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Eleventh Report of the DEPARTMENT OF HEALTH AND WELFARE (HEALTH BRANCH) (Sixtieth Annual Report of Public… British Columbia. Legislative Assembly 1957

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 PROVINCE OF BRITISH COLUMBIA
Eleventh Report of the
DEPARTMENT OF HEALTH
AND WELFARE
(HEALTH BRANCH)
(Sixtieth Annual Report of Public Health Services)
YEAR ENDED DECEMBER 31st
1956
VICTORIA, B.C.
Printed by Don McDiarmid, Printer to the Queen's Most Excellent Majesty
1957  Office of the Minister of Health and Welfare,
Victoria, B.C., January 11th, 1957.
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, 1956.
ERIC MARTIN,
Minister of Health and Welfare. Department of Health and Welfare (Health Branch),
Victoria, B.C., January 11th, 1957.
The Honourable Eric Martin,
Minister of Health and Welfare, Victoria, B.C.
Sir,—I have the honour to submit the Eleventh Report of the Department of Health
and Welfare (Health Branch) for the year ended December 31st, 1956.
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.
E. J. Bowmer, M.B., Ch.B., M.R.C.S., L.R.C.P.,
Acting 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.
C. W. B. McPhail, B.Sc, D.D.S., M.S.D.,
Acting Director, Division of Preventive Dentistry.
R. H. Goodacre, M.A., C.P.H.,
Director, Division of Public Health Education.
Miss J. Groves, B.H.Ec,
Consultant, Public Health Nutrition.
C. R. Stonehouse, C.S.I. (C),
Senior Sanitary Inspector.
C. E. Bradbury,
Rehabilitation Co-ordinator.
J. McDiarmid,
Departmental Comptroller.
5  TABLE OF CONTENTS
Page
Report of the Bureau of Administration  13
British Columbia's Organization for Public Health Services  13
Staff  14
Administrative Surveys  15
Accommodations  16
Training  17
Administrative Chart  19
Table I.— Local Health Services  (Other than Greater Vancouver and
Victoria-Esquimalt)  20
Table II.—Offices and Divisions Providing Administrative, Consultative,
and Other Specialized Services  21
Report of the Bureau of Local Health Services  22
Health-unit Organization and Development  22
Administration  24
Community Health Centres  28
Resident Physician Grants  30
Home-care Programmes  31
Vernon Home-care Programme  33
Courtenay, Powell River, and Saanich Home-care Programme  34
School Health Services  35
The Health of the School-child  38
Disease Morbidity and Statistics  40
Table of Poliomyelitis Case Fatality Rates, British Columbia  43
Table I.—Summary of Health Status of Pupils Examined, according to
School Grades, 1955-56  43
Table II.—Health Status of Total Pupils Examined in Grades I, IV, VII,
and X for the Year Ended June 30th, 1955-56  44
Table III.—Health Status by Individual Grades of Total Schools, 1955-56 44
Table IV.—Number Employed and X-rayed amongst School Personnel,
1955-56  45
Table V.—Immunization Status of Total Pupils Enrolled, according to
School Grade, 1955-56  45
Table VI.—Notifiable-disease Incidence in British Columbia, Age-groups
5-14 Years and 15-19 Years, September 1st, 1955, to June 30th,
1956, Inclusive  45
Table VII.—Notifiable Diseases in British Columbia, 1952-56 (Including Indians), Rate per 100,000 Population  46
Table VIII.—Notifiable Diseases in British Columbia by Health Units and
Specified Areas, 1956  47
Report of the Division of Public Health Nursing  48
Status of the Service  48
Public Health Nursing Consultant Service  49
Public Health Nursing Training  50
Local Public Health Nursing Service  52
Maternal Health—Prenatal and Postnatal  52
Child Health—Infant and Pre-school  52
Child Health—School  53
Tuberculosis  53
Other Communicable Diseases  54
Nursing Care  54
General  55 W 8 BRITISH COLUMBIA
Page
Report of the Division of Environmental Management  56
A. Nutrition Services   58
Consultant Service to Local Public Health Personnel  58
Community Health  59
Maternal and Child Health  59
School Health  59
Consultant Services to Hospitals and Institutions  59
General Observations  60
B. Sanitary Inspection Services  60
Milk  60
Eating Places  61
Food Control  62
Slaughter-houses  62
Meat Inspection  62
Industrial Camps  62
Summer Camps  63
Plumbing..:  63
Trailer Parks  63
Barber-shops and Beauty-parlours  63
Pest-control  64
Garbage-disposal  64
C. Civil Defence Health Services  64
Hospital Planning  65
Survey of Facilities and Personnel  65
Training  65
Study Forums  66
D. Employees' Health Service  66
Constructive Medicine (Counselling and Health Education)  67
Emergency Medical Care  68
Surveys  68
Report of the Division of Preventive Dentistry  70
Outline of the Preventive Dental Programme in British Columbia  70
Education  71
Treatment  72
Research  72
The Role of the Community  72
Dental Personnel  73
General Remarks  73
Table I.—Part-time Dental-treatment Services in British Columbia (Community Preventive Dental Clinics) School-years 1948-49 to 1955-56 74
Table II.—Full-time Preventive Treatment Services in British Columbia,
Shown by Local Health Agency, School-years 1954-55 and 1955-56 74
Report of the Division of Public Health Engineering  75
Water-supplies  75
Sewage Disposal  77
Stream Pollution  78
Shell-fish  79
Swimming and Bathing Places  79
Frozen-food Locker Plants .  79
General  80 DEPARTMENT OF HEALTH AND WELFARE,  1956 W 9
Page
Report of the Division of Vital Statistics  81
Registration of Births, Deaths, and Marriages  82
Current Registrations  82
Delayed Registration of Births   82
Documentary Revision  83
Legal Changes of Name  83
Administration of the " Marriage Act "  84
Registration of Notices of Filing a Will  84
Microfilm and Photographic Services  85
District Registrar's Offices  85
Changes in Registration Districts and District Offices  85
Inspections  86
Vancouver Office  86
Statistical Services  86
Dental-health Statistics  87
Tuberculosis Statistics  87
Venereal-disease Statistics  88
Crippled Children's Registry  88
Mental Health Statistics  88
Cancer Statistics  89
Western Rehabilitation Centre Statistics:  89
Infant and Maternal Morbidity and Mortality Statistics  89
Child Growth and Development Charts  90
Epidemiological Statistics  90
Morbidity Statistics  90
Other Assignments  90
Procedure Manuals  91
Vital Statistics Special Reports  91
Summary of 1956 Vital Statistics  92
Principal Causes of Mortality  92
Report of the Division of Public Health Education  93
Revised Programme  93
Federal-Provincial Conference.^  94
Staff Education  94
Education of the Public  95
Personnel  96
Report of the Bureau of Special Preventive and Treatment Services, Vancouver  97
Administration  97
Faculty of Medicine, University of British Columbia  98
Voluntary Health Agencies  98
Alcoholism Foundation of British Columbia  99
British Columbia Cancer Foundation  99
British Columbia Medical Research Institute  99
Canadian Arthritis and Rheumatism Society (British Columbia Division) 100
Narcotics Addiction Foundation of British Columbia  100
Western Rehabilitation Centre  101
Canadian Red Cross Blood Transfusion Service  101
National Health Grants  101
General  101
Administration  102 W 10 BRITISH COLUMBIA
Page
Report of the Bureau of Special Preventive and Treatment Services, Vancouver—
Continued
National Health Grants—Continued
Grants Received for the Year Ended March 31st, 1956  102
Comparison of Amounts Approved and Actual Expenditures with
Total Grants for the Year Ended March 31st, 1956  102
Crippled Children's Grant  103
Professional Training Grant  103
Hospital Construction Grant  103
Venereal Disease Control Grant  103
Mental Health Grant  104
Tuberculosis Control Grant  105
Public Health Research Grant  105
General Public Health Grant  106
Cancer Control Grant  106
Laboratory and Radiological Services Grant  106
Laboratory Services  106
Radiological Services  107
Medical Rehabilitation Grant  107
Child and Maternal Health Grant  108
Report of the Division of Laboratories  109
Tests for the Diagnosis and Control of Venereal Diseases  109
Tests Relating to the Control of Tuberculosis  110
Salmonella-Shigella Infections  110
Other Types of Tests   112
Bacterial Analysis of Milk and Milk Products and Water  112
Bacterial Food Poisoning   112
Diphtheria  112
Parasitic Infestations   112
Fungous Infections  112
Miscellaneous Tests   113
Branch Laboratories  114
General Comments  114
Table I.—Statistical Report of Examinations Done during the Year 1956,
Main Laboratory  115
Table II.—Statistical Report of Examinations Done during the Year 1956,
Branch Laboratories   116
Report of the Division of Venereal Disease Control  117
Administration  117
Clinics  118
Epidemiology   119
Social Services  120
Education  120
Report of the Division of Tuberculosis Control  122
Case-finding Programme  122
Analysis of Hospital Admission Chest X-ray Programme   122
Mortality from Tuberculosis  125
Bed Occupancy   125
Committals to Sanatorium   127
National Health Grants  127
Report of the Rehabilitation Co-ordinator  129
Report of the Accounting Division  131
. Eleventh Report of the Department of Health and Welfare
(HEALTH BRANCH)
Sixtieth Annual Report of Public Health Services
YEAR ENDED DECEMBER 31st, 1956
G. F. Amyot, Deputy Minister of Health and Provincial Health Officer
In accordance with the practice of recent years, this volume consists of reports
written by the heads of the various bureaux and divisions which make up the Health
Branch. Although the reader is referred to those reports for the details of any one service
and its programme, some general observations may be made, as follows:—
During 1956 there was steady progress in the public health programme as a whole.
However, a larger than usual number of changes among senior professional and administrative personnel added considerably to the normal load of providing service.
According to preliminary figures, British Columbia's birth rate continued at a high
level in the Province during 1956 and the death rate changed only slightly from the previous year's figure. The excess of births over deaths (the natural increase) amounted
to about 22,400.
The preliminary figures also indicate that there was a reduction in the mortality rate
from the two leading causes of death—diseases of the heart and cancer. There was little
change in the death rate from the third leading cause—vascular lesions of the central
nervous system. These three causes accounted for approximately two-thirds of all deaths
in the Province. These were mainly in the older age-group.
Accidents were the fourth leading cause of death, when all ages are considered, and
were the leading cause between 1 and 39 years of age.
It is gratifying to be able to report, once again, that there were no grave outbreaks
of communicable disease. Poliomyelitis showed a marked decrease, displaying the lowest
incidence since 1950. There was a definite downward trend in the tuberculosis mortality
rate. The incidence of syphilis declined (although the incidence of gonorrhoea increased,
following a trend displayed in certain other areas on this continent).
The labour load carried by personnel of local health services continued to increase
because of the increase in population (particularly infants and younger children), the
expansion in industry, and the assumption of certain tasks and services which were
formerly the responsibility of the institutions. (Improved case finding and treatment in
the tuberculosis programme has enabled patients to return to their homes sooner than was
formerly possible. Many must be supervised and given further treatment in their homes
and this has added to the labour load of the public health nurse particularly. At the
same time, it has resulted in a significant reduction in the cost of sanatorium care.)
The relationships with voluntary health agencies have continued on a sound basis.
Those agencies receiving financial aid from the Provincial Government have co-ordinated
their programmes with those of the official health services. This has helped to avoid
duplication of effort and unnecessary expenditures.
In many places throughout this Annual Report, there are references to the National
health grants and the ways in which the grants have assisted British Columbia's health
and hospital services to advance more rapidly. The grants themselves and the assistance
and understanding of the officials of the Department of National Health and Welfare, who
supervise the grants on a Canada-wide basis, are deeply appreciated.
11 W 12
BRITISH COLUMBIA
The Deputy Minister of Health wishes also to express his deep appreciation of the
support and co-operation which he has received from many individuals and organizations.
These included professional groups, voluntary agencies, and other departments of government, as well as his fellow public health workers in the Health Branch. DEPARTMENT OF HEALTH AND WELFARE,  1956 W 13
REPORT OF THE BUREAU OF ADMINISTRATION
A. H. Cameron, Director
Most employees in the Health Branch, as in other organizations, find themselves
engaged in administrative activities of one form or another. This is true of nurses,
medical personnel, statisticians, and like groups who, although their chief responsibilities
lie in fields other than administration, must, nevertheless, be administrators. However,
as much as possible of the administrative burden should be taken away from such
employees. In the Health Branch, the Bureau of Administration has this responsibility.
Organizationally it consists of the central office staff (who deal primarily with general
administration) and also the Division of Vital Statistics and the Division of Public Health
Education. The Bureau is concerned with general organization, administrative procedures, personnel, accommodations, budgeting, education, training, and vital records and
analyses. The following sections deal with the year's experiences (the reader is also
referred to the Reports of the Division of Vital Statistics and the Division of Public Health
Education which appear later in this volume):—
BRITISH COLUMBIA'S ORGANIZATION FOR PUBLIC
HEALTH SERVICES
Preliminary returns from the census which was taken this year indicate that the
population of the Province is about 1,350,000. This is an increase of some 45,000 over
the estimate for 1955. On the basis of a Provincial area of approximately 366,000 square
miles, this gives a population density of 3.7 persons per square mile, one of the lowest
among the Provinces of Canada. The metropolitan areas of Greater Vancouver and
Victoria-Esquimalt account for almost half of the total population. Although there are
many flourishing cities throughout the remainder of the Province, there are also vast
areas which are only sparsely populated. The great distances and sometimes difficult
travel conditions are factors of great importance, particularly to the public health physician, the public health nurse, and the sanitary inspector.
Under the "Health Act," the Deputy Minister of Health is responsible for the
organization and development of the public health services throughout the Province.
Operating directly under his supervision is the Health Branch, whose organization is
shown in the administrative chart at the end of this section. As the chart indicates, the
Health Branch consists of central administrative and consultative services (for example,
Central Offices and the Division of Public Health Engineering), the Divisions concerned
with treatment and special services (for example, the Division of Tuberculosis Control
and the Division of Laboratories), and the "field " staff (local public health personnel).
The last mentioned are the public health physicians, public health nurses, sanitary
The last mentioned are the public health physicians, public health nurses, sanitary inspectors, dental officers, and clerical workers who serve at strategic points throughout the
Province outside the metropolitan areas of Greater Vancouver and Victoria-Esquimalt.
These Provincial Government employees form the staff of the seventeen health units*
which cover the non-metropolitan areas of the Province from the International Boundary
north to the units whose headquarters are at Prince Rupert and Dawson Creek. Table I
provides certain detailed information concerning the seventeen health units which comprise the Health Branch's local health services. Table II shows the offices and divisions
which make up the remainder of the Health Branch.
The two metropolitan areas of Greater Vancouver and Victoria-Esquimalt operate
their own health departments. Although they do not come under the direct supervision
of the Deputy Minister of Health, they receive substantial financial assistance from the
* A health unit is defined as a modern local health department staffed by full-time public-health-trained personnel
serving one or more population centres and the rural areas adjacent to them. W 14 BRITISH COLUMBIA
Provincial Government and, through the Provincial Government, from the Federal Government. The two areas co-operate closely with the Health Branch and their two Senior
Medical Health Officers are members of the Health Officers' Council which meets twice
yearly under the chairmanship of the Deputy Minister of Health.
Through either the metropolitan health departments (Greater Vancouver and
Victoria-Esquimalt) or the Provincial health services, public health services are made
available to practically every citizen of British Columbia. Calculations based on the
non-Indian population* show that slightly more than 50 per cent of the people of the
Province are served by the Provincial health Services, and slightly less than 50 per cent
are served by the two metropolitan health departments.f In all, 99.5 per cent of the
non-Indian population have public health services available to them.
STAFF
Table I shows that there were 261 staff positions in the seventeen health units of
local health services. This represents an increase of fifteen positions (thirteen public
health nurses and two sanitary inspectors) over the figure for 1955. The number of
vacant positions at any one time during the year was not large.
Table II, which relates to the remainder of the Health Branch, including the institutions, shows the number of employees on staff at the end of the year rather than numbers
of positions. (This method is used because there is a significant number of positions
which are not being utilized, although they are included in the official establishment.)
Although the number of persons employed on a particular date (the year's end in this
case) is not necessarily indicative of the trend throughout the year, a comparison with
the table in the 1955 Report shows that there has been considerable reduction in the staff
of Tranquille Sanatorium and a slight increase in the Division of Laboratories.
The year 1956 was noteworthy for the large number of changes in senior personnel
resulting from resignations, transfers, and deaths. The headquarters of the Bureau of
Special Preventive and Treatment Services and that Bureau's Division of Venereal Disease
Control and Division of Laboratories were most seriously affected. The sudden death of
Miss Jean Gilley of the Bureau headquarters came as a great shock to her many coworkers who had come to depend on her administrative abilities. The Bureau Director
suffered a serious illness at about the same time. These unhappy events necessitated a
reallotment of duties and responsibilities and a general reorganization of the offices concerned. Earlier in the year the Director, Division of Laboratories, who had been with
the Public Health Services on a part-time basis for some twenty years, resigned to assume
full-time duties at the University of British Columbia. The Assistant Director in the same
Division resigned to be married. Full-time appointments were made to both positions
and it is felt that the Division's high standard of service has been maintained. However,
the two resignations of the Director and Assistant Director represented great losses to the
Division of Laboratories and the Health Branch as a whole and created some problems
of reorganization. In the Division of Venereal Disease Control the untimely death of E.
Southen, epidemiology worker, was a sad blow to the members of this Division.
The problem of recruiting and retaining staff continued to present great difficulties
in certain employee-groups throughout the year. The shortage of properly qualified health
nurses was such that it was possible to maintain services only by adopting special staffing
policies which were not entirely satisfactory. Again the Health Branch had to employ
some nurses lacking the necessary special training in public health and to provide these
nurses with bursaries so that they could obtain the special training at university. Some
stability of staff was achieved by virtue of the fact that such nurses are obliged (by
* The Federal Government provides services for the Indians.
t It should be noted that the Provincial Health Branch provides the special services of its Divisions of Tuberculosis
Control, Venereal Disease Control, and Laboratories on a Province-wide basis which includes the metropolitan areas.
J DEPARTMENT OF HEALTH AND WELFARE,  1956 W 15
written agreement) to work for the Health Branch for two years following completion
of training. It was also necessary to employ a significant number of married women.
Although these married employees were properly qualified and experienced, it was difficult to transfer them to the areas of greatest need because of their family responsibilities.
The Division of Public Health Engineering has been forced to function with only
two engineers throughout the year. Although the present establishment makes provision
for three engineers, the nation-wide shortage in this professional group has been such that
the Division has not been successful in recruiting endeavours. This situation is particularly serious because a staff of only two engineers cannot cope properly with the normal
engineering tasks, let alone the responsibilities which have been added under the " Pollution Control Act." In order to include these last-mentioned responsibilities in a successful
programme, it is felt that the Division should have a staff of five engineers.
A somewhat similar situation has existed throughout the year in the Division of
Public Health Education, although the problem is, perhaps, somewhat less serious because
the responsibilities are not imposed by Acts of legislation as they are in the case of the
Division of Public Health Engineering. The Division of Public Health Education has had
no success in its efforts to recruit university graduates who are qualified to take advantage
of postgraduate training in public health which the Health Branch, using National health
grant funds, can provide to them. Throughout the year, the Division has attempted to
give Province-wide service, although there have been only two professionally qualified
public health educators on staff.
Because the Health Branch had not been able to obtain additional personnel already
qualified in sanitary inspection, the plan of recruiting untrained men and providing them
with training opportunities was again followed. Under this plan, eight employees joined
the staff as sanitary inspectors-in-training to gain the necessary practical experience and
also to assist in the public health programme. At their own expense they undertook the
correspondence course leading to the Certificate in Sanitary Inspection for Canada.
The provision of clerical services in the health units has long been a matter of great
concern, because there was some evidence that the professional staff were devoting too
much of their time to clerical tasks. With a view to developing at least a general policy,
the Director of Local Health Services appointed a survey team of an administrator from
the Division of Vital Statistics and a consultant from the Division of Public Health
Nursing to investigate and make recommendations to him. The team visited and studied
every health-unit office and sub-office in the Province. Although the report had not been
submitted in final form at the year's end, there is every indication that additional clerical
help is required if professional workers, particularly public health nurses, are to devote
their time and energy to the professional tasks for which they are trained and so urgently
needed.
ADMINISTRATIVE SURVEYS
In last year's Report reference was made to the survey of the entire Government
service, which was conducted under the general direction of the Civil Service Commission.
The chief purpose was a study of the efficient utilization of staff. In so far as the Health
Branch was concerned, the investigations were undertaken by two survey teams composed
largely of Health Branch officials. One team surveyed the institutions and the other
surveyed the remainder of the Branch.
The report of the survey conducted in the institutions was completed in June, 1956.
It showed that substantial reductions in expenditures on salaries had been made and that
further reductions could be made through appropriate reallocation of duties, amalgamation of positions, and deletion of unused positions. Most of the recommendations have
been put into effect.
The report of the original survey on the remainder of the Health Branch was completed in 1955 and was summarized in last year's Annual Report.   In that survey it was W 16 BRITISH COLUMBIA
recommended that the administration of the Divisions and offices occupying the Provincial Health Building in Vancouver be studied after those Divisions and offices had had
an opportunity of becoming accustomed to their new quarters. It was also recommended
that further studies of the practices in health units be undertaken.
The survey of the Health Branch services occupying the Provincial Health Building
was completed in January, 1956. The Divisions and offices surveyed were as follows:—
1. Headquarters of the Bureau of Special Preventive and Treatment Services:
2. Division of Venereal Disease Control:
3. Division of Laboratories.
The general conclusions of the survey report were:—
" The Provincial Health Building provides very adequate, modern accommodations
to almost all of its occupants. However, in the Division of Veneral Disease Control on
the ground floor, some improvements could be effected if certain structural alterations
could be made.
" There is good administrative organization and control.
" The Assistant Provincial Health Officer and other senior officials in the Building
appear to be giving constant attention to matters of organization and administration.
They seem to be keenly aware that changing needs in the health field must be reflected in
changes in administration and numbers of staff.
"It should be possible to effect some further centralization and consolidation of
services, now that the several offices and Divisions are located in one building.
" There is no evidence of any serious problem of overstaffing. However, it may be
possible to delete two or three positions through the consolidation of certain services and
modification of certain procedures."
The report in respect to the Provincial Health Building also made many detailed
suggestions concerning administrative and clerical procedures and, therefore, the effective
use of employees' services. In Bureau headquarters and the Division of Venereal Disease
Control, most of these recommendations have since been implemented. In the Division
of Laboratories, however, consideration of some of the more important recommendations
has been deferred until the new Director has had the opportunity of acquainting himself
with all aspects of his Division.
In the case of the health units, the formal survey undertaken this year dealt with
administrative and clerical procedures. This has been mentioned briefly in the previous
section on " Staff."
Thus, during 1955 and 1956, there have been four closely related surveys of the
administrative organization and procedures in the Health Branch. These surveys have
dealt with the Health Branch as a whole (excluding the institutions), the institutions
themselves, the services occupying the Provincial Health Building in Vancouver, and the
health units.
ACCOMMODATIONS
Last year's Annual Report referred to the serious problem of overcrowding in the
offices occupied by the Division of Vital Statistics in the Parliament Buildings. In an
effort to alleviate this problem, at least to some extent, certain changes in the allocation
of space were made toward the end of the year. The Division of Public Health Education moved some of its personnel from the second floor to the ground floor and so released
three relatively small offices for the use of the Division of Vital Statistics. Although this
has been a great help to the Division of Vital Statistics, it should be emphasized that it
was far from an ideal solution. Personnel of the Division still suffer from overcrowding,
excess noise, and the enforced utilization of too widely separated offices. In addition, the
convenient and safe storage of records, particularly vital records, still presents a problem
of the greatest importance. DEPARTMENT OF HEALTH AND WELFARE,  1956 W 17
The remainder of the Health Branch staff in the Parliament Buildings have pleasant,
adequate offices, although there is no longer any room for expansion. Further, the
storage room is now so crowded that space in the adjacent basement corridors must be
utilized for the storage of supplies and equipment.
Changing needs in the treatment of tuberculosis indicate that in-patient services
should be reduced, or even discontinued, in certain areas and increased in others. Reductions are indicated at Tranquille Sanatorium and the Vancouver Island Chest Centre.
