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Division of Venereal Disease Control Department of Health and Welfare ANNUAL REPORT For the Year 1955 British Columbia. Legislative Assembly 1957

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 PROVINCE OF BRITISH COLUMBIA
Division of
Venereal Disease Control
Department of Health and Welfare
ANNUAL REPORT
For the Year 1955
VICTORIA, B.C.
Printed by Don McDiaemid, Printer to the Queen's Most Excellent Majesty
1956  •
Victoria, B.C., July 10th, 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 on Venereal Disease in the
Province of British Columbia for the year 1955.
ERIC MARTIN,
Minister of Health and Welfare.
!■■ Department of Health and Welfare (Health Branch) ,
Victoria, B.C., July 10th, 1956.
The Honourable Eric Martin,
Minister of Health and Welfare, Victoria, B.C.
Sir,—I beg to submit the Annual Report on the work of the Division of Venereal
Disease Control of the Department of Health and Welfare for the year January 1st to
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),
Division of Venereal Disease Control,
828 West Tenth Avenue,
Vancouver 9, B.C., July 10th, 1956.
G. F. Amyot, Esq., M.D., D.P.H.,
Deputy Minister of Health, Victoria, B.C.
Sir,—I beg to submit the Annual Report on the work of the Division of Venereal
Disease Control of the Department of Health and Welfare for the year January 1st to
December 31st, 1955.
I have the honour to be,
Sir,
Your obedient servant,
A. A. LARSEN, B.A., M.D., D.P.H.,
Director, Division of Venereal Disease Control. TABLE OF CONTENTS
Page
1. List of Tables    6
2. List of Charts  6
3. Organization Chart  7
4. Epidemiology ■-    9
5. Treatment _  10
6. Social Service   :  11
7. Education      12
8. Administration    13
9. Statistical Section ,  14 STATISTICAL SECTION
LIST OF TABLES
Table Page
I. New Notifications of Venereal Infection and Rate per 100,000 Population,
1941-55  14
II. New Notifications of Venereal Infection Classified according to Reporting
Agency, Sex, and Diagnosis, British Columbia, 1955  16
III. New Notifications of Venereal Infection Classified according to Age-group,
Sex, and Diagnosis, British Columbia, 1955  18
IV. New Notification of Gonorrhoea by Age-groups and Sex, British Columbia,
1946-55   20
V. New Cases of Gonorrhoea Reported in British Columbia, by Age-groups and
Marital Status, 1955  21
VI. Patient-visits at All Clinics of the Division of Venereal Disease Control Classified according to Diagnosis, 1946-55  21
VII. Male Contacts Named by Female Gonorrhoea Cases according to Reporting
Agency, 1949-55  22
VIII. Female Contacts Named by Male Gonorrhoea Cases according to Reporting
Agency, 1949-55  22
IX. Places of Meeting Reported as Facilitating the Spread of Venereal Disease,
1951-55  26
X. Places of Exposure Reported as Facilitating the Spread of Venereal Diseease,
1951-55  26
XL Contact to Venereal Infection Classified according to Result of Examination
and Reporting Agency, British Columbia, 1955  27
XII. Report of Laboratory Work Done by the Division of Laboratories relating to
the Diagnosis and Treatment of Venereal Disease for All Agencies in
British Columbia, 1955  28
XIII. New Notifications of Syphilis and Gonorrhoea by Health Units and School
Districts, British Columbia, 1951-55  29
LIST OF CHARTS
Chart
I. New Notifications of Venereal Infection and Rates per 100,000 Population,
1941-55  15
II. Semi-annual Gonorrhoea Indices by Sex and Reporting Agency, British Columbia,
1949-55  25 r- j
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'5 5  DIVISION OF VENEREAL DISEASE CONTROL
ANNUAL REPORT FOR THE YEAR 1955
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 five years ago, 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. J  10 DEPARTMENT OF HEALTH AND WELFARE
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 restaurant 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 fuUy 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 veneral 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 gonorrhoeal 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 VENEREAL DISEASE CONTROL REPORT,  1955
J  11
School has been discontinued as of November 1st, 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
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 J  12 DEPARTMENT OF HEALTH AND WELFARE
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.
