directed to those who
should benefit from them. For the past three years this section of the report has dealt
with the problem of staff shortage due to difficulties in both obtaining and retaining suitably qualified and experienced personnel. This problem is perhaps the greatest single
deterrent to any programme designed ultimately to provide enough for those who have
too little. Moreover, the staff shortage became somewhat more acute during the year
through the resignations of Miss Joan List, health educator with the Central Vancouver
Island Health Unit, who returned to teaching, and Mr. Urban Nelson, who accepted a
position with the Greater Vancouver Metropolitan Health Committee.
It is somewhat discouraging to note that whereas the Division consisted of six professional persons in 1952, there are now in 1955 only two members. Although negotiations for a salary revision which began one year ago recently culminated in a small
increase for all classifications, it is not yet possible to predict whether or not this revision
will either attract or retain an adequate professional staff.
In the opening paragraphs of this report it was noted that the methods by which a
division of public health education's services are provided must be improved if these
services are to result in more efficient utilization by those for whom they are intended.
In the past a continuing process of evaluation has, of course, been applied to the programme of this Division in an attempt to crystallize the concept of public health education within a frame of reference more compatible with the administration and organization of health services in this Province.
Further discussion among Health Branch officials on a recently developed proposal
is scheduled to take place early in the new year, at which time it is hoped that some
encouraging conclusions will emerge to form a sound basis for the 1956 programme. DEPARTMENT OF HEALTH AND WELFARE,  1955 N  107
REPORT OF THE BUREAU OF SPECIAL PREVENTIVE AND
TREATMENT SERVICES, VANCOUVER
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 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. Consultants in public health nursing and
in nutrition, who have been seconded to the Vancouver area by the Bureau of Local
Health Services, are located in the office of the Assistant Provincial Health Officer. Also
housed within this office is the Vancouver Branch of the Division of Vital Statistics,
including representatives of the Statistical Section of the Division of Vital Statistics, and
the usefulness of this policy continues to grow each year. The Co-ordinator of Rehabilitation and the Medical Consultant in Rehabilitation are located in this building.
BUILDINGS
In March, 1955, the Poliomyelitis Pavilion at Pearson Tuberculosis Hospital on
West Fifty-seventh Avenue, Vancouver, received the first patients on transfer from the
Vancouver General Hospital, and this development has been of untold benefit to the
convalescing poliomyelitis patients in the Province of British Columbia.
On September 26th, 1955, the new Provincial Health Building at 828 West Tenth
Avenue, Vancouver, was opened, and this was indeed a most auspicious occasion. This
building, having 1,050,532 cubic feet and seven floors, houses the Divisions of Laboratories and Venereal Disease Control, as well as the Vancouver office of the Division of
Vital Statistics. The building is also connected with the building in which the headquarters of the Division of Tuberculosis Control are located, with the result that all Provincial Health Branch offices in Vancouver are now located in the one area. One floor
of the new building is occupied by the Red Cross Blood Transfusion Service.
This building has not only enabled the Health Branch to bring increasingly excellent
services to the people of the Province of British Columbia, but has also been a terrific
morale-builder to all members of this Bureau after their many years in buildings that
were unsatisfactory, not only from a structural view-point, but also from location as well.
The co-operation at all times received from the administrative and maintenance staff
of the Vancouver General Hospital is gratefully acknowledged. Only through their
assistance, particularly during the last few years, was it possible for the Division of
Veneral Disease Control and the office of the Assistant Provincial Health Officer to continue to occupy the old buildings on Laurel Street until the new Provincial Health Building was completed.
GENERAL
The appointment of a personnel officer to the Bureau of Special Preventive and
Treatment Services, mentioned in the 1954 Report, has proven its value. During the
year the personnel officer participated in the Civil Service Commission survey and did
much to strengthen and stream-line personnel policy within the Bureau. In addition,
the personnel officer assisted the voluntary health agencies on many occasions. It has
been the policy of the Health Branch that those voluntary health agencies who receive N  108 BRITISH COLUMBIA
financial aid through the Health Branch budget should, as far as practicable, use Civil
Service salary schedules as a guide in their personnel practices, and in this field the personnel officer has been most valuable.
During 1955 the Consultant in Epidemiology was appointed Assistant Dean of
Medicine, University of British Columbia. The Director of the North Fraser Health Unit
was appointed as Consultant Epidemiologist and was also appointed Director of the
Division of Venereal Disease Control. The former Director of the Division of Venereal
Disease Control has become Consultant in Syphilology to the Division of Venereal Disease Control. The dual appointment of Consultant Epidemiologist and Director of the
Division of Venereal Disease Control was possible due to the excellent progress that has
been made in this Province in the control and treatment of venereal diseases.
In the field of epidemiology, excellent statistical studies were carried out in relation
to poliomyelitis, and in particular the Salk vaccine programme. The studies relative to
the Salk vaccine programme were the most authentic and comprehensive studies carried
out in Canada, and the results of the Salk vaccine programme in British Columbia have
been used at the Federal level in order to assess results of the 1955 Salk vaccine programme and plans for 1956.
Studies were also continued in the epidemiology of tuberculosis, as well as shigellosis and sonnei infections. It is in the field of tuberculosis, in particular, that much work
must be done relative to the epidemiology of this disease.
During 1955 there was appointed to this Bureau the Technical Supervisor for
Clinical Laboratory Services. This appointment has been a most valuable one, and this
highly qualified Technical Supervisor, formerly with the Division of Laboratories, has
given valuable advice and direction in the management of the Laboratory and Radiological Services Grant. Further details of the work of the Technical Supervisor will be
found later under the Laboratory and Radiological Services Grant in the National Health
Grants section.
During 1955 the Co-ordinator of Rehabilitation for this Province was transferred
from central office in Victoria to this Bureau, and the Medical Consultant in Rehabilitation was appointed.
The progress that has been made in the field of rehabilitation is discussed in the
report of the Rehabilitation Co-ordinator elsewhere in this Health Branch Report, as well
as under the Medical Rehabilitation Grant in the National Health Grants section.
The Consultant in Public Health Nursing attached to this Bureau from the Bureau
of Local Health Services, continues to be most valuable in co-ordinating the relationship
between local health services, this Bureau, and those specialized agencies in Vancouver
responsible for the care of the sick child in British Columbia. The Consultant in Public
Health Nursing also accepts much of the responsibility in co-ordinating the services of the
Crippled Children's Registry with local health services. More detail of the function of
this most important Crippled Children's Registry will be found later in this report.
The work of the consultant nutritionist, attached to this office from the Bureau of
Local Health Services, continues to prove the value of having this consultant located in
Vancouver. Detailed information regarding this work is given earlier in this Report, in
the Nutrition Service, Division of Environmental Management.
In the field of poliomyelitis, the Director of this Bureau continued to act as coordinator of all the agencies concerned with the care of poliomyelitis patients, and also
took the responsibility for the distribution of the Salk vaccine used in the Bureau of Local
Health Services in 1955. Details of the results of the Salk vaccine programme will be
found in the Local Health Services section of this Report.
Once again recognition must be given to the outstanding co-operation received from
the Royal Canadian Air Force in carrying out mercy flights in the air evacuation of
poliomyelitis patients and premature babies from distant points of British Columbia to
Vancouver.   In the poliomyelitis programme the work of the British Columbia Polio- DEPARTMENT OF HEALTH AND WELFARE,  1955 N  109
myelitis Foundation, the Poliomyelitis Committee of the Vancouver General Hospital,
and the Canadian Red Cross Society (British Columbia Division) is also sincerely
acknowledged.
Gamma globulin was once again available for prophylactic use in poliomyelitis, and
its use was also extended to the prevention of infectious hepatitis and rubella in pregnancy.
FACULTY OF MEDICINE, UNIVERSITY OF BRITISH COLUMBIA
As mentioned in previous Annual Reports, the most satisfactory working relationship with the Dean of the Faculty of Medicine, University of British Columbia, continues
to be of great value to this Health Branch. In particular, the Heads of the Department of
Paediatrics, Obstetrics, and Gynaecology and the Department of Preventive Medicine have
given valuable assistance to this Health Branch in planning health requirements for the
Province of British Columbia.
The formal arrangements whereby the Department of Paediatrics, Faculty of Medicine, University of British Columbia, is the official consultant to the Health Branch in
child care has been of great benefit to the people of the Province of British Columbia.
VOLUNTARY HEALTH AGENCIES
Alcoholism Foundation of British Columbia
The Alcoholism Foundation of British Columbia, mentioned in the 1954 Report,
has developed out-patient services under the direction of competent physicians, a psychiatrist, and counsellor. Plans are under way whereby a rehabilitation centre will be
opened with in-patient services early in 1956.
The Alcoholism Foundation of British Columbia is a voluntary health agency, but
the board of trustees of the Foundation has Provincial Government representation from
the Attorney-General's Department, the Mental Health Services of the Provincial Secretary's Department, and from both the Health Branch and the Welfare Branch of the
Department of Health and Welfare.
British Columbia Cancer Foundation
This organization, named as the agent of the Provincial Government for the diagnosis
and treatment of cancer in the Province of British Columbia, has steadily continued its
programme of expansion as drawn up in 1949. Operational expense is provided by the
Cancer Control Grant of the National health grants by a matching grant from the Provincial Government and from private patients' fees. The Cancer Foundation operates the
British Columbia Cancer Institute, its main treatment centre; the Victoria Cancer Clinic
at the Royal Jubilee Hospital, Victoria; ten consultative cancer clinics at centres throughout the Province; and a new 36-bed boarding home attached to the Institute in Vancouver.
The new boarding home, which was provided by funds of the Canadian Cancer
Society and the Cancer Foundation, is connected to the Institute by a covered passageway. It was completed in September, 1955, and is fully occupied. Its primary purpose
is to provide accommodation for patients of the Institute undergoing diagnostic procedures
and treatment, particularly those from out of town. It is adequately equipped to supply
nursing care for patients who are not sufficiently ill to require a hospital bed but who need
some special care.
Canadian Arthritis and Rheumatism Society (British Columbia Division)
During 1955 arthritis treatment centres and mobile units have been established in
Central British Columbia covering Prince George, Vanderhoof, and Quesnel, and the
physiotherapy service already established has been extended to cover Invermere, Salmo,
Hope, Clinton, Duncan, Ladysmith, and Campbell River.   Up to December, 1955, over N  110 BRITISH COLUMBIA
10,000 patients had been referred to the Canadian Arthritis and Rheumatism Society
for treatment.
Regular travelling consultant service is now being given where necessary and
requested by physicians to all districts except Greater Vancouver, New Westminster,
and Victoria. Patients referred for intensive rehabilitation treatment are brought to
Vancouver, and in-patient care arranged either in the University Health Service Hospital,
Holy Family Hospital, or at the Canadian Arthritis and Rheumatism Society Medical
Centre in the Western Society for Rehabilitation Building.
The occupational-therapy staff has been increased to give home treatments in Vancouver, and an arts and crafts instructor now gives training at the new patients' workroom
at the Provincial headquarters of the society in Vancouver. Volunteer workers conduct
the arts and crafts programmes in co-operation with the physio-therapist in each of the
outside districts.
Lectures or field-work supervision are arranged by staff for student doctors, nurses,
and social workers, and potential therapists.
Research projects reported in 1954 are being continued, and new investigations
include a study of common rheumatic problems occurring in patients of tuberculosis
sanatoria and a study of serological reactions now being used in diagnosis of rheumatic
conditions.
Assistance in the treatment programme has been given through general Provincial
health grants and in the research programme through the National Public Health Research
Grant.
Western Society for Rehabilitation
In January, 1954, two additional wings were added to the Rehabilitation Centre,
which substantially increased its facilities. The society's objective during 1955 was to
strengthen its services in the medical, social, psychological, and vocational areas. In this
regard, 20 of the Centre's 53 beds have been converted to rehabilitation nursing beds,
with twenty-four-hour nursing and orderly service provided. This service does not provide for acute or terminal care. It does, however, make it possible to admit cases at an
earlier date, which provides the opportunity for more effective and intensive self-care
training, as well as other rehabilitation measures. When cases admitted to the nursing-
bed section no longer require this service, they are transferred to another residential wing
of the Centre which provides non-nursing beds.