(Fifteen beds at the Vancouver Island Chest Centre have already been released to the
Royal Jubilee Hospital for use as general hospital beds. This has, of course, been
reflected in reduced costs to the Division of Tuberculosis Control.)
Throughout the year, the planning committee, consisting of officials from the Health
Branch and the Department of Public Works, continued their studies of the proposed
addition to Pearson Hospital. Although agreement has been reached in respect to the
general planning, the detailed drawings have yet to be undertaken.
Space requirements at the Poliomyelitis Pavilion present an interesting problem.
Although the Pavilion, which is attached to Pearson Hospital in Vancouver, was intended
to accommodate fifty-five patients, experience has shown that the building is capable of
housing only a somewhat smaller number. This stems from the fact that some patients
require not only an ordinary hospital bed, but also a respirator and, perhaps, a rocking
bed. Much of the ward space is occupied by these additional items of bulky equipment.
This problem would be particularly serious if there were an increase in poliomyelitis.
During the year, efforts were made to plan—although not necessarily to build—suitable
storage space.
It is gratifying to note that there was a continuation of the construction programme
to provide adequate office and working accommodations for the staff of local health
services throughout the Province. (Under a plan introduced five years ago, the cost
of constructing any one community health centre is shared by the Federal, Provincial,
and municipal Governments. Service clubs and voluntary health agencies often make
important contributions to the municipal share. National health grants are the source
of funds for the Federal share.) During 1956, five more community health centres,
including two in Greater Vancouver, were completed, bringing to twenty-two the number
constructed under this plan. Similar facilities were being planned or were, indeed, partially completed in approximately twelve other communities.
TRAINING
The Health Branch is responsible for providing a wide range of services to the public.
The adequacy of these services depends very largely on the professional and technical
qualifications of the Health Branch employees. It is fortunate, therefore, that the Health
Branch has been able to maintain an active training programme. During 1956, there
were, broadly speaking, three general methods used. First, National health grants funds
were used to support university training. Nineteen Health Branch employees completed
postgraduate training at university and fourteen embarked upon similar training. Forty-
three others attended short courses for which the cost of tuition and travel was also
defrayed by the National health grants. Second, the Health Branch, in co-operation with
the Department of Public Health of the University of British Columbia's Faculty of
Medicine, organized a refresher course for medical health officers who had received their
basic training some years ago. This enabled these key officials to gain knowledge in the
newer public health developments. National health grants were used to help defray the
costs. Third, the professional status of the field staff generally was improved by a concentrated series of lectures conducted over a period of four days at the Public Health
Institute held immediately after Easter. Because the whole purpose of the Institute is
to provide further training, and so to improve the quality of service to the public, the W 18
BRITISH COLUMBIA
speakers and discussion leaders are chosen carefully for their ability to deal with subjects
which are causing some concern to Health Branch personnel. The lectures are conducted
on a formal basis and attendance is compulsory. The Health Branch was fortunate this
year in having as its guest speaker Dr. Charles Smith, Dean of the University of California's School of Public Health. Other speakers, from the Health Branch and from
other agencies, dealt with public health law, accident prevention, stress, mental retardation, and other subjects on which public health workers must keep informed. DEPARTMENT OF HEALTH AND WELFARE,  1956
W 19
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BRITISH COLUMBIA
Table I.—Local Health Services (Other than Greater Vancouver
and Victoria-Esquimalt)
Population (Excluding
Indians)
Staff (Positions)1
Health
Unit
No.
Health Unit
Headquarters
School
Districts
Included
n
M
O
u
fi
s
"6 8
•§85
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U ■1-'
38
'3 o.
C-M
.-H    M
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oo
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1
East Kootenay
Selkirk 	
West Kootenay
North Okanagan...
South Okanagan...
South Central	
Cranbrook	
Nelson..   .
Trail 	
Vernon	
Kelowna         	
Kamloops	
Chilliwack	
Mission.—  	
Cloverdale 	
New Westminster	
Gibsons and Squamish
464 Gorge Road East,
1, 2, 3, 4, 5,
18   	
35,556
21,791
34,817
36,448
52,134
32,464
47,005
26,666
69,986
28,775
11,506
58,470
71,938
32,778
50,392
23,085
18,060
8,579
3,900
HO6
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
9
6
10
10
14
8
10
6
14
6
3
14
15
10
12
6
4
2
1
1
2
2
2
2
3
2
3
1
3
1
1
2
3
2
3
2
1
1
1
1
1
_
1
1
i
i
i
l
i
i
1
1
2
2
3
2
3
2
3
1
3
4
3
2
2
1
13
2
3
4
5
6
6, 7, 8, 10
9, 11, 12, 13...
19, 20, 21, 22,
78  	
14, 15, 16, 17,
23, 77	
24, 25, 26, 29,
30, 31 	
10
15
17
23
13
7
32, 33, 34	
42, 75, 76
35, 36, 37     ...
43  .
46, 48 	
17
8
9
10
11
North Fraser	
Boundary     _
Simon Fraser2
Gibsons-Howe
Sound3	
Saanich and South
Vancouver
Island
12
21
11
4
12
61', 62, 63,64
65, 66, 67, 68,
69, 70, 79....
47, 71, 72
27, 28, 55, 56,
57, 58 	
50, 51, 52, 53,
54  	
59, 60, 81     ...
80  	
49    .
^n
13
Central Vancouver Island
Upper Island	
14
15
Courtenay	
Prince George	
Prince Rupert 	
Dawson Creek	
Kitimat5 	
Ocean Falls5 	
Telegraph Creek5..	
25
16
16
17
Skeena...	
20
11
7
2
1
Totals
1
16
161
35
6
6
35
059
1 These figures show the authorized positions. There were vacancies in various places at various times during the
year. Further, in addition to the clerks shown, part-time clerical assistance was provided in certain centres at various
times.
2 The 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.
4 In part.
5 Kitimat, Ocean Falls, and Telegraph Creek have not yet been included officially in health units, although a nurse
is stationed in each area.
6 Approximate. DEPARTMENT OF HEALTH AND WELFARE,  1956
W 21
Table II.—Offices and Divisions Providing Administrative,
Consultative, and Other Specialized Services
Office or Division
Location
Staff1
Central Office2. - -  	
Branch Offing
Vi ctoria  ■	
Vancouver _    	
Victoria    	
Vancouver  _ 	
Vancouver  	
Vancouver _	
Nelson _ _ 	
28
22
Division of Vital Statistics   	
Division of Venereal Disease Control...   	
Division of Laboratories    	
Division of Tuberculosis Control—
61
15
23
53
2
15
Willow Chest Centre '■	
161
226
Tranquille Sanatorium  	
Tranquille  	
252
11
7
4
Coast Travelling Clinic   _. _  	
Vancouver.   __.
3
3
3
Vancouver _ 	
62
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 numbers 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. W 22 BRITISH COLUMBIA
REPORT OF THE BUREAU OF LOCAL HEALTH SERVICES
J. A. Taylor, Director
Health Department administration at all levels of government, National, Provincial,
or municipal, aims at the development of conditions suitable to the initiation and maintenance of maximum health for all citizens. Toward accomplishment of that goal, it is
necessary that practical public health programmes be designed to meet the health needs
of the people for whom they are destined; the most logical approach to this being through
local health services at the municipal level, which are in more direct contact with the
people and best able to determine the community health needs, the basic services required,
and the methods of administering them. The National and Provincial health departments,
in order to have their services attain maximum effectiveness, have a very definite interest
in the organization of local health services, and provide encouragement and assistance in
the form of technical, supervisory, and consultative aid, as well as financial grants.
The Bureau of Local Health Services exists at the Provincial level to guide in the
development of a basic minimum standard of local health service throughout the Province, while co-ordinating the consultative and supervisory technical services provided by
the various Departmental Divisions and voluntary health agencies. It serves as a link
between the services designed at the National-Provincial levels and their administration
at the municipal level in the form of community health services.
Local Health Services in British Columbia has become organized along the lines of
health-unit administration. This provides for the organization of a full-time Health
Branch to provide public health services to a number of communities and school districts
which, of themselves, could not support an adequate local health service, but through
unification under a Union Board of Health, aided by National and Provincial health
grants, are able to do so. Equivalent full-time public health services on the local level
are thus available to nearly every resident in British Columbia, regardless of location,
through the seventeen rural and eight urban health units in the Province. The seventeen
rural health units, serving the large interior areas of the Province, are administered more
or less directly through the Health Branch, Department of Health and Welfare, while the
eight urban health units operate in the Greater Vancouver and Greater Victoria areas
under a metropolitan type of administration, functioning under Metropolitan Boards,
which employ their own staff directly, but, nevertheless, provide the same type of public
health service. Certain areas of the Province, because of the mountainous terrain, are
sparsely populated and full-time local health service administration is hardly warranted;
in those areas, part-time service is provided through periodic visits from a nearby health
unit, or employment of resident physicians or nurses on a part-time basis.
While, in principle, the provision of local health service is a municipal responsibility,
the significant contribution by National and Provincial health departments in the matter
of monetary grants, has aided materially in the organization, expansion, and development
of those local health services. The National health grants programme, commencing in
1948, gave a very direct impetus to health-unit organization; expansion of the existing
services and development of new services become permissible through the continuation
of the grants, permitting Provincial planning to meet the health needs of an expanding
population.
HEALTH-UNIT ORGANIZATION AND DEVELOPMENT
The continuing expanding economy of the Province creates demands for additional
public health services, since the mere fact that there are additional people to be served
increases the work load on each member of the health-unit team to the degree that
additional staff must be provided to cope with the increased demands. Health-unit
organization is planned on a definite population basis on a formula developed around a DEPARTMENT OF HEALTH AND WELFARE,  1956 W 23
recognizable effective case load per member of the staff. As these case loads become
exceeded, then consideration must be given to the placement of additional staff within
the unit. A considerable amount of this has taken place during the year, particularly in
the ranks of public health nurses and statistical clerks, and to a lesser degree in sanitary
inspectors. Thus it became necessary to place additional public health nurses in the
Cariboo, Boundary, Gibsons-Howe Sound, Skeena, Upper Island, South Central, Simon
Fraser, North Okanagan, and Saanich and South Vancouver Island Health Units, while
sanitary inspector trainee positions were created in the Selkirk and Upper Island Health
Units in addition to the five such positions created a year ago. Probably the most pressing
demand was in relation to statistical clerk positions in the health-unit offices and sub-
offices to deal with the increased amount of office administration, record maintenance,
and filing. It was found necessary to place additional clerks in the Upper Island and
North Fraser Health Units on a full-time basis, while many hours of additional part-time
clerical assistance was added in toto as each of the seventeen rural health units benefited.
Industrial developments throughout the Province are creating population increases
and community growth generally, but more rapidly in some areas than in others. One
of these is the community of Kitimat, which, because of expert town-planning prior to its
inception, is following an orderly pattern of development. Included in the town-planning
recommendations was the provision of an adequate local health service, designed on a
progressive step-by-step development paralleling the population growth and community
needs. A year ago, the first resident public health nurse, succeeding the previously
appointed part-time nurse, took up duties in Kitimat to assist the part-time Medical
Health Officer, while regular visits by a sanitary inspector from the neighbouring Skeena
Health Unit were arranged. As the planned industrial growth took place and housing
became available, further population increases occurred, so that an additional public
health nurse appointee became necessary during this year. Plans are progressing for
further industrial expansion and negotiations are under way for extension of the community medical-care programme in which preventive medical services are to assume their
justifiable share. In keeping with the original community planning, negotiations will be
undertaken during the forthcoming year to establish a complete full-time local health
service in Kitimat, under the direction of a qualified public health physician. Certain
preliminary discussion in that direction has occurred in meeting with the Hospital Administrator, the Hospital Board, the community administrator, and the present Medical
Health Officer.
Another area of the Province which is experiencing a more than normal industrial
expansion, with an allied population increase, is that area served by the Cariboo Health
Unit. This health unit, originally designed to serve the communities of Prince George,
Vanderhoof, Quesnel, Williams Lake, and the school districts related to them has, over
the year, taken on the communities of Burns Lake and McBride, and the school districts
centred on them. Thus, a health unit which was originally planned to provide service to
about 30,000 people has now grown to provide service to 50,000 people. Because of
the population density, the communities are scattered over the length of the major transportation routes, so that the unit has become a large sprawling area in which many hours
of travel must be expended in the provision of public health services. Recently, the
organization of yet another school district in the Chilcotin area indicates that the unit
should probably expand its borders to include that rural school district formerly within
the health-unit area. It does appear that the unit is attaining a size unwieldy to administer
and raises the suggestion that a division be made to establish two separate administrative
units in place of the present one. Certain investigations are being conducted to determine
population distributions on the basis of the recent census which may give additional data
indicative of the division that could be established.
School District No. 49 (Ocean Falls), which became established as a public health
nursing district a year ago, experienced an interruption in service with the resignation of W 24 BRITISH COLUMBIA
the public health nurse. For a period of four months a replacement was unobtainable
and the service had to be discontinued in that particular area; fortunately, the interruption coincided with the summer vacation period when schools were closed and service
demands were at a minimum. With the reopening of the schools in the fall a public
health nurse from one of the organized health units, with a background of experience,
transferred to the Ocean Falls area and re-established the service.
It was also possible during the year to re-establish the full complement of the Peace
River Health Unit, which had been operating for a year without the services of a public
health physician. A physician, qualified in public health, accepted the appointment
during the summer, emigrating from Ireland to Canada to take up this post. This occurred
at a fortuitous time since considerable industrial development occurring in the Peace
River Block will present the need for a complete local health service in keeping with the
expanding community demands. The Director of the Selkirk Health Unit, with headquarters at Nelson, had for some time felt that increased interest should be concentrated
in the field of mental health. He decided that he would like to direct his energy and
training in that direction, but recognized that he should obtain further postgraduate
qualification in the mental-health field. Consequently, he submitted his resignation in
the early fall to pursue postgraduate training in the United Kingdom. As his departure
came unexpectedly, it was not possible to replace him until almost the end of the year,
when a young physician from Scotland arrived to take up the appointment.
While two of the physicians accepted bursaries toward public health postgraduate
studies, it was, nevertheless, possible to cover their leave of absence with additional
recruits, particularly in the Skeena Health Unit, so that as the year ended, all established
positions requiring health-unit directors were completely staffed. This is the first time
that this has been possible within the past two years. It is recognized that certain staff
changes and health-unit expansion proposed for next year will effect a disturbance in this
state of affairs, and that additional physicians will still have to be recruited in order to
meet the demands.
The local health services within the metropolitan areas of Greater Vancouver and
Victoria-Esquimalt continued to make substantial progress during the year. While these
services operate somewhat independently of the direct supervision through the Health
Branch, they nevertheless maintain a very excellent co-operation and participate in the
annual Public Health Institute and the bi-annual meeting of the Health Officers' Council.
The negotiations that have been under way in the Greater Victoria area toward amalgamation of local health services became reactivated during the year when a meeting of the
various local Boards of Health was convened to review the matter. It was evident from
that meeting that there was some interest in a merger of the local health services of the
Victoria-Esquimalt Health Unit, the Saanich and South Vancouver Island Health Unit,
and the Municipality of Oak Bay, but that there were some factors of administration and
staffing that would require detailed study. Dependent upon those details was the matter
of an over-all financial consideration of paramount importance, particularly to the
Municipality of Oak Bay, but also to some extent to the Victoria-Esquimalt Health Unit.
The meeting finalized a recommendation that a committee be struck of representatives of
the various groups to prepare detailed data on those points, for consideration by the
committee at a subsequent meeting. Negotiations are continuing in that direction in the
hope that a merger can take place to establish a Greater Victoria metropolitan area in
which there will be unification of the local health services under one administration.
ADMINISTRATION
Certain changes within the Division of Preventive Dentistry occurred during the year
as the Director of the Division was granted leave of absence to undertake a dental-caries
study in Malaya, under the Colombo Plan.   It is anticipated that he will be absent from DEPARTMENT OF HEALTH AND WELFARE,  1956 W 25
his duties for a period of one year. Meanwhile the administration of the Division is
being assumed on a part-time basis by the Regional Dental Director from the Fraser
Valley, as Acting Director. It is anticipated that this temporary move will suffice for
the interim period of leave of absence, as sufficient advance planning had been prepared
to provide for continuity of administration within that Division and the Acting Director
had been carefully oriented in the Divisional activities.
The major administrative problem requiring special consideration was in relation
to the clerical assistance needs within local health units. The population growth within
the Province led to additional professional staffs being required, which in turn creates
demands for additional clerical assistance. At the same time, there seemed to be a
need to review the records being used, and the manner in which they were handled.
About five years ago, a study was conducted through the health units then in existence,
to determine the volume and methods and use of records, following which a clerical
administrative manual of procedure was prepared for the guidance of the health-unit
clerks. There would seem to be some value in re-examining those recommendations to
see if health-unit usage had shown them to be practical, and to revise the manual, if
necessary. Further, there would seem to be some reason to determine whether the
formula of one clerical worker to each four professional personnel was justified, since
public health nursing time-studies revealed that the amount of non-professional clerical
work being undertaken by public health nurses was steadily increasing, having risen
from 4.1 per cent in 1953 to 6.6 per cent in 1955, of the time of the average public
health nurse. Consequently, it was decided when an appointment was made to the
vacant Public Health Nursing Consultant position that her first major job would be to
conduct a health-unit clerical survey, to be assisted by the Chief Clerk of the Division
of Vital Statistics who was to be loaned to the Bureau of Local Health Services for that
purpose. The team has conducted a very extensive survey of the office administrations,
office management, volume of records, handling of records, record needs, filing systems,
office accommodation, volume of correspondence, filing procedures, stenographic requirements, and so forth. It becomes evident that the health-unit clerks perform a considerable number of functions which place an exceedingly heavy burden on them during a
working-day, and that they, as the first contact with an inquiring public, have a major
role to perform in the public relations of the health service. Clerks are seen to be acting
as receptionist, record-clerk, file-clerk, mail-clerk, stenographer, typist, and general
information clerk. The growth of public health services has increased the scope of
activities performed by health-unit clerks, requiring more and more service from them
to maintain a smoothly operating office. It was possible to make certain individual
recommendations to the health-unit directors in respect to individual offices dealing with
local phases, such as physical rearrangement of the office, readjustments in office management, and certain minor changes in office procedures. The other recommendations
of somewhat greater magnitude dealt with the need for additional clerical assistance in
specific offices, the provision of dictating equipment, reorganization of office administrative functions, establishment of a uniform sanitation record system, and revision of
public health nursing record systems. In order to effect some of these changes, it is
recommended that three special committees be struck to get the recommendations under
way, namely, an administrative procedure committee, a sanitation record committee,
and a public health nursing record committee. These recommendations were under
active consideration as the year ended, to determine how far it would be possible for
the Health Branch to effect the changes, and establish the committees. It is generally
recognized, however, that the clerical survey of the health units did establish the first
comprehensive analysis of the office routines, while creating a base-line on which to
reorganize the office systems.   Certainly, it was learned that the formula of one clerical W 26 BRITISH COLUMBIA
worker to each four professional personnel was inadequate, and the team has recommended that it would probably be more in keeping with clerical needs if the formula
became one clerical worker to 3.5 professional personnel.
For some time, there has been an indication from some individual Union Boards
of Health that there was a need for an annual gathering of representatives of Union
Boards of Health to discuss problems which might be of common interest. Department-
ally, it has been recognized that there might be some merit in the suggestion and the
Health Branch has indicated a willingness to co-operate in such a meeting. The major
hindrance in the proposal lies in the fact that Union Boards of Health are composed
of representatives from Municipal Councils and from District School Boards, and it is
difficult to determine what type of meeting could be arranged which would satisfy both
representative bodies. One suggestion was that a meeting be held to coincide with the
annual meeting of the Union of British Columbia Municipalities, and certain steps were
taken in that direction two years ago when a meeting was convened during the Union
of British Columbia Municipalities Convention in Victoria; arising from that meeting,
a committee was struck to investigate ways and means of convening an annual meeting
in conjunction with the Union of British Columbia Municipalities Convention, but the
Executive Committee of the Union of British Columbia Municipalities did not much
favour the proposal, feeling that they did not desire to foster sub-committees, preferring
that the matter that might come before a sub-committee be discussed openly on the floor
of the Convention. However, the South Okanagan Union Board of Health, who were
the original sponsors of the proposal, felt that the matter merited further consideration
and suggested that representatives of Union Boards of Health be convened in Penticton
during October, when the Union of British Columbia Municipalities Convention would
again be in session. Consequently, such a meeting was convened at that time, and
following discussion by the members present, it was decided that an Executive Committee
pro tern, be appointed to draft a constitution for consideration by the various Union
Boards of Health toward establishing a Provincial Co-ordinating Committee of Union
Boards of Health. It was further decided that another meeting should be called the
following year, again in conjunction with the Convention of the Union of British Columbia Municipalities, at which time the proposed constitution could be voted upon.
Administratively, the guidance provided 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, has been of significant assistance to the
Bureau of Local Health Services. The Local Health Services Council, while serving to
orient each of the divisional directors in all phases of local health services, has additionally given consideration to changes in policy procedures and programmes. The frequency
of the meetings lends itself to their being kept acquainted with events occurring within
local health services in the field, while promoting an inter-exchange of information on
services within the separate Divisions.
The bi-annual meetings of the Medical Health Officers' Council were convened,
as usual, in April and September. This Council, composed of the Medical Health
Officers from the seventeen rural health units, the Senior Medical Health Officer from
the Vancouver Metropolitan Health Service, the Senior Medical Health Officer from
the Victoria-Esquimalt Health Unit, the Professor of Public Health in the Faculty of
Medicine at the University of British Columbia, the Regional Superintendent, Pacific
Region, Indian Health Services, acts in the capacity of an advisory group to the senior
officials in the Health Branch, advancing suggestions for modification in existing policies
and programmes, while introducing the need for new policies and programmes. It has
now become common practice to refer such matters as proposed new legislation, new
regulations, and new administrative materials to this Council for their study and comment
before finalizing the details.   In this way it is felt that the legislative and administrative DEPARTMENT OF HEALTH AND WELFARE,  1956 W 27
materials become as practical as possible to fit the field needs. In addition to their practical function in this way, the biannual conferences of the Health Officers' Council serve
as a clearing-house in which exchange of ideas leads to uniformity of public health
practice throughout the Province, while promoting pilot studies of new practices in specific areas. In keeping with this, there have been a number of sub-committees established
to deal with specific services in which there seems to be need for constant review. Thus,
there have been active standing committees established in such fields as school health
services, communicable-disease control, tuberculosis practices, and others. The deliberations of these committees serve as a guide to points for discussion at future Health
Officers' Council meetings in relation to modifications that may be necessary in the practical field service in those particular fields.
It has been Departmental opinion, emphasized by the Health Officers' Council from
time to time, that opportunity should be presented within the service for professional
growth. One method of approach to staff education is through the medium of the
annual Public Health Institute at which health-unit personnel throughout the Province
are convened for a period of one week, to hear discussions on the latest public health
trends, presented through lectures, panels, forums, and symposiums. Each Public Health
Institute is organized around a guest speaker who deals in current topics in the field of
public health, and this year's gathering was no exception, since Dr. Charles E. Smith,
Dean of the School of Public Health at the University of California, very capably assumed
that role.
A year ago, inquiries were made of the Royal College of Physicians and Surgeons
to determine if an opportunity for the examinations toward certification as specialists in
public health might not be provided to candidates from Western Canada, through a
Western centre. The answer was that, if there should be a sufficient number of applicants
from the West, the examinations could be held in Vancouver during the present year.
A poll of the employed Medical Health Officers indicated that there would be a dozen or
more interested in taking the examination, and a sub-committee of the Health Officers'
Council was appointed to further the proposal. The Department of Public Health within
the Faculty of Medicine at the University of British Columbia organized a short series of
lectures and recommended certain reference reading to assist the potential candidates in
their studies toward certification examinations. Eleven physicians successfully completed
the examinations, obtaining certification in public health.
In addition to the training that was offered to this group of health-unit personnel,
another course was organized for the sanitary inspectors to provide them with information
on plumbing. The course was developed by a master plumber, acquainted with the
developing trends in plumbing installations, and an exceedingly capable instructor who
was able to develop his subject clearly, and handle discussions that followed. As a result,
the sanitary inspectors' group benefited materially from the two-week course, while local
health services became manned by persons able to approach plumbing problems and
complaints with confidence, realizing that they were possessed of the most up-to-date
knowledge on that phase of sanitation services.