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. VENEREAL DISEASE CONTROL REPORT,  1955
J 13
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,
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. J 14
DEPARTMENT OF HEALTH AND WELFARE
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J  15
The downward trend in the total number of reported cases of venereal disease in
British Columbia has continued through 1955 though at a reduced rate. This year the
decrease is only 5 per cent, compared with a 10-per-cent drop in 1954. The rate per
100,000 population has also continued its decline, being 210.7. This compares with a
high of 677 per 100,000 in 1946.
Gonorrhoea, as always, has been the main venereal-disease problem, accounting this
year for 90.7 per cent of all cases reported, though again the rate of 191 per 100,000 of
population continues the steady decline first begun in 1946.
Only 13 cases of infectious syphilis were reported to us, as compared to 645 cases
ten years ago. This is a striking conquest of a very serious communicable disease. The
number of cases of latent or symptomless syphilis discovered increased this year by
approximately 25 per cent, indicating that present case-finding methods are effective and
that our efforts should not be relaxed.
CHART I.—NEW NOTIFICATIONS OF VENEREAL INFECTION,
BRITISH COLUMBIA, 1955
(Rates per 100,000 population.)
RATE
700
600
500
400
300
200
100
^TOTAL
G°X
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1942   1943   1944   1945   1946   1947   1948   1949   1950   1951   1952   1953   1954  1955 J  16
DEPARTMENT OF HEALTH AND WELFARE
TABLE II.—-NEW NOTIFICATIONS OF VENEREAL INFECTION CLASSIFIED
ACCORDING TO REPORTING AGENCY, SEX, AND DIAGNOSIS, BRITISH
COLUMBIA, 1955.
Reporting Agency
Gonorrhoea
A o
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OS
Syphilis
Acquired
o2
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Totals     	
 .T.
M.
F.
 .T.
M.
F.
- T.
M.
F.
T.
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F.
New Westminster	
 T.
M.
F.
Oakalla 	
; ." T.
M.
F.
Girls' Industrial School and Juvenile Detention Home T.
M.
F.
Metropolitan Health Committee
Clinics   T.
M.
F.
Other sources .
Private physicians
Indian Health Services-
Department   of  National   Defence  T.
M.
F.
Hospitals     T.
Other
2,494
1,878
616
1,125
716
409
775
515
260
39
24
15
223
167
56
1,369
1,162
207
1,125
978
147
34
22
12
1   2,493
1 | 1,877
616
146 |
99 |
47 |
1,125
716
409
775
515
260
39
24
15
223
167
56
1,368
1,161
207
1,124
977
147
34
22
12
64
63
1
146
99
47
248
175
73
87
72
15
71
59
12
9
7
2
161
103
58
121
73
48
7
4
3
6.\,
6|.
23    145
18     94
5 j   51
13 |   44
12 |   36
1
| ...... |     1|     8 |
37 |
31 |
6|
4
2|
2
10 101
6 58
4     43
12
2|
M
1,1
1
1
1|
11
2,750
2,060
690
1,217
793
424
849
577
272
50
33
17
56
16
40
38
38
224
167
57
1,533
1,267
266
1,248
1,052
196
41
26
15
70
69
1
165
111
54 VENEREAL DISEASE CONTROL REPORT,  1955
J 17
When one classifies the new notifications of gonorrhoea according to reporting
agency, it can be seen that the clinics of the Division and all the private physicians in
the Province reported an equal number of cases in 1955, each accounting for 44.9 per
cent of new cases discovered. The remainder were reported for the most part by the
various Federal Government health agencies.
Private physicians also reported 49 per cent of the total number of new cases of
syphilis discovered during the year. Of these, only 1 case was in the infectious stage.