The vocational services have been strengthened through the engaging of a vocational counsellor, who is a graduate of the University of British Columbia, with a Master
of Arts degree in psychology. This provides vocational counselling at a professional
level and has lightened the burden of the social worker.
A psychiatrist was engaged to commence work in January, 1956. This completes
a prolonged search to find a qualified physician to fill a vacancy on the medical staff.
The services of the occupational-therapy department will shortly be augmented by
the addition of a complete training-kitchen, which will be very effective in the rehabilitation of disabled home-makers.
The programme for cerebral palsy children, operated in co-operation with the Cerebral Palsy Association of Greater Vancouver, has also experienced some developments.
Through the co-operation of the Vancouver School Board, a second academic schoolteacher has been added to the staff. An occupational-therapy department has been
added to the programme, which is staffed by a graduate occupational therapist.
The Western Society is continuing to study plans to further develop and strengthen
the services of the Centre in order to keep up with the rehabilitation requirements of this
Province.
Canadian Red Cross Blood Transfusion Service
September, 1955, was the first full month during which the Blood Transfusion
Service functioned in the Provincial Health Building.    During this month the service DEPARTMENT OF HEALTH AND WELFARE,  1955 N  111
collected and processed 4,652 bottles of blood, 1,788 bottles were cross-matched for city
hospitals, and 1,138 bottles were issued unmatched to out-of-town hospitals. The Rh
laboratory tested 2,145 specimens from maternity cases.
This is an average month's work for the Blood Transfusion Service, and the laboratories have been able to function efficiently in their new quarters. The floor plan, which
was drawn up five years ago, is, in the main, satisfactory. Because blood is transported
in and out of the building twenty-four hours a day, seven days a week, the transport
department has had some difficulties caused by the Transfusion Service being on the
third floor and by the building being locked at night. However, these problems are gradually being solved.
NATIONAL HEALTH GRANTS
General
The total amount of funds available to British Columbia for the fiscal year 1955-56
is $3,720,225, excluding the Public Health Research Grant, which is allocated in Ottawa.
The Hospital Construction Grant for this year is $650,532 less than that for the previous
year. However, the Laboratory and Radiological Services Grant increased $75,900, the
Child and Maternal Health Grant increased $65,149, and the General Public Health
Grant increased $18,000. With the exception of the Tuberculosis Control Grant, in
which there was a slight decrease, the remaining grants increased only slightly in 1955-56.
The net result was a decrease of $490,219 in the total amount available in 1955-56 from
the previous year.
The General Public Health Grant was increased in October by the transfer of
$150,000 from the Laboratory and Radiological Services Grant. The additional funds
required in the General Public Health Grant are primarily for the purchase of poliomyelitis vaccine.
Administration
The various opportunities provided during the year for personal discussion with
officials of the Department of National Health and Welfare of problems arising from the
National health grants programme undoubtedly contribute to the satisfactory administration of the grants. In January, Federal officials conferred with Provincial officials in
Victoria and Vancouver, and as a result established the Provincial base-line of expenditures on services maintained to March 31st, 1953, with respect to the matching funds
provision of the Laboratory and Radiological Services Grant and the Medical Rehabilitation Grant. In May Dr. G. E. Wride, principal medical officer of the National health
grants, Ottawa, visited British Columbia; it was most opportune that he was able to
attend a meeting in Kelowna of physicians interested in establishing a pathology service
for the Okanagan Valley.
A circular was distributed to all general hospitals in June outlining the assistance
available from the National health grants, as well as the procedure to be followed in
requesting grants. In this connection, as well as in all other phases of the National health
grants programme relating to hospitals, close co-operation continues to be maintained
with the British Columbia Hospital Insurance Service.
Grants Received for the Year Ended March 31st, 1955
Total expenditures for the year ended March 31st, 1955, were $2,938,220 or 69
per cent of the total available, as compared with $2,617,625 or 68 per cent of the total
grants available in the year ended March 31st, 1954. Although there was only a slight
increase in the percentage of the total available which was expended, it should be noted
that the percentage expended of the amount available in the three newer grants. Laboratory and Radiological Services, Medical Rehabilitation, and Child and Maternal Health, N  112
BRITISH COLUMBIA
was approximately three times greater in the year ended March 31st, 1955, than in the
previous years. This definite increase in expenditures indicates progress in the development of the programme in these areas.
Comparison of Amounts Approved and Actual Expenditures with Total Grants
for the year Ended March 31st, 1955
Grant
Total Grant
Approved
Actual Expenditures
Amount
Per Cent
Amount
Per Cent
$43,702
48,702
1,610,391
43,702
605,867
351,213
38,779
738,000
216,464
400,500
84,561
67,342
$33,283
39,534
1,465,798
43,702
587,642
313,477
38,779
671,486
214,321
134,024
27,819
27,195
76
81
91
100
97
89
100
91
99
33
33
40
$31,538
35,492
993,874
43,702
552,359
249,417
34,183
657,416
194,443
98,963
24,209
22,624 .
72
73
62
100
Mental Health                                	
91
71
88
89
90
25
29
34
$4,249,223
$3,597,060
85
$2,938,220
69
Again this year British Columbia maintained a good position in relation to other
provinces in making use of the available funds. Excluding the Public Health Research
Grant, 85 per cent of British Columbia's total allotment was approved for specific expenditures. The comparable average for all Provinces was 77 per cent. Similarly the
amount actually spent by British Columbia was 69 per cent of the total available to the
Province, whereas the average for all Provinces was 64 per cent.
Crippled Children's Grant
The Crippled Children's Registry, which was begun in 1952 after a two-year survey
had been completed in the Province of British Columbia, has continued to grow even
though registration is on a voluntary basis. The Registry is located in the Provincial
Health Building, 828 West Tenth Avenue, Vancouver, and funds are provided by the
Crippled Children's Grant. The objects of the Registry are: Firstly, to gather statistics
to ascertain the magnitude and nature of the problems of the crippled child; secondly,
to follow up and facilitate the treatment of the low-income group of handicapped children
throughout the Province; thirdly, having ascertained the needs and shortages, to make
a real effort to have set up further facilities of the right nature to cope with the problems.
The Registry does not provide treatment or transportation, having no funds for such
purposes, but it has served a very useful purpose in that it co-ordinates all agencies dealing
with children in the Province so that a child receives the necessary treatment, and it also
provides a follow-up service after treatment if such is necessary.
The Registry has available the services of an advisory panel of twenty-one specialists
who are appointed by the British Columbia Division of the Canadian Medical Association.
The chairman or deputy chairman of this panel reviews all new registrations received and,
where assistance is requested, recommends where the best possible treatment for the case
is available. Cases that are being followed up, which are the chronic, long-term type of
cases, are reviewed regularly by either the chairman or the deputy chairman.
The problems that appear at the Registry are many. They may be the request for
additional medical aid; the question of how best to continue a child's education; the
requesting of transportation costs and maintenance while in Vancouver; where an older
child can receive vocational counselling or vocational training; or what to do with children who are suffering from an incurable condition. The problems are sorted out and
directed to the agency that can best help in their particular field. —
DEPARTMENT OF HEALTH AND WELFARE,  1955 N  113
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
prevent them from completing their education and becoming self-supporting.
Close liaison exists between the Registry and the local health services in the Province,
as well as the private agencies concerning themselves with the care of children.
The use of a Physician's Notice of Live or Stillbirth in the Province enables the
Division of Vital Statistics to routinely register cases who have congenital malformations
or birth injuries at the time of birth. A check is made of these cases as to whether the
condition is still present, whether it is under proper care, or whether it has disappeared.
The Division of Vital Statistics has supervised the statistical aspects of the Registry
from the beginning, and since that is an important side of the Registry, great care has
been taken in the preparation of statistics to make it useful to public health authorities,
private physicians, and other agencies.
The Registry adds about 150 new cases per month, not counting duplications which
may appear because of the number of agencies registering, and will have on its rolls over
7,000 cases by the end of 1955.
It is proposed to give assistance from the Crippled Children's Grant to the Health
Centre for Children in the part-time employment of an additional speech therapist and
audiologist, who will give consultative service to the parents of children attending the
Health Centre for Children, and, on request, to other hospitals and agencies in the
Vancouver area. Assistance was continued again this year to the Health Centre for
Children toward the payment of salaries for two orthoptists and to the Cerebral Palsy
Association of British Columbia for the payment of salaries.
Professional Training
The number of persons completing training under all projects during the calendar
year 1955 was forty-six, an increase of fourteen over the previous year. The number
of persons attending short courses was seven, but this does not include the nurses who
attended the course in body mechanics and rehabilitation which was given throughout the
Province by the Registered Nurses' Association of British Columbia. Attendance figures
for these latter courses are not yet available.
Assistance is being continued this year to the training of public health staff and the
staff at general hospitals, as well as training in specialized fields such as tuberculosis,
mental health, and psychiatric social work. Funds for professional training have been
provided by other grants in addition to the Professional Training Grant.
Hospital Construction Grant
The total approvals for construction projects under this grant exceed the total funds
provided in the current year. However, estimated expenditures for the current year will
not exceed the total funds available. The difficult situation created by the decrease in
this grant has been discussed with Federal officials, and it is hoped that some satisfactory
solution will be obtained in order that necessary hospital construction may go forward
as planned.
New submissions approved to date this year total approximately $130,000 for
general hospitals, $38,000 for health units, and $992,000 for mental hospitals.
Venereal Disease Control Grant
This grant is on a matching basis, and the total amount is therefore paid to the
Province, as expenditures by the Province on the control of venereal disease are considerably in excess of the amount of the grant. The standard and extent of service given
during the year 1948-49 are being maintained. N  114 BRITISH COLUMBIA
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
another section of this Health Branch Report, constitutes the report made on the use
of this grant.
Mental Health Grant
The Provincial Mental Health Services, Department of the Provincial Secretary,
initiate most of the projects submitted under the Mental Health Grant. It is used principally to provide staff and equipment for the various institutions of the Mental Health
Services. Another large portion of the grant has been made available to the Faculty of
Medicine, University of British Columbia, for research in mental health.
During 1955-56 the grant totalled $606,628. Almost all of this has been allocated
to specific expenditures.
A new building to house the Provincial Child Guidance Clinic and to permit the
establishment of a mental-health centre for adults has been completed in Burnaby. The
equipping of these new mental-health facilities is being assisted by the Mental Health
Grant.
At the Provincial Mental Hospital, Essondale, the North Lawn Building, devoted to
the care and treatment of the mentally ill person suffering from tuberculosis, was opened
in May. The technical equipment for the X-ray department, together with special equipment for the wards, was provided by a Mental Health Grant project. A physician specialist in diseases of the chest has been seconded to the Mental Health Services from the
Division of Tuberculosis Control for duty in the North Lawn Building. This combination
of building, equipment, and personnel will permit the development of a modern programme of treatment of tuberculosis in the mental hospitals.
The consultant services in general surgery, neurosurgery, and orthopaedic surgery
continue to be supported by the grant. This year further equipment and instruments
have been provided for the operating-room. Surgical services are now at a very
acceptable standard.
In May the Mental Hospital suffered a heavy loss when the industrial-therapy shops
and contents were totally destroyed by fire.
Great assistance in re-establishing the industrial-therapy programme was given by
the approval of a project for the purchase of equipment to replace that lost. This has
now been received and has been set up in temporary quarters pending construction of
a new industrial-therapy centre.
The physiotherapy department established last year in The Woodlands School has
proved to be very successful, and this year a project was approved to provide further
equipment.   A second physiotherapist was added to the staff to expand the treatment.
The narcotic-addiction studies have been diligently carried on by the research team
of the Faculty of Medicine, University of British Columbia. It is expected that the survey
will be concluded and the final report submitted early in 1956.
The research studies on human lobotomy and experimental lobotomy will be concluded this year. The studies on the relationship of the electroencephalogram and psycho-
pathology have proved very interesting. It is planned to carry this research on for at
least another year.
Considerable attention is now being directed to new research problems. It is hoped
to submit projects for research in mental deficiency, schizophrenia, and a sociological
survey of the mental hospital for next year.
The Canadian Mental Health Association (British Columbia Division) was again
assisted in its programme. This year the association has extended the volunteer visiting
programme in the Mental Hospital and has established an apparel-shop for women where
good-quality used clothing is presented to those women patients who have special needs.