There were numerous other items within administration fields that took a great deal
of administration time during the year. Two of these were related to sanitation, the first
being in regard to milk legislation, and the second in regard to fish canneries. Numerous
discussions and conferences were convened with officials of the Department of Agriculture
in the designing and interpretation of new legislation in the nature of regulations
required under the newly drafted and adopted " Milk Industry Act." The place of each
of the people involved in inspections is more clearly defined and interpreted to prevent
overlapping while rendering thorough coverage toward production of safe milk, as proposed through the Clyne Report. W 28 BRITISH COLUMBIA
In so far as the fish canneries are concerned, there has been some dissatisfaction
expressed in the matter of housing, overcrowding, and sanitation for the cannery employees, particularly the native groups. This, coupled with the fact that there seems to
be certain typhi and paratyphi carriers amongst that population, creating potentialities for
spread of infection, leads to a desire to improve their lot, while protecting others. Thus,
conferences were convened on at least three occasions during the year between representatives of the Indian Health Services, Local Health Services, cannery management,
and cannery operators. Arising from those conferences was a definite programme toward
improving the situation through joint efforts of the interested parties. This involved
intensive immunization programmes on the part of Local Health Services, improvement
in living conditions by cannery operators and management, regular inspections of the
premises by sanitary inspectors, and a programme of medical care through the Indian
Health Services. Progress was evident during the recent canning season, and it is planned
that further progress will be developed for future canning seasons, so that the problem
will become less intense in the future. In all of this, the role of the native employee
loomed large and it is evident that the efforts of the official groups are dependent upon
the co-operation of the native employee, who must pursue a changing course in the
interests of his own, and his neighbour's, health.
COMMUNITY HEALTH CENTRES
Consistent progress in the construction of new community health centres to accommodate local health services, both official and voluntary, can be recorded, originating
from the plan introduced five years ago toward shared financing of the construction. This
past year has seen five more community health centres attain completion to bring the
total to twenty-two community health centres now in operation under this plan. With three
others under construction, nine in the planning stage, and two in which additions are
being contemplated, it becomes evident that the accommodation for local health services
throughout the Province is becoming considerably improved over the poor makeshift
rented premises formerly pertaining as office accommodation.
The plan operates on the premise of a one-third financial sharing by National,
Provincial, and municipal Governments toward construction of a specially designed
community health centre. In so far as the municipal share is concerned, contributions
by local service clubs or voluntary health organizations or by public subscription have
been accepted, and often the local municipal sponsorship of the building is undertaken
by a voluntary service club. In a considerable number of instances, the British Columbia
Tuberculosis Society contributed from funds raised through Christmas seal campaigns,
recognizing the part that Local Health Services contribute to the broad programme of
tuberculosis control, while at the same time acknowledging the contributions that have
been made over the years to that fund by these local communities. In much the same
way, contributions from the Canadian Cancer Society, British Columbia Division, have
assisted in the financing of the building, as well as rental contributions from the British
Columbia Branch of the Canadian Red Cross Society.
In return for the financial assistance provided to the construction of these community health centres, the voluntary health agencies are provided with space in which to
conduct their activities, including board rooms for their meetings and storage space for
their supplies and materials. Thus, the building becomes truly a community health
centre, accommodating both the official health department personnel and the voluntary
health agencies, thereby co-ordinating all the community health services in one centre.
In conjunction with this movement toward improved accommodation for community
health services, due recognition must be accorded the very considerable assistance stemming from the financial contributions of the National health grants.  The support engen- DEPARTMENT OF HEALTH AND WELFARE,  1956 W 29
dered by their participation in the planned shared financing did much to originate the
scheme, while its continuation over the years has spelled increasing success as the move
toward improved health-unit quarters becomes adopted by more and more communities.
Two of the health centres constructed during this past year were in the Metropolitan
Health Service area serving Greater Vancouver. The first of these was designed and
built in conjunction with the modern municipal building for the Municipality of Burnaby,
which unites all the municipal services in a combined administrative unit. The space
allocated to health department purposes entailed an expenditure of $99,953, of which the
National health grants contributed $15,000, matched by an equivalent amount Provin-
cially. The second, built at a cost of $80,485, was erected in North Vancouver to provide
administrative headquarters for the staff of the North Shore Health Unit. This building
was officially opened by the Federal Minister of Fisheries during the early summer.
During the opening ceremonies, the Deputy Minister of Health for the Province, who
served as the first Medical Director of that Health Unit, reviewed some of the highlights
of the early struggles of the service which laid the groundwork for the present progressive
community approach. The Health Unit has kept pace with the growth of the communities
and school districts it serves, to exemplify the value of unification in local health
administration.
During the summer, also, the Deputy Minister of Health officiated at the opening
of the Lillooet sub-office in the South Central Health Unit. Construction of this modern
office and clinic space was undertaken by the Board of School Trustees for School District
No. 29, who included the space as a unit of the newly constructed School Board offices.
Financial arrangements, in addition to the National and Provincial sharing, included
some contributions from voluntary health agencies.
The City of Prince George became interested in a community health centre for their
health department purposes in 1955, when it became evident the School Board was in
need of the space being rented to the Health Unit as headquarters offices. Plans were
speedily completed, but the earlier-than-usual winter prevented construction completion
until this past summer. The building, constructed at a cost of $58,155, became occupied
soon after completion, with an official opening during September by the Chairman of the
local Board of Health, Mrs. E. Gray. There was a very fine spirit of community co-operation in financing the project, as many associations and groups contributed funds and
materials to assist with the local share of the cost. It has resulted in a two-story building,
the first of its kind in design, providing for present official and voluntary health agency
needs, while offering opportunities for future accommodation in keeping with the anticipated demands for service from a rapidly growing community.
The last of the community health centres to become completed during this past year
was the headquarters of the North Fraser Health Unit at Mission City, which was constructed at a cost of $31,411 through the sponsorship of the Rotary Club there. It has
resulted in an exceptionally well-designed, well-constructed, and well-appointed health-
unit centre, in which space is sufficient to meet the needs of the community health agencies,
both official and voluntary. It represents co-ordination of all community health services
in a unified approach to the health needs of the community and district. Financing was
a joint arrangement with contributions from National health grants, Provincial health
grants, district municipal grants, Village of Mission City grants, Tuberculosis Society
grants, Cancer Society grants, Red Cross Society grants, and Rotary Club grants. The
Minister of Health and Welfare, who officiated at the opening ceremonies, took the
opportunity to emphasize the value of the unified approach in the conduct of community
health services and complimented the area for their forward outlook in that regard. The
first public health nurse appointed to Mission City and District, Miss M. Grierson, was
signally honoured at the opening ceremonies, establishing a link with the past and the
present in due recognition of the major contribution of the resident public health nurse, W 30 BRITISH COLUMBIA
who pioneered the way in community health with the commencement of functions as
a school nurse.
Interestingly enough, two community health centres constructed under this programme are already beginning to find that additional space is desirable, and negotiations
are under way toward construction of additions to the original buildings. The headquarters of the South Okanagan Health Unit at Kelowna, which was constructed in 1952,
find that additional quarters are needed for the voluntary health agencies. Discussions
are under way between the community and the voluntary health agencies to see if an
addition could not be made to the original building to provide the much-required space.
The other is the sub-office of the North Fraser Health Unit at Haney, where the Maple
Ridge Community Health Centre was constructed in 1953 under the sponsorship of the
Maple Ridge Lions Club. In this particular building, increased staff needed to meet the
increased growth of the community, require more office and clinic accommodation.
Plans are therefore being considered for additional construction to that building.
At the moment, construction is under way toward the provision of community health
centres in the Municipality of Richmond, the City of Penticton, and the City of Rossland.
Hopes are held for their completion in the early spring of 1957. In addition, planning
is going forward for construction of community health centres at Kitimat, Burns Lake,
Vanderhoof, Salmon Arm, Trail, Cloverdale, Langley Prairie, Ladysmith, and Qualicum
Beach. From all of this can be gathered the considerable amount of community interest
that has become centred in construction of these centres. The construction of one serves
as a concrete example of accomplishment in a community, thereby creating a desire for
similar health department buildings in other communities; thus, the project grows as the
years go by, indicative of the fact that the plan of financed sharing should be continued
into the future.
Health units in certain other parts of the Province obtained new office accommodation during the year through other means. The headquarters of the East Kootenay
Health Unit at Cranbrook, which had been exceedingly poorly housed, were able to move
into new space provided in the newly constructed Court-house there. This serves to meet
their needs for some time to come and provides them with up-to-date modern quarters to
carry on the community health services for that large district. The Saanich and South
Vancouver Island Health Unit, which has grown apace with the rapidly increasing population in the lower Vancouver Island area, has had to move four times in the past eight
years in order to accommodate the increasing staff. Another move during this past year
provided much more spacious accommodation for their needs, although, regrettably, the
accommodation had to be located outside the municipality for which the major service is
provided. This arrangement was provided on a rental basis; a community health centre
would be a much happier approach to the housing needs of that local health department.
RESIDENT PHYSICIAN GRANTS
Numerous small communities, often in remote areas, are unable to obtain medical
care because of their inability to attract a local resident physician, since there would
hardly be a sufficient volume of therapeutic need to maintain his professional interest, or
provide sufficient remuneration for a livelihood. In order to assist in the provision of
medical care to these communities, a programme of grant-in-aid to resident physicians
has been operative for some years through the Department of the Provincial Secretary,
but for the past three years through the Health Branch, Department of Health and
Welfare. It is designed to encourage physicians to take up residence in remote communities and to provide service on a periodic schedule of visits to neighbouring communities which are not sufficiently large enough in themselves to support a physician. The
amount of the grant is based upon a definite formula of grants on a sliding scale, inversely
proportionate to the population density, and directly proportionate to distances to be DEPARTMENT OF HEALTH AND WELFARE, 1956 W 31
travelled. The grant in itself, therefore, is not large, merely serving to reimburse the
physician to some extent for the out-of-pocket expenses incurred in providing the necessary medical supervision of the community's sick. 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 to the Health Branch, Department of Health and Welfare, outlining the
services provided for which a quarterly proportion of the grant is paid. During the year,
grants were continued to twenty-one physicians in the administration of medical care to
thirty communities.
An increase in the grant paid to a physician at Sooke was negotiated to permit him
to provide more frequent periodic visits to the small communities along the extreme
south-western tip of Vancouver Island. With the aid of this grant the physician has been
enabled to carry on a medical-care programme for those residents, the grant assuming
the major share of the travel expense involved in travel from Sooke to the communities
concerned.
A problem requiring considerable attention during the year was the provision of
some type of medical care to Telegraph Creek. Over the past year and a half it has been
possible for the Health Branch to maintain some degree of medical care through the
placement of a resident nurse in Telegraph Creek, who was able to give immediate
attention to sick and injured patients, and by radio-telephone to consult with physicians
at Whitehorse in respect to more advanced treatments, while screening the patients that
might require evacuation to a medical centre such as Whitehorse. This plan served to
supply the best answer to handling the medical care needs of that community, which is
composed of a mixed native and white population. The nurse, however, submitted her
resignation as of January, 1956, and negotiations had to be conducted toward locating
a replacement. This did not prove to be too easy; a well-qualified nurse with experience
in such a type of service was located for the summer months, but her family responsibilities would not permit her to accept the appointment on a long-term basis. Consequently,
service was re-established during July, August, and September, only to come to a halt
again thereafter. All efforts since then have failed to locate a replacement. Negotiations
have to be undertaken in conjunction with the Indian Health Services, who have assumed
50 per cent of the cost of the service, but lately, because of the greater proportion of
Indian population, have agreed to accept a larger share, up to 75 per cent of the cost of
the service. As the year ended, all available efforts were being devoted to location of
a nurse who might be interested in assuming the appointment. It must be recognized
that these remote, inaccessible locations do not appeal to a great many people, and that
it takes a professional graduate with a missionary outlook to become interested in such
service. For that reason, investigations were being directed toward some of the Missionary Boards to determine if they had nurses who might take up the position.
Another northern location that required some special attention was in the community of Atlin. Here, fortunately, the British Columbia Branch of the Canadian Red
Cross Society serves to fill a need by the introduction of a Red Cross Outpost Hospital,
manned by a resident nurse. Government assistance in this matter was rendered in the
provision of a building moved to a suitable site by the Department of Public Works.
The resident nurse is assisted in her provision of medical care by regular monthly visits
by three physicians, on a rotating basis, from Whitehorse. This supplies a degree of
medical care to that community, not otherwise obtainable.
HOME-CARE PROGRAMMES
The initial success that attended the home nursing-care programme over the past
four years has led to an active demand from other municipalities for inclusion of such
services in their public health programme and, consequently, plans have to be negotiated W 32 BRITISH COLUMBIA
toward extension of the service. The matter of obtaining sufficient nursing staff hindered
more rapid progress. It has been found that a home nursing programme effects an
economic saving to the community in terms of hospital usage, while providing the patient
and the family with much-needed help. In addition to the nursing care, it is found that
provision of a housekeeping service is also of distinct advantage in provision of home
help, and in most cases, this has been introduced in co-ordination with the home nursing
programme. Patients are referred to the home-care service only upon the approval of
the attending physician. It was evident from studies conducted in the past that the
success of the service is dependent upon a co-operative interest on the part of physicians
and hospital nurses, and that the whole service provides for a community health programme in which the hospital, practising physician, and the local health services are
intimately associated in a united endeavour.
The earliest programme was in the nature of a special study which was introduced
under the stewardship of the North Okanagan Health Unit in conjunction with the Vernon
Jubilee Hospital, and was designed primarily to determine if home care for convalescent
patients discharged from hospital early, might thereby release hospital beds for more
acute cases. It was proven early that the programme effected the desired results in release
of hospital beds for more acute patients, and thereby saved the community the need for
construction of facilities to provide additional hospital beds. In its early phases this
service was confined entirely to the City of Vernon, but, as experience was garnered from
the service, it was determined that it could be extended to Vernon and District, provided
additional public health nursing staff could be obtained. Consequently, in 1955, this
extension was undertaken as additional staff became available. The programme was
established under the financing advanced by National health grants and, as a pilot study
under a National grant project, it occasioned considerable interest by the staff devoted
to research into National health studies, as well as senior officials within the Provincial
Health Branch. Statistical figures presented over the past four years have served to
emphasize the results obtainable; during this past year the preparation of the statistical
material was undertaken by the Division of Vital Statistics to establish comparative tables
which would be of benefit in supplying information, not only on the Vernon home-care
programme, but on other programmes, since introduced. From these tables comparative
analysis can be made in development of additional programmes for the other communities
seeking this service, so that some prediction of the results that may be anticipated can be
forecast for discussions with Union Boards of Health involved. DEPARTMENT OF HEALTH AND WELFARE,  1956
Vernon Home-care Programme
W 33
January to September
1954
1955
1956
Number of patients—
66
19
8
88
25
33
73
On housekeeping service only 	
On both nursing and housekeeping service 	
36
17
93
146
130
482
5.7
282
10.5
365
3.2
402
6.9
469
49
7 7
Hospital-days saved—
969
270
129
901
234
343
876
319
By both _          .            	
194
1,368
1,478
1,389
Hospital-days saved per patient—
14.6
14.2
16.1
14.7
10.2
7.0
13.1
10.9
12.0
8.8
10.8
10.6
Time of public health nurses—
Travel                                                    .... min.
Service.              ,,
4,016
5,929
3,678
5,455
4,815
9,093
Totals	
9,945
9,133
13,908
Average public health nurse time per visit—
Travel   min.
Service                                                                                                         ,t
8.3
12.3
10.08
14.94
10.27
19.39
20.6
25.02
29.65
Average public health nurse time per patient.—
Travel _ min.
Service..      „
54.2
80.1
30.2
44.8
53.5
101.0
Totals
134.3
75.0
154.5
1,357.75
4.88
50.28
2,414.50
6.01
41.62
2,615.75
5.92
45.89
Costs
Total cost  	
Hospital-days saved-
Cost per day-
Standard hospital per diem..
$2,626.56
1,368
$1.92
$11.35
$3,511.67
1,389
$2.53
A study of the statistics shows that there was a slight decrease in the number of
patients referred to the home-care programme during 1956, as compared to 1955, but
a significantly greater number than 1954 when the plan was still in its formative stage.
However, this lesser number of patients required a greater amount of service and the time
taken up in nursing care per visit was significantly increased to 29.65 minutes during
1956, as compared to 25.02 minutes in 1955, and 20.6 minutes in 1954. The travel
involved in making these visits remained constant at about 10 minutes per visit, and the
major portion of the increased nursing time per visit was involved in actual service to
the patient.
This amount of service has shown a gradual increase over the past three years from
12.03 minutes in 1954, to 14.94 minutes in 1955, and 19.39 minutes in 1956. Experience indicates further that the amount of nursing care per patient which decreased from
134 minutes in 1954 to 75 minutes in 1955 has doubled in 1956 to 154 minutes. This
seems to be due to the fact that patients with a more prolonged illness are being referred
to the service and, therefore, require a greater proportion of nursing care than heretofore.
2 W 34
BRITISH COLUMBIA
On the other hand, the amount of housekeeping service per visit and per patient
has remained fairly constant during 1956, as compared to 1955, involving between 40
and 45 hours per patient, requiring 7.7 visits per patient, of approximately six hours
per visit.
As there were a lesser number of patients receiving care, there has been a corresponding decrease in the number of hospital-days saved in 1956, as compared to 1955,
but the hospital-days saved per patient has remained fairly constant at approximately ten
days per patient, during the past two years. This provides to the community use about
five beds per annum, the figures being 5.0 for 1954, 5.2 for 1955, and 5.0 for 1956.
The costs, as might be anticipated, have shown a gradual continuing upward trend
over the past three years, rising from $1.92 per diem in 1954 to $2.53 in 1956. This
must be related to the fact that the standard hospital per diem cost has shown a similar
trend over those years, rising from $11.35 per diem to $12.05 per diem. Thus, it is
evident that in proportion, the community benefits financially in provision of nursing care
through a home-care programme operated in co-operation with the community general
hospital.
A home-care programme commenced to supply service to Saanich in 1955, to
patients referred to it by private physicians, and was not particularly directly related to
convalescent nursing care of the discharged hospital patients. As it has now been in
operation for one full year, it is possible to compile statistics in relation to the experience
obtained in supplying that service. In addition, home-care programmes of a similar
nature were introduced in the Upper Island Health Unit in the Municipalities of Courte-
nay, Comox, and Cumberland on Vancouver Island and in Powell River on the mainland.
These have now been in operation long enough to obtain statistical information over a
six-months' period, and to compare the average figures with that of Saanich. It is also
further possible to compare some of the information with the experience obtained from
the Vernon Home-care Programme and to note somewhat similar trends in the number
of nursing visits required per patient, the average nursing-care time per visit, and the
average nursing-care time per patient. A table exhibiting the comparative data is as
follows:—
COURTENAY, POWELL RlVER, AND SAANICH HOME
•care Programme
Courtenay
(Six Months)
Powell River
(Six Months)
Saanich
(Twelve Months)
25
206
8.2
2
18
80
4.4
4
973
3,957
4.07
35
Time of public health nurses—
Travel       -                  min.
Service   ,,
2,450
6,285
523
1,780
33,634
103,711
8,735
2,303
137,345
Average public health nurse time per visit—
Travel  —min.
Service  -  ,,
11.9
30.5
6.5
22.3
8.5
26.2
Totals                                   	
42.4
28.8
34.7
Average public health nurse time per patient—.
Travel   _~ min.
Service   „
98.0
251.0
29.0
98.8
34.5
106.5
Totals                                        	
349.0
127.8
141.0
818.7
32.7
175.7
9.7
9,632.7
9.9 DEPARTMENT OF HEALTH AND WELFARE,  1956 W 35
It is evident that there is some difference in the amount of service per patient supplied in Courtenay, as compared to that supplied in Powell River and Saanich, since the
average number of visits per patient is almost doubled in Courtenay. In addition, the
average time per visit is somewhat greater and the amount of nursing care per patient is
thereby greatly increased.
This would seem to denote that the patients referred to the service in Courtenay
are more likely to be suffering from a prolonged illness, which is to be anticipated in the
light of the request that the service be introduced to provide a measure of home care to
elderly, ill persons who did not actually require hospitalization, but did require some
nursing care.
The Courtenay programme is hampered by the fact that it is confined to the three
organized communities of Courtenay, Comox, and Cumberland, which are separated by
unorganized areas in which it was not possible to provide home-nursing care, because of
administrative difficulty in financing. Consequently, the amount of travel required to
provide the service becomes increased and this is reflected in the comparison of the travel
item involving a distance of 32.7 miles per patient in Courtenay as compared to 9.7 miles
per patient in Powell River, and 9.9 miles per patient for Saanich.
The trend toward home-care programmes is being felt in other health unit areas
throughout the Province and certain investigations are going forward in local areas toward
initiation of these services as part of the official public health nursing programme. Interest
has been shown in communities in the North Fraser Health Unit, South Okanagan Health
Unit, and the Boundary Health Unit. Progress toward introduction of a programme is
necessarily slow since it involves a co-operative community approach in which a number
of related groups must be co-ordinated in their features that the service will fulfil. In the
meantime, information is being garnered from the existing programme to serve as a guide
as to what can be anticipated from new programmes. An effective programme of home
nursing and housekeeping care continues to operate to the advantage of the community
in the City of Kelowna.
The Victorian Order of Nurses, who were originally pioneers in the field of home
nursing-care service, continue in that field in a number of communities, particularly in
the larger cities of Victoria and Vancouver, but also in Trail, Cloverdale, and Nanaimo.
In each of these, there is a united action between the official public health agency and
the Victorian Order of Nurses agency to provide an effective community health service
without duplication or overlapping in essential services. While this is a desirable situation, there remains the fact that certain duplication must continue in respect to administration, travel, and home visiting, and questions must be raised as to whether both services in one community are desirable.
SCHOOL HEALTH SERVICES
School health services are designed to provide a medical and preventive health
supervision of the school-child, in which attention is focused upon the mental, emotional,
physical, nutritional, and immunization status of the school-child, and the sanitary aspects
of the school plant. Changing concepts have influenced changes in the school health
programme. The first was the realization that the school-child could not be segregated
from the rest of the community, as he was actually a definite member of a family group
within the community. It is, of course, evident that the health of the school-child is
a direct reflection of the community health, since the school pupil spends a greater proportion of his daily life in the community, rather than a dweller within the school. Indeed,
his experiences during his formative years as an infant and pre-school child may equip
him mentally, emotionally, and physically to deal with his environment during his school-
years to the degree that the school health service has only to provide continuity of that
developmental optimum health. W 36 BRITISH COLUMBIA
Coincidentally, evidence was multiplying indicative of the need to provide concentrated service for certain individual children, while providing routine service for the
pupils as a whole. " The Manual of School Health Practices," Department of Health,
City of New York, has very ably summarized this, as follows:—
" Behind us are the days of emphasizing great numbers of routine inspections and
examinations which supposedly gave the administrator a cross-section of the health status
of the whole school population, but which, without doubt, revealed little about the well-
being or progress about the individual child. To-day the individual child and his specific
needs are of chief concern.
" Behind us are many outmoded methods of controlling communicable disease, but
ahead of us are such unsolved problems as the prevention of rheumatic fever and dental
caries, problems that must remain unsolved until medical science reveals their causes.
" Behind us also are over-specialized, independent, unco-ordinated efforts in caring
for such problems as defective vision and hearing and emotional disorders. Before us is
the need to fit these activities into proper relationship through a comprehensive, over-all
administrative programme, so planned as to conserve our resources and, at the same time,
serve the individual in the best possible manner.
" Discarded is the concept that school-children owe their favourable health status
solely to medical examinations, and administrations of school-teachers and nurses. To-day
we see so much more clearly than we did a generation ago that the prenatal instruction
given to mothers, better professional attention at birth, training in infant nutrition and
care, early immunizations, improvements in housing, advances in sanitary conditions and
neighbourhoods, protection of milk and other foods, introduction of playgrounds, planned
community attacks on tuberculosis and other communicable diseases—all can make their
contributions. We have learned that without the co-operative functioning of each of
these services to-day's children cannot achieve well-being."
Thus, improved community health services are reflected in the health of the school-
child.   The school health programme, as it is developing, has several objectives:-—
(1) It is designed to present an appraisal of the child, physical, mental, emotional, and social. What are his assets, his liabilities? What needs to be
done to help this child achieve a level of health commensurate with his
potentialities for health?