The clinics of the Division first saw 9 out of the 14 cases of infectious syphilis discovered
and reported 28 per cent of the total number of newly found cases of syphilis. The clinic
maintained at Health Unit No. 1 continues to be a fruitful source of new cases of gonorrhoea. This year 223 cases were diagnosed there, which is an increase of 70 over
1954. An increase of over 400 per cent is recorded in the number of cases of gonorrhoea
revealed at the Girls' Industrial School and Juvenile Detention Home, 39 cases being
found in 1955, as compared with only 9 in 1954, in these two institutions. The ratio
of male to female cases reported this year is 1.8 to 1 for the clinics of the Division and
5.3 to 1 for the private physicians. The difference in these ratios shows that females
are not being brought to treatment in the way that they should be, and shows where
increased effort could be directed with advantage. One key to the control of gonorrhoea
in this Province would appear to lie in the locating and treating of more female contacts
to male patients reported by private physicians.
' J  18
DEPARTMENT OF HEALTH AND WELFARE
TABLE III.—NEW NOTIFICATIONS OF VENEREAL INFECTION CLASSIFIED ACCORDING TO AGE-GROUPS, SEX, AND DIAGNOSIS, BRITISH
COLUMBIA, 1955.
Age-group
Gonorrhoea
cd E
if
S o
SI O
OZ
0
Syphilis
Acquired
> o
OC
Totals
Under 1 year
1- 4 years
5- 9
10-14
15-19
20-24
30-34
35-39
40-44
45-49
50-59     „
60-69
70-79
80 years and over
Not stated
...T.
M.
F.
...T.
M.
F.
. T.
M.
F.
...T.
M.
F.
T.
M.
F.
_T.
M.
F.
_T.
M.
F.
...T.
M.
F.
. T.
M.
F.
...T.
M.
F.
_T.
M.
F.
. T.
M.
F.
_T.
M.
F.
...T.
M.
F.
...T.
M.
F.
...T.
M.
F.
_T.
M.
F.
2,494
1,878
616
6
6
10
10
221
97
124
647
481
166
610
479
131
378
306
72
186
153
33
141
120
21
83
59
24
86
76
10
17
17
103
86
17
2,493
1,877
616
24S
175
73
10]
221
97
124
647
481
166
610
479
131
378
306
72
186     21
153     14
331      7
141
120
21
83
59
24
86
76
10
17
17
103
86
17
145
94
51
I
8|2,750
7|2,060
1|   690
I
-        1
....|       1
-I-	
6
6
11
1
10
225
98
II    127
666
496
170
638
494
144
392
314
78
208
168
40
156
130
26
110
75
35
136
110
26
69
65
4
18
15
3
5
4
1
107
89
18 VENEREAL DISEASE CONTROL REPORT,  1955
J  19
As in previous years, the greatest number of cases of venereal disease continued to
be reported in the 20-24-year age-group. One quarter of all cases reported to us occurred
in this five-year group. In the age-group 10-20 years there were 231 cases of gonorrhoea
reported, of which 134 were in the female.
Ninety-three per cent of all syphilis reported was diagnosed as non-infectious. Half
of these cases occurred in the over 50-year age-group and are considered to have come
from the reservoir of undiscovered cases built up before Venereal Disease Control services
became as active as they are now. Twenty-seven per cent of the late and non-infectious
cases of syphilis had already developed symptoms of heart or brain damage at the time
of diagnosis. J 20
DEPARTMENT OF HEALTH AND WELFARE
TABLE IV.-
-NEW
NOTIFICATIONS
OF GONORRHOEA BY AGE-GROUPS
AND SEX, BRITISH COLUMBIA,  1946-55
(Rates per 100,000 population.)
Age-group
1946
1947
1948
1949   |    1950
1
1951
1952
1953
1954
1955
0- 4 years.	
_ T.
21
3
6
5
6
4
1
4
2
M.
13
4
5
2    |   	
1
F.