This service, which meets a long-felt need, will be extended to the men in the future. DEPARTMENT OF HEALTH AND WELFARE, 1955 N 115
As in former years, the Mental Health Grant has provided bursaries for selected
staff members to attend postgraduate courses in psychiatry, social work, psychiatric
nursing, and psychology.
The mental-health programme of the Metropolitan Health Committee of Greater
Vancouver has continued to receive support. A new development this year is the establishment by the Vancouver School Board and the Mental Hygiene Division of the Metropolitan Health Committee of a course in mental health for senior school counsellors.
This course is a development of the programme of training mental-health co-ordinators.
It is assisted by a Mental Health Grant project.
The psychiatric services of the Vancouver General Hospital and the Royal Jubilee
Hospital have also continued to receive support from the Mental Health Grant.
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
Dr. A. S. Dekaban, the director of the research project " Causation, Prevention, and
Cure of Multiple Sclerosis," left Vancouver on August 31st to assume a position in the
Eastern United States, and this project has therefore been terminated. Final reports were
submitted to the Department of National Health and Welfare, and the equipment purchased under this project has been transferred to the Provincial Division of Laboratories.
A study is being made of the etiology of non-specific urethritis by means of human-
tissue culture under a project approved this year. Non-specific urethritis is now almost as
frequent as gonorrhoea. Trauma, chemicals, B. coli and other non-gonococcal bacteria,
tuberculosis, fungi, pleuro-pneumonia organisms, and trichomonos vaginalis may all
occasionally cause urethritis. However, in the majority of cases and especially in the
acute form no etiological agent has been.found. An investigation is therefore being made
of cases of acute non-specific urethritis from which no primary bacterial organisms can
be obtained.
Research projects continued this year under the Public Health Research Grant are
the Control of Skin Infection in the New-born, the Antibiotic Control of Tubercle Bacillus
Infection, Investigation of ABO Foetal-Maternal Incompatibility, British Columbia Hospital Insurance Statistics, Determination of Human Blood Patterns and Levels of Adrenal
Steroid Hormones, and the Assessment of Cortisone in the Prevention of Permanent
Rheumatic Heart Disease.
General Public Health Grant
The National Health Grants Regulations provide that not more than 75 per cent of
certain grants can be committed for continuing services. This regulation applies to the
General Public Health Grant and does create some difficulty, as a large percentage of this
grant is required for the provision of staff, which is considered a continuing service.
As the total requested under this grant for continuing services for 1954-55 was
greater than the 75 per cent allowed, it was agreed that the Province would absorb one-
third of the salaries under a project which provides staff for the Provincial Health Branch,
and that the assistance under this grant to the Metropolitan Health Committee of Greater
Vancouver Would remain at approximately the same figure. This agreement came into
effect when the submissions for 1955-56 were made. As a result, these two projects are
no longer considered as continuing-services.   The length of time for which assistance N  116 BRITISH COLUMBIA
would be given in the future is also limited in the project to assist the University of
British Columbia in the training of bacteriologists and to provide an industrial nursing
service in the Parliament Buildings, Victoria.
All phases of the general public health programme carried on by the local health
services staff continue to receive assistance from this grant. Detailed information in
regard to these services is given earlier in this Report, in the report of the Bureau of
Local Health Services.
Cancer Control Grant
The operations of the British Columbia Cancer Foundation, which are financed
jointly by this grant and matching Provincial funds, are outlined earlier in this report in
the section on 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; the average number per quarter for the first nine months of 1955 was 5,244. These figures do not include
biopsy examinations originating in the hospitals having pathologists on their staffs, but
the number of these examinations has also increased. The quarterly average number of
all biopsy examinations was 10,739 in 1954, and 12,045 for the first nine months of 1955.
Provision is made under this grant and matching Provincial funds for the operation
of a cytology laboratory at the British Columbia Cancer Institute, Vancouver, where
specimens may be examined free of charge. The volume of work done in this laboratory,
which is under the direction of the Director, Pathology Department, Vancouver General
Hospital, has also increased greatly. There were 6,581 specimens examined in 1952 and
10,055 during the first nine months of 1955.
Laboratory and Radiological Services Grant
The appointment of a Technical Supervisor of Clinical Laboratory Services at the
beginning of this fiscal year made available the technical knowledge which is prerequisite
to an adequate programme of diagnostic services. The utilization of the Laboratory and
Radiological Services Grant moneys has been from the outset, therefore, the subject of
close and careful scrutiny of the actual requirements, both economic and technical.
Early in the year a questionnaire was compiled to gather data on basic laboratory
facilities, personnel, and equipment available in hospitals. In co-operation with the
British Columbia Hospital Insurance Service, this questionnaire was circulated to seventy-
six hospitals of the Province, and to date returns have been completed from fifty, most of
the remainder having no organized laboratory service at the present time. The data
collected have been most useful in assessing equipment and personnel needs, and in
evaluating applications for grant aid. During the summer this information was supplemented by a personal visit of the Technical Supervisor to twenty-seven hospitals, and a
valuable liaison and public relations has evolved with many hospitals. As a result, the
services of this office have been used as a consultative and reference point by several
hospitals in the planning and organization of their laboratory facilities.
Early in the year, plans were completed for the appointment of two Advisory Councils to the Health Branch—one to organize laboratory services and the other to organize
radiological services. Representing the Faculty of Medicine, University of British Columbia, were the Professor and Head of the Department of Radiology (Radiological
Advisory Council) and the Professor and Head of the Department of Pathology (Laboratory Advisory Council). On each Council there was also a representative from the British
Columbia Hospitals Association, the British Columbia Hospital Insurance Service, and
the Health Branch, Department of Health and Welfare. In addition, there are three
representatives from the Canadian Medical Association (British Columbia Division) on
the Laboratory Advisory Council and four representatives on the Radiological Advisory DEPARTMENT OF HEALTH AND WELFARE,  1955 N  117
Council. These representative Advisory Councils to their respective services have already
proved to be of inestimable value in the planning of a total programme.
The Deputy Minister of Health called a joint meeting of the Advisory Councils on
July 14th and outlined the terms of reference under which they would operate. Subsequently each Council has met on three occasions to advise the Health Branch on matters
pertaining to their respective services, and there is every reason to believe that their deliberations will very shortly produce general and specific programmes which will certify to a
sound approach in diagnostic services for the Province of British Columbia. In general,
the basic programmes which are being studied and formulated are those of training of
technical personnel, organization of reference and regional areas for services to rural
areas, and evaluation and standardization of technical procedures. Concurrently with
these studies, which are in the planning and organizational phases, the Councils have
advised on applications for grant aid which are referred to them.
The actual expenditures in the Laboratory and Radiological Services Grant have
been shown in a preceding section of this report. The utilization of these funds reflects
the policy of a cautious approach to the problems of diagnostic services in which sound
planning is considered prerequisite to effective accomplishment.
This year six X-ray units or accessories have been approved, and a further ten
applications have been submitted for thirteen hospitals of the Province. In addition,
miscellaneous basic laboratory equipment has been approved for fifteen hospitals, and
applications have been submitted for equipment for another five hospitals. Moreover,
continued and extended support has been given to the pathological service initiated last
year under the Laboratory and Radiological Services Grant at the Trail-Tadanac Hospital. Experience thus far has shown that this new service is fulfilling a requirement
which had not heretofore been realized. It is hoped that laboratory and radiological
services will develop in a manner which will satisfy these needs in other areas of this
Province.
Medical Rehabilitation Grant
Funds were provided under this grant to assist the Registered Nurses' Association of
British Columbia in conducting an itinerant programme in body mechanics and rehabilitation nursing throughout the Province. This course has been given to both hospital and
public health nurses and been very favourably received.
Assistance is also being given to the Western Society for Rehabilitation to provide
staff to enable them to extend their services to include trainees requiring some nursing
care.   As a result, it will be possible for cases to be accepted earlier for training.
Provision was made under this grant for the appointment of a physician on a part-
time basis to act as chairman of the Rehabilitation Assessment Team. As the name
implies, this team will be composed of professional persons directly concerned with rehabilitation; it will be their responsibility to review individual cases, assess the possibility of
rehabilitation, and make recommendations in connection therewith. It is hoped that with
the appointment of this Provincial Rehabilitation Assessment Team, hospitals will become
more conscious of this service and an increasingly large number of hospital patients requiring rehabilitation will be referred to this team at an earlier date.
Assistance has been continued to the Vancouver General Hospital for the pilot plan
at the Glen and Grandview Hospitals for chronic patients and also to the Western Society
for Rehabilitation.
Child and Maternal Health Grant
The child and maternal health services in this Province are an integral part of the
general public health programme carried on by the staff of the local health department,
and this grant is being used to strengthen and expand this phase of the general programme.
In particular, equipment has been purchased under this grant to enable the local health N 118 .;<• BRITISH COLUMBIA
services to conduct prenatal education classes, including relaxation exercises and the
demonstration of proper methods of child care.
The public health nurse appointed under this grant, and seconded by the Metropolitan Health Committee of Greater Vancouver to the Health Centre for Children to provide
a liaison service between these pediatric services and the general public health services,
continues to be of value.
In 1954 approval was given to the purchase of two premature-care incubators to be
retained in Vancouver for loan as required by the various hospitals. Through the generous
co-operation of the Vancouver General Hospital, arrangements were made whereby they
would store, service, and ship these incubators as required. Requests are made by the
hospital through the local health unit to the Assistant Provincial Health Officer in Vancouver, who authorizes the Vancouver General Hospital to make shipment. During the
past nine months three requests have been received for the loan of this equipment. An
additional incubator is now being specially adapted for transportation of premature infants
and sick babies.
Nine premature-care incubators have been supplied to general hospitals this year, as
well as a small amount of other equipment.
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 Hospital 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. . DEPARTMENT OF HEALTH AND WELFARE,  1955 N 119
REPORT OF THE DIVISION OF LABORATORIES
C. E. Dolman, Director
For this Division the most noteworthy feature of 1955 was the occupancy of new
quarters in the Provincial Health Building early in August. This long-awaited development was greatly welcomed. Inevitably the transfer of an establishment of nearly fifty
persons, along with much intricate apparatus, from the four old-fashioned wooden nouses
on Hornby Street to three floors of a modern concrete structure entailed several weeks of
detailed planning beforehand, and, of course, many minor adjustments still remain to be
made. But it is gratifying to report that this transfer was effected without a single day's
cessation of function, despite the fact that the week-end finally chosen for the move coincided with the unalterable vacation time of several staff members.
The year's work was handicapped not only by complications incidental to the transfer
of quarters, but also by an unusually heavy turnover of staff, particularly in the technical
classifications. At the time of writing, Requisition No. 28 for the replacement of a
technician or bacteriologist has been submitted, and there are still four vacancies to be
filled in these categories. Thus the number of staff changes occurring during the year
constituted one-half the total establishment.
The total number of tests performed during the year remained practically unchanged
from 1954. The demand for tests for M. tuberculosis continued to mount, but was offset
to some extend by a reduction in the number of specimens for Salmonella-Shigella cultures. Increases also occurred in serodiagnostic tests for syphilis on blood specimens; in
sanitary bacteriological tests of milk, water, and cottage-cheese samples; and in examinations of fasces for intestinal parasites.
TESTS FOR DIAGNOSIS AND CONTROL OF VENEREAL DISEASES
The anticipated downward trend in the number of blood specimens submitted for
serodiagnostic tests for syphilis did not occur during this year, despite the continuing low
incidence of syphilis in the community. Perhaps a situation is arising analogous to that
in the tuberculosis section, where for many years the work has mounted despite a marked
decline in the incidence of that disease. With the continuing reduction in the incidence
of clear-cut and manifest cases of syphilis, efforts to detect occult and latent cases of the
disease by means of serological surveys have broadened. For example, all prospective
employees of the Aluminum Company at Kitimat have been subjected to a routine
serological test. The incidence of possible syphilis revealed by this means has been
surprisingly low. In another instance, in co-operation with the Director of the Peace
River Health Unit, a survey of an Indian population in the Kelly Lake area was undertaken. Of 118 individual blood specimens received, only 2 showed a definitely positive
reaction, 2 others being equivocal. A very different state of affairs would have been
revealed by such a survey a decade ago.