(2) How can each child in school be considered as an individual? Unless
a way is found to accomplish this end, the knowledge of the principle of
the individual difference is of no avail.
(3) How can the school environment be improved so that the growth and
development of the child will not be impeded? The concern here lies
with both the sanitation and the emotional environment; that is to say,
the emotional environment of the classroom, including such factors as
the effect of the teacher's personality, the routines and disciplines imposed
on the children.
(4) How could an educational programme be developed in a school which
enables a child to learn how to make judgments which affect health
behaviour?
These, then, are the main considerations in the school health programme—health
service, health guidance, health instruction, and school environment. In order to accomplish this, education and school health personnel are required to reorient their efforts
so that consideration is given to the needs of the child in developing a programme that
meets the mental, emotional, social, and physical needs of this age-group.
In this, the classroom teacher and the public health nurse predominate in the programme, since close collaboration between them can materially aid the school-child who
is in the greatest need of professional attention.   The teacher-nurse conference may pro- DEPARTMENT OF HEALTH AND WELFARE,  1956 W 37
vide, therefore, sufficient information leading to satisfactory treatment, but in other
instances the support of the parents, family physician, and others will be required. The
public health nurse serves to link up the school with the health and welfare of the
community.
Toward this end, the Health Officers' Council has devoted considerable attention
toward a revision of the school health programme over the past two years. Details in
respect to these revisions elaborating upon the reasons for, and recommendations for
revision, are contained in the last two Annual Reports. During the past year attention
has been focused on the new system of categorization of the physical, emotional, and
mental status of the individual school-child. Thus, the new categorization utilizing " P,"
"E," and "M" as symbols to indicate physical defects, emotional problems, and mental
defects, respectively, was introduced with a numerical designation from 1 to 4 to indicate
the magnitude of the respective defect. Reactions from the school medical inspectors
engaged in this new classification have been somewhat mixed, with a certain amount of
complaint that it is difficult to assess the mental status of the school-child upon the basis
of a short examination. Proponents of the plan argue, however, that the assessment of
the mental status of the child should be determined from the teacher-nurse and parent-
nurse relationship, and that the school medical inspector should be guided in his assessment by the public health nurse serving that particular school. It may be too early to
determine the practicability of the new categorization system since it has only been in
effect for one academic year, further use of the system seems desirable in order that the
experience with it may determine its value.
The effect of school environment upon the well-being of the school occupants
requires that the sanitary inspectors throughout the Province provide at least an annual
inspection of the school plant. The growth in school population had created a need for
additional school plants which are being constructed in all areas of the Province. Two
years ago, the Department of Education brought out a "School Building Manual" in
which certain recommended standards of plant construction were detailed. Since then,
there has arisen a need for revision of that Manual, and certain consultations have been
held toward modification of the sanitation features of the Manual.
Some attention has also been focused on the matter of first-aid instruction in schools,
originating from a couple of inquiries. The first of these came from the Public Health
Committee of the Canadian Medical Association who expressed interest in the subject of
artificial resuscitation, feeling that if more people were trained in the principles, there
would be less likelihood to depend upon mechanical resuscitators and the attendant delay
in awaiting the arrival of that mechanical equipment. It was argued, then, that probably
more deaths from gas poisoning and drowning could be prevented if more people were
trained in artificial resuscitation. The second approach was from Civil Defence authorities who expressed interest in training of a greater number of persons in the basic
principles of first aid from the point of view of aid in natural disaster. Authorities from
the Department of Education indicated their personal reaction was favourable toward
pupils becoming qualified in first aid, but stated it had to be a definite and purposeful
continuing policy in which teachers qualified in the subject would undertake to include
that subject in the school curriculum. It was evident that further discussions should be
entered into by the Health Branch and the Department of Education toward development
of a definite policy, from an education and health viewpoint. Other discussions centred
upon the role that the teacher may play in undertaking certain routine parts of the physical
examination of the school-child, notably in respect to height and weight determination,
and possibly in screening of visual acuity. Further exploration of this proposal is to be
made to determine whether the teacher can participate in that capacity, utilizing the
experience as a teaching medium. W 38
BRITISH COLUMBIA
Investigations into height-weight relationship in the development of the school-child
have continued through the use of the Wetzel Grid in the school health programme in the
Central Vancouver Island Health Unit. At the same time, research has been going
forward under the direction of the Director of that health unit into the possibilities of
development of a Provincial chart to supply information on the height-weight relationships
in a graph form. The head of the Department of Pediatrics in the Faculty of Medicine
at the University has been interested in this development and has provided consultative
advice on the subject; at the same time, the Division of Vital Statistics, through its
Director, has co-operated in the study in analysing charts and graphs submitted, and in
obtaining breakdowns of the figures obtained on British Columbia residents during the
National height-weight survey conducted by the Division of Nutrition within the Department of National Health and Welfare two years ago. From this study it is hoped something tangible may develop which can be mutually utilized throughout local health
services in the Province.
Various other sections of this Annual Report deal with services which are intimately
related to the school health programme, or are directly participating in it. These will be
found especially in the sections dealing with public health nursing services, dental health
services, nutrition services, sanitation services, and health education. In a total assessment, therefore, of the school health programme, these services must be given due
consideration.
THE HEALTH OF THE SCHOOL CHILD
Over recent years an endeavour has been made on the basis of the school health
programme to analyse in general terms the health of the school-child. As a basis of
analysis, the statistics on physical examinations, immunization status, and disease incidence have been utilized, comparing the result with that obtainable over a five-year
period. This year, however, a comparison with previous years, at least in so far as
physical examinations are concerned, is not possible because of the changed classification
brought about in the revision of the school health programme. Certain conclusions
remain, however, which do reflect some concept of the general health of the school-child.
For the academic year, September, 1955, to June, 1956, the school health programme was operative in the eighty-two large school districts and the various smaller
school areas. The continuing increase in the school enrolment resulted in a far greater
number of pupils in the grades examined, there being 230,433, as compared to 215,945
a year ago. Of this number, only 44,211 (19.2 per cent) received medical examinations,
a further decrease in the percentage examined. This may not be as serious as it appears
since the emphasis in the school health programme has become directed to examinations
of preferred groups and referred pupils rather than routine examination of all pupils.
An examination of Table I would confirm that a very large proportion (81.3 per cent)
of the pupils enrolled in Grade I received a physical examination, the majority of them
just prior to entering school. The results shown, by grade, in Table III, indicate further
that a considerable number of pupils become examined in Grade IX (33.6 per cent), just
as they are transferring to high-school studies.
It is apparent from the statistical tables, particularly Table I and Table III, that the
great majority of the pupils examined exhibited no defects, or only minor, physical,
emotional, or mental defects. Somewhat less than 20 per cent showed any physical
defects, while emotional and mental problems accounted for 4 per cent and 2 per cent,
respectively. The special attention that is given to referred pupils is reflected somewhat
in the statistics as is evidenced in Table III in comparison between the results in Grade I
and Grade II. In Grade I, the effort is made to provide a physical examination of as
many pupils as possible, in an approach to ensure that the pupil is in ideal health upon
entering school at a time when he must readjust to a new phase of life. That programme
reveals over three-quarters of the pupils to be in fit condition.   In contrast, in Grade II, DEPARTMENT OF HEALTH AND WELFARE,  1956 W 39
examinations are concentrated on pupils referred by teachers, public health nurses, and
parents, which pupils are felt to be suffering from some condition inimical to health.
It would be logical, therefore, to anticipate that a larger proportion of these examinees
would show graded defects; this is evident in Table III as 26.4 per cent have physical
defects, 4.7 per cent emotional defects, and 2.2 per cent mental defects.
Attention was directed in the last Annual Report to the unfortunate trend toward
a lesser number of school personnel being X-rayed than in former years. Table IV
revealed an encouraging change as a greater number were done, 52.7 per cent, compared
to 42.9 per cent the previous year. While this is encouraging, there remains a need for
further intensification of that programme, since it is desirable that the great majority of
the school personnel be adequately checked by X-ray examination.
It is gratifying to report that the immunization status of the school-child, as evidenced
in Table V, is being maintained at a high level, and as a matter of fact is showing
improvement over the situation in recent years, as a higher proportion of the enrolled
pupils are now protected against such diseases as smallpox, diphtheria, and tetanus. As
was indicated in past Reports, the use of combined antigens was promoting an increase
in the number of children protected against tetanus, and it is astounding to observe the
change that has occurred; during this past year, 63.6 per cent of all grades exhibit
immunization to tetanus, as compared with 44.9 per cent the previous year, and 29.4
per cent the year before that. This is a desirable situation, since sporadic cases of tetanus
continue to occur through the Province, three such cases having been recorded during
the past year for a rate of 0.2 per 100,000 population.
Complacency should not, however, be allowed to develop in respect to the immunization status of the school-children, since actually the percentage immunized should
approach totality as nearly as possible. Examination of the tables revealed that children
enrolled in the higher grades are less adequately protected from this point of view, and
probably intensification of the programme amongst that school-group is justified, so that
they graduate from high school into the community as fully protected as possible.
As has been indicated in previous Reports, the percentage of school population
immunized against typhoid fever remains significantly low, and is becoming decreasingly
so with each passing year. While there is an increased incidence of typhoid fever, particularly during this last year, this has been occurring in certain population groups in
which sanitation has been extremely poor; the incidence is further isolated to certain
localities and there does not seem to be a need for general over-all immunization against
this infection. Consequently, the programme of typhoid-paratyphoid immunization has
been lessening as is evident in the numbers of school-children maintaining such immunity
status.
A new phase of immunization status not revealed in Table V is in relation to
poliomyelitis immunization. Actually, some 166,000 school-children from ages 5 to 15,
enrolled in Grades I to IX, were given the initial injection of this vaccine prior to June,
1956. This was in addition to the 45,067 children who received a complete series of
injections during 1955. As vaccine becomes available, administration of poliomyelitis
vaccine is to be increased to provide the same degree of protection to all children for
whom parental consent becomes authorized.
The communicable-disease incidence among school-age children is shown in Table
VI, indicating that the so-called childhood infections, such as chicken-pox, measles,
mumps, and rubella, continue to reap their toll. Rubella increased sharply during the
year, following on a very low incidence over the past two years; this infection tends to
display an aptitude for reoccurrences as the non-immune population increases in size.
Mumps also displayed a much higher attack rate, almost doubling the number of cases
involved over the past two years. The number of cases of chicken-pox was increased
over that prevalent the previous year, but was not in undue proportion to that existing W 40 BRITISH COLUMBIA
in the years beyond 1955. A very definite decrease occurred in respect to measles, which
had the lowest incidence of the past five years, being only half as great as the incidence
during the immediate past year. Influenza, which had shown an extremely heavy attack
rate in 1955, was significantly lower in 1956, but still considerably greater than in the
years preceding 1955. It remained a mild type of infection and did not create any particular complications, so that no particular lasting effects from the disease were experienced. Poliomyelitis was considerably lower in its attack rate and the incidence among
school-children is a mirror of the community incidence in the lesser number of cases
involved. A similar type of statement may be applied to bacillary dysentery of the
Shigella variety, since an increase in the community incidence there is also reflected in
the number of cases involving school-children. Streptococcal infections, scarlet fever,
and septic sore throat were recorded in a lesser number of cases; significance is attached
to it, however, because of its relationship to rheumatic fever incidence and some attention
is being focused in that direction to determine if prophylactic measures, utilizing antibiotic drugs, is justified. A certain measure of gratification can be obtained from the
indication that no cases of diphtheria or tetanus occurred among the school-age population in which the increased immunization levels have been seen.
DISEASE MORBIDITY AND STATISTICS
Material derived from the information collected through the Canadian Sickness
Survey, 1950-1951, continues to be prepared. The survey was carried out over a twelvemonth period, under grants made available through the National health grants programme
and collected information on the amount and types of sickness for the nation as a whole,
in a project administered in each of the ten Provinces by the Provincial health departments, in co-operation with the Department of National Health and Welfare. Further
reports analysing the data are anticipated as the material becomes reviewed.
The notifiable diseases during 1956 are shown in Table VII in which comparison
is made with that reported over the previous four years. The rate of 3,444.6 per 100,000
population for 1956 approximates the rate of 3,462.0 per 100,000 population for 1955,
which was the highest incidence recorded to date. The statistics show a decrease in
the incidence of epidemic influenza from a rate of 1,195.4 for 1955 to 297.8 for 1956,
but this is offset by an increase in chicken-pox (526.9 for 1956 as compared to 379.0
for 1955), mumps (501.3 for 1956 as related to 223.9 for 1955), and rubella (836.8
for 1956 compared to 58.9 for 1955). Actually, the Report of a year ago predicted
the likelihood of a slightly upward trend in rubella, since the incidence had been falling
to a very low level over the past four years and it could be suspected that a high proportion of non-immune susceptibles was developed in the population.
While some decrease in the amount of epidemic hepatitis took place with a rate of
25.4, nevertheless this infection continued to display epidemic seriousness in certain
communities. The distribution of immune serum globulin as a prophylactic for this infection has been continued. During the year, the Health Officers' Council Sub-committee
on Communicable-disease Control gave consideration to increasing the criteria for utilization of immune serum globulin, and thereafter greater amounts were used. The actual
effect on the incidence of epidemic hepatitis is, however, not too clear.
Bacillary dysentery of the Shigella type has continued to exhibit a fairly high attack
rate at 26.6 per 100,000 population, slightly up over the 22.5 rate of 1955, but lower
than the 47.8 rate for both 1954 and 1953. It is likely that this situation will continue for
some years to come, since the infection is not indigenous to the Province as a whole, and
local outbreaks can be anticipated from time to time, arising from carriers.
An exceedingly bright spot in the notifiable-disease picture was the extremely decreased incidence of diphtheria, only one case being reported during 1956. Adequate
protection against this infection can be obtained through immunization, and emphasis on DEPARTMENT OF HEALTH AND WELFARE,  1956 W 41
the increased immunization of young adult populations would probably yield a complete
absence of the disease from British Columbia.
Salmonellosis showed a very definite upward trend in 1956, particularly salmonella
typhi with a rate of 2.4 as compared to a rate of less than 1.0 for the last three years, and
also Salmonella of various other types, unqualified, in so far as the report is concerned,
showed an increase to 13.9 as compared to a rate of 7.0 a year ago. Salmonella paratyphi
exhibited a very slight decrease to a rate of 2.4 as compared to a rate of 3.1 the previous
year. The amount of typhoid and paratyphoid fever prevalent in the Province had occasioned some study, particularly by the staff of the Skeena Health Unit in which there
seemed to be a fairly high prevalence of the disease among native and related population
working in the fish canneries along the Skeena River. There was some suggestion that
improvement in the housing conditions and the sanitation facilities for this group seemed
to be indicated if any inroads were to be made in controlling the spread of infection, while
at the same time concentration on typhoid-paratyphoid immunization clinics for those
groups seemed desirable. There were a couple of meetings convened between representatives of the cannery management, cannery operators, Indian Health Services, Provincial
Health Services and local health services, at which the subject was fully reviewed and
consideration given to the steps that might be taken toward control of the infection. It
was evident that it was going to require co-operative action on the part of all groups and
steps were taken toward that end. Indian Health Services undertook to provide medical
supervision of the native population, cannery management and operators undertook to
improve housing and sanitation facilities, and the local health services undertook to
organize immunization clinics. As a result of this concerted attack, it is hoped that the
amount of infection occurring during the cannery operating seasons can be materially
decreased.
A couple of outbreaks of typhoid fever also arose among Mennonite population,
who had recently immigrated to Canada from Mexico to escape the heavy Mexican tax
laws. The first outbreak occurred in June, when four children were found to have positive
cultures in families within the Boundary Health Unit. This was followed by an outbreak
in September among Mennonite families resident at Burns Lake in the Cariboo Health
Unit, where sixteen cases were located over a ten-week period from the infection spreading from family to family. It was evident from both of these incidents that personal
hygiene and household sanitation were factors in the spread of the infection, while the
causative factor seemed to be carriers emigrating into Canada, where the disease is
endemic. Discussions were immediately undertaken with officials of the Department of
National Health and Welfare to determine if some control over immigrating Mennonites
could be instituted, and an arrangement was worked out by them with the Department
of Immigration to provide information on date of entry and destination of all future
immigrating Mennonites.
Infections due to streptococcal organisms showed a downward trend during 1956,
particularly in the incidence of scarlet fever and septic sore throat. This is a situation
that has been developed over the past five years as the rates decreased each year to a
new low of 47.8 for scarlet fever and 12.7 for septic sore throat. This is encouraging,
since even although the newer methods of treatment with chemotherapeutic or antibiotic
drugs have decreased the seriousness of these conditions, there does remain the possibility of developing rheumatic fever from streptococcal infections. The Health Officers'
Council has given some attention to the amount of rheumatic fever that may now be
existing throughout the Province, feeling that some measures of prevention of recurrence
of attacks is justified in the hope of curtailing cardiac complications. A pilot study was
established in the South Okanagan Health Unit a year ago, and a certain measure of
progress has been forthcoming on a rather gradual basis. The study was reported upon
during meetings of the Health Officers' Council throughout the year, and suggestions were
advanced for a further step in the study, since other health units are desirous of tackling W 42 BRITISH COLUMBIA
the problem on the basis of the approach made by the South Okanagan Health Unit.
There are certain guides already available, since this matter of prevention of rheumatic
fever had been investigated in certain areas of the Province of Saskatchewan, from which
reports indicated the procedure that may be introduced in a control programme.
Tetanus, which only occasionally revealed itself in the past years has, in recent years,
exhibited a somewhat higher incidence. This warrants, therefore, some attention to
tetanus immunization and it is encouraging that the use of the combined antigen is promoting an immune population among the pre-school and school-age groups. Infections
for the most part have been confined to adults, indicating that immunization of adult
populations is seemingly justified. Certainly, in the face of community disaster of any
type, the problem of tetanus infection may be a serious consideration.
Tick paralysis, which has not shown itself for the past five years, occasioned one case
during 1956. This is a condition that may be expected from time to time as the British
Columbia forests during the spring months are heavily inundated with ticks, which can
create tick paralysis through the toxins secreted by the burrowing tick. It remains a
condition which must be borne in mind by the medical practitioner, since early and rapid
removal of the tick prevents the condition arising, and overcomes the paralysis if done
effectively, even after paralysis has set in.
The incidence of tuberculosis showed a trend downward, as does also the incidence
of syphilis. On the other hand, the amount of gonorrhoea has increased. The problems
in relation to these various infections are, however, presented in the reports of the Divisions dealing with those specialized conditions. Poliomyelitis has presented a marked
decrease with a rate of 6.2 per 100,000, which is the lowest incidence since 1950.
A similar trend has been occurring throughout Canada, and it is felt that it is only one of
the peculiarities of this infection and not any reflection upon the fact that Salk poliomyelitis vaccine has become utilized. In the first place, the amount of vaccine administered has been exceedingly small and it could in no way influence the total Provincial
incidence, particularly as the administration was confined to specific age-groups between
5 to 15 years of age. Difficulties in production prevented completion of a programme
prior to the 1956 poliomyelitis season, so that it is questionable whether any of the 1956
vaccinees could be considered adequately immunized prior to the seasonal infection
developing. Therefore it must be argued that the amount of immunity conferred among
the general population remained significantly low and could hardly be a factor in the
decrease that occurred in the incidence of the disease.
Administration of the vaccine during 1956 followed the pattern established during
1955, in which the staffs attached to local health services throughout the Province undertook to obtain parental consents and to administer the vaccine to all those for whom
consent was obtained in Grades I to IX throughout the schools, and those likely to enter
school in September, 1956. Vaccine deliveries hampered progress in the programme, so
that it was not possible to administer the second injection as had been planned, before
the closure of schools in June. Further delay during the summer and early fall led to a
late recommencement of the programme, which did not get under way until October and
has been continued on a prolonged basis throughout November and December into
January. While some areas of the Province have completed the initial two injections,
others are still awaiting vaccine for that purpose. Plans are now going forward for the
1957 campaign in which it is hoped to complete the third injection to the 1956 vaccinees
and the re-enforcing dose to the 1955 vaccinees, before considering extension of the
programme to the immunization of all children from age 1 to 16.
The control measures in poliomyelitis are evidence of a fine co-operative teamwork
on the part of a number of groups, notably Connaught Medical Research Laboratories;
Department of National Health and Welfare; British Columbia Foundation for Poliomyelitis; Western Society for Rehabilitation; Royal Canadian Air Force 121 Communi- DEPARTMENT OF HEALTH AND WELFARE,  1956
W 43
cations and Rescue Flight, Sea Island; the Provincial health service, and local health
services. Through a combination of all these agencies, it is possible to provide immunization procedures, diagnostic services, consultative services, evacuation services, treatment services, and rehabilitation services, all of which play their part in prevention and
treatment for poliomyelitis.
In spite of the decrease in the number of cases, there has been an increase in the
case fatality rate to 3.6 for 1956. A comparison with the rates occurring in the previous
years of peak incidence and recent years indicates, however, that this is a rather low
fatality rate, in harmony with the experience of the past four years, during which the
handling of poliomyelitis patients has been organized to a high degree of efficiency.
The statistical handling of notifiable diseases through the Division of Vital Statistics
permits the preparation of tables and charts for analysis of the reportable-disease situation
throughout the Province at any one moment. Statistical tables featuring the number of
cases and case rates over the most recent five years, while listing the incidence by health
unit throughout the year graphically represent British Columbia experience in disease
incidence.
Table of Poliomyelitis Case Fatality Rates, British Columbia
Year
Cases
Deaths
Case
Fatality
Rate
1927	
182
102
43
34
42
313
584
787
211
224
84
37
19
13
8
11
12
37
26
6
3
3
20 3
1928	
18.6
1929                     -	
30 2
1930               	
23 5
1931  _
26 2
1947        - 	
3 8
1952              - 	
6 3
1953	
3 3
1954
2 8
1955 _ -
1 3
1QS6
Table I.—Summary of Health Status of Pupils Examined,
according to School Grades, 1955-56
Item
Total
Pupils,
All
Schools
Examined in Grades
Grade
I
Grades
II-VI
Grades
VII-IX
Grades
X-XIII
Total pupils enrolled in grades examined..
Total pupils examined-
Percentage of enrolled pupils examined..
Percentage of pupils examined with minor or no physical, emotional, or mental defects	
Percentage of pupils examined having specified type and degree
of defect—
Physical 2.
Emotional 2—
Mental 2	
Physical 3.	
Emotional 3...
Mental 3	
Physical 4	
Emotional 4...
Mental 4	
230,433
44,211
19.2
76.6
17.6
3.8
1.3
1.2
0.2
0.2
0.1
0.11
0.11
28,334
23,046
81.3
76.8
17.9
4.0
1.3
1.3
0.2
0.2
0.1
0.11
0.1
117,879
9,775
8.3
73.4
21.0
4.0
2.0
1.5
0.3
0.4
0.1
0.11
0.11
54,659
9,209
16.8
81.9
13.8
3.0
0.8
1.1
0.3
0.1
0.2
0.11
29,561
2,181
7.4
65.2
15.7
3.4
0.3
0.2
0.2
0.1
1 Less than 0.1 per cent. W 44
BRITISH COLUMBIA
Table II.—Health Status of Total Pupils Examined in Grades I, IV, VII, and X
for the Year Ended June 30th, 1955-56
Total pupils enrolled in grades examined.
Total pupils examined..
  85,128
  30,177
Percentage of enrolled pupils examined.       35.4
Percentage examined with minor or no physical, emotional,
or mental defects       76.2
Percentage of pupils examined having specified type and degree of defect—
Physical 2       18.5
Emotional
Mental 2 _.
Physical 3
Emotional
Mental 3 __
Physical 4
Emotional
Mental 4 __
3.9
1.3
1.4
0.2
0.2
0.1
O.li
0.1
1 Less than 0.1 per cent.
Table III.—Health Status by Individual Grades of Total Schools, 1955-56
Item
AM
Schools
Grade
I
Grade
n
Grade
III
Grade
XV
Grade
V
Grade
VI
Total pupils enrolled in grades examined...
230,433
44,211
19.2
77.9
17.6
3.8
1.3
1.2
0.2
0.2
0.1
O.li
O.li
28,334
23,046
81.3
76.8
17.9
4.0
1.3
1.3
0.2
0.2
0.1
O.li
O.li
26,421
2,247
8.5
66.8
24.5
4.5
1.7
1.7
0.2
0.4
0.2
0.11
26,714
2,958
11.1
79.2
17.3
5.4
4.3
1.4
0.4
0.8
0.1
O.li
0.U
23,763
2,667
11.2
72.1
22.8
3.3
1.0
1.6
0.4
0.2
O.li
20,621
967
4.7
73.7
19.9
3.4
1.1
1.1
0.1
0.1
20,360
Percentages of enrolled pupils examined ....