29
2
8
10
10
7
3
9
3
5- 9     „    	
T.
M.
18
3
15
2
9
2
6
9
2
2
4
2
4
5
F.
33
28
16
12
18
4
4
7
9
10
10-14     „    	
 T.
22
4
7
7
29
15
5
2
5
10
M.
9
3
6
3
3
2
2
F.
36
6
9
11
58
28
10
5
9
20
15-19     „    	
_  T.
583
533
446
407
480
412
359
280
267
273
M.
515
474
354
309
377
436
304
266
267
235
F.
650
590
539
507
585
386
415
293
266
313
20-24     „    	
  T.
1,677
1,545
1,270
1,346
1,305
1,196
1,259
1,062
975
829
M.
2,338
2,197
1,765
1,759
1,686
1,697
1,652
1,545
1,497
1,240
F.
1,058
950
796
956
939
708
873
579
460
423
25-29     „	
 T.
1,127
978
914
927
894
845
827
797
639
669
M.
1,722
1,541
1,427
1,355
1,281
1,335
1,281
1,301
1,067
1,071
F.
557
441
423
517
532
399
407
329
232
282
30-34     „	
 T.
651
487
476
457
487
526
502
462
432
395
M.
1,005
793
755
717
751
872
795
737
741
671
F.
299
181
203
200
241
217
239
216
153
144
35-39     „    	
 T.
443
399
377
368
353
290
277
252
213
192
M.
690
625
596
544
549
459
451
440
361
326
F.
168
155
153
190
165
124
108
72
73
66
40-44     „	
 T.
331
261
250
282
232
236
235
173
167
155
M.
489
418
379
398
352
366
359
290
286
263
F.
141
76
103
153
104
94
102
53
46
46
45-49     „     	
     T.
223
199
190
188
212
164
170
141
126
109
M.
355
300
299
292
343
273
271
213
207
147
F.
69
79
65
70
58
33
51
58
35
66
50-54     „    	
 T.
104
107
102
118
107
110
121
105
81
66
M.
181
190
164
193
167
174
207
172
139
104
F.
16
12
30
33
40
39
25
27
17
23
55-59     „    	
 T.
66
61
49
61
78
69
41
40
55
75
M.
107
107
76
102
132
120
64
59
92
134
F.
12
4
15
11
16
16
15
18
15
11
60-64     „     	
 T.
57
50
30
49
36
36
50
46
47
9
M.
92
83
54
82
62
63
89
80
89
18
F.
10
5
8
4
4
4
8
65-69     „   	
     T.
23
24
31
19
26
21
17
17
31
23
M.
40
38
53
33
42
37
30
31
46
43
F.
6
5
13
70 years and over	
 T.
8
14
11
13
9
7
15
7
3
3
M.
10
23
20
21
16
12
28
13
6
6
All ages	
F.
 T.
4
3
404
388
333
332
319
286
266
241
211
191
M.
561
539
458
435
416
412
368
356
325
203
F.
235
225
199
220
217
154
160
121
92
96 VENEREAL DISEASE CONTROL REPORT,  1955
J 21
This table shows that the total rate per 100,000 of population for all age-groups has
continued to decline. For the first time in a number of years though there is evidence of
an increased rate in four of the age-groups. The fact that the rate in the 15—19-year
age-group has not declined as rapidly as in the 20-29-year age-group, and has indeed
increased in 1955 in the face of the general downward trend, has given us cause for some
concern. It is worthy of note also that only among those under 20 years of age is the
rate for females higher than that for males.
TABLE V.—NEW CASES OF GONORRHOEA REPORTED IN BRITISH
COLUMBIA, BY AGE-GROUPS AND MARITAL STATUS, 1955
Age-group
Single
Widowed and Divorced
Married1
Male
Female
Male
Female
Male
Female
15-19 years  	
20-24    „    	
96
422
582
165
54
26
6
109
110
85
8
5
2
15
13
6
1
2
1
4
4
7
9
1
49
168
88
31
17
3
10
49
25-34    „   	
105
35-44   „ 	
45-54    „    	
39
16
55-64   „ _  	
1
65-69    „	
Includes separated.