The V.D.R.L. test was satisfactorily used throughout the year, and it seems unlikely
that the presumptive and standard Kahn tests, which have served their purpose well for
roughly a quarter-century, will return to favour. During the year the change-over to the
V.D.R.L. test was also made by the branch laboratories at Victoria and Nelson, after the
technicians had been given a first-hand opportunity in the central laboratories of acquiring
proficiency with this technique. The respective merits of the various serological tests for
syphilis have been regularly discussed at annual meetings of the Provincial laboratory
directors which take place each December in Ottawa, and the consensus now seems to
be that the V.D.R.L. test is less demanding on technical and glassware-cleaning staff, and
is on the whole more specific and sensitive than the Kahn test. Periodically an undue
percentage of discrepant results tends to be exhibited between the V.D.R.L. and complement fixation tests, probably owing to slightly excessive sensitivity of occasional batches N 120 BRITISH COLUMBIA
of the former antigen. However, this factor is beyond the control of this Division, since
this material is standardized and furnished through the Laboratory of Hygiene.
The introduction of facilities for performing the Treponema pallidum immobilization
(T.P.I.) test in the Ontario Department of Health laboratories two years ago has continued to afford limited opportunities for this test to be carried out on specimens from
problem cases under the care of the Division of Venereal Disease Control. During the
year the Laboratory of Hygiene, which recently established a T.P.I, test unit, offered
additional facilities to Provincial departments of health under prescribed conditions.
Between them, these two laboratories in Toronto and Ottawa respectively are currently
willing and able to accept from our Division of Venereal Disease Control around eighty
specimens monthly from selected cases in which repeated routine serological tests, in
conjunction with the clinical and epidemiological data, do not settle the question whether
a given patient has syphilis or not. In the near future it is hoped to devise a system by
which the Division of Laboratories can take over from the Division of Venereal Disease
Control the responsibility for receiving and sending on appropriate specimens of blood
serum to the above-mentioned laboratories in Eastern Canada. In recent months the
Division of Venereal Disease Control has expressed some desire for extension of the
circumstances under which this service might be requested, and the possibility of revising
these criteria will receive careful consideration by the Technical Advisory Committee on
Public Health Laboratory Services to the Minister of National Health and Welfare.
The number of complement fixation tests performed on both blood and cerebrospinal-
fluid specimens showed some decline, as did other types of cerebrospinal-fluid examinations. These trends no doubt reflect the diminished incidence of suspected syphilis.
As noted in recent Annual Reports, there appears little laboratory evidence of any
significant change in the incidence of actual or suspected gonorrhoea. The numbers of
specimens submitted for direct microscopic examination for gonococci remained practically unchanged, while cultural examination again increased. The method of shipping
charcoal-impregnated swabs in a transport medium continued to give satisfactory results.
When staff facilities permit, this method might well be made available to directors of
health units, and possibly private physicians, in areas not too remote from Vancouver.
TESTS RELATING TO TUBERCULOSIS-CONTROL
Once again all types of examinations relating to the laboratory diagnosis of tuberculosis underwent a substantial increase. The acute shortages of technical staff throughout the year were particularly harrassing to the tuberculosis section of the Division owing
to the high liability of untrained staff to contract infection, especially in overcrowded
quarters. In the new building this section, like all the others, will greatly benefit from
the improved quarters.
The continuing demand for increased numbers and varieties of tests in this field
seemed to warrant separating from it certain types of specimens relating to miscellaneous
bacteriology, which had traditionally remained under the same supervision. Eventually
this transfer should permit the tuberculosis section to extend its programme of testing
the comparative merits of different nutrient media and to launch some investigations in
co-operation with the Division of Tuberculosis Control. For example, the latter Division
is anxious to have repeated on a larger scale an earlier comparison of the bacteriological
results yielded by laryngeal swabs and stomach washings from certain types of patients
under their control.
In response to a request made by the Division of Tuberculosis Control toward the
end of the year, plans were being devised for resuming the former practice of issuing
negative reports on all specimens received, and also of providing directors of health units,
as well as the Division of Tuberculosis Control and any private physicians involved, with
copies of all reports, whether positive or negative, on specimens received from patients DEPARTMENT OF HEALTH AND WELFARE,  1955 N  121
suspected of tuberculosis. These arrangements, if they prove feasible, will entail a heavy
load on the general office and may involve a drastic revision in the present types of report
forms.
SALMONELLA-SHIGELLA INFECTIONS
This section was again very hard pressed, particularly during the later months of
the year when outbreaks of enteric infection developed in the South Okanagan and Peace
River Health Unit areas. The rapid staff turnover also affected this section acutely, since
prolonged experience is needed for accurate work in this field of bacteriology. Fortunately last year's high incidence of Salmonella-Shigella infections showed an appreciable
reduction. Salmonella isolations from different patients numbered around 120, about
half the 1954 figure and roughly the same as in 1953. There were eleven different Salmonella types involved, with S. typhimurium, S. paratyphi B, S. thompson, and S. bareilly
predominating. As before, there was no evidence that these infections were being conveyed from animals to man, although S. typhimurium is extremely versatile in the number of animal species from which it has been isolated, while S. thompson is generally
regarded as prone to infect domestic fowl. There were five isolations of S. typhi from
separate individuals.
The heavy and widely distributed incidence of Shigella sonnei infection characteristic of the last few years in this Province was at a distinctly lower level than in the past
two years. Some 250 separate isolations of Shigella sonnei were made, less than half of
last year's total; but these figures are still high enough to ensure continuance of sporadic
outbreaks throughout the Province in future years unless the standards of personal hygiene in households and public eating-places show marked improvement. The total of
over forty cases of Shigella flexneri infection (generally a more serious type of dysentery
than that due to Shigella sonnei) was the highest since early in the last war.
OTHER TYPES OF TESTS
Bacteriological Analysis of Milk and Milk Products and Water
Another increase of roughly 10 per cent was shown in the standard plate counts and
Coli-aerogenes tests on milk. A slightly smaller increase also occurred in the number
of phosphatase tests performed on pasteurized-milk samples. The Division is prepared
to handle still more tests of this type, which are of vital importance to sanitation in the
Province. The Director presented a brief to the British Columbia Royal Commission on
Milk, 1954-55, which summarized the findings of the Division over the last several years,
as they related to raw-milk samples reaching us from outlying parts of the Province, as
well as tests on pasteurized milk distributed in the Greater Vancouver area. Quite lengthy
evidence was given before the Commission by the Director, and the report mentioned was
filed as Exhibit No. 300.
Some difficulties remain to be solved in regard to the examination of water samples
shipped from remote parts of the Province. Even when these specimens reach the
laboratories by air express, they are often delayed in transit or in delivery, and in any
case are liable to have been taken several hours before departure of the aircraft. Sometimes when individuals have gone to considerable trouble to procure these specimens, it
seems unkind to reject them; but falsely negative reports may have serious consequences.
Moreover, there is perhaps some need to restrain an undue tendency to blame water-
supplies as a cause of outbreaks of diarrhceal disease, when person-to-person conveyance
of such infections has mostly been operative in this Province in recent years. A partial
remedy for the transportation difficulty, which, of course, reflects unavoidable features
of Provincial geography, may lie in a much larger supply of suitable small containers for
shipping samples on ice or Sno-gel. However, this would greatly increase the expense of
performing these tests. Proper instruction of nurses and first-aid attendants at outlying
logging camps, as well as reminders to sanitary inspectors and public health nurses in the N 122 BRITISH COLUMBIA
Provincial service, about the need for avoiding delay in the shipment of specimens might
also be helpful. The problem is, of course, not peculiar to this Province. Trials have
been made elsewhere of such other devices as the use of portable membrane filter outfits
and of field kits containing culture medium, which enable sanitary inspectors and others
to initiate tests for completion later in the laboratories. But these arrangements are
subject to many errors and do not conform to internationally accepted standard methods.
Bacterial Food Poisoning
There were no further instances of botulism during 1955. Several episodes of
staphylococcal food poisoning were investigated, while there were other instances in which
bacteriological examination failed to disclose any recognized pathogen. These examinations have been listed under a separate heading in the Annual Report for 1955, since'
they frequently represent a disproportionate amount of work which would not be indicated
by merely grouping them under "miscellaneous cultures." The actual amount of food-
poisoning outbreaks would be much higher than is indicated under this heading, for a
high percentage of the Salmonella-Shigella infections in the Province may well have been
food-borne.
Diphtheria
Cultural examinations for C. diphtheria continued the downward trend, which has
been manifest for several years, and which reflects diminishing concern with the risk of
this disease arising in a well-immunized population. However, occasional cases of
diphtheria continue to develop, and in their diagnosis and control the work of the laboratories is indispensable. One interesting case of wound diphtheria was identified, and
there were seven instances of the typical faucial disease.
Parasitic Infestations
The sharply upward trend in requests for this type of examination evident in last
year's report was maintained during 1955. There is little doubt that the numbers and
varieties of intestinal infestations in our populace are increasing. There were several
identifications of E. histolytica, and many inquiries for skin test materials for the detection
of trichinosis and echinococcosis. In one case of suspected hydatid disease, material
prepared by the Laboratory of Hygiene from reindeer slaughtered in Northern British
Columbia gave a strongly positive Casoni skin reaction in the patient, whereas the standard material procured from the Commonwealth Serum Laboratories in Australia, and
prepared from infested sheep and cows, gave a negative or equivocal result. The
diagnosis of hydatid cyst was confirmed in the patient at operation. This indicates the
possibility of differences in the antigenic constitution of Echinococcus granulosa in
different parts of the world, and underlines the desirability of procuring a standardized
supply of the skin testing material from Canadian sources.
Fungous Infections
There has been a sharp increase in requests for these types of examinations. As
mentioned in last year's report, further interest in this field and the corresponding need
to develop this section of our activities may be anticipated. These examinations, which
totalled over 400, have been separately listed this year in Table I. One case of suspected
Coccidioides immitis infection in a man who had frequently visited the San Joaquin Valley
in the California area, where the disease is endemic, was eventually ruled out after lengthy
investigation. However, cases of coccidioidomycosis, and likewise of histoplasmosis,
may well occur in residents of this Province who have travelled to other parts of the
North American Continent. DEPARTMENT OF HEALTH AND WELFARE,  1955 N  123
Miscellaneous Tests
The increased number of cultures for luemolytic staphylococci and streptococci is
probably due to the widespread concern over outbreaks of staphylococcal infection in
several hospitals in the Province. When these hospitals have technicians, the relevant
specimens are naturally examined by them, but many of the smaller hospitals are dependent on this Division for help. Apart from cultural examinations for staphylococci,
many requests for titration of staphylococcus alpha-antitoxin were received. In selected
instances, these titrations were carried out in the Western Division of the Connaught
Medical Research Laboratories. The Director also participated in several symposiums
concerned with endeavours to control these troublesome outbreaks.
As in the last two years, occasional requests for agglutination tests for leptospirosis
were referred to Dr. J. E. Bismanis, of the Department of Bacteriology and Immunology
at the University of British Columbia, who kindly carried out the tests on our behalf.
Although positive results have been obtained on several occasions with blood specimens
from dogs in the Vancouver area, so far no human case of leptospiral jaundice has been
verified serologically. It must be presumed that most of the cases and outbreaks of
infective hepatitis diagnosed clinically in this Province are of viral origin.
In November a dog at Rossland was diagnosed as suffering from rabies by the western branch laboratory of the Division of Animal Pathology, Federal Department of
Agriculture. The dog had been shot after biting five people, and its head was shipped
to us. Close co-operation between the Division and the above-mentioned laboratory is
always involved in these instances of suspected rabies. Arrangements were made for
vaccine to be supplied for all human contacts at risk, and also for the immunization of
dogs in the affected area. These measures were effectively carried out under the supervision of the Director of the West Kootenay Health Unit, the field veterinarian for the
South Okanagan area, and the local Royal Canadian Mounted Police. At the time of
writing, any extension of the outbreak appears likely to have been forestalled by destruction of stray dogs and of skunks and other wild rodents (found to be a reservoir of rabies
in adjacent States across the border) and by immunization of all other dogs in the
Rossland area.