Percentages examined with no physical,
4.6
73.6
20.8
Percentage   of   pupils   examined   having
specified type and degree of defect—
Physical 2 — -
Mental 2.              	
Physical 3 	
1.5
1.1
Mental 3..      	
Physical 4 -	
0.3
0.3
Mental 4 	
Item
Grade
VII
Grade
VIII
Grade
IX
Grade
X
Grade
XI
Grade
XII
Grade
XIII
Total pupils enrolled in grades examined...
20,384
3,055
15.0
78.2
19.1
3.3
1.3
1.4
0.5
0.2
0.1
18,308
796
4.3
72.4
19.7
4.4
1.4
1.8
0.4
0.1
0.4
0.1
15.967
5,358
33.6
85.4
9.9
2.6
0.4
0.4
0.1
0.3
O.li
12,647
1,409
11.1
68.3
18.5
4.0
0.5
1.8
O.li
9.116
435
4.8
58.6
11.9
1.4
0.7
0.7
0.5
6,998
307
4.4
61.9
9.4
3.0
0.3
0.3
800
30
3.7
50.0
3.3
6.7
1.3
Percentages of enrolled pupils examined
Percentages examined  with no physical,
Percentage   of   pupils   examined   having
specified type and degree of defect-
Mental 	
Physical 3  	
Emotional 3   .  	
Mental 3	
Physical 4	
Emotional 4  	
Mental 4         	
1 Less than 0.1 per cent. DEPARTMENT OF HEALTH AND WELFARE,  1956 W 45
Table IV.—Number Employed and X-rayed amongst School Personnel, 1955-56
Item
Total
Organized
Unorganized
Number employed^
Number X-rayed	
6,492
3,423
4,626
2,967
1,866
456
Table V.—Immunization Status of Total Pupils Enrolled,
according to School Grade, 1955-56
Grade
Total
Pupils
Enrolled
by Grades
Percentage Immunized
Smallpox
Diphtheria
Tetanus
Typhoid
230,433
28,334
26,421
26,714
23,763
20,621
20,360
20,384
18,308
15,967
12,647
9,116
6,998
800
63.7
70.0
69.2
67.6
64.1
67.3
68.8
63.2
56.9
70.0
79.8
78.9
75.7
70.7
73.0
74.4
66.3
62.0
63.6
85.9
81.5
72.1
64.5
64.2
62.4
51.8
48.7
41.3
49.6
47.0
46.1
49.6
0.8
Grade T
0.7
Grade II             	
0.9
Grade III                 	
1.1
Grade TV
1.0
Grade V _      ...
0.7
Grade VI    .
0.8
Grade VII	
0.8
Grade VIII	
0.4
Grade IX. 	
50.3 53.1
56.4 !        60.9
54.9                60.1
52.9                54.0
46.4        1        49.1
0.5
Grade X
0.4
Gradf- XT
0.4
Grade XTT
1.3
Grade XTIT
1.2
Table VI.—Notifiable-disease Incidence in British Columbia, Age-groups 5-14
Years and 15-19 Years, September 1st, 1955, to June 30th, 1956, Inclusive
Disease
5-14 Years
Male
Female
Not
Stated
15-19 Years
Male
Female
Not
Stated
Chicken-pox-
Conjunctivitis-.
Dysentery, bacillary (Shigella)..
Encephalitis, infectious	
Hepatitis, epidemic	
Influenza, epidemic	
Measles 	
Meningitis	
Mumps.-
Pertussis	
Poliomyelitis-
Rubella	
Salmonellosis—
Typhoid fever..
Paratyphoid fever..
Unqualified-
Streptococcal infections-
Scarlet fever	
Septic sore throat	
Vincent's angina	
Totals..
2,376
56
45
2
87
19
1,154
7
1,970
263
28
3,733
2
4
9
204
45
 3_
10,007
2,264
51
30
1
71
16
1,207
9
1,780
250
16
3,892
5
6
211
57
 2_
9,868
45
48
14
3
1
9
2
44
1
52
1
6
585
17
10
1
750
24
2
2
9
103
51
~51
2
8
569
11
6
841 W 46
BRITISH COLUMBIA
Table VII.—Notifiable Diseases in British Columbia, 1952-56
(Including Indians)
(Rate per 100,000 population
)
1952
1953
1954
1955
1956
Notifiable Disease
Number
of
Cases
Rate
Number
of
Cases
Rate
Number
of
Cases
Rate
Number
of
Cases
Rate
Number
of
Cases
Rate
1
0.1
1
3
7
3,600
6,085
64
7
605
1
1,220
78
0.1
0.2
0.5
284.4
480.6
5.1
0.5
47.8
0.1
96.4
6.2
12
3,366
6,266
346
11
1
102
2
212
548
1.0
281.0
523.0
28.9
0.9
0.1
8.5
0.2
17.7
45.7
5
2,785
6,869
193
8
1
588
4
789
808
1
1
7,646
42
8,071
717
787
1,095
10
23
83
24
2,220
206
1
2
0.4
226.4
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
13
3,556
4,947
134
8
2
293
2
841
15,601
1.0
272.5
379.0
10.3
0.6
0.2
22.5
0.2
64.4
1,195.4
0.1
625.2
3.7
223.9
129.0
17.2
58.9
0.6
3.1
7.0
0.9
58.0
27.0
4
3,115
7,113
115
1
0.3
230.7
Chicken-pox...	
Conjunctivitis	
526.9
8.5
0.1
Dysentery—
Bacillary (Shigella)	
Encephalitis, infectious.  . ~
342
9
343
4,021
25.3
0.7
25 4
297.8
2
8,227
33
7,088
976
594
1,986
30
8
109
26
4,163
536
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
1
8,160
48
2,922
1,683
224
768
8
40
92
12
757
352
1
5,616
45
6,768
987
84
11,297
32
32
187
21
645
171
0.1
Measles 	
6,572
47
3,548
1,096
211
832
11
36
173
21
1,355
179
519.1
3.7
280.3
86.6
16.7
65.7
0.9
2.8
13.7
1.7
107.0
14.1
416.0
3.3
501.3
Pertussis 	
73.1
6.2
Rubella '.!,
Salmonellosis—
836.8
Streptococcal infections—
1.6
47.8
12.7
Puerperal septicaemia	
Tetanus	
2
0.2
1
4
1,434
1
2,668
784
36
12
0.1
0.3
113.3
TJ.l
210.7
61.9
2.8
0.9
4
6
1,414
0.3
0.5
108.4
3
1
2
1,331
1
3,442
763
6
4
0.2
3
1,411
0.3
117.8
255.2
45.2
13
1,494
1
2,969
691
11
26
1.1
121.5
0.1
241.4
56.2
0.9
2.1
0.1
98.6
0.1
Tularaemia	
Venereal disease—
3,057
541
19
2,508
765
7
11
192.2
58.6
0.5
0.8
255.0
56.5
Syphilis    (includes   non-
gonorrhceal   urethritis,
Chancroid 	
1.6
0.3
Totals     	
39,677
3,312.0
38,185
3,104.4
30,692
2,424.3
45,179
3,462.0
46,502
3,444.6 DEPARTMENT OF HEALTH AND WELFARE,  1956
W 47
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1 W 48 BRITISH COLUMBIA
REPORT OF DIVISION OF PUBLIC HEALTH NURSING
Monica M. Frith, Director
Ten years have now elapsed since the public health nurses became Provincial
Government employees. During this time unprecedented growth and expansion has
taken place in the Province. This has led to a much larger public health nursing service
than could have been anticipated ten years ago. During the interval there have been
many new scientific and medical discoveries which have altered the public health nursing
service to fit in with the changing concepts of prevention and treatment of disease, and
the promotion of positive health. Some of the developments include Salk vaccine for
the prevention of poliomyelitis, streptomycin for the treatment of tuberculosis cases,
greater use of B.C.G. vaccination to prevent tuberculosis, nursing care and housekeeper
service in the home, prenatal or parentcraft classes, use of expanded resources for the
treatment of crippled and handicapped children and adults, and more emphasis on
rehabilitation, mental health, and health education. These developments have required
public health nurses with better preparation, and at the same time have led to a more
efficient public health nursing service as less essential activities have been dropped to
make way for the more concentrated programme which our present health knowledge
demands.
The number of public health nurses on the staff has increased 110 per cent in the
last ten years to 164 positions in 1956, compared with 77 in 1946. As the population
has increased, and new centres of population have sprung up, public health nurses have
been added to existing local health services. Thirteen new positions were financed by
National health grants during the year. These have been in the Skeena Health Unit at
Terrace, the North Okanagan Health Unit at Salmon Arm, the South Central Health Unit
at Kamloops, the Simon Fraser Health Unit at Coquitlam, the Cariboo Health Unit at
Prince George, the Gibson's public health nursing service, the Upper Island Health Unit
at Courtenay and Powell River, the Boundary Health Unit and the Saanich and South
Vancouver Island Health Unit where two public health nurses have been added to each
unit. In addition, part-time service has been added at Lake Cowichan and in the Alberni
Canal area of the Central Vancouver Island Health Unit. Efforts have been made to
provide more public health nursing service on a part-time basis in the outlying areas too
small for full-time service by employing resident married nurses wherever possible to
carry on a programme of health visiting and immunization in their communities. During
the year, arrangements were completed for service at Zeballos, Gold Bridge, and Smith
Inlet. Part-time service has been given for some time at Tahsis. During the year, public
health nursing service has been extended to certain Indian reservations and thus a comparable public health service is now available to Indian and white populations living side
by side in certain parts of the Province. The Upper Island Health Unit this year provided
service to Campbell River, Cape Mudge, Comox, and Sliammon Reserves; the Simon
Fraser Health Unit to the Coquitlam Reserve; the Boundary Health Unit to Langley
Nos. 3 and 5, Tsawassen, and Semiahmoo Reserves; Skeena Health Unit to Kitselas
Reserve; and Saanich and South Vancouver Island Health Unit to Songhees and Esquimau Reserves.
STATUS OF THE SERVICE
During the year, fifty placements were made to fill existing public health nursing
vacancies. Twelve nurses returned from university following the completion of the public
health nursing course and twenty-one nurses without public health nursing qualifications
were posted to positions requiring staff. Only three qualified public health nurses were
recruited from the course at the University of British Columbia, the remainder being
mostly married public health nurses living in areas where vacancies occurred. Once
again we have been dependent upon the public health nurses trained by National health
- DEPARTMENT OF HEALTH AND WELFARE,  1956 W 49
grant bursaries to accept positions in the outlying parts of the Province. It is always
difficult to fill vacancies in sub-offices of health units where the public health nurse must
work with a minimum of supervision and frequently with very few local resources, and
for this reason the National health grant bursaries have filled a great need. This year
public health nursing trainees returned to fill positions at Smithers, Nakusp, New Denver,
Qualicum, Grand Forks, Greenwood, and Quesnel.
Public health nursing supervisory positions were established at Cranbrook in the
East Kootenay Health Unit, at Trail in the West Kootenay Health Unit, at Vernon in the
North Okanagan Health Unit, and at Courtenay in the Upper Island Health Unit in order
to provide full-time public health nursing supervision to the health units concerned. It
is hoped that additional senior positions may be established in the coming year in the
larger health units.
Thirty-one resignations were received during the year. Thirteen nurses left, due to
family and home responsibilities, seventeen resigned to take other positions, and one
resigned to travel. Eleven nurses are on leave of absence to complete public health
nursing training at university. Twenty-two transfers of public health nursing staff took
place during the year to provide continuity of service in areas where staff adjustments
were required.
Although it was necessary to close the Grand Forks, Greenwood, Vanderhoof, and
Princeton districts, it was possible to have the services instituted again after public health
nursing staff became available in the fall. Public health nurses have been active in
recruiting suitable nurses to the field.
PUBLIC HEALTH NURSING CONSULTANT SERVICE
The Division of Public Health Nursing provides consultant service to local health
units and nursing districts through the Bureau of Local Health Services. The consultants
visit assigned areas twice a year to confer with the public health nursing senior or supervisor and the medical director, concerning the health programme being carried out by
the public health nurses. At this time the case loads and work plans of the individual
nurses are reviewed with a view to improving efficiency. Suggestions and ideas for the
advancement of the service are received from the local health service staff and thus the
consultants' visits provide a link between the central administration and the public health
nurse in the field. The consultants may be called upon by public health staff to help
solve special problems, for example, to advise on control methods for checking staphylococcus infections in a small hospital, as was the case this year.
The public health nursing consultants provide an advisory service to the Bureau of
Local Health Service concerning trends and demands for new public health nursing
services. For example, through analysis of the annual time study it can be shown that
the amount of time being spent by the public health nurse on home visiting has declined
from 20.4 per cent in 1952 to 14.9 per cent this year, while time spent by the public
health nurses on non-professional activities accounted for 8.5 per cent of the nurses' time
this year. This would indicate that some adjustment of the duties of the health-unit personnel should be made so that the public health nurse can devote more time to professional activities and allow less well-trained individuals to carry out non-professional duties.
The non-professional activities include such clerical responsibilities as recording routine
information, filing and sorting records, cleaning, wrapping and autoclaving syringes and
needles, sorting laundry and other housekeeping chores. In an effort to determine the
present need for clerical and other non-professional workers in local health service, Miss
Alice Beattie, newly appointed public health nursing consultant, was assigned to a study
team set up to investigate clerical and non-professional staff needs and to recommend
standardized office procedures and administration. We were most fortunate to have Miss
Beattie accept the position of public health nursing consultant in March, as she brings W 50
BRITISH COLUMBIA
with her a wealth of field experience. Miss Beattie has devoted most of her time since
appointment to the survey and has made a very fine contribution to this study.
The reorganization of the public health nursing records committee has been awaiting
the findings of the survey team which has been reviewing the various record forms in use
in the field. It is expected the committee will be reconstituted in the new year under the
guidance of Miss Alice Beattie, public health nursing consultant. The new committee
will be comprised of a medical director, four public health nurses, and a representative of
the Division of Vital Statistics. During the year, the public health nurses have gradually
changed from the visible filing record system to the family folder system. By the use of
this system the nurse will have all the health records pertaining to the family available at
one time and thus greater efficiency of service will result. Reports for services to Indians
were brought in line with the Provincial record system this year.
Mrs. Dorothy Slaughter, public health nursing consultant, has continued to act in a
liaison capacity with the Divisions of Tuberculosis and Venereal Disease Control and the
voluntary health organizations which have their headquarters in Vancouver. Work has
continued on revisions to the Tuberculosis Policy Manual and the general Policy Manual.
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 Junior Red Cross Nursing and St. John's Ambulance Nursing Committee, the Public Relations and Educational Policy Committees 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.
PUBLIC HEALTH NURSING TRAINING
A university degree or certificate in public health nursing is the requirement for a
staff position in the public health nursing field. However, due to inability to attract sufficient members qualified in this manner, it has been necessary to continue the public
health nursing trainee programme. In this plan, registered nurses without public health
qualifications are taken on staff and given a short orientation period and placed in areas
where they will have the opportunity of receiving close supervision. The department has
the opportunity to assess the nurse before awarding a National health grant bursary to
assist her financially to qualify for a permanent position. The nurse is able to give
minimum service in a district for a short period until a qualified public health nurse
becomes available. During the year twenty-one nurses were appointed as public health
nursing trainees. Ten public health nursing trainees are on leave of absence to complete
the diploma course in public health nursing at a university. Seven of this group are in
receipt of National health grant bursaries and are required to return to the service for a
minimum period of two years. Twelve nurses returned to the staff this summer following completion of this training programme. Thus, the public health nursing trainee programme has proved to be our most reliable method for the recruiting and training of
public health nursing staff.
During the year two senior nurses returned to the staff following completion of
courses in public health nursing administration and supervision at university and were
able to fill supervisory vacancies. Another senior nurse is currently enrolled in a similar
programme at McGill University. This training is made possible through National health
training grants. It is hoped that it will be possible in the future for all the senior nurses
and supervisors to take advantage of advanced training. DEPARTMENT OF HEALTH AND WELFARE,  1956 W 51
Field experience is made available to university students completing the basic public
health nursing programme in various health units where qualified staff are available as
student field guides. Field experience for nursing students from the University of British
Columbia was provided for twenty-nine nurses for a period of from four to six weeks.
The following health units provided this experience in the centres noted: The North
Okanagan Health Unit, four students at Vernon; South Okanagan Health Unit, four
students at Kelowna; South Central Health Unit, two students at Kamloops; Upper
Fraser Valley Health Unit, one student at Chilliwack; Simon Fraser Health Unit, three
students at Coquitlam; Saanich and South Vancouver Island Health Unit, two students;
Boundary Health Unit, four students at Cloverdale and Langley; Central Vancouver
Island Health Unit, seven students at Nanaimo, Port Alberni, Ladysmith, and Duncan;
Selkirk Health Unit, two students at Nakusp and New Denver. In addition, the Cariboo
Health Unit at Prince George provided four weeks of experience for two public health
nursing students from the University of Saskatchewan. The numbers of nursing students
requiring experience in public health nursing from the University of British Columbia
School of Nursing has increased as the new degree programme has had a heavier enrolment than the former programme.
During the year observation periods have been made available for undergraduate
nurses from the two Victoria Schools of Nursing, the Royal Jubilee Hospital and St.
Joseph's Hospital, and for the Royal Inland Hospital in the South Central Health Unit.
It is expected that the Royal Columbian Hospital in New Westminster will be sending
undergraduate nurses to the Coquitlam district of the Simon Fraser Health Unit during
the coming year. A planned experience in the public health nursing field was arranged
for the director of nurses at Tranquille and for six senior staff members. Through these
programmes it is expected that better co-ordination between the public health service
and hospitals will result.
This year the Simon Fraser Health Unit is providing nursing experience for a limited number of practical nurse students from the Vancouver Vocational Institute in Vancouver. This is the first time that practical-nurse students have had the opportunity of
doing practical nursing in the homes in a health unit in this Province. It is hoped that
in the future that more practical nurses will receive training in home-nursing procedures
and that they eventually may be employed in community home-care nursing programmes.
Each health unit carries on a planned in-service education programme to keep the
public health nurses up to date with new developments in the public health nursing field.
The health units select their own topics for study based on the need of the particular unit.
For example, this year many of the health units have used the booklet " Health Supervision of Young Children " as a guide in studying methods of improving the infant health
programmes particularly in relation to better methods of administration, interviewing,
and conferencing at child health clinics. During the year a number of public health
nurses participated in the course in rehabilitation nursing (body mechanics) which was
made available on a local level by the Registered Nurses' Association of British Columbia.   Two nurses participated in the civil defence nursing course given at Arnprior.
The Public Health Institute is one of the most valuable means of in-service training
and staff education, as it is possible at this time to bring together all members of the
nursing staff to learn from experts the best methods of developing current programmes.
During the nurses' section meeting an excellent panel was presented on " Hearing and
Speech Defects " and " Mental Health," while papers were given on tuberculosis and
poliomyelitis nursing at Pearson Hospital. A demonstration was also given on the use
of the Wood's lamp. The public health nurses have an opportunity to meet as a group
at the Institute and thus the Institute provides one method of staff in-service education
and programme planning so that all areas of the Province will benefit. W 52 BRITISH COLUMBIA
LOCAL PUBLIC HEALTH NURSING SERVICE*
The public health nurse is a member of the local health-unit staff and as such works
under her immediate public health nursing supervisor or health unit director. Ocean
Falls, Gibsons, and Howe Sound are the remaining nursing districts where the public
health nurse works alone and receives assistance from the local part-time medical health
officer. Each public health nurse is responsible for an assigned area in which she provides generalized public health nursing service. Because of the steadily growing population and demand for service in rural areas, it has become increasingly difficult for the
public health nurses to carry the nursing programme which is growing along with the
expansion in this Province. Although the recognized standard of one public health nurse
for 5,000 population for a generalized health programme and one public health nurse
to 2,500 population with a bedside programme is used as a guide for nursing needs, it is
not possible to use this standard arbitrarily as very rural districts with scattered populations involving long travel distances make it necessary for the public health nurses to
serve smaller areas. The public health nurses serve in a great variety of communities
and must adapt the service to fit the available local resources, methods of communication, and travel, as well as weather conditions. The public health nursing service has
been divided into the following arbitrary categories:—
Maternal Health—Prenatal and Postnatal
As the prenatal period is known to be most important in affecting the future health
and development of the new-born child, more emphasis is being placed on prenatal
education in order to insure potentially healthy citizens. Parentcraft classes have continued for expectant mothers and in some cases fathers, to prepare them for new family
responsibilities. This year twenty-two centres gave classes, which represents an increase
of ten centres over last year. The classes consist of lectures and discussions on the
hygiene of pregnancy, prenatal and family diet, and such items as demonstrations of the
baby's layette and bath, and techniques of child-care. Relaxation exercises are given at
most centres in conjunction with the class. Basic equipment, including the demonstration layette, teaching films, posters, basic reference texts, and mats for exercise classes,
was again provided for the new centres through National health grants. Prenatal classes
have almost doubled attendance since last year with a total attendance of 3,511. In
addition, 1,839 home and office visits were made to expectant mothers. There were
16,999 postnatal visits to mothers following return home from hospital with the new
baby.
Child Health—Infant and Pre-school
The guidance and instruction in care of the new-born child which the mother receives
soon after her return home from hospital has a most important influence on the future
health of the infant. Therefore the public health nurses attempt to make at least one visit
to the home to give assistance and further visits are arranged as required. Priority is given
to premature and new babies, babies of unusually young mothers, or mothers with special
language or other problems. Following the initial visit, mothers are invited to bring their
infants and pre-school children to child health conferences which are held at regular
intervals throughout the public health nurse's district. Usually the infants attend monthly
during the first year or until the basic immunizations are completed and then at less
frequent intervals during their pre-school years. At the child health conferences the
mothers have the opportunity of discussing the physical and mental development of their
children with the public health nurse and receiving anticipatory guidance. Child health
conferences have gradually been placed on the appointment system so that the clinics are
* Figures shown in this section apply only to the seventeen local health units and nursing districts and do not
include the metropolitan health departments of Vancouver, Victoria-Esquimalt, or Oak Bay. DEPARTMENT OF HEALTH AND WELFARE,  1956 W 53
better organized and less waiting results. Child health conferences in the rural areas are
frequently held in private homes, schools, or halls. Many of these locations are not too
satisfactory, but attendance has continued as the child health conference proves more and
more helpful to mothers.
Child Health—School
The public health nurse supervises the health of the school-children in her district.
These children may be located in a number of schools so that routine visits to the schools
are arranged in order that service may be provided on a definite schedule by the public
health nurse. The public health nurses average 33.1 per cent of their time to the school
health service without counting the time required for travel to the schools, and to the
homes for home-school visiting. School service includes teacher-nurse conferences,
immunization, referral, and follow-up of children requiring special assistance, assistance
with medical examinations on selected children, tuberculin testing, and home visits as
required. This year a considerable amount of time was devoted to the Salk vaccine programme for protection against poliomyelitis. All school-children in Grades I to IX, plus
pre-school children about to begin school, had the opportunity of receiving protection
with Salk vaccine. This was a tremendous undertaking which was completed with the
assistance of volunteers.
The public health nurse concentrates on the children needing special attention as
her time can be best used in this manner. In addition, the public health nurse acts as a
health consultant in the schools and is in a position to give guidance to the teachers in
health teaching and other health problems which arise in the school. The nurse will refer
children needing special treatment or care to their private physicians and may in turn
assist in obtaining special help if required from voluntary health agencies 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.
During the year an attendance of 50,731 infants and 52,606 pre-school children at
the office or at child health conferences was recorded. In addition, public health nurses
made 27,161 infant home visits and 27,706 pre-school home visits for health supervision.
During these visits the public health nurses may discuss such items as dietary problems,
need for protection by immunization, need for correction of physical defects such as cleft
palate and harelip, speech defects, and crippling conditions.
During the year the public health nurses assisted with 24,690 medical examinations,
and in addition made 109,442 nursing examinations and inspections. The public health
nurses held 57,544 conferences with school staff, 37,790 with pupils and 8,552 with
parents. Health problems concerning 72,929 pupils were reviewed. A total of 25,634
visits were made to the homes of school-children, while 3,749 conferences were held with
parents in the office. A total of 172,445 doses of biologicals were given to children at
school.