As in previous years, this table shows that the major venereal-disease problem
presents itself in the 20-34-year age-group of single males and in the 15-24-year
age-group of single females.
TABLE VI.—PATIENT-VISITS AT ALL CLINICS OF THE DIVISION OF VENEREAL DISEASE CONTROL CLASSIFIED ACCORDING TO DIAGNOSIS,
1946-55.
Year
Total
All
Clinics
Vancouver
Clinic
Syphilis
All
Clinics
Vancouver
Clinic
Gonorrhoea
All
Clinics
Vancouver
Clinic
Other Venereal
Disease
All
Clinics
Vancouver
Clinic
Not Yet
Diagnosed
All
Clinics
Vancouver
Clinic
1946..
1947-
1948.
1949..
1950..
1951..
1952..
1953-
1954-
1955-
56,385
51,129
43,897
36,685
31,107
24,315
20,721
18,307
16,792
13,308
41,856
38,180
32,495
27,970
21,976
15,943
11,798
9.732
8,779
7,094
30,047
28,291
24,894
16,425
11,685
8,109
5,754
4,503
3,432
1,992
23,158
21,986
19,166
13,139
9,301
6,606
4,314
3,494
2,831
2,137
11,382
9,799
8,480
9,102
8,548
5,904
4,511
3,551
2,279
1,529
9,297
8,051
7,014
7,858
7,418
4,964
3,606
2,758
1,848
1,254
26 |
44 j
43 |
124 j
125 j
23
36
31
122
114
121 |  115
34 |   33
I
14,956
13,039
10,497
11,114
10,831
10,178
10,331
10,165
10,960
9,753
9,401
8,143
6,292
6,937
5,226
4,251
3,764
3,392
3,985
3,670
Again this year there has been a decrease in the number of patient-visits to the
clinics of the Division. As mentioned in previous Reports, this is due to the decrease
in the total number of cases of venereal disease reported and to our ability to effect
a cure with a much shorter course of treatment. J 22
DEPARTMENT OF HEALTH AND WELFARE
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-J VENEREAL DISEASE CONTROL REPORT,  1955
J 23
These tables and the accompanying chart show the results obtained by interviewing
patients with newly diagnosed cases of gonorrhoea. The purpose of these interviews was
to elicit from the patients information about the source of their infection and the names
of others that they might have given their disease to.
For each sex, indices have been derived for patients reported by private physicians
and for patients reported by the clinics of the Division of Venereal Disease Control.
These indices are:—
(a) A Contact Index, which shows the ratio between the number of contacts
named and the number of newly diagnosed cases of gonorrhoea, expressed
in terms of the number of contacts per 100 new cases of gonorrhoea.
(b) An Epidemiologic Index, which shows the ratio between the named contacts who were found to be infected and the number of newly diagnosed
cases of gonorrhoea, expressed in terms of the number of infected contacts
per 100 new cases of gonorrhoea.
(c) A Brought-to-treatment Index, which shows the ratio between those
infected contacts who had to be located and brought in for examination
because they did not seek treatment of their own accord and the number
of newly diagnosed cases of gonorrhoea, expressed in terms of the number
of contacts it was possible to bring in to treatment and who were found
to be infected per 100 newly diagnosed cases of gonorrhoea.
These indices, when properly interpreted, measure the effectiveness of contact-tracing
as a method of control of gonorrhoea, and measure also the effectiveness of the work being
done by the investigating staff of the Division.
Both Tables VII and VIII and the accompanying chart show the number of contacts
named per 100 cases of gonorrhoea reported by the clinics of the Division as opposed to
the number reported by private physicians. The arrow on the chart indicates the introduction of the speed-zone technique in the clinics as a method of increasing our contact-
tracing efficiency. It can be seen that for male cases the contact index has been increasing
considerably faster for the clinics than for the private physicians since the speed-zone
technique was introduced.