Branch Laboratories
The branch laboratories at Victoria and Nelson showed no significant change in their
turnover of specimens. The senior technician at the Royal Jubilee Hospital spent a week
in the central laboratories, and her assistant also came over for a few days, in order to
become familiar with the V.D.R.L. test technique and to bring themselves up to date in
other fields.
At Nelson the bacteriologist elected to remain for another year, but the technician
was replaced late in the summer and returned to duties in the central laboratories. When
it was learned that plans were under way for a new Kootenay Lake General Hospital, the
local authorities were urged to make suitable provision for accommodating the branch
laboratory therein. Their consent was procured, and plans have been drawn up for
suitable disposition of the space alloted to this work. The new laboratory, which may not
be occupied for at least a year, will provide nearly double the space hitherto available in
improvised quarters.
GENERAL COMMENTS
In the introductory section of this report, allusion was made to the continuing difficulties of procuring technical staff. This appears to be due mainly to heavy competition
for trained persons from local hospitals, other government institutions, and university
departments. Many of the young women concerned have received their training in the
Department of Bacteriology and Immunology at the University, and it often seems disappointing to have devised teaching programmes for future bacteriologists only to find the N  124 BRITISH COLUMBIA
graduates absorbed by departments engaged in research in biochemistry, pharmacology,
and other fields. There appears to be an irresistible glamour about the combination of
campus life and scientific research. The competition from local hospital laboratories
should be lessened in future because of the marked improvement in the accommodation
of the central laboratories.
Salary ranges still constitute a factor in these persistent shortages of technical staff.
Although the current ranges for most classifications in this Division compare favourably
with those offered in many other Provincial laboratories throughout the country, they have
lagged behind those available in such branches of the Federal Government service as the
Laboratory of Hygiene and National Research Council laboratories. In addition, the less
rigid classification requirements of hospitals permit them to offer substantially higher
salaries to a technician, if the need is acute enough, than we are able to offer. Several
suitable applicants for positions in the central laboratories were lost to us during the year
because salary offers far outbidding ours were made to them by hospitals desperately short
of technical help. It is gratifying to report that the Civil Service Commission has provisionally recommended increases in the salary ranges applicable to certain grades of
bacteriologists and technicians. A further helpful decision is the Commission's acceptance
of our recommendation that recruits in the Bacteriologist—Grade 1 and Technician—
Grade 2 categories having some years of acceptable experience might be placed in the
second or third step of these ranks.
The Division was also handicapped by difficulties in procuring satisfactory office
staff, again largely owing to salaries not being attractive enough to persons of the right
calibre. Approval of the recommendation that a full-time specialist physician should be
appointed to the Division represents an important advance in strengthening its establishment. A protracted search for the right kind of person appears to have come to a satisfactory conclusion, and it is hoped that the appointee will be able to obtain release from
his position in the Royal Army Medical Corps early in 1956.
The Director attended the eleventh annual meeting of the Technical Advisory Committee to the Minister of National Health and Welfare at Ottawa in December. Thereafter
he attended the annual meeting of the Laboratory Section of the Canadian Public Health
Association, which was held this year in Toronto, and subsequently, as a member of the
Panel on Infection and Immunity of the Defence Research Board of Canada, participated
in the annual meeting of that group. At the end of August he attended the tenth annual
meeting of the Northwest Pacific Conference on Diseases in Nature Communicable to
Man, held at the University of Moscow, Idaho. He was invited to participate in a symposium on the epidemiology of poliomyelitis in the Northwest, and spoke on " The Canadian
Poliomyelitis Immunization Programme." At this meeting he also presented a paper on
Salmonellosis. It was resolved by the Conference that the 1957 annual meeting would
be held in Vancouver, presumably under the joint auspices of the Provincial Health
Branch and of the University.
The Director was joint author of a chapter on food poisoning in the new edition of
Laboratory Agents and Procedures, published by the American Public Health Association. He was also invited to contribute to a monograph on meat hygiene, which is to be
published by the World Health Organization, and wrote the introductory chapter on the
epidemiology of meat-borne diseases.
The Division has maintained very happy relationships with the medical profession,
health units, other divisions of the Provincial Health Branch, and with representatives
of municipal and Federal departments of health. The Director wishes to express his
appreciation of the most co-operative attitude displayed by all staff members during a
difficult and eventful year. DEPARTMENT OF HEALTH AND WELFARE,  1955
N  125
Table I.—Statistical Report of Examinations Done during the Year 1955,
Main Laboratory
Out of Town
Metropolitan
Health Area
Total, 1955
Total, 1954
Animal inoculations—
226
2
4,852
1,712
1,276
28
42
9,786
5,099
684
620
105
16
1,023
5,163
9,679
1,413
25
50
300
739
238
7
5,552
4,196
2,111
28
25
10,689
5,408
7,346
3,138
8,306
355
14
1,369
19,577
8,142
3,008
293
192
1,333
1,161
464
9
10,404
5,908
3,387
56
67
20,475
10,507
8,030
3,758
8,306
460
30
2,392
24,740
17,821
4,421
318
242
1,633
1,900
447
Blood serum agglutination tests—
10,616
6,635
Paul-Bunnell ..__   _ 	
3,297
53
Cultures—
M. tuberculosis   __
18,624
12,413
8,729
Hasmolytic staphylococci and streptococci    	
3,427
7,845
2,313
25,003
16,562
Direct microscopic examination—
iV. gonorrhoea   _	
M. tuberculosis (miscellaneous) 	
4,585
438
Vincent's spirillum   _ 	
246
1,352
1,629
55,796
Serological tests for syphilis—
Blood-
Presumptive Kahn  	
Standard Kahn _	
8,128
Quantitative Kahn	
149,546
2,096
21,273
2,346
50
426
1,687
2,375
5,417
5,413
3,583
999
8,528
214
212
213
113
152
897
V.D.R.L.      	
45,579
633
6,918
702
9
166
537
707
3,417
3,413
2,051
12
6,834
1
1
1
103,967
1,463
14,355
1,644
41
260
1,150
1,668
2,000
2,000
1,532
987
1,694
213
211
212
113
52
94,043
2,373
21,619
2,499
V.D.R.L. quantitative 	
Cerebrospinal fluid—
Cerebrospinal fluid—
551
1,926
2,661
5,040
5,015
3,380
928
7,956
Protein      ____ 	
Milk-
Water—
Standard plate count 	
Ice-cream—
100
299
113,921
216,050
329,971
338,198 N 126 BRITISH COLUMBIA
Table II.—Statistical Report of Examinations Done during the Year 1955,
Branch Laboratories
Nelson Victoria
Animal inoculations      25
Blood serum agglutination tests—
Typhoid-paratyphoid group  540 100
Brucella group  108 85
Paul-Bunnell      83
Cultures—
M. tuberculosis      3,087
Typhoid-Salmonella-dysentery group  149 741
C. diphtheria  132 2,235
Hemolytic staphylococci and streptococci 246 2,235
N. gonorrhoea      257
Miscellaneous   286 2
Direct microscopic examinations—
N. gonorrhoea  254 451
M. tuberculosis (sputum)    267 5,790
M. tuberculosis (miscellaneous)         118
Treponema pallidum      1
Vincent's spirillum  36 12
Intestinal parasites  47 19
Serological tests for syphilis—
Blood—
V.D.R.L.   4,322 16,766
V.D.R.L. quantitative   44 285
Complement fixation      1,889
Cerebrospinal fluid—Complement fixation     273
Cerebrospinal fluid—
Cell count 1      348
Protein  8 357
Colloidal reaction  87 309
Milk-
Standard plate count  894 1,572
Coli-aerogenes  878 1,572
Phosphatase  319 1,572
Water—
Standard plate count  27 1,203
Coli-aerogenes   781 1,203
Unclassified tests  15 40
Totals   9,440 42,622
Grand total, 52,062. DEPARTMENT OF HEALTH AND WELFARE, 1955 N  127
REPORT OF THE DIVISION OF VENEREAL DISEASE CONTROL
A. Larsen, Director
The decline in the total number of venereal-disease cases reported in British Columbia, which first became evident in 1947, has continued through 1955. In contrast to
previous years, the reduction this year is due solely to a decrease of about 170 in the
number of cases of gonorrhoea reported. Though much remains to be done in the control
of gonorrhoea, it is gratifying to find that the yearly improvement now appears to be a
steady one. It appears that the approach presently in use by this Division, to which
reference will be made later, has now proved its value and should be continued and, if
possible, further refined. For the first time in nine years the number of infectious syphilis
cases reported and treated has not changed appreciably from the year before. This year
thirteen new cases have been found. A review of these cases would appear to indicate
that there is still a small but definite reservoir of infection in British Columbia, probably
centred in Vancouver.
Six cases of late congenital syphilis were reported this year. Although this is a
marked decline from previous years, it is also a reminder that prenatal blood tests serve
a very real purpose and should be done on every expectant mother.
The number of cases of latent or symptomless syphilis brought to light this year has
increased by over one-third. This is an indication that there are still many people in our
Province infected with syphilis who are quite unaware that they have the disease.
Venereal disease other than gonorrhoea and syphilis reported this year includes only eight
cases of chancroid, and these, it would appear, were all contracted outside of this Province.
EPIDEMIOLOGY
As the problem of infectious venereal disease in British Columbia declines, the role
of the epidemiologist, in tracing sources of infection and tracing contacts to infected
patients, becomes more important year by year.
Studies recently completed by Dr. A. J. Nelson, a former Director of this Division,
show conclusively the value of carefully interviewing every patient regarding the source
of infection and other possible contacts, and of making every effort to bring in everyone
named, particularly females, for examination as quickly as possible. With this in mind,
efforts are being continued to improve the techniques employed in patient-interviewing
and in contact-tracing. The success or failure of this epidemiological approach to the
control of venereal disease hinges on the Division's receiving the fullest co-operation
from private physicians and the many other agencies with whom it has to deal. The
assistance that the Division has received from the Indian Health Service, the Canadian
and American armed forces medical services, Vancouver City Police, the Greater Vancouver Metropolitan Health Committee, the British Columbia Hotels' Association, the
Liquor Control Board, the Department of Citizenship and Immigration, the Washington
State Department of Health, and the American Social Hygiene Association is acknowledged with pleasure.
Health units throughout the Province in the Bureau of Local Health Services have
continued to act as the local representatives of this Division, and their staff members have
spent a great deal of time tracing contacts and acting as consultants within their areas.
The information that is being obtained from private physicians treating cases of venereal
disease appears to be improving yearly, and the Division is now able to trace many more
of the contacts of these patients than it could formerly.
The supervisor of the Epidemiological Section has been made responsible for tabulating all information given by patients relating to place of meeting and place of exposure.
From the information secured in this way in the current year, it would appear that no
bawdy-houses are now in operation in British Columbia, and that most hotel and restau- N 128 BRITISH COLUMBIA
rant owners are co-operating very well and are making sincere efforts to prevent their
premises from being used to facilitate the spread of venereal disease.
It was not felt necessary this year to hold the customary meetings with the armed
services, police, and hotel association to discuss problems relating to facilitation as they
affected hotels, restaurants, and beer-parlours.
The " call girl" system, which has arisen in recent years, has continued to exist to
some degree and has made the work of the epidemiologists, in tracing sources of infection,
more difficult. The splendid co-operation received from the Vancouver City Police has
enabled the Division to locate most of the contacts reported who fall into this group.
At the present time over 65 per cent of the contacts to new infections treated at the
Vancouver clinic are located in less than one day. Eighty-three per cent of all contacts
reported are brought to treatment in less than three days, and fully 94 per cent have been
found, examined, and treated within two weeks. These figures, it is felt, compare favourably with other national or international results where the speed-zone method of tracing
is employed.
The blood-testing survey instituted some years ago, as a summer project of this
Department amongst the Indians of this Province, was continued again in the early
summer of the year. A member of the epidemiological staff spent some time at a large
cannery along the west coast and took blood samples from many of the Indians and their
families working there.
During 1955 requests were made for two field-visits from the staff for the purpose
of studying the problem of venereal disease as related to homosexual practices in the area.
During the past year over 100 nursing-school undergraduates and approximately
40 university and metropolitan health service nurses were given instruction at the
Vancouver clinic in patient-interviewing and case-finding.