Tuberculosis
The public health nurse assists with the tuberculosis-control programme by case-
finding methods and through the supervision of the tuberculosis patients and contacts in
her district. A total of 6,668 visits were made by the public health nurses to tuberculosis
cases, and 7,623 to contacts of cases of tuberculosis. Four-fifths of these visits took
place in the homes, while the remainder were in the nurse's office. The nurses continue
to give streptomycin injections to patients as ordered, and this year 15,454 injections were
given. This year it is encouraging to note that it was possible to arrange for the patients
to come in to the office or a clinic for slightly less than half of the treatments. B.C.G. is
given to tuberculin-negative contacts to cases and to special groups such as hospital
employees.  The amount of B.C.G. given was double that of the previous year with a W 54 BRITISH COLUMBIA
total of 543 vaccinations. As the present trend indicates that more cases will be treated
in the community, more time will of necessity be devoted to the treatment and supervision of tuberculosis cases and contacts by the public health nurse.
Other Communicable Diseases
The communicable-disease control programme includes the organization of clinic
services for immunizations which are held at various child health centres and schools
throughout the public health nurses' districts. During the year an intensive poliomyelitis-
vaccination programme was carried out for the protection of pre-school children about
to enter Grade I at school, and for school-children in Grades I to IX. A total of 87,447
injections of Salk vaccine were given. There were 9,589 children who completed the
series of injections for protection against whooping-cough, 13,938 for diphtheria, 13,294
for tetanus, 35,893 were vaccinated against smallpox, and 1,342 received protection
against typhoid fever. In all, a total of 361,022 individual doses were given by field staff
this year. The immunization programme has been increasing gradually as may be illustrated by the fact that over 100,000 more treatments were given this year than'five
years ago. In addition to the above there were 2,577 prophylactic injections, such as
anti-measles serum and gamma globulin given for protection from other communicable
diseases. Public health nurses made a total of 4,683 home visits, and held 487 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 where the incidence is highest in the service. An epidemiology
worker has been seconded to the Cariboo Health Unit by the Division of Venereal Disease
Control and has been effective in the venereal-disease control programme in the area
concerned. A total of 878 office and clinic visits were made for venereal-disease control,
while 369 home visits were made for this purpose.
Nursing Care
Organized programmes of bedside nursing care in the home were extended this year
when the Upper Island Health Unit introduced this service in the Courtenay-Comox-
Cumberland districts in February, and in the Municipality of Powell River in April.
Additional nursing staff were added so that each nurse could reduce the size of her
district in order to add the necessary home-nursing to her generalized programme.
Nursing care is provided from 8.30 a.m. to 5 p.m. each day including week-ends and
holidays and must be ordered by a private physician. During the first nine months a
total of 619 nursing visits were made to 55 patients in the Courtenay-Comox-Cumberland
area, while a total of 181 visits were made to 38 patients in the Powell River area during
the first eight months of operation. The number of calls has increased gradually as the
service has become better known.
Saanich Municipality, in the Saanich and South Vancouver Island Health Unit,
continues to provide the largest volume of nursing care of the areas providing this service,
as may be illustrated by a total of 4,082 nursing visits. This is an increase over a similar period one year earlier.
The North Okanagan Health Unit in Vernon continues to operate the pilot study
hospital home-care programme in conjunction with the Vernon Jubilee Hospital. During
the year the regular public health nursing staff were relieved of week-end call duty as
local, part-time, married public health nurses were recruited for this purpose. The
number of nursing visits has also shown an increase over last year with 469 recorded for
the first nine months of the year. It is estimated that a total of 1,389 hospital-days were
saved by this service during this same period.
Kelowna in the South Okanagan Health Unit continues to provide a bedside nursing ,
service, in conjunction with the housekeeping service which is sponsored locally. DEPARTMENT OF HEALTH AND WELFARE,  1956
W 55
It should be pointed out that nursing care in the home is provided routinely by all
the public health nurses on a short-term and demonstration basis. This includes such
procedures as hypodermic injections, enemas, treatments, and dressings as ordered by
a physician. In an emergency the public health nurse will give more extensive nursing
care and teach someone else to carry on the daily routine. The amount of nursing care
provided routinely varies with the local demand. A total of 16,011 nursing-care services
(exclusive of streptomycin injections) were rendered this year.
GENERAL
The public health nurse provides a family health service in which she is prepared
to do general health teaching and to assist in solving the health problems of the various
individuals in the family group. Public health nurses visited a total of 80,472 homes
during the year for this purpose. The public health nurses refer persons needing special
assistance to the appropriate health and travelling clinic, the Children's Hospital clinic,
the cancer consultation clinic, and the Child Guidance Clinic. Many referrals to other
health agencies in Vancouver, such as the Health Centre for Children and the Canadian
National Institute for the Blind, 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 2,271 home visits and held 280 office conferences concerning
individuals with mental health problems. A total of 55,657 home visits and 16,445
conferences were made for adult health.
The scope of the public health nurses has continued to extend, and with increasing
demands for service, public health nurses continue to work under pressure in order to
provide good public health nursing service in their districts. W 56 BRITISH COLUMBIA
REPORT OF THE DIVISION OF ENVIRONMENTAL MANAGEMENT
Thomas H. Patterson, Director
This Division is responsible for the provision of consultant service in nutrition,
sanitary inspection, Civil Defence Health Services, and occupational or industrial health
from the Provincial level. In addition to consultant service in occupational health, the
Division operates an Employees' Health Service within the Parliament Buildings, whereby
civil servants receive the professional service of one industrial nurse.
As the services associated with nutrition, sanitation, Employees' Health Service, and
Civil Defence Health Service are well established, they are reported on, in separate
section reports which follow.
The establishment of a sound occupational health service, however, has not yet been
accomplished. There are currently at least three Government agencies interested in taking
limited steps to provide some service in this field, and it would appear necessary to clarify
with all agencies concerned, the part and responsibility the Health Branch might have in
developing such a service.
In the opinion of the Director of this Division, there is no doubt that the most
effective service to industry on a Province-wide basis can be developed through the
utilization of public health nurses, doctors, and sanitary inspectors who are already
providing public service in the health units throughout the Province. It is true that many
industries need to employ full and part-time medical and nursing personnel, but in this
Province as elsewhere in Canada and the United States the greatest number of workers
are employed in plants and industries which are too small to employ health staff.
Most health problems encountered in industry are non-occupational in origin and
might not, therefore, be considered of interest to management of industry. It should be
remembered, however, that regardless of whether illness or injury is occupational or
non-occupational in origin, the resulting time-loss or reduced working capacity of the
worker has the same economic impact on production. Therefore, it is in the interest of
all companies to protect and promote good health among all employees.
It is encouraging to see a growing interest in industrial health service on the part of
the medical and nursing professions as well as among some of our industrial-management
groups. An opportunity presented itself during the year to attend a meeting of a group
of personnel officers and to present a talk on the problems of employee health. The
interest of this group in the recognition and management of these problems ran very high.
A Board of Trade group in British Columbia has requested that consideration be
given to holding a symposium on the subject of industrial health at one of their meetings.
This tends to follow the line along which the Pacific Northwest Industrial Health Conference was started three years ago. This Conference is now an annual three-day affair,
sponsored by the Chamber of Commerce of Portland, Ore., and is attended by representatives of labour and management of industry, as well as from professional medical,
nursing, and engineering groups. The Industrial Health Committee of the Greater
Vancouver Health League has also continued to encourage industry to develop industrial
health services.
During the course of the year, lectures on industrial medicine were given to undergraduate medical students at the University of British Columbia. These lectures served
to introduce this subject to the students in such a way that they may realize not only the
need for medical services in industry, but the type of service required and the type of
greatest value to the employees and employers.
Two large companies have requested advice on the type and method of setting up
industrial health services required for their employees. The industrial nurse now operating the Employees' Health Service in the Parliament Buildings also gave advice on DEPARTMENT OF HEALTH AND WELFARE,  1956 W 57
request to a number of nurses employed, or going to be employed in British Columbia
industries. A few physicians also requested advice concerning either specific industrial
health problems they had encountered, or concerning the proper management of industrial
health services.
Special occupational health problems continue to arise, and many are carried over
from past years. For instance, in the field of radiation there is a growing awareness of
the hazards associated with this phenomenon. A survey by questionnaire was carried
on throughout the Province to determine the number and types of X-ray shoe-fitting
machines being operated in British Columbia. It was revealed that there were many older
type machines in operation which could quite likely be capable of scattering considerable
stray radiation, but to measure this would require special equipment and personnel. In
addition, detailed measurement of this type of radiation would only serve to assess the
magnitude of one part of the hazard. It is extremely important that the operators of these
machines know the dangers of radiation, both to themselves and to the customers.
Children particularly, can suffer serious exposure to the growing bones of their feet, when
these machines are used to excess. There is definitely some question as to the value of
this type of equipment as an aid to proper shoe fitting, but until more definite steps can
be taken to control its use, this department is undertaking to provide safe operating
instructions to all operators. Also, a warning card for public information has been
provided and is expected to be placed in a prominent position on each machine.
Concerning other types of radiation hazards, the Department of National Health
and Welfare is continuing to provide a film monitoring service, the use of which the
British Columbia Health Branch is promoting in hospital and clinical X-ray units and
in industries where X-ray and radioactive isotopes are used. All reports of the readings
of these monitoring badges are collected and recorded by this Division. Although it is
desirable that some of the levels of radiation now experienced by some employees be
lowered, there would appear to be a definite reduction occurring among those persons
using these badges. This might exemplify the educational value of these badges, in
keeping the employees aware of the fact that carelessness in handling radiation is a
serious matter.
Because of the newness and still incomplete knowledge of the handling of radioactive
isotopes for industrial purposes, handlers have been very cautious in their dealings with
isotopes and for this reason it has not become of major concern to date. On one occasion,
however, a rather disturbing report was made to this Division concerning possible mishandling of one of the isotopes on a construction project. On further investigation it was
found that correct handling procedures were being carried out at the time of the visit and
that the operators were alert to the possible dangers. With the growing use of these
procedures in industry, particularly away from the larger centres, public health personnel
are going to have to closely observe the handling techniques in order to protect the health
of operators and workers in the vicinity of these operations.
One example of other types of problems referred to this Division concerned the
escape of ammonia fumes from a printing establishment into living accommodations
situated above the plant.   Here, improved local exhaust ventilation was recommended.
Several questions concerning the use and toxic effect of insecticides were referred to
this Division during the year and two industrial situations leading to possible lead poisoning were investigated.
The need for a laboratory, properly equipped and staffed to carry out chemical
analyses and field investigations for both the public health engineering division and the
occupational health service, is quite evident and plans have been developed in this regard.
The Department of Mines Laboratory in Victoria has continued to give assistance when
requested, but such requests undoubtedly impose an extra burden on the already very
busy staff of this laboratory. W 58 BRITISH COLUMBIA
A number of the interests of the Health Branch might be considered the joint
responsibility of the Director of Public Health Engineering and the Medical Director of
this Division. The growing problem of atmospheric pollution was under joint review by
these two Directors during the year. Similarly, the ventilation requirements for the
proposed Deas Island tunnel were also reviewed from a health-engineering and medical
viewpoint by these two Divisions of the Health Branch.
Growing awarness of the importance of accident prevention in the homes and on the
highways has led this Division, along with others, to take an active interest in this subject.
In recent years the medical representatives of the Health Branch have been called upon
to interpret to the Motor-vehicle Branch the ability of certain persons to drive an automobile safely while subject to various physical handicaps. In this regard also, a special
committee of the British Columbia Branch of the Canadian Medical Association has been
formed to determine standards which physicians might use for reference in making
recommendations to the Motor-vehicle Branch upon individual examinees.
Unfortunately there are very few statistics available concerning the extent of the
problem of home accidents. At present, only accidents resulting in death are reported
to the Health Branch, but there is no doubt that a considerable number of preventable
accidents result in temporary, or even permanent disability. Some means of finding the
cause and incidence of these accidents is necessary if a proper control programme is to
be developed. One possible source of valuable information in this regard is through the
hospital admission-discharge records now being collected by the British Columbia
Hospital Insurance Service.
An important step has been taken in this Province with the establishment of a Poison
Control Centre in Victoria. This Centre is operated on a 24-hour basis from the Royal
Jubilee Hospital, and stands ready to give information concerning antidotes and treatment
for all known poisons.   A similar centre is being planned for Vancouver.
Prevention of accidents is primarily a matter of public education and in this regard
the British Columbia Safety Council has now established a Community Safety Section,
in which this Branch has representation. The objective of this Section is to promote the
development of local safety councils and to guide and assist these councils in preventing
accidents in homes, schools, recreational activities, and in agriculture.
The Health Branch has worked closely with the Department of Education in developing a programme of first-aid instruction in schools throughout British Columbia. Should
this type of training be adopted as a regular part of the school curriculum it would
eventually result in a major portion of our population having at least a basic knowledge
of how to save lives and to deal with the most common emergencies. This would serve
to supplement the training now being sponsored by the Civil Defence office and the
St. John Ambulance Association.
A.   NUTRITION SERVICES
The role of the Nutrition Services is the practical application of nutrition knowledge.
This is carried out by a nutrition education programme directed toward the improvement
of food habits and the wise selection of food from the abundant variety available to-day.
Consultant Service to Local Public Health Personnel
Nutrition education reaches many of the people of the Province through the public
health team by means of prenatal classes, child conferences, and home and school visits.
Consultant service has been provided to local health units by keeping personnel
informed on the latest nutrition information, by providing technical data and educational
material, by giving advice and assistance with projects and problems. Some of this
service was provided directly by visits to health units.
The areas to which nutrition education was directed in 1956 were mainly community
health, maternal and child health, and school health. DEPARTMENT OF HEALTH AND WELFARE, 1956 W 59
Community Health
Food budgeting and the planning of low-cost adequate menus are an important
consideration in the wise selection of food. Information on this subject was provided to
the local newspapers. Much advice and help has also been given to the local public
health personnel on this subject.
"Family Meals," a publication much used by housewives, was revised with the
co-operation of the Vancouver Nutrition Group.
Maternal and Child Health
A leaflet, entitled " A Guide to Food Selection for Expectant Mothers," was prepared
in co-operation with the Professor and Head of the Department of Pediatrics, University
of British Columbia, and the Vancouver Nutrition Group, and approved by the Committee on the Foetus and New Born, of the British Columbia Division of the Canadian
Medical Association. This has been made available to physicians and to public health
personnel for use in their prenatal classes, which are conducted in many areas of the
Province.
The services of the nutrition consultant were used by the Victoria-Esquimalt Health
Department during discussions on food selection with prenatal classes.
School Health
Dietary studies using Canada's Food Rules as a guide have indicated that the chief
deficiencies in school-children's meals are milk, cheese, Vitamin D supplements, and
foods rich in Vitamin C. Excessive consumption of sweet foods and soft drinks, which
contribute to dental decay, were evident.
Instruction within the schools has been planned to direct attention to these deficiencies. The keeping of food records followed by rat-feeding demonstrations has been a
graphic means of teaching the value of good eating habits. Fifty-four rat-feeding
demonstrations were carried out with the kind co-operation of the Animal Nutrition
Laboratory at the University of British Columbia, who supply the rats.
An outline for menu planning for use in dental clinics and offices was compiled by
the Nutrition Consultant and the Director of the Division of Preventive Dentistry. This
outline, based on Canada's Food Rules, shows what foods should be chosen for dental
health.
School-lunch programmes in many schools enable children to obtain milk and other
food supplements to their carried lunches or, in many cases, a full meal. Advice has been
given in several schools on the planning of these meals.
In co-operation with the Vancouver nutritionists and the Vancouver School Board
dietitians, the school lunchroom section of the School Planning Manual was revised at
the request of the School Planning Division of the Department of Education.
Consultant Services to Hospitals and Institutions
Consultant services in co-operation with the British Columbia Hospital Insurance
Service were arranged for several hospitals. Eleven hospitals were visited and information given on menu planning, purchasing and cost control, food preparation, personnel
management, sanitation, and the selection of equipment. Visits on a consultant basis
were paid to one private hospital in Surrey, to the Queen Elizabeth Hall (Home for the
Aged Blind), the British Columbia Alcoholism Foundation Home, the British Columbia
Cancer Home, and to New Haven. Routine visits have also been paid to Oakalla Prison
Farm.
A study was made of the food costs at Tranquille Sanatorium and a report containing recommendations was submitted. W 60 BRITISH COLUMBIA
A thorough survey was made of the food service of the Dominion-Provincial Vocational Training School in Nanaimo, at the request of the Director of Technical and
Vocational Education there.
Technical information was provided to the Department of Fisheries at their request.
Samples of numerous foods were tested for the Purchasing Commission to determine
their flavour and general quality.
Emergency feeding courses at the Civil Defence College, Arnprior, Ont, were
attended by the nutrition consultants in February and May, respectively. Assistance was
given to local Civil Defence officials in organizing a course in emergency feeding, which
was given in Victoria.
General Observations
The Vancouver Nutrition Group, composed of nutritionists from the Vancouver
Metropolitan Health Committee, University of British Columbia, Vancouver General
Hospital, this Department, and other agencies, meets to co-ordinate nutrition activities
within the Province and to act as a common meeting-ground for general discussion and
the interchange of ideas on nutrition problems.
The programme of 1956 has continued to work for the improvement of the
nutritional status of the people of the Province. A loss was suffered in August by the
resignation of Miss Doris Noble, who had contributed greatly to the Nutrition Services
for the last ten years.
B.   SANITARY INSPECTION SERVICES
The Division provides a broadly planned programme of practical assistance and
consultation service to the local sanitary inspector and medical health officer in the
prevention and correction of health hazards. The continuing, conscientious efforts of
local health services with a keen appreciation of the needs of the public provides the
personal element in elevating hygenic practice in food control, industrial transient housing,
private water supplies, private sewage disposal, rodent and insect control, and other
community sanitation matters. Firm policy procedures in the categories of barber-shop
hygiene and quality milk control were established during the year, which allows for closer
liaison between the inspector and the operator, yet provides the means for a disciplinary
action in maintaining statutory obligations.
In meeting the demand for increased service, the establishment of thirty-three
sanitary inspectors was increased to thirty-five. Five vacancies in staff, one by death and
four by resignation, occurred in the year. As a means of maintaining staff requirements
despite the shortage of qualified persons, seven sanitary inspectors-in-training, employed
by the Department, successfully completed the examination conducted by the Committee
on Certification, Canadian Public Health Association.
An intensive two-weeks' course in plumbing was provided for sanitary inspectors
and plumbing inspectors employed by the Regional Planning Division, Department of
Municipal Affairs.
Milk
For the sixth consecutive year an evaluation has been made on the bacteriological
quality of pasteurized milk. Aji average plate count of 9,600 colonies per cubic centimetre was obtained from 1,933 samples from seventy-nine vendors. Each successive
year since 1950 this tabulation has indicated improvement over the previous years. The
relatively low plate count indicates that on the average a comparatively good milk, in
bacterial quality, is being supplied to the consumer. Nine of the seventy-nine vendors
failed to meet the allowable limit of 50,000 colonies per cubic centimetre. A further six
vendors ranged between 30,000 and 50,000 colonies per cubic centimetre or, a total of DEPARTMENT OF HEALTH AND WELFARE,  1956
W 61
fifteen vendors failed to qualify in the new standards contained in the regulations pursuant
to the "Milk Industry Act," 1956. Comparative figures for six years are summarized
as follows:—
Average Plate Counts on Pasteurized Milk,
1950-1955
Year
Number of
Vendors
Number of
Milk Samples
Average Plate
Count per C.C.
1950                                                         -   -               	
56
45
56
68
74
79
586
728
1,021
1,386
1,930
1,933
22,000
1951
13,000
1QS2
13,700
jim
10,300
19S4
10,000
1955 ...	
9,600
In 1956 the "Milk Industry Act" was passed and legislation under the "Health
Act" and " Municipal Act" was repealed. A new Act provides for co-ordination of the
activities of the veterinary inspector on the policing and grading of farm premises, the
Dairy Branch inspector on policing and licensing of dairy plants, and the sanitary
inspector and medical health officer in policing the bacterial quality of the milk as
delivered to the consumer. All of which places a line of demarcation on inspection
duties and removes overlapping of inspections often encountered in the application of
the previous legislation.
Under the " Milk Industry Act," compulsory pasteurization is the rule. The exception to this rule enables municipalities to adopt raw-milk by-laws. Forty-three municipalities are reported as having taken advantage of this exception. However, less than
5 per cent of the milk so distributed is non-pasteurized.
It was the privilege of this Division to assist the Department of Agriculture in the
preparation of the regulations pursuant to the "Milk Industry Act," to assist on the
Government-Farmer Committee on Dairy Farm Standards, to assist the Live Stock
Commissioner in the orientation of veterinary inspectors to the bacterial standards and
policies of enforcement of the new regulations, to assist the dairy commissioner in the
orientation of Dairy Branch inspectors to bacterial standards and requirements of
municipal milk by-laws, to work with the Department of Municipal Affairs in the
preparation of a model milk by-law for a municipality, and to participate in the presentation of the annual plant operators' short course conducted at the University of British
Columbia.
Municipal milk by-laws for The District Municipality of Powell River; Cities of
Armstrong, Kaslo, Trail, Rossland, and Kelowna; and villages of Gibsons Landing,
Squamish, Fruitvale, Warfield, Montrose, and North Kamloops were reviewed prior to
submission for approval by the Lieutenant-Governor in Council.
Eating Places
The inspection of eating and drinking places is an important feature in the routine
activities of the sanitary inspectors. Only three complaints were received by the Division
during the year. All these complaints concerned the lack of rest-room facilities for
patrons. While most premises provide rest-room facilities or permit the use of the
employees' facilities, it is not a requirement by the regulations that facilities be available
to the patron. A women's organization, by resolution, requested that rest-room facilities
for patrons be mandatory in all restaurants.
Food-handling classes sponsored by health units, and emphasis on proper food-
handling techniques by the sanitary inspectors on routine visits are credited with lowering
criticism of public eating places.   More important is the minimum incidence of food- W 62 BRITISH COLUMBIA
poisoning episodes in recent years. Attendance at these classes has been on a voluntary
basis. It is recognized that it is the participation of the better-class establishment and
particularly the members of the Canadian Restaurant Association that has contributed
to the success of the food-handler training programme.
Food Control
Inquiries were made concerning alleged inferior food products, including cut-up
poultry, shell-fish, imported eggs, cereals, and the transportation of meat in summer
months without adequate refrigeration. Liaison on these items and related matters is
maintained with the Inspection Division, Food and Drugs Branch, Department of National
Health and Welfare.
Slaughter-houses
There are seventy-four slaughter-houses in the Province, licensed annually under
the " Stock Brands Act," Department of Agriculture. Before a licence is issued or
renewed the operator is required to obtain a certificate of inspection completed by the
medical health officer and attach the certificate to the application for a licence. If the
application is not accompanied by the inspection certificate, the issuance of the licence
is held in abeyance until the requirements of the sanitary regulations have been met.
Eight applications on the initial submission in 1956 were not accompanied by an inspection certificate and required follow-up through this Division. This approval-licensing
arrangement has been in operation for seven years and has proven mutually satisfactory
to the Department of Agriculture and the Health Branch and has raised the sanitary
standards of slaughter-houses.
Meat Inspection
It is estimated that 90 to 95 per cent of meat sold in the Province is inspected in
abattoirs under Federal licence. In most of the remaining 5 to 10 per cent, the animal
is slaughtered in slaughter-houses approved by the medical health officer or the animal is
slaughtered and inspected under municipal by-law. Cities with municipal inspection are
Vancouver, Kelowna, Penticton, Vernon, Salmon Arm, and Kamloops.
For several years the Union Boards of Health and other agencies passed resolutions
requesting meat inspection to supplement that now carried out in Federally licensed
abattoirs. The passing of the "Meat Inspection Act" in 1954 has not satisfied the
proponents for meat inspection and resolutions received in 1956 propose the requested
supplementary inspection be carried out by the appointment of Provincial meat inspectors.
Industrial Camps
Joint planning of industrial camps by the operator and the sanitary inspector has
proven particularly effective in elevating industrial camp standards. The regulations for
the sanitary control of industrial camps were used as the guide in the planning. This type
of programme provides for quality in accommodations provided by the employer and an
appreciation of the accommodation by the employee.