This does not hold true for female cases because the clinics have, to a degree, relaxed
their efforts to locate their male contacts, as it is known that most males take treatment
if they develop symptoms. In contrast, experience has shown us that many females can
be infected and yet have no symptoms.
It can be seen that the total number of contacts found to be infected rises as the
number of contacts named per 100 cases of gonorrhoea increases. The ratio of named
contacts infected to newly diagnosed cases is called by us the epidemiologic index, and
also has been rising since the introduction of speed-zone technique. This same trend is
not apparent for private physicians as far as female contacts named by their male patients
are concerned. However, the private physicians have far surpassed the clinics in relation
to male contacts found to be infected who were named by their female patients. Because
of this the Division is now endeavouring to elicit more contact information from its
female cases.
The brought-to-treatment index measures the accomplishments of the Division's
investigating staff, and in addition measures the adequacy of the information about the
contacts supplied to them by private physicians as compared to the information that the
Division is able to elicit from its patients. If we assume that the investigators pursue
their contacts named by the patients of private physicians with a zeal equal to that used
for pursuing contacts of clinic patients, a comparison between the two groups of the
number it is possible to bring in for treatment will give an idea of the relative adequacy
of the contact information supplied. J 24 DEPARTMENT OF HEALTH AND WELFARE
It is interesting also to note that the brought-to-treatment index for male contacts
to female cases has always been below 10 per 100. This, of course, is to be expected
because most men usually seek treatment of their own volition.
For the clinics of the Division there is reassuring evidence that investigation of
female contacts to male cases is continuing to be successful. This information is important because it is a major factor in the success of the Division's control programme. It is
known that a small group of infected females are responsible for a high percentage of
the cases of gonorrhoea. Our ability to locate these females and to treat them is a major
factor in the Division's control programme. VENEREAL DISEASE CONTROL REPORT,  1955
J 25
CHART II.—SEMI-ANNUAL GONORRHCEA INDICES BY SEX AND
REPORTING AGENCY, BRITISH COLUMBIA, 1949-55
SEMI-ANNUAL GONORRHOEA CONTACT INDEX-MALE
By REPORTING AGENCY. BRITISH COLUMBIA, 1949-55
Per 100 male coses
220 	
200
180
160
60
'/,
V.D. CONTROL CLINICS
PRIVATE PHYSICIANS     .
J UJ UJ LlI L
JL,
i   i.i   i
1949  1950  1951  1952 1953 1954  1955
YEAR
SEMIANNUAL GONORRHOEA EPIDEMIOLOGIC INDEX-MALE
By REPORTING AGENCY. BRITISH COLUMBIA, 1949-55
Per 100 male cases
140
120
100
80
60
40
20
V.D  CONTROL CLINICS
PRIVATE PHYSICIANS     -
...       /\ ''
J l_i_l LU LU L
1
J_U L
1949     1950      1951     1952     1953     1954     1955
YEAR
SEMI ANNUAL GONORRHOEA BROUGHT TO TREATMENT INDEX   MALE
By REPORTING AGENCY. BRITISH COLUMBIA, 1949-55
Per 100 male cases	
60
40
20
V.D  CONTROL CLINICS
PRIVATE PHYSICIANS    .