TREATMENT
Since 1949 the policy of the Division has been to deliberately overtreat patients
diagnosed as having gonorrhoea in order to prevent the development of concomitantly
acquired syphilis. Though it is generally expected that about 3 per cent of the patients
will develop syphilis at the same time that they acquire a gonorrhceal infection, no such
cases have been reported in British Columbia in patients treated for gonorrhoea with the
1.2 million units of penicillin which have been used since this programme began. During
this past summer a clinical survey was completed comparing the penicillin presently in use
by this Division with one of the very long acting penicillins, in the hope that a product
could be found that would not only require fewer injections for the treatment of syphilis,
but that would also be easier to inject into the patient. The study, including penicillin
blood level assays, was carried out by a senior medical student attached to this Division
for summer relief work and will be reported shortly in a separate paper. At the present
time several of the newer medium-acting penicillins are being tested in an attempt to
determine whether a product can be found that is easier to give than the ones presently
in use.
During the past year several changes have been made in the clinics maintained by
this Division. Night hours have been discontinued at the main Vancouver clinic due to
lack of attendance, and the weekly visit by members of the staff to the Girls' Industrial
School has been discontinued as of November lst, at which time the Industrial School
established its own part-time medical service. Inmates of this School will now be
examined by their own medical staff, and problem cases will be referred to the Vancouver
clinic on a consultative basis.
The number of patients attending the clinic at Health Unit No. 1 on Abbott Street,
Vancouver, has increased by more than 50 per cent over the past year. The geographic
situation of this clinic in the centre of the down-town area probably accounts for this
increase.   Clinics are timed to run through the noon hour at Health Unit No. 1 in order DEPARTMENT OF HEALTH AND WELFARE,  1955 N  129
to accommodate those patients who are unable to get time off from work. A physician
is now in attendance from 11 a.m. to 1 p.m. two days a week. Negotiations are now under
way toward improving the physical arrangements of the clinic, and some thought is being
given to increasing the number of days that a doctor will be in attendance.
The new City Gaol, which is to be opened early in the new year, will very much
improve facilities for the Division's diagnostic and treatment clinic that has been in
operation there for a number of years. Clinics at Oakalla Prison Farm, Juvenile Detention Home, Prince George and Prince Rupert Gaols, the Simon Fraser Health Unit in
New Westminster, and Victoria have continued unchanged throughout the year.
A public health nurse from our epidemiological staff has been seconded to the
Cariboo Health Unit at Prince George to assist that health unit in its venereal-disease
control programme because of the large number of cases being reported from that area.
In order that no person in British Columbia may be deprived of the proper treatment
for any venereal disease that he might have contracted, due to his inability to pay for the
necessary drugs, this Division still supplies free drugs to all private physicians for the
treatment of any patient whom they report as having a venereal disease. The drugs are
made available through the Vancouver clinic in the metropolitan area and through the
health units in the rest of the Province. In addition, depots are maintained in some of the
isolated hospitals for the convenience of the physicians practising there.
SOCIAL SERVICE
The Social Welfare Department has continued its policy of previous years of assigning a trained social worker to the Vancouver clinic, though, due to staff shortages, no
worker was available for the first five months of the year. The social worker's role at the
Vancouver clinic is to give a direct but short-term service to those patients who appear
to need his assistance and to refer patients to other community agencies for help with
whatever problems they have presented. As venereal disease is seldom the major problem
but is merely symptomatic of other difficulties, it is not possible to carry on a lengthy
casework type of treatment service at the Vancouver clinic. The direct short-term service
is focused on the patient's immediate problems which have necessitated a visit to the clinic
for medical treatment. Many patients are found to require help with their feelings about
their infection and about the general implications of their behaviour. This type of treatment is designed to support the patient and to ascertain what the immediate and underlying problems might be and what plans might be made to assist the patient so that he
may make a start at seeking a solution to them.
During the seven-month period in which a social worker was available, 609 patient
interviews were held. More than three-quarters of the patients seen were thought to have
the capacity to gain some insight into the reasons why they have acquired a venereal
disease. The remainder were mainly patients who came within the repeater category,
whose promiscuous behaviour was a reflection of their casual way of life, which was
unlikely to be changed by anything that the Division could do. The experience of the
social worker at the Vancouver clinic has demonstrated the need for expanding the community services giving aid to people in the 15- to 30-year age-group. In British Columbia
single men between 20 and 34 years of age and single women between 15 and 24 years
constitute the greatest problem. To be helpful to these patients, such a community agency
would have to have evening hours, since most of the patients in this age-group are
working. In referring patients to existing agencies, the Division has at times experienced
difficulty because of a prejudice against the patient when the referral came from a venereal-
disease clinic. This prejudice, it is felt, is inappropriate and calls for continued interpretation to social workers and workers in allied agencies in the community. In every
instance it was very apparent that the community out-patient resources for psychiatric
referrals were far too limited.
9 N 130 BRITISH COLUMBIA
With the increase in effectiveness of both the medical treatment and the epidemiological control over venereal disease, it has become increasingly apparent that the social
and psychological aspects of venereal disease are of primary importance in any control
programme. The real roots of venereal disease lie in the patient's lack of social or personal adjustment, and whatever can be done toward alleviating those conditions which
predispose the individual toward promiscuity will affect positively the total venereal-
disease control programme.
As in previous years, the clinic social worker took part in the Division's training
programme and lectured to undergraduate nurses, public health nurses, and social-work
students . In addition, he has now undertaken to spend some time with each new member
of the clerical staff of this Division explaining the purposes and implications of the total
venereal-disease control programme.
EDUCATION
Patient and public education about venereal diseases and their control is considered
an important part of the work of this Division. Responsibility in this field is shared
between the Divisions of Venereal Disease Control and Public Health Education and the
health units, who act as the local representatives of both Divisions throughout the Province. Professional education in the field of venereal disease has been the main activity
of this Division. A total of forty lectures were presented during this past year by members
of the staff to student-nurses in the six nursing schools of the Province, as well as instructions to psychiatric nursing students at Essondale and to selected groups of similar students
from the Vancouver Vocational School. A one-day symposium was presented to a senior
class of nursing students at the University of British Columbia in June, in which an
outline of the processes involved in an effective venereal-disease control programme were
presented. Nursing students from the Vancouver General Hospital are given an intensive
three-day course which takes them through all the sections of the Division. Three
students are received each week throughout the year. The programme now includes a
series of lectures on the medical aspects, epidemiology, social-work processes, and public
health nursing aspects of venereal disease. Clinical experience is provided by having the
nurse assist in treatment procedures and in contact-tracing.
A period of orientation is provided for new nurses coming on to the staff of the
Metropolitan Health Committee and for nurses joining the World Health Organization,
as well as for new Provincial public health personnel. Medical students from the University of British Columbia spent some time in the Division, as in former years.
As always, patient education played a prominent part in the Division's programme
through individual interviews and the supplying of pamphlets and booklets dealing with
venereal disease to the patients attending clinics.
These same pamphlets and booklets were also provided on request to individuals
and groups who were interested in the control of venereal disease. A quantity of the new
pamphlet entitled " Syphilis, the Invader " was purchased this year for distribution, and
a very excellent and up-to-date film of the same name is being purchased and will be used
as part of the lay educational programme.
A reorganization of the educational section of the Division took place in August of
this year. At that time the responsibility for the educational programme was given to
a well-qualified nurse who had just returned from a year's postgraduate work at the University of British Columbia, where she received her certificate in teaching and supervision.
ADMINISTRATION
The most outstanding event of the year was, of course, the move of this Division
from its previous temporary headquarters, where it had been located for thirty-five years, DEPARTMENT OF HEALTH AND WELFARE,  1955 N  131
to modern permanent quarters in the new Provincial Health Building on Tenth Avenue,
Vancouver. In October of this year Dr. W. S. Maddin resigned as Director of the Division
to enter private practice and is now acting as a consultant to the Division in dermatology
and venereology. The position of Director has now been combined with that of Consultant in Epidemiology.
Federal health grants continued to assist the operation of this Division greatly.
As well as being used to purchase drugs, this year funds were made available for the
employment of a third-year medical student to act as a relief epidemiologist and laboratory technician. In addition to his regular work, this medical student carried out the
blood-testing survey of Indians up the coast and the experimental work on the new longer-
acting penicillins previously mentioned. The Division was also able to assist in the
maintenance of the University of British Columbia Bio-medical Library through the
allocation of funds for the purpose of up-to-date literature on venereal disease. The
special study being conducted by Dr. D. K. Ford at the British Columbia Research
Institute on the etiology of non-specific urethritis continued throughout this year.
At the present time this Division has arranged with the Provincial laboratories in
Ontario and the laboratories of the Federal department of health in Ottawa to do approximately 80 T.P.I, tests per month free of charge. These tests are proving very valuable
in the diagnostic problems relating to syphilis that so frequently occur. It is hoped that
before too long arrangements may be made to have the test done in the Division of
Laboratories. As a first move toward this, it is hoped that early in the new year the
Provincial laboratories will take over the handling of the tests and the reporting of the
results to private physicians. The assistance that has been given to the Division up to
this time by the Federal and Ontario health departments is gratefully acknowledged.
Two members of the staff were granted leave of absence during the year to continue
their education. The nursing instructress attended the University of British Columbia to
take the course in teaching and supervision. The senior epidemiology-worker was granted
leave of absence to take the short-term course in the techniques of epidemiology offered
by the United States Department of Health, Education and Welfare in Los Angeles, Calif.
In December Dr. W. S. Maddin attended the conference of the American Academy of
Dermatology and Syphilology at Chicago for the purpose of studying recent developments
in the techniques and management of syphilis. In May Dr. A. J. Nelson attended the
Ottawa conference of Directors of the Divisions of Venereal Disease Control for the
Canadian Provinces. The Division has received the usual excellent co-operation from
the Divisions of Laboratories, Vital Statistics, and Public Health Education, and would
like at this time to express deep appreciation for the help and assistance provided. N 132 BRITISH COLUMBIA
REPORT OF THE DIVISION OF TUBERCULOSIS CONTROL
G. F. Kincade, Director
Organizations set up for the control of tuberculosis must approach the problem and
organize their forces for attack along four major fronts, namely, treatment, case-finding,
prevention, and rehabilitation. Treatment for many years at the outset of the campaign
demanded all the Division's attention, and the other phases gradually developed and
increased in importance. As success was achieved on one front, greater resources could
be shifted to strengthen the attack on other fronts.
In the natural history of any disease, alleviation of suffering and prevention of death
always becomes the first concern. When treatment becomes mastered, death rates fall,
and in the broader aspects of control the emphasis must change from therapy to other
phases of the problem. With the improvements that have taken place in therapy of
tuberculosis, the cure of the disease now appears possible. For those developing the
disease, recovery is almost a certainty. One might wish for more effective drugs, and
undoubtedly they will be developed; but even with the tools presently at hand the treatment of tuberculosis can be said to be in a very satisfactory state. Therefore the control
of tuberculosis is well into the transition stage, and the emphasis in the Division's programme must shift from mortality to morbidity. This finds its expression in the new
emphasis on case-finding and epidemiology, and the marshalling of forces for greater
effort along this line.
The case-finding effort in the Province is reflected in 332,996 chest X-rays taken in
this programme throughout the Province during 1954. This represents a slight increase
over the previous year and more than double the effort over the past ten years. A breakdown of the total examinations shows that 105,860 were done on hospital X-ray units,
78,740 of these having been taken as part of the admission X-ray survey and the rest as
out-patients referred to local hospitals. A total of 96,284 examinations were done by
the mobile X-ray units, one operating entirely in Vancouver and the other covering chiefly
the smaller centres in the Province where X-ray facilities are not available. The remainder
of the survey examinations, totalling 130,852, were done in the stationary units.