Native Indian housing at the salmon canneries on the Skeena River was given more
than the usual attention by the cannery operators, both individually and in committee,
and by the medical health officer.
Further to the 1955 survey by the Director of the Division, assisted by the local
medical health officer and with the co-operation of the Aluminum Company of Canada,
progress was made toward the elimination of that segment of camp housing which is
substandard.
The use of tents and other substandard housing was encountered in the industrial
activity on Vancouver Island. Corrective measures were instituted after review by the
contractors and the medical health officers. DEPARTMENT OF HEALTH AND WELFARE,  1956
W 63
Conventional trailers, designed by manufacturers, continue to increase in number
on temporary construction projects. These trailers are limited to accommodate five
workers. Exception is made to the rule where separate recreational facilities are provided
and use is extended, by permit, to accommodate six persons.
Summer Camps
The usual co-operation was given to the Welfare Institutions licensing authority in
the inspection of camps, with recommendations leading to the licence granted under the
"Welfare Institutions Licensing Act." The emphasis in the course of inspection is to
discuss good sanitation practices with the operator.
In the evaluation of the thirty-nine camps reported in 1956, twenty-nine were
classified as good, eight as fair, and two as poor. Comparative ratings for the inspections
of 1951 through 1956 are as follows:—
1951
1952
1953
1954                        1955
1956
Class
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
Number of
Camps
Per
Cent
Good 	
Fair	
Poor.	
Unsatisfactory
22
18
6
3
46.0
36.0
12.0
6.0
35
13
4
4
62.0
23.0
7.5
7.5
29
13
3
2
61.5
27.5
6.5
4.5
1
48     |    63.0
24     |    32.0
3     1      4.0
1     j      1.0
!
44     |    55.0
28     |    35.0
5            6.5
3     [      3.5
29
8
2
75.0
20.0
5.0
Totals...	
49      1
56
	
47      1      ...
76      1
80     1
39
1
Plumbing
The sanitary inspector normally acts as a consultant to municipalities and endeavours
to limit plumbing inspection to public buildings and occasional private premises in
unorganized territory. As many municipalities have adopted the National Building Code,
sanitary inspectors were given a two-weeks' intensive course in the interpretation of the
National Code to better fit them as advisors to the municipal plumbing department. As
plumbing inspection is related to the normal activities of the sanitary inspector, municipalities within health-unit areas often request routine plumbing inspection under the
auspices of the health unit. The Health Branch policy has been to resist assuming this
additional work load. Exceptions have been made on the health-unit level until the
municipality arranges to assume this function.
Likewise, the routine inspection of Central Mortgage and Housing Corporation
septic tanks within municipalities has added to the load of the sanitary inspector, and
health units have been encouraged to stimulate the municipalities to assume the inspection
within the municipal boundary and reserve the inspection on the health-unit level to
unorganized territory.
Trailer Parks
With increasing popularity of self-contained trailers as a means of housing, particularly in the vicinity of construction projects and as tourist accommodation, many inquiries
have been received concerning the establishment of trailer parks. Information on auto-
trailer park by-laws has been supplied to all health units and to some municipalities.
Two requests were received proposing trailer-park regulations under the " Health Act."
Barber-shops and Beauty-parlours
Expenditure in time on this phase of sanitation was increased this year, pursuant to
rescinding regulations of the Provincial Board of Health, 1936, and replacing with the
" Regulations for the Sanitary Control of Barber-shops," 1955.   The policy of inspecting W 64 BRITISH COLUMBIA
and method of recording inspection were decided by the Health Officers' Council, 1955.
Inspections on the part of the health officer prior to this year supplemented the " self-
inspection" process conducted by the Barbers' Association of British Columbia, by
inspectors appointed from within the ranks of the trade. Routine inspection in 1956 by
the sanitary inspectors, under the new regulations and requested by the Association,
resulted in 548 reports being submitted to this Division. For the most part shops are
of a high standard and the operators as a rule have a keen appreciation of hygiene
practices. The problem of the trade in the evaluation of sterilizing cabinets has been
solved from the information gathered from the reports.
Pest-control
Mosquito larviciding and control is carried out on an increasingly larger scale each
year and is done in all sections of the Province. Costs of the measures employed must
be borne by the local areas. The Health Branch budget is designed for expenditures
for the control of communicable disease and the mosquito in British Columbia is not
considered a factor in the transmission of disease. Seven requests were received for
grants-in-aid. Despite having to turn down the requests for aid, the medical health
officer is, however, able to offer advisory services on eradication measures when financed
locally.
Co-operation with the Laboratory of Hygiene, Department of National Health and
Welfare, continues. The City of Victoria routinely collects rodent specimens in the
rodent-plague activities, and the South Okanagan Health Unit collected ticks during the
early summer months in search for Rocky Mountain Spotted Fever incidence.
Garbage-disposal
Several requests are received each year toward locating Crown land for municipal
areas and communities in unorganized territory. Many municipalities look to sites
beyond their boundaries for the establishment of refuse-disposal grounds. In most
areas Crown land is available. The medical health officer assists in locating possible
sites and the local authorities make application to the Lands Department to have the
parcel reserved. These sites are often used jointly by the residents of the municipality
and residents of the adjacent unorganized territory. As the population of the municipality increases, a municipal collection system is invoked under by-law and more attention is given to maintaining the disposal-site, often to the exclusion of residents of unorganized territory. The excluded persons then request a separate site. As any disposal-
site is a nuisance-ground, the Health Branch feels one such nuisance-ground in a locality
should suffice. It is the policy of the Division to stimulate municipalities toward extending the use of the disposal-site to residents of unorganized territory at a nominal charge
per deposit to the non-municipal residents.
C. CIVIL DEFENCE HEALTH SERVICES
The changing concepts of Civil Defence which result from studying world affairs
and the potential striking force of possible enemies, has introduced the present trend of
thinking along the lines of evacuating total populations from target areas in the event of
the outbreak of war.
Planning for such large scale evacuations does not negate the need for continued
development of previously designed disaster plans for hospitals and communities. Plans
for evacuation or disaster allows either alternative to be used according to the dictates of
circumstance. The responsibilities now placed on Civil Defence planners and personnel
have therefore been greatly increased and may no longer be considered part-time occupations if proper planning and organization is to be expected. DEPARTMENT OF HEALTH AND WELFARE,  1956 W 65
Hospital Planning
With a policy of evacuation of target areas being considered, the Federal Civil
Defence Health Services realized that the evacuation of hospitals would constitute a
special problem. There was not any reliable information available on this continent
that could be utilized to aid or instruct hospitals how to plan for this emergency. Therefore, it was thought that if one large hospital in Canada could be persuaded to carry out
an evacuation scheme, a great deal of basic essential information would become available.
St. Paul's Hospital in Vancouver had developed an excellent disaster plan which
was demonstrated in 1955 and, when approached concerning the evacuation-plan proposal, readily volunteered to participate providing financial and staff assistance would
be forthcoming. After two and a half months of detailed study and planning, which
involved not only St. Paul's Hospital but the services and personnel of the Civil Defence
offices of Burnaby, Vancouver, the Provincial and Federal Governments, a very successful exercise was carried out in November.
The exercise consisted of the evacuation of 100 simulated patients of the types
usually found in St. Paul's Hospital throughout the year. These patients were actually
admitted to beds throughout the hospital and then on a given signal were evacuated by
bus, transport truck, and cars to an improvised 200-bed hospital set up in a school in
Burnaby.
The exercise proved that such a procedure was feasible, but that there were many
problems to be faced for which solutions were required. A full report of the study will
be published when all the data and observations are complete.
Many hospitals in British Columbia do not yet have disaster plans developed, but
several have requested assistance in this regard.   An added stimulus to the development
of these plans is now being given in that such a plan is required and must be approved
before the hospital may receive accreditation by the Joint Commission on Accreditation
of Hospitals.
Survey of Facilities and Personnel
In 1950 a questionnaire was sent out to all health units requesting information concerning the number of persons in each area who were trained to carry out medical, nursing, or first-aid duties in time of emergency and also information concerning existing
hospital facilities and other accommodation which might be converted to emergency
hospitals. This information was reviewed and brought up to date again in 1956. The
potential ability of any community to cope with disaster or to give assistance to another
disaster area can be estimated by studying these data and they are therefore of use to
the Provincial Civil Defence office in directing Province-wide operations.
Training
In addition to the first-aid training being carried on throughout the Province, more
specialized training for professional personnel was offered during the year. Two courses
on ABC Warfare were held in the Civil Defence College at Arnprior, Ont, for physicians
and dentists.   British Columbia sent a total of nine candidates to these courses.
Two indoctrination courses in ABC Warfare were held for nurses at Arnprior and
fourteen nurses were able to attend these courses from British Columbia.
The training for pharmacists who are expected to act as supply officers in the Civil
Defence Health Services was increased by having nine pharmacists attend the course held
at Arnprior during the year and by having twenty-seven British Columbia pharmacists
attend a course sponsored by the British Columbia Provincial Civil Defence office and
held at the University School in Victoria.
One other important type of health service training was supplemented by having
twelve more candidates attend the Casualty Simulation Course put on by the Federal
Civil Defence College at Arnprior. W 66 BRITISH COLUMBIA
In order to integrate the various Civil Defence Health Service organizations and also
to study the many problems encountered in all the Provinces an Inter-Provincial Civil
Defence Health Service Conference was held in Ottawa during the year. Representatives
of this Province and of the City of Vancouver were in attendance at this meeting.
Study Forums
The Provincial Civil Defence office carried on three more study forums during 1956.
The health problems presented in these forums varied from those encountered in the
previous year because of the fact that each of the areas in which they were held were
reception areas expecting tremendous increases in population, due to evacuation of target
areas. Rather than preparation for casualty treatment, the emphasis now falls on prevention of communicable disease, protection of water supplies, maintenance of sewage
and sanitary services, and it was quite evident in each of these forums that a strong
public health service in peace-time was the key to coping with the problems of mass
evacuation in time of disaster.
D. EMPLOYEES' HEALTH SERVICE
The prime objective of the Employees' Health Service is the conservation of the
health of the employees of the Provincial Government in Victoria. A full-time occupational health nurse is located in the Health Centre, Room 132 of the Douglas Building.
When necessary the services of a physician are available.
During the year the Health Centre has made available health counselling and
emergency medical services for both occupational and non-occupational illnesses and
injuries to approximately 3,000 Provincial Government employees. Although all Provincial Government employees in Victoria are eligible to make use of this service, the
greatest number of patients come from the Parliament Buildings or their immediate surroundings. The farther away the employees were from the Health Centre, the less they
utilized it. The following table gives a comparative analysis of the activities and services
rendered by the Health Centre during 1955 and 1956.
Number of visits—
Total 	
First visit of occupational or non-occupational
disease or injury	
Repeat visit	
Follow-up       351
Consultation, doctor or nurse	
Visitors to health centre	
Civil Defence	
Requested visit before returning to work	
Miscellaneous	
Visits by sex—
Male 	
Female 	
Classification
All new diseases      485
Occupational 	
Non-occupational
All new injuries	
Occupational
Non-occupational
1955
1956
2,714
3,384
914
1,141
939
831
351
374
403
408
39
14
8
0
8
12
62
58
1,570
1,610
1,144
1,774
485
669
14
6
471
663
429
472
181
215
238
257 DEPARTMENT OF HEALTH AND WELFARE, 1956 W 67
All repeat visits  939 831
Occupational  149 167
Non-occupational  770 664
Disposal—
Sent to hospital  11 30
To physician, dentist, specialist  122 146
Sent home  35 86
Returned to work  2,040 2,354
In reviewing the analysis of the services and activities rendered by the Health Centre,
several factors must be considered, as follows:—
(a) The Health Centre is closed when the nurse is making surveys, conducting
clinics, lecturing, taking in-service training, and attending meetings pertinent
to occupational health in Vancouver. Due to these factors it is felt that the
case load of the Health Centre has increased considerably more than the figures
indicate.
(b) The Health Centre is used as a teaching unit, to make the employee aware of
his responsibility for his health and to teach him practical first-aid measures by
his correct handling of his own injuries and illnesses.
During the year 162 reports on accidents were submitted to the Workmen's Compensation Board, but of these only thirty-six cases required the attention of a private
practitioner and only fourteen lost working-time as a result of their condition.
It is worthy of note that record-keeping is one of the most important duties of the
occupational health nurse. Accuracy and completeness of records about compensable
conditions are important for legal reasons and for statistical data related to occupational
and non-occupational illnesses and injuries. Through tables and graphs of these records
the Employees' Health Service can illustrate the health trends of the employees as well as
its own accomplishments and needs.
This last year a greater variety of personal and personality problems was seen. This
is probably due to many causes—the emotional stress created by the lack of trained
professional personnel causing a heavy load of supervision and teaching, the change in
the type of people working, and the unrest caused by the series of crises and increasing
world tensions. The type of health counselling is also changing due to the influx of
working mothers, older workers, and new Canadians. This influx has also brought new
health problems, such as those related to pregnancy, fatigue, and the diseases of the older
employed group. Many older people, especially those due to retire soon, tend to be
prone to tension. Then again, many new female employees who are also married, have
conflicts of interest between their marriage and their job, with the result that family and
job troubles grow to major proportions.   Thus morale, health, and work all suffer.
Constructive Medicine (Counselling and Health Education)
Counselling, the art of interpreting and making available special knowledge or
resources to those who desire them, is an important function of the Employees' Health
Service. Often, an employee using the Health Centre for a minor injury or illness is made
aware of symptoms which show a predisposition of that individual to a certain illness.
After he has thoroughly understood the need, a referral of this individual to his family
doctor has resulted in early recognition of the condition and more effective treatment.
It is during this initial visit that the nurse establishes the rapport on which future counselling depends. Employees inquire not only about their own health, but also the health
of their families. Many patients, after their visit to their family doctor, utilize the Health
Centre for treatments or injections ordered by their doctor.   In this way illness or injury W 68 BRITISH COLUMBIA
is continually under the surveillance of medical personnel. There is less danger of
secondary infection, less absenteeism, and a shortened period of convalescence or rehabilitation.
Many patients present symptoms such as headache, fatigue, difficulty in relaxing, and
anxiety or depression, without any apparent physical basis. These symptoms usually
denote excessive tension. Simply by being objective and a good listener, the occupational
health nurse can let the employee talk about his problems and his feelings. By discussions with the nurse the employee is often able to understand for the first time what is
really bothering him. However, if the employee's problem warrants it, he is referred to
the appropriate clinic, agency, or physician. Symptoms such as the above are common.
They result in a great loss of time and operating efficiency.
Needs of the employee are often expressed in the types of health pamphlets he
selects. In this way, health education during his visit can be directed to his needs. Much
practical nutrition teaching has been done as the employees are becoming aware of its
importance in daily living.
The counselling service at the Health Centre helps the employee to preserve his
greatest asset—his health. It also helps to teach habits of sound living and to delay many
of the disabling conditions that develop over the years.
Emergency Medical Care
Emergency medical care is the immediate and temporary care given in case of accident or illness before the services of a physician can be secured. Patients with minor
illness and injuries are kept under medical surveillance and treatment and are instructed
in safety and the care of injuries. At other times illnesses and injuries are referred to the
family doctor.
In reviewing the cause of an accident, the following is considered: The presence and
use of safety devices, the physical and mental handicap of the employee, any unsafe act
or unsafe condition, and the general housekeeping of the area. For example, many of the
accidents reported have occurred at 10 a.m. or 3.30 p.m. This is indicative of a fatigue
state, which is a common complaint. It may be caused by lack of proper skill or increased
responsibility, lack of interest in the job, emotional conflict, imbalance between work and
play, or lack of sleep. Fatigue may be a defensive method in meeting psychological needs
of the individual. It can be understood why no injury or illness is too minor to warrant
attention at the Health Centre.
Surveys
Lighting study was conducted again this year where complaints about eye strain and
headaches seemed to indicate that poor lighting might be the cause. The report was
forwarded to the appropriate department.
Because of the evident lack of an adequate job description for occupational health
nurses, a comprehensive study was made of records and reports, home-visiting, and
accident prevention. The remaining portions of this study were gleaned from articles in
nursing periodicals. This report, in the form of a brochure, was sent to the occupational
health nurses throughout the Province.
A manual of employee health services policies and procedures was also compiled
and assisted greatly in giving constructive criticism to a procedure manual now under
discussion at a National level. A reference list of publications pertinent to occupational
health nursing in British Columbia is also being completed.
A review was made of the absenteeism rates and records of the civil servants compiled for the Civil Service Commission by each Government department. These forms
were devised for statistical data and could not in their present form be used by the
Employees' Health Service.   However, need of an absenteeism report is under discussion. DEPARTMENT OF HEALTH AND WELFARE,  1956
W 69
For the convenience of the employees, the Canadian Red Cross Society's Blood
Donor Service held two clinics at the Parliament Buildings. The total response was 592.
A number of Government employees are on call and donate regularly at Red Cross
House, Victoria.
An active part was taken by the occupational health nurse in community health and
welfare projects in the form of lectures, committee meetings, conferences, and institutes.
An Occupational Health Nursing Institute was held in Vancouver, the theme of which
was to define the function of the occupational health nurses, their standards, and their
qualifications for practice. This institute provided an excellent learning experience for
many nurses now employed, and for relief nurses of the nurses in industry. After obtaining these nurses' opinions during the workshops, a committee continued follow-up and
completion of the standards. Ways and means of putting this statement into effective
use for the betterment of occupational health nursing services in industries of British
Columbia is under study. Nurses in isolated parts of the Province or those unable to
attend the Institute were kept informed by data sent from the Employees' Health Services.
The active participation and attendance at these meetings has developed a greater
rapport between the nurses and this office. Numerous requests of minor and major proportions regarding the operation facilities and personnel of health services in industry
have been received. Research into these various problems has been done. It is felt that
much more could be accomplished by the consulting occupational health nurse making
personal visits to industry in order to see at first hand the facilities, programme, and
attitude of management. Production of British Columbia's industries is dependent in
part on the health of the working population. The services of the industrial nurse,
properly used in industry, is one major means of achieving this goal. W 70 BRITISH COLUMBIA
REPORT OF THE DIVISION OF PREVENTIVE DENTISTRY
C. W. B. McPhail, Acting Director
To-day in public health, as in many community health services and agencies, we are
concerned not only with a longer life, but as well with a better life. Based upon the
number of deaths directly attributable to dental disease, it could be argued that this
disease is not a community or public health problem. However, when we consider that
over 95 per cent of our population is afflicted with one form or other of dental diseases,
and knowing the undermining effect that such diseases can have upon the well-being of
the individual, both physically and emotionally, as well as socially, and at practically any
period of life, we must surely agree that dental health is a public health problem. If in
addition we consider the discomfort and suffering as well as the economic factors involved,
it is then apparent that this problem is of sufficient size and severity to warrant not only
our deep concern but our combined efforts to combat.
Further, when we note the prevailing high incidence of dental disease and the tremendous backlog of untreated disease, plus the shortage of dental man-power, it is
obvious that treatment, although a very important factor, is not, and can not alone be the
answer. What then is the answer? With dental disease, as it has been in the past with
many other diseases, including smallpox, diphtheria, scarlet fever, and tetanus, the answer
lies in prevention.
However, unless people are sufficiently aware of and concerned with the importance
of dental health as it relates to general well-being, knowledge of prevention will not be
generally sought; nor, even if known, will it be put into action.
Therefore, our first objective—the chief weapon in prevention—is an educational
programme designed to stress the important role that dental health plays in the welfare
of an individual throughout his life span; to stress the enormity of the problem as it
exists; and to point out how good dental health may be achieved and maintained by
practising the principles of prevention both on an individual and community basis.
The second weapon in a preventive dental health programme is dental treatment
itself. A dental treatment programme designed particularly for the younger-aged groups
serves these functions:—
(1) It acts as an inducement and a liaison to bring more people into the scope
of preventive dental health services, both from the standpoint of establishing early and regular dental examination and care, as well as from the
standpoint of establishing good dental health habits at an early age.
(2) It illustrates dramatically the importance of good dental health as well as
exemplifying the effectiveness of preventive dental health measures.
(3) It provides a means whereby a portion of dental time from a busy general
practice may be devoted to children's preventive dentistry.
(4) It shares, on a community basis, the initial accumulated cost of restoring
neglected mouths to good dental health, thus insuring that the large initial
expense of restoring a neglected mouth to dental health does not prove
to be a stumbling-block in an educational programme which promotes the
importance of early and regular dental examination and treatment.
The third weapon of prevention is research. Only through constant research will
new ways be found of preventing and treating diseases of the mouth, evaluating the
problem of dental disease, and measuring the success of procedures already in use.
OUTLINE OF THE PREVENTIVE DENTAL PROGRAMME IN
BRITISH COLUMBIA
The existing preventive dental health programme initiated by the Health Branch,
Department of Health and Welfare, in 1949, through the Division of Preventive Dentistry,
is designed not only to include these basic principles of prevention (i.e., education, treatment, and research)  but, as well, to extend such services to as many communities DEPARTMENT OF HEALTH AND WELFARE,  1956
W 71
throughout British Columbia as present limited finances and dental man-power will
permit. This has been attempted by an equitable distribution of available funds for
treatment and educational services to the various communities throughout British
Columbia, as follows:—
(a) Grants are made available to some larger established areas of population
on a Grade I school-enrolment basis toward the establishment and maintenance of full-time dental health services. Periodically, new equipment
is added through the use of National health grants:
(b) Fifty per cent matching grants-in-aid to various areas throughout British
Columbia are made toward the cost of treatment services through community preventive dental clinics sponsored by local groups and agencies
within the community. National health grants contribute toward such
services:
(c) Transportable dental equipment on a loan basis, free of charge, and a
grant toward the cost of travel, are made available and the Health Branch
acts as a liaison in attempting to encourage dentists to visit the outlying
areas of British Columbia where dental services are in short supply, or
non-existent:
(d) Grants are made available toward the cost of establishing, equipping, and
maintaining part-time dental clinics for use by dentists in private practice
to provide part-time treatment services for children, apart from their
private practices:
(e) Subsidy grants are made available to encourage dentists to locate in those
areas which have no dentist and which normally would not support the
services of a dentist full time:
(/)  The dental services of full-time members of the Health Branch are made
available to some areas.
(g)  The Health Branch, through Federal health grants, has equipped the
Health Centre for Children in Vancouver.   By agreement, dental treatment is also provided for trainees referred from the Western Rehabilitation Centre and for children from the Cerebral Palsy Society of Greater
Vancouver through this Centre:
(h) Payment by the Department of Health and Welfare,  Social Welfare
Branch, is made for dental care for dependents of persons in receipt of
social assistance, presently including children of less than twelve years
of age. This fund is administered by the British Columbia Dental Association.
An outline of the scope and coverage of the preventive dental programmes, including the
distribution of these various types of services and grants throughout the Province for the
programme-year (September, 1955, to August, 1956) is shown in Tables I and II.
Education
A wide selection of posters, pamphlets, films, and film-strips suitable for the various
grade levels was made available and distributed to many schools throughout the Province from the central library of the Health Branch. Where possible, a display of these
various teaching aids was set up at teachers' conventions. Pamphlets were made available to dental offices for distribution to young patients and parents.
Arrangements were made for window displays during the opening week of school
in drugstores throughout the Fraser Valley, to emphasize that the child's dental health
is another important consideration in preparing the child for this important step in his
development.   Poster-display contests were encouraged in the schools to emphasize the W 72 BRITISH COLUMBIA
" how," " when," and " why " of good dental habits. Community groups were encouraged to arrange dental-health displays at local fairs, etc., with some success. An attempt
was made to have dental-health manuals distributed to school libraries as reference
material for both teacher and student.
Radio talks and classroom talks were given by various members of the health-unit
staffs. All dentists participating in the clinics were encouraged to devote time to chair-
side dental-health education of both parent and patient. Material prepared by the Canadian Dental Association suitable for press release or for presentation to parent-teacher
associations, service club meetings, etc., was distributed throughout the Province by the
health units. The Health Branch co-operated fully with the British Columbia Dental
Association during their " Dental Health Week " and " Dental Health Conference."
A new poster and a diet sheet were added to the list of teaching aids during this period.
A " quick reference " to dental-health habits suitable for dental chairside teaching and
use in the home is presently under consideration.
Treatment
A prime factor in treatment services for these clinics was the dire shortage of dental
time particularly in the rural areas of the Province. However, excellent co-operation of
the dental profession was enjoyed, resulting in services being rendered as shown in
Tables I and II.