1949     1950     1951      1952     1953     1954     1955
YEAR
SEMI-ANNUAL GONORRHOEA CONTACT INDEX - FEMALE
By REPORTING AGENCY, BRITISH COLUMBIA, 1949-55
Per 100 female cases
220
200
140
60
V.D. CONTROL CLINICS  	
PRIVATE PHYSICIANS     	
J La_
J_iJ I ■  I    "I
1
J-jlJ III     I
1949     1950     1951      1952     1953     1954    1955
YEAR
SEMI-ANNUAL GONORRHOEA EPIDEMIOLOGIC INDEX-FEMALE
By REPORTING AGENCY, BRITISH COLUMBIA, 1949-55
Per 100 female cases
140
120
~   V.D. CONTROL CLINICS   	
PRIVATE PHYSICIANS      ___
A
IX
100
80
60
/"
/
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1   III   III   III   III   11
i iii i
1949     1950     1951
1952     1953     1954     1955
YEAR
SEMI-ANNUAL GONORRHOEA BROUGHT TO TREATMENT INDEX ■ FEMALE
By REPORTING AGENCY. BRITISH COLUMBIA. 1949-55
Per 100 female cases	
60
40
20
V.D  CONTROL CLINICS
PRIVATE PHYSICIANS    -
I
1949  1950  1951
1952  1953
YEAR
1954  1955 J 26
DEPARTMENT OF HEALTH AND WELFARE
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J 27
The figures given in Tables IX and X show the place of meeting and place of
exposure given by patients diagnosed as having a venereal infection. It is apparent that
the places which are most often named as facilitating the spread of venereal disease are
beer-parlours, cafes, hotels, and rooms.
Control of venereal disease through control of places of meeting and of exposure
is carried out on a co-operative basis with the owners of the premises concerned, the
police, the Hotels' Association, and Liquor Control Board officials.
It is felt that further attempts at control over establishments which facilitate the
spread of venereal disease would be fruitful. Increased activity along this line is planned
for 1956.
TABLE XL—CONTACT TO VENEREAL INFECTION CLASSIFIED ACCORDING TO RESULT OF EXAMINATION AND REPORTING AGENCY,
BRITISH COLUMBIA, 1955.
Reported by—
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39
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270
382
69
95
30
This table reports the results of examinations made by various agencies as part of
their investigation of alleged contacts of venereal disease. There has been an 11-percent decrease in the number of contacts investigated in 1955 as compared with 1954.
The reason for this is that during the past two years major emphasis has been placed on
locating female contacts named by male patients with gonorrhoea. Though this has
resulted in an increase in the average time required to locate a contact and a decrease
in the number of contacts located, the results as indicated elsewhere have been worth
while. J 28
DEPARTMENT OF HEALTH AND WELFARE
TABLE XII.—REPORT OF LABORATORY WORK DONE BY THE DIVISION
OF LABORATORIES RELATING TO THE DIAGNOSIS AND TREATMENT
OF VENEREAL DISEASE FOR ALL AGENCIES IN BRITISH COLUMBIA,
1955.
Examination
1951
1952
1953
1954
1955
Gonococcus cultures	
Gonococcus microscopic examinations	
Treponema pallidum microscopic examinations..
Serological tests for syphilis   	
6,797
28,510
370
228,547
6,582
28,656
283
232,270
7,080
27,349
257
253,756
8,228
26,005
448
211,634
8,563
25,445
319
198,890
During the past year the trend toward fewer microscopic examinations and more
cultural examinations for the diagnosis of gonorrhoea continued. Again this year there
was a moderate decrease in the number of serologic tests done for the diagnosis of
syphilis. There was also a decrease in the number of microscopic examinations done
for the diagnosis of infectious syphilis. VENEREAL DISEASE CONTROL REPORT,  1955
J 29
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«OfiO J 32 DEPARTMENT OF HEALTH AND WELFARE
This table shows the areas in the Province (by health units and school districts)
where venereal disease presents the greatest problem. As in past years, most new notifications (53 per cent) were from the Greater Vancouver area.
The other areas from which a relatively large number of reports come are Prince
George, Prince Rupert, and Kamloops. With the exception of the Kamloops area, there
is a slight decline in the total number of cases reported from each of these districts compared with 1954. The increase (over 100 per cent) in the number of cases reported
from the Upper Vancouver Island is probably due to the influx of single males working
on the major construction projects under way there. In most other areas reported cases
are roughly the same in number.
VICTORIA, B.C.
Printed by Don McDiarmid, Printer to the Queen's Most Excellent Majesty
1956
360-656-4111

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