Out of 287,210 general survey examinations analysed, 340 new cases of tuberculosis
were found. The active cases numbered 124, with the hospital admission surveys finding
25 cases and other surveys finding 99 cases. The incidence of new active tuberculosis
cases was one for every 2,316 survey examinations. However, in addition to new active
cases, 68 previously known tuberculosis cases were relocated and found to be active by
survey X-rays, 27 by hospital admission X-rays, and 41 by other surveys. This gave
a case-finding rate for all active cases found of 1 per 1,514 hospital admission examinations and 1 per 1,489 examinations by other surveys. It is worthy of note that 27, or
52 per cent, of the 52 active cases found through hospital admission surveys were previously known cases, whereas only 41, or 29 per cent, of the 140 active cases found by
other surveys were previously known. The case-finding rates vary in different localities,
and the effectiveness of the Division's work is shown by the following analysis of active
cases found in selected operations:— DEPARTMENT OF HEALTH AND WELFARE,  1955 N  133
Active Cases, 1954
Active Cases
(Including Activity
-Total Undetermined)
Examined Number Rate
Oakalla Prison Farm  5,041 19 1 in 264
New Westminster clinic  9,808 19 1 in 516
Metropolitan Unit No. 1  19,688 30 1 in 656
General hospitals—out-patients _____ 27,120 40 1 in 678
Willow Chest Centre  28,972 32 1 in 905
General hospitals—admissions  78,740 82 1 in 960
Health unit at Courtenay  1,464 1 1 in 1,464
Pacific National Exhibition  11,232 7 1 in 1,604
Provincial mobile  42,441 25 1 in 1,698
University of British Columbia  4,367          	
Totals  228,873        255
The hospital admission X-ray surveys are gradually becoming more effective. The
percentage of admissions examined by miniature X-ray has risen from under 40 per cent
in 1951 to over 60 per cent in 1954, and 62.7 per cent for the first six months of 1955.
For those hospitals taking large X-rays, the percentage of admissions X-rayed gradually
increased from 38.6 per cent at the beginning of 1953 to 55.3 per cent for the fourth
quarter in 1954. For the first six months in 1955, 55.5 per cent of the admissions have
been X-rayed.
The majority of hospitals are doing a good job of having their admissions X-rayed,
while a few are falling down badly.   For the third quarter of 1955 the results are as
follows:  Hospitals Using—
Miniature     Standard
X-ray X-ray
70 per cent of admissions X-rayed  15 14
50 to 70 per cent of admissions X-rayed  14 7
25 to 50 per cent of admissions X-rayed  7 8
Under 25 per cent of admissions X-rayed  2 9
Totals  38 38
Every effort is being made to stimulate all the hospitals throughout the Province to
provide adequate coverage for this programme. The programme is endorsed by the
British Columbia Hospital Insurance Service and the British Columbia Hospital Association, and a spirit of competition is being developed amongst hospital administrators to do
a good job, realizing the importance of finding tuberculosis for the protection of their
staff, not to mention the economic significance to the hospitals when a case of tuberculosis
is found and transferred to the Division of Tuberculosis Control, thus relieving themselves of the financial burden. Quarterly summaries of the results of the admission
X-ray programme in each hospital are prepared and distributed to all hospitals and
interested agencies. Those hospitals showing less than 50 per cent of their admissions
X-rayed are brought to the attention of the local health authorities in the hopes that they
can be impressed with the importance of doing a better programme.
When, through National health grants, it became possible to provide miniature
X-ray equipment to all the major hospitals in the Province, as well as to a few health
units and institutions, the idea of mass X-ray surveys was generally abandoned because it
was possible to provide continuous X-ray coverage throughout most of the Province by
the use of hospital equipment on an out-patient basis. For the outlying areas without
X-ray service, a mobile unit was made available to give a complete coverage on a biennial
basis.   The Division has now had four years' experience with case-finding in practically N 134 BRITISH COLUMBIA
all centres in the Province, and these have been surveyed at least twice in that period.
In this way it has been possible to establish incidence rates to determine how effective this
work has been, and to show where efforts should be directed in the future.
On the basis of the figures prepared, it seems indicated that while continuing to
make X-ray facilities available throughout the Province, mass X-ray surveys are indicated
in some centres, while in other areas this type of effort would be wasted. There is a
tendency to judge the effectiveness of the survey by the number of people examined, and,
by the same token, some surveys are planned on the easy accessibility of large groups of
people and on the ease with which they can be organized for X-ray purposes. This
obviously should not be a criterion; rather the Division must be guided by the tuberculosis
experience in the area under consideration.
Since the beginning of the streptomycin era in 1946, the Division has been reporting
a marked reduction in mortality rates, which declined from 57.4 per 100,000 at that time
to 9.7 per 100,000 in 1954. In 1954 the downward trend was slackened, having only
been reduced from 11.5 in the previous year. This trend has now been reversed, and
there were 141 deaths from tuberculosis during 1955. This changing trend has been
noted in other parts of the world as early as 1951, but is only now apparent in British
Columbia, and by many is considered to be in the nature of a delayed mortality of a
number of advanced cases as a result of treatment with antimicrobials.
The death rate in 1955 from the 141 tuberculosis deaths recorded was 10.8 per
100,000 population, as against a rate of 9.7 per 100,000 in 1954. This increase in
tuberculosis deaths of approximately 15 per cent occurred chiefly among the older age-
groups, where 89 deaths occurred in persons over 50 years, compared to 75 deaths
recorded in 1954 for the same age-group. A continued reduction in deaths is evident in
persons under 20 years of age. In 1954 there were 7 deaths in persons under 20 years,
4 of them being Indians. This year there were only 2 deaths reported for this age-group,
these both being Indians. Tuberculosis deaths among whites increased by 10 per cent,
from 92 deaths in 1954 to 103 in 1955, while deaths among Orientals for the same cause
increased from 9 in 1954 to 18 in 1955. The Indian figure of 20 deaths remained
unchanged from 1954.
In common with other places throughout America, the demand for beds for the
treatment of tuberculosis in British Columbia continues to decrease. At the beginning
of 1954 the Division of Tuberculosis Control was operating 935 beds. As the demand
for beds decreased, the bed capacity was reduced to 788 with the closing of Jericho Beach
Hospital one year ago. The highest occupancy of beds in the Division during the past
year was in January, when there were 757 patients in institution. The highest number
of patients at Tranquille during the past year was 337 in February. The bed capacity of
the Division was further reduced to 773 in April of 1955, when it was determined that
Tranquille Sanatorium should operate with the bed capacity of 325. At the end of
October there were 770 beds within the Division for the treatment of tuberculosis and
only 627 were occupied, with Tranquille Sanatorium having only 217 patients in the 325
beds provided, or 65 per cent occupancy. The units in Vancouver were operating to
over 90 per cent of their capacity. In Victoria the administration of St. Joseph's Hospital
found that the beds in Vernon Villa, presently and for many years used for tuberculosis
cases, could be used for other types of illness, and with the demand for tuberculosis beds
lessening, it was agreed that Vernon Villa would cease to operate as a tuberculosis institution.   This further reduced the beds in the Division by 34 in number.
For the fiscal year 1956-57 it has been decided that Tranquille Sanatorium will
operate at a capacity of 278 beds, this being accomplished by the closure of the main
building, and starting in April of next year the total capacity within the Division of
Tuberculosis Control will be 689 beds, being a reduction of 241 beds in slightly over
two years. DEPARTMENT OF HEALTH AND WELFARE,  1955 N 135
In this connection it should also be noted that at the same time Shaughnessy Chest
Unit has been almost entirely converted from a tuberculosis hospital to a non-tuberculosis
hospital. At one time that institution was treating approximately 100 cases of tuberculosis. The Division of Tuberculosis Control has absorbed these cases and is now able
to fulfil its contract to treat tuberculosis cases that are the responsibility of the Department
of Veterans' Affairs.
It had been expected that the admission of non-pulmonary tuberculosis cases to the
Division of Tuberculosis Control might create a demand for large numbers of beds.
However, this has not occurred. In 1954 there were only 20 cases of pleurisy and 37
with other extra-pulmonary tuberculosis out of 1,015 admissions to the Division's
instiutions.   There is no apparent increase this year.
The census of the sanatoria populations taken on October 31st reveals that there
were 615 patients in these institutions. Of these, 364 patients were under 50 years of age
and 251 over 50. There were 96 cases over 60 years old, 51 cases over 70 years of age,
and 17 over 80 years of age. The sanatoria population over 50 years of age represents
40.8 per cent of the total and has increased steadily from 32.3 per cent in 1952. A year
ago there were 284 patients over 50 years of age in institutions, and this represented 39.5
per cent of the population. However, the greatest number of deaths is occurring in this
group, and the reduction of 33 in total numbers of older persons in the Division's beds is
probably accounted for by this fact. In persons over 50 years of age occupying beds, the
males predominate in the ratio of 8 to 1, there being 223 males and only 28 females. Of
the total admissions to sanatoria in 1954, the group of persons over 50 years of age
represented 32.6 per cent, an increase from 26.6 per cent in the previous year. In bed
occupancy there are twice as many male patients as female in the institutions of the
Division.
An analysis of the length of treatment of discharged cases following first admission
during the past year shows that of 657 discharges, 428 were treated under one year,
representing 65.1 per cent of first admissions.   These are as follows:—
Cases Per Cent
Treated 1 month  44 6.7
Treated 1 to 3 months  101 15.4
Treated 4 to 7 months  151 22.9
Treated 8 to 11 months  132 20.1
Forty-five per cent of first admission cases were treated under eight months. The
length of treatment has not changed appreciably over the past year, when 46 per cent of
the cases were treated less than eight months and 66.8 per cent were treated less than
one year.
It is probably significant that in 1954 there were 110 more discharges after first
admission than there were the previous year, there being 657 discharges of first admissions
in 1954 as against 547 in 1953. These represent the cases in which present methods of
treatment are so effective, and one cannot help being encouraged by the increasing
numbers of such cases that are passing through the Division's institutions.
An important development in the control of tuberculosis in this Province occurred
in the past year, with the completion and opening of a tuberculosis hospital of 265 beds
at the Provincial Mental Hospital, Essondale. For many years, segregation of the known
tuberculous cases at Essondale has been practised under rather unsatisfactory conditions,
with the patients isolated in wards in various buildings. The new building, which was
specially planned and designed as an infectious-disease hospital, is most admirably suited
to this purpose, and provides excellent facilities for the treatment of mental patients with
tuberculosis.
Throughout the years the Division of Tuberculosis Control has worked very closely
with those in charge of the mental-health programme, but with the opening of the new N 136 BRITISH COLUMBIA
building an even closer relationship has been established. One of the specialists from
the Division of Tuberculosis Control has been placed on the staff of Essondale Mental
Hospital to supervise the tuberculosis treatment programme in that institution, and to
carry on a programme of tuberculosis-control amongst the other patients and amongst
the staff of that institution. This programme includes admission and periodic re-examination chest X-rays, as well as a tuberculin-testing and B.C.G. vaccination programme for
all patients admitted to the institution, and a similar programme for the members of the
staff. The present arrangement has greatly facilitated the handling of the mentally ill
patient in institutions of this Division, and those problem cases can now be transferred in
and out of Essondale in much the same manner as transfers between the Division's regular
tuberculosis units. With a closer relationship established between the two services, a
better understanding of the problem has been brought about, and better continuity in the
treatment of the patient is possible.
It is approximately two years now since it was decided that action should be taken
under the health regulations to forcibly commit to our institutions tuberculous patients
who are creating a public health problem in their community. Since then thirteen cases
have been committed—eleven to Tranquille Sanatorium and one each to Pearson Tuberculosis Hospital and Shaughnessy Hospital. One case was committed in 1953, three
cases in 1954, and nine cases this year. Eleven cases are still in institution, one having
been discharged after a satisfactory treatment period and one having gone absent without
leave. Seven of these patients are now at Tranquille Sanatorium, one at Essondale
Mental Hospital, one at Shaughnessy Hospital Chest Unit, one at Willow Chest Centre,
and one at Pearson Tuberculosis Hospital. The areas from which they have been committed embrace most of the Province and are as follows: Vancouver, 3; Victoria, 2;
Powell River, 2; Fraser Valley, 2; Okanagan, 2; Peace River, 1; and White Rock, 1.
Although committal powers have been used in only thirteen cases, their existence and
the knowledge that they are being enforced has had a very salutary effect in many other
instances . On numerous occasions when patients were threatened with committal, they
finally submitted to voluntary admission. In many other instances, when warned of these
regulations, patients in hospital who were about to leave against advice have remained
in institution.
For the most part, those patients committed to hospital under these regulations have
not proved too troublesome, and have accepted treatment when they found it was easier
to co-operate than to continue to resist. However, it was necessary to transfer two
patients to Essondale, one of whom has now returned to Tranquille Sanatorium. One
would feel that the results of this method so far have been satisfactory, but it is apparent
that the accommodation for the confinement of some of these patients in restraining areas
within the Division is stretched to the limit, and only available at Tranquille Sanatorium.
At the same time it is obvious that there are still many cases outside of institutions who
are creating a public health problem and should be committed. In any future expansion,
adequate facilities for the handling of this type of patient will be provided, but in the
meantime each of this Division's institutions must be provided with properly constructed
rooms fo rthe confinement of recalcitrants.
People who are suffering from tuberculosis and who are committed to penal institutions present a greater problem When treatment has been needed, these cases have
been transferred to Provincial institutions. For the most part, they are drug addicts
and chronic alcoholics. These people are entirely unreliable, unco-operative, and unmanageable, and, in fact, objectionable to other patients and to the staff. In the recent case
of a notorious drug addict and peddler, the Division was requested by the Provincial Gaol
to accept him because he was unmanageable in that institution. It is the considered
opinion of this Division that proper hospital facilities should be provided at the Provincial
Gaol for the treatment and management of many of these cases. DEPARTMENT OF HEALTH AND WELFARE, 1955 N 137
There has again been a slight increase in the amount of money made available for
tuberculosis-control through Federal health grants, the amount for the fiscal year 1955-56
being $366,070. During the previous year, projects were submitted and approved in the
amount of $313,477 or 89.2 per cent of the grant. Actual expenditures, however,
amounted to only $249,417.14 or 71 per cent of the grant. This was in large part due
to the fact that it was impossible to obtain delivery of equipment ordered by the cut-off
date. This year, projects have been submitted and approved in the amount of $308,602
or 84.5 per cent of the amount available.
In previous years a considerable portion of the grant has been used for the purchase
of new equipment for the institutions and clinics, but this year the only approved requests
have been for photographic equipment and an X-ray Vu-graph for the Willow Chest
Centre and a Stryker bed for the Vancouver Island Chest Centre. Requests have been
received for office equipment, but this is not normally provided from Federal health
grants.
The largest single project is for the hospital admission X-ray programme. The
amount for this project is $109,574, which includes provision of survey X-ray equipment
for three additional hospitals and payment to all general hospitals for admission films and
for miniature films on out-patients. Some of the other major projects are as follows:
Provision of antimicrobials, $48,000; community survey programme, $32,000; and
rehabilitation programme, $26,000. The sum of $88,846 has been allocated for salaries.
These positions are all within the Division of Tuberculosis Control, with the exception
of two nursemaids at the Vancouver Preventorium and four X-ray technicians with the
Metropolitan Health Committee.
Under the professional education project, two members of the nursing staff are at
present receiving postgraduate training at the University of British Columbia. A sum of
$2,000 has been provided for short postgraduate courses, but, to date this year, little of
this money has been utilized.
All the projects during the current year have been continuations of projects from
previous years, this being the first year that no new projects have been initiated.
In an endeavour to promote a closer working relationship between local health
services and the Division of Tuberculosis Control, and to provide a better understanding
of the problems of the tuberculosis patient in the community and in the sanatorium, a
co-ordinating committee was set up, composed of three representatives of the Division of
Tuberculosis Control, three from the Medical Health Officers' group, and three from the
central office of the Health Branch. This committee was to concern itself with those
tuberculosis practices which have a direct influence on and require a working relationship
with local health services. The committee met on five occasions during the past year and
discussed patient education, discharges from sanatorium, the significance of the positive
culture in tuberculosis, criteria for admission, transportation of patients to sanatorium,
records, and chest X-ray surveys.
Through the deliberations of this committee, many troublesome problems have had
a thorough discussion, with the result that a better understanding of common problems
has come about.
The success of the tuberculosis-control effort depends on many individuals and
various organizations, both voluntary and official, that work in close co-operation with
the Division to carry out the several phases of the programme. With post-sanatorium
care developing to a greater degree and with case-finding and follow-up being intensified,
the field health services have been called on to devote considerably more time to tuberculosis work, and a close working relationship has been developed between the Division and
the field health services. The success of the programme depends entirely on the very close
co-operation of these two groups, and this has been achieved and continues to be fostered
by creating a better understanding of common problems. N  138 BRITISH COLUMBIA
The British Columbia Tuberculosis Society, as in the past, has whole-heartedly
supported the campaign both financially and through provision of services, particularly
in the fields of case-finding and education. The Vancouver Preventorium Board continues to provide hospital facilities for the treatment of children, as it has for many years,
and this group operates the only hospital for tuberculous children in the Province.
The work of the Division of Tuberculosis Control also depends on the co-operation
of many other departments and branches of government, such as the Welfare Branch,
the Department of Public Works, the Civil Service Commission, and the Purchasing
Commission. For all this assistance, without which the Division could not carry out
a successful programme, sincere gratitude is offered. It is also desired to express sincere
appreciation to all organizations and individuals who have co-operated so enthusiastically
in the preventive programme of clinics and surveys, to the hospitals for their co-operation
in carrying out the admission X-ray project, and to all the voluntary groups who continue
to support the work of tuberculosis-control. To all the staff of the clinics and institutions
of the Division who continue to maintain such a high standard of service, sincere
appreciation of their loyal support is recorded. DEPARTMENT OF HEALTH AND WELFARE,  1955 N 139
REPORT OF THE REHABILITATION COORDINATOR
C. E. Bradbury
From the humanitarian standpoint, the problems of those in our Province who have
suffered a disability through accident or disease are those which continue to challenge the
imagination and skill of personnel in all areas of professional service. Economically,
the problems of the disabled are the cause of sober reflection on the part of administrators
of public and private welfare agencies. Although in Canada we are not yet faced with
general labour shortages and to a great extent can afford to be prodigal with our available
labour-supply, industry and trade-unions are becoming more aware of the implications
and the cost of the loss of an increasing segment of our population to the labour market.
The crippling effects of many diseases still remain beyond the scope of the most
skilled technicians, and many accident victims grimly face a bleak future. But as knowledge increases and skills and techniques improve, the picture becomes brighter.
Although the Health Branch was the first Provincial Government agency to engage
actively in a rehabilitation programme in British Columbia, the programme was limited
to those disabled by tuberculosis. However, the Health Branch has continued to be
keenly aware of the serious implications of all types of disablement and has initiated
a rehabilitation programme to deal as effectively as possible with the other disabilities.
During the year that has passed since the first annual report of the Rehabilitation
Co-ordinator was submitted, considerable progress has been made. It has been a year
during which planning for a co-ordinated rehabilitation service in British Columbia has
proceeded at an accelerated rate.
In British Columbia we are fortunate in the quality and extent of the services available to our people, particularly in the areas of public health, welfare, and education.
The many voluntary agencies in these fields also have established a reputation not
exceeded elsewhere on the continent. The fact that these services exist makes the task
of establishing a programme of rehabilitation for the handicapped easier. Gradually, as
the serious humanitarian and economic implications of disability become apparent,
rehabilitation of the handicapped is seen to be a goal toward which all must strive
together. Each special service has a part to play in achieving the goal, and the joining
of professional skills with industry, labour, and the community is being accomplished.
The effective administration of a rehabilitation programme is dependent first on a
knowledge of the answer to three important questions: Who are the handicapped?
Where are the handicapped? What is the nature of their disabilities? At the present
time the answers to these questions are not immediately available. A modest beginning
was made early this year to gather this information and to record it centrally by a survey
of public records. The " Disabled Persons' Allowances Act" provides for the referral
of certain applicants to the rehabilitation service, and such referrals by the Disabled
Persons' Allowance Board have been made consistently to the office of the Rehabilitation
Co-ordinator. Referrals from various agencies interested in the handicapped and self-
referrals of handicapped individuals also have been accepted. As a result, a register of
adult disabled persons has been started.
A second consideration is the need for accurate assessment of the rehabilitation services required by each registered individual. Medical assessment is vital, and in most
cases social and vocational assessment are equally important. Concurrent with the
acceptance of referrals for rehabilitation service, the nucleus of a Rehabilitation Assessment Team was organized and a medical rehabilitation consultant appointed. Cases have
been actively reviewed and their needs assessed. Whenever possible, arrangements have
been made to make the necessary rehabilitation facilities available to the client. In consequence, clients now are receiving the benefits of rehabilitation service on an organized
basis. N  140 BRITISH COLUMBIA
For some of the clients, retraining in a new occupation is indicated. Such training
is provided for through Schedule R of the " Canadian Vocational Training Co-ordination
Act," the cost of which is shared equally by the Provincial Department of Education and
the Federal Department of Labour. A Training Selection Committee, comprising the
Director of Technical and Vocational Education as chairman, the Rehabilitation Coordinator, and the Regional Supervisor of Special Placements, has been organized and
meets regularly to ensure that the provisions of Schedule R are properly administered.
These are the modest beginnings of a rehabilitation programme, and in the ensuing year
it is proposed to extend the registration of the handicapped so that statistical data can be
presented and greater knowledge of the need for additional and extended services can be
obtained.
ACKNOWLEDGMENT
Grateful acknowledgment is made to the Federal Department of Labour, which,
through the Co-ordination of Rehabilitation Agreement, shares the cost of administration of the office of the Rehabilitation Co-ordinator, and to the Department of National
Health and Welfare for making available the Medical Rehabilitation Grant, which is
mentioned in greater detail elsewhere in this Annual Report.
Acknowledgment also must be made to the various government departments and
agencies, both Provincial and Federal, with particular reference to the Provincial Department of Education, the Social Welfare Branch, and the Unemployment Insurance Commission, and the many voluntary agencies, whose assistance and counsel have been most
helpful. DEPARTMENT OF HEALTH AND WELFARE,  1955
N  141
REPORT OF THE ACCOUNTING DIVISION
E. R. Rickinson, Departmental Comptroller
The volume of work handled by the Accounting Division continued to increase
during the fiscal year 1954—55. As a result, several revisions in methods and procedures
were made in order that the necessary service, control, and information would be available
without increasing the staff. As an example of this, a new petty-cash form was devised
and put into use in 1954, which simplified the submission of accounts from the field
offices, resulting in a saving of time in the field offices as well as in the Accounting Division.   A similar saving was effected by the introduction of a payroll time-sheet.
The mechanical staff carried out 450 inspections on the 162 government-owned
vehicles which are operated by Health Branch personnel. These vehicles travelled a total
of 1,063,072 miles during the fiscal year. In addition, 128 private cars were driven
a total of 538,482 miles by Health Branch personnel.
The work involved in accounting for National health grants continued to increase
in 1954-55. The expenditure in this fiscal year was approximately triple that in the first
year, 1948-49.
Below is a chart in which the Health Branch expenditure is shown by sections, with
the percentage that each section is of the total Health Branch expenditure. Two years
are shown, 1953-54 and 1954-55, to give a comparison. The chart shows that in
1954-55 Venereal Disease Control and Tuberculosis Control took a smaller percentage
of the health budget than previously, with a consequently larger share being spent on the
other work, including preventive medicine.
1953-54
1954-55
RESEARCH, TRAINING, ETC.
VENEREAL DISEASE CONTROL
ADMINISTRATION
LABORATORIES
VITAL STATISTICS
CANCER, ARTHRITIS, ETC.
LOCAL HEALTH SERVICES
23.1
TUBERCULOSIS CONTROL
56.4
1.8% VENEREAL DISEASE CONTROL
2.7      RESEARCH, TRAINING, ETC.
ADMINISTRATION
VITAL STATISTICS
LABORATORIES
CANCER. ARTHRITIS, ETC.
3.0
3.1
3.3
8.7
24.0      LOCAL HEALTH SERVICES
53.4     TUBERCULOSIS CONTROL
— 0 —
PROPORTION OF THE TOTAL EXPENDITURE OF THE HEALTH BRANCH BY THE
VARIOUS DIVISIONS ON SERVICES AS SHOWN, FOR THE FISCAL YEARS 1953/54
AND 1954/55. VICTORIA, B.C.
Printed by Don McDiarmid, Printer to the Queen's Most Excellent Majesty
1956
610-1155-7810  

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