Research
A study was undertaken by a member of the dental field staff on a dental follow-up
programme on Grade II children. The character of the follow-up programme for Grade
II pupils was in the nature of a pilot study to lead and suggest the way whereby all children over the eligible age of the clinics may be stimulated to begin or continue good
dental-health habits.
A method of more accurately determining the number of children in given rural
areas attending their family dentist is under consideration so that a better over-all picture
of treatment coverage may be obtained.
Pre-fluoridation surveys were arranged for areas contemplating fluoridation. The
centres of Smithers, Prince George, and Kelowna have instituted fluoridation. Prince
Rupert and McBride passed favourably, and Cranbrook is presently contemplating such
a procedure.
A much needed method, both for estimating the size of our dental-health problem
and for evaluating the effectiveness of our present approach to this problem, has been
provided by the introduction of the annual British Columbia Dental Health Survey.
The three areas chosen for study as being representative were the Fraser Valley, Greater
Vancouver, and Greater Victoria. Complete procedure, data, and analysis from the
first (1956) of such surveys are given in Division of Vital Statistics Special Reports
Nos. 17 and 18, entitled " British Columbia Dental Health Survey (1956), Parts I and
II." Copies may be obtained by writing to Health Branch, Department of Health and
Welfare, Victoria, B.C.
The Role of the Community
The success of all these preventive measures, particularly educational, is determined
largely by the degree of interest and co-operation of various groups in a community.
Who are these groups?
1. Members of the allied health professions and ancillary personnel of medicine, dentistry, nursing, and pharmacy whether in public service or private practice, who, by the very nature of their professions, are dedicated
to the welfare of their fellowman. DEPARTMENT OF HEALTH AND WELFARE,  1956 W 73
2. Members of local official bodies, who, by the nature of their office, carry
the responsibility of public welfare, whether it be in the field of education,
civic administration, social welfare, workmen's compensation, or public
health.
3. Members of voluntary agencies, such as the Red Cross Society.
4. Members of the teaching profession who, by the nature of their training,
are best qualified to educate.
5. Members of local groups who make the welfare of their community their
concern, including parent-teacher associations, service clubs, women's
institutes, women's auxiliaries, etc. Added to these must be the individuals comprising the community.
Dental Personnel
Dr. F. McCombie, Director, has accepted an appointment to act as Consultant to
the Department of Dentistry, University of Malaya, for a period of one year. Dr. C. W. B.
McPhail is serving as Acting Director while carrying on his duties as Regional Dental
Consultant during Dr. McCombie's absence. One field dental officer returned from, and
one left for, a year of graduate study in Public Health during 1956. One dental officer
attended a three-day postgraduate course in preventive orthodontics; five dentists in
Public Health Services in British Columbia attended a three-day course in children's
dentistry. All of this training was supported financially by National health grants. One
field dental officer left the Department to return to private practice.
GENERAL REMARKS
Our dental-health problem in British Columbia to-day presents three pertinent
facets:—
(a) A heavy burden of treatment needs:
(b) An overloaded and limited supply of qualified dental personnel:
(c) An unequitable distribution of existing services throughout the Province.
The approach to our problem would, therefore, appear to be threefold:—
(a) A reduction in the tremendous burden of treatment needs by the immediate and widespread application of all available preventive measures:
(b) An increased supply of qualified dental personnel in British Columbia
by the immediate establishment of a dental faculty at University of British Columbia;  and
(c) A more equitable distribution of the existing facilities as outlined in the
policy of the Division of Preventive Dentistry.
In an attempt to enhance this aspect the Health Branch has recommended that the
matching grant toward the cost of clinical services be based upon an increased fee, more
commensurate with that of private practice, in order to induce more dentists, either from
within or outside the Province, to participate in these clinics in the rural and outlying
areas of British Columbia.
An effective preventive programme must include education, treatment, and research
predicated upon sufficient qualified personnel to carry out such services. In addition,
in every community, each group has a part to play in all of these aspects, and it is only
through the combined and deliberate efforts of all of these groups that we can hope to
meet our dental-health problem. W 74
BRITISH COLUMBIA
Table I.—Part-time Dental-treatment Services in British Columbia (Community Preventive Dental Clinics), School-years 1948-49 to 1955-56
School Year
Health
in
i Clinics
ted*
«,J3     -O
._. u      u
O       -0
K 3
V    r —
bo
5 £3 a
o _      <u
I
1
nent of
Areas
er of
I's
iiy
leted
eted,
tool,
si,
mi
age
t
hild
ars)
Loca
Unit
Whic
Oper
«5.suo
!"§ s
Z;uo
ill
ZQfl.
Pre-s
Chile
Dent
Com
Grad
Scho
Enro
Clini
Num
Grad
Dent
Com
Tota
Com
Pre-s
Grad
II, ar
Aver
Gran
per C
(Doll
1948-49  	
(4)
(4)
2
2
(4)
(4)
(4)
(4)
(4)
1949-50.... 	
(4)
(4)
6
8
(4)
(4)
(4)
(4)
18.46
1950-51 	
(4)
(4)
9
12
(4)
(4)
(4)
(4)
15.76
1951-52     	
(4)
(4)
18
22
(4)
(4)
(4)
(4)
13.26
1952-53 	
(')
(4)
20
25
(')
(')
(')
(4)
12.78
1953-54 	
(4)
(4)
43
47
(4)
(4)
(4)
(4)
15.45
1954-55 	
15
35
55
64
1,553
5,166
2,601
5,777
7.78
1955-56  	
145
37
59
74
1,753
7,888
3,260
6,444
7.73
1 Seventeen health units in British Columbia.
2 Eighty school districts in British Columbia.
3 "Dentally Completed" includes examination, fillings, extractions, cleaning and dental X-rays where indicated.
4 Figures from 1948-54 not included, comparison used for years 1954-55 and 1955-56 only.
5 Two had clinics arranged but could obtain no dental services, one had the services of a full-time dental officer,
and one had the services of both full-time dental officer and clinics.
Table II.—Full-time Preventive Dental Treatment Services in British Columbia, Shown by Local Health Agency, School-years 1954-55 and 1955-56
Local Health Agency
5 i.,3
■O _3"o
Grade I Pupils
■sE
■do,
cE
<a o
fiu
(1)
c
M  ,   J.T3
«cEW
(2)
<tt<Q
(3)
. E'o
hUr
oOsJS
__ -_- ~ c_.
2J.cS
o= " o
HOflO
1955-56 School-year
South Okanagan Health Unit-
North Okanagan Health Unit-
Central Vancouver Island Health
Unit
Sub-totals1	
Greater Vancouver Metropolitan
Health Committee
Board of Trustees, New Westminster School District
Powell River and District Preventive Dental Clinic
Board of Trustees, Greater Victoria School District 	
Totals1 	
Nos. 14, 15,
16, 17
Nos. 19, 21,
22,28
Nos. 66, 68,
69
I I
I I
Services temporarily discontinued due to resignation of dental officer.
i        i
84    | 61    |       620
I I
Pre-school programme only.
433
669
455
I
522    |       669    |
455
Nos. 38, 39,
41, 44, 45
No. 40
No. 47
No. 61
I
I
84    |
61
620    |
8
907    | 10,594    I    3,276 3,889    |    2,447    |    9,612
I ■.    I II'
Full-time dental programme changed to Community Preventive
Dental Clinic (January, 1956)
944
340
46
313
1,847
1,815    I 13,423
1954-55 School-year
Totals1 	
1,853       13,506
30
117
3,878
4,213
Suspended, May, 1956, no
dentist.
Complete data not available.
I
737    I       694    I    1,548
4,710
3,202
3,945
1,749
600
14
11,780
1,566
9,907
No data
Includes only those areas where clinics operated. DEPARTMENT OF HEALTH AND WELFARE,  1956 W 75
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 purpose 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.
The demand for public health engineering services was on the increase during 1956,
along with the increase in population. In addition, with the increasing wealth of the
Province, and improving living standards, there has been 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, it was not possible to recruit new engineering staff during 1956 to replace engineers
who had left in 1955. The result is that the Division was short-handed throughout the
entire year and many of the items that were slated for 1956 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 1956, fifty-five plans
in connection with waterworks construction were approved, and six plans were provisionally approved. This is a total of sixty-one waterworks plans studied, compared with
fifty-two the year before. 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 toward their improvement.
The number of field visits was greatly reduced this year owing to shortage of staff.
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. Most of the larger waterworks systems in the Province use chlori-
nation for protecting the bacteriological quality of the water. It is estimated that about
three-quarters of the population of the Province use water protected by chlorination.
Another type of treatment of water was introduced into British Columbia in 1955, when
two communities installed fluoridation equipment. A third community installed fluoridation equipment in 1956. 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
proper limits. Reports have been received regularly and these reports indicate that the
chemical is being added properly. W 76 BRITISH COLUMBIA
It was the intention of the Division to try to organize some sort of training for waterworks operators in the Province. This has become necessary because of the large number
of waterworks plants having chlorination equipment. Owing to the shortage of staff, it
was not possible to organize such a programme in 1956. 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 were able to attend a short course in Washington
State. There is, however, a need for such a course in British Columbia.
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 are forwarded to the
Division of Public Health Engineering, where they are recorded for easy reference. 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 need for a chemical
examination of water. During 1956 there was great difficulty in having chemical examinations made, but it is hoped that the Division of Laboratories will have a chemical-
analyses service operating in 1957.
The Division receives a number of inquiries each year concerning private water-
supplies. These are referred to the local health units. A considerable amount of advice
is given by mail and occasionally by visits. Also, when visiting health units, public health
engineers consult with health-unit officials on various small water-supply problems. The
present estimate of persons in the Province receiving water from public waterworks
systems is 83 per cent of the population, or about 1,000,000. Of the thirty-six municipalities organized as cities, thirty-four own their own water-supply systems, one is completely served by a private utility company, and one does not have a public water-supply
system. Of the thirty-four cities owning their own systems, twenty-two obtain water by
gravity only, eight obtain water by both gravity and pumping, and four obtain water by
pumping only. This means that most of the water supplied to the cities of British Columbia is from gravity sources. Most of the cities have a very soft water, with the larger
coastal communities all having a hardness of less than 25 ppm. as calcium carbonates.
Of the thirty district municipalities, twelve have municipally owned water-supply
systems that serve practically the whole municipality, four have no water-supply systems
and seven are served wholly or in part by privately owned water systems.
There are approximately fifty communities incorporated as villages in the Province.
Of these, thirty-two have a municipal water system, thirteen are served by non-municipally
owned water systems, and five have no water systems.
Of the thirty-two municipally owned supplies, only three get their water by gravity
entirely, seven get water by pumping and gravity, and twenty-two get water by pumping
only. Ten of the villages obtain water from ground sources, and two have combined
ground and surface water sources. Two of the villages use filtered surface water, twelve
use chlorine treatment and one uses fluoride treatment.
In general, the municipalities of British Columbia are well supplied with water.
It is estimated that 89 per cent of all people living in municipalities of all classifications
obtain water from public water-supply systems. In most cases, the sources of water are
plentiful and can be developed to supply water for a greatly increased population.
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
Columbia this year. This fact is evidence of the care being taken by the various water
authorities to provide a safe water-supply 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 DEPARTMENT OF HEALTH AND WELFARE,  1956 W 77
efficient operation of the chlorination 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. This includes the
sewage-treatment plants. The "Health Act" requires that plans of all new sewerage
constructions be approved before construction may commence. During the year, fifty-
four approvals were given in connection with sewerage work and twelve provisional
approvals were made, for a total of sixty-six approvals with respect to sewage. This
compares with thirty-five in 1955. This is an indication of the tremendous amount of
work that is being done in sewerage field at the present time.
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 bodies of water, in order to determine
the degree of treatment required. It is expected that several entirely new sewerage
systems will be built during the coming year. The Village of North Kamloops and the
Village of Mission City both passed referendums on sewerage during the December
elections.
It was mentioned in the 1955 Report 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. In 1956 the "Greater Vancouver Sewerage and Drainage
District Act" was passed, which made for mandatory membership in the Greater Vancouver Sewerage District by the City of Vancouver and the District of Burnaby, together
with the University area. Provision was made for voluntary joining of the Board by other
municipalities. The District of Coquitlam subsequently joined the Board. The Greater
Vancouver Sewerage Board will now commence building the central Burnaby Valley
sewer. The three north-shore municipalities, the District of West Vancouver, the District
of North Vancoucer, and the City of North Vancouver, have also proceeded very well in
their sewerage planning. It is expected that a very large volume of sewerage construction
will be carried out during 1957 in the Greater Vancouver area.
It was also mentioned in the 1955 Report that a change in policy by the Central
Mortgage and Housing Corporation had 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. During
1956 some of these privately built sewerage systems were completed. One of them has
completed a complete sewerage system with sewage-disposal plant, which is now in
operation.
The problem of the unorganized urbanized area is still a major one as far as lack
of sewerage is concerned.
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. It was hoped in 1956 to publish a booklet
bringing up to date all the information we have on septic tanks and private sewage-
disposal systems.   Owing to the shortage of staff, this was not possible.
The Division also gives advice and reviews plans of sewage-disposal systems for
schools and hospitals. The Division also provides consultative service regarding sewage-
disposal problems for Government institutions. W 78 BRITISH COLUMBIA
There is need also for better training of sewage-treatment plant operators. It is felt
that the time has come when short schools should be established in British Columbia.
However, a considerable amount of work is required for the establishment of a short
school and this matter has had to be held in abeyance in 1956.
It is felt that the existing sewage-treatment plants would be better operated if more
visits could be paid to them by public health engineers. In February, a fairly detailed
study of the sewage-treatment plant at Kelov/na was made and as a result, the City
employed a firm of consulting engineers to suggest plans for modernizing the plant.
Another interesting feature this year was the construction of the first sewage-lagoon in
British Columbia. This was built at Dawson Creek and the results so far have been
satisfactory, although it is still too early to determine whether or not this will become
a good method of sewage treatment in British Columbia. If it does prove to be a good
method of sewage treatment in British Columbia, important economies in sewage treatment can be obtained, particularly by the smaller communities. A sewage-lagoon was
suggested by the Division for the treatment of the sewage from Tranquille Sanatorium.
STREAM POLLUTION
Stream pollution is one of the items dealt with by the Division of Public Health
Engineering. Although stream pollution may be 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.
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 control should be established in order to prevent pollution, rather than
to wait until it becomes a problem. 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 had legislation for the control of certain
types of pollution. Groups interested in fishing, navigation, public water-supplies,
irrigation, and bathing places are concerned with sewage pollution.
In the 1956 Session of the Legislature a "Pollution-control Act" was passed for the
purpose of setting up a Pollution-control Board. Administration of the Act is the
responsibility of the Minister of Municipal Affairs. The Pollution-control Board will
only have authority in the Lower Fraser Valley and the contiguous waters offshore. The
Board had not been completely appointed by the end of 1956 so that very little was
accomplished by the Board in 1956. One of the features of the legislation is that
engineers of the Health Branch are responsible for carrying out technical work required
by the Board. This will entail a considerable amount of survey work and detailed study
of plans for industrial-waste treatment as well as for sewage treatment. Additional staff
are urgently needed for this work, which should get under way early in 1957.
In summary, with the passing of the " Pollution-control Act" and setting up of the
Board, there is now better machinery for controlling pollution, particularly in the Lower
Fraser basins. There is some demand on the part of the public for having the powers
of the Board extended to include air pollution. It is felt that it would be better at the
moment to confine the operations of the Board to water pollution until the Board gets
under way.
{ DEPARTMENT OF HEALTH AND WELFARE,  1956 W 79
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 others a considerable amount
of survey work is necessary. There were twenty-eight certified shucking plants in operation in 1956. Most of these were family operations. Certification must be renewed
annually. There were four 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 came from
certified plants and shippers.
Some sanitary survey work was done at Peddar Bay during 1956. However, the
amount of work done was not suitable to determine whether or not this area should be
used for production of shell-fish.
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 1956. There have been no deaths due to the eating of toxic shell-fish in British
Columbia since 1942.
SWIMMING AND BATHING PLACES
A considerable amount of time was spent during the summer in consultation work
on swimming-pools. There is a good demand for the paper that was prepared several
years ago by the Division on suggested requirements for swimming-pools. This paper
has had an excellent effect in that many of its recommendations have been adopted by
persons building and operating swimming-pools.
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. At the end of 1956 there were 145
frozen-food locker plants in operation in the Province. Approvals were given in connection with four locker plants during 1956. There are approximately 60,000 lockers
available for rent in British Columbia. In addition to this, by September, 1955, there
were 24,000 home freezers in operation in British Columbia.
As indicated by the activity in 1956, the construction of new frozen-food locker
plants has passed its peak. The day to day inspection of the locker plants is the
responsibility of the local health units. W 80 BRITISH COLUMBIA
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 matters dealing with
engineering in public health. This entails a considerable amount of work and travel.
During 1956 it was not possible to visit all of the health units. During the visits to the
various health units, problems requiring engineering knowledge for their solution are
examined in the field.
There has been a considerable increase in reviewing of plans of subdivision for
recommendation with respect to possible sanitation hazard at the request of the Department of Highways, who are the approving officers for subdivisions in unorganized
territories. In most cases, the actual inspection of the ground is made by local sanitary
inspectors in correspondence with the Division of Public Health Engineering.
The position of Chairman of the British Columbia Examining Board for Sanitary
Inspectors was again filled by the Director of the Division. Eleven candidates wrote the
examinations in sanitary inspection in 1956.
Owing to the change in arrangements with respect to inspections of tourist accommodation there was less work required by this Division in 1956 on tourist-accommodation
work. These inspections of tourist accommodation are now made in the field by the local
health units without reference to the Division of Public Health Engineering, except in
certain special cases. It is felt that this has been an improvement in administration
resulting in less work for this Division.
The annual convention of the Pacific Northwest Section of the American Waterworks
Association was held in Victoria in May, 1955. Many waterworks officials from British
Columbia attended the convention. There were a number of excellent papers dealing
with waterworks problems of special interest to people in British Columbia.
The Director served as a member of the advisory committee on health, which is
a sub-committee of the associate committee on the National Building Code of the National
Research Council of Canada. Two meetings of this committee were attended during
the year.
As mentioned previously, the work of the Division was considerably hampered in
1956 due to shortage of staff. The continued expansion of the economy of the Province
will lead to more and more public health engineering problems. The coming into operation of the Pollution-control Board will greatly expand the work of this Division. It is
the intention of the Division to try to pick out the work having the most influence on
public health for priority during 1957. DEPARTMENT OF HEALTH AND WELFARE,  1956 W 81
REPORT OF THE DIVISION OF VITAL STATISTICS
J. H. Doughty, Director
The Division of Vital Statistics performs two major functions in the Health Branch.
It is responsible by statute for the administration of the "Vital Statistics Act," the
" Marriage Act," the " Change of Name Act," and certain sections of the " Wills Act."
These Acts set forth a wide range of registration and certification responsibilities. It also
compiles the formal vital statistics of the Province as derived from the registrations of
birth, death, stillbirth, and marriage. The Division likewise offers to all other divisions
of the Health Branch a complete statistical service, including mechanical processing,
statistical analyses, and consultant service. In addition, it provides extensive statistical
service to the British Columbia Mental Health Services, the British Columbia Cancer
Institute, and to other associated health agencies.
The steady increase in the volume of services rendered, which has been noted in
recent years, continued in 1956. Certificates issued approached the 68,000 mark, a
9-per-cent increase over the figure for 1955 and more than double the number issued
in 1950. Birth certificates issued numbered over 50,000, an increase of 9 per cent from
1955. Marriage certificates issued increased by 9 per cent and death certificates by
1 per cent. Change of name certificates exceeded the 1955 figure by almost 50 per cent.
It is again apparent that the demand for birth and marriage certificates is increasing at
a considerably faster rate than the increase in population.
Revenue-producing searches of vital-statistics registrations increased by 3 per cent
in 1956, while non-revenue searches increased by 7 per cent. Total revenue collected
by the central office increased by 6 per cent.
The number of registrations received and filed totalled over 63,000 in 1956, a
2.4-per-cent increase over 1955.
In line with the increasing development of the northern area of the Province two
new registration districts were created to provide better service to the people in that area.
These new registration districts have been named Kitimat and Cassiar respectively.
In co-operation with the Division of Preventive Dentistry, the first community
dental-health surveys were carried out during the year and statistical indices of dental
health of the selected communities were compiled. This project marks one of the first
uses of statistical sampling on a large scale for the production of public health statistics
in this Province. The Division intends to explore other possible applications of sampling
methods in the production of public health statistics.
The marked increase in the demand for laminated birth certificates during the last
few years has caused the Division to investigate faster and more efficient methods of
producing these certificates on a mass-production basis. The number of manual operations in the production of a laminated certificate is high in comparison with a paper
certificate, and the cost of such a certificate is consequently greater, although the two
types are sold to the public for the same price. The blank certificates are received from
the printers in sheets of ten to a page and it was found that these certificates could be
perforated during the printing process in such a way that the work of cutting and trimming, subsequent to typing, could be eliminated. In addition, it was found that the
number of operations required in connection with trimming and cornering the finished
laminated certificates could be greatly reduced through the purchase of a special die
cutting-machine. This machine has been in operation for approximately nine months
and has effected a valuable saving of clerical time. W 82 BRITISH COLUMBIA
REGISTRATION OF BIRTHS, DEATHS, AND MARRIAGES
Current Registrations
The Province continued to enjoy a high level of registration completeness during
1956 with very few delinquent registrations being reported. The problem of securing
complete and accurate registration for all vital-statistics events continues to be a matter
of patient effort and co-operation between the central office and the various District
Registrars.
The current registration picture for 1956 followed the pattern of general increase
which has been noted for the last number of years.
Although the responsibility for registering a birth rests with the parents concerned, it
has long been the policy of the Division to assist the parents and to make them aware of
their responsibility by mailing blank registration forms and instructions to the mother
immediately upon receipt of the doctor's notification of the birth. During 1956 an
improved method referred to as the " package system " of distributing birth registration
forms, was introduced. A package is prepared consisting of the registration form, the
instruction leaflet, a certificate application form, and an envelope addressed to the District
Registrar of Births, Deaths, and Marriages. Each hospital is supplied with a stock of
these packages and the hospitals undertake to hand the packages to the mothers while
they are still in hospital. This new system appears to be working very well and has
resulted in a considerable increase in the promptness with which registrations of birth
are filed. The success of the scheme is in a large measure due to the excellent co-operation which the Division has received from the hospitals throughout the Province.
It has become apparent that it is no longer practicable to refuse to accept vital-
statistics registrations completed with a ball-point pen. Furthermore, recent improvements in the quality of ball-point pens appear to have largely nullified the former objections to their use. For this reason, all District Registrars of Births, Deaths, and Marriages
have been notified that registrations need not be rejected solely on the grounds that they
were completed with ball-point pens.
Delayed Registration of Births
The volume of delayed registrations continued on approximately the same level as
for 1955. There is some indication that the delayed-registration applications which are
now being received relate to cases where clear cut evidence to support the application is
not available. Because of this it has become necessary to make more use of unusual
items of evidence and to build up the necessary standard of evidence from a number of
fragmentary sources. The persistence of both the Delayed-registration Section and of
certain applicants has led to the successful filing of delayed registrations in interesting and
almost dramatic fashions. A recent example was the case of a 45-year-old person who
had been born in a remote district of British Columbia. Shortly after birth she had moved
to Eastern Canada and later to Eastern United States. Because the applicant had been
taken from the Province at an early age, coupled with the fact that she was born in a
remote rural area, there appeared little likelihood of obtaining any satisfactory documentary evidence to support the application. After a long and fruitless exchange of
correspondence, the delayed-registration clerk linked the application with a delayed registration filed some time earlier, but relating to the same area of the Province. An examination of this file resulted in contact being established with an elderly person living in
Victoria who was fully aware of the birth in question and was able to make a full and
detailed statement, which established beyond any doubt the claim of the applicant. It is
becoming increasingly clear that the balance of outstanding delayed-registration applications from older persons will tend to be based on miscellaneous items of evidence rather DEPARTMENT OF HEALTH AND WELFARE,  1956
W 83
than on documents of the Class "A" type, such as baptismal records and doctors' reports.
Whether or not such evidence can be found will depend largely upon the ingenuity which
applicants use in pursuing the required evidence.
The verification library which the Division has built up as a means of assisting
applicants for delayed registrations has been referred to in earlier Reports. A valuable
improvement in the reference material contained in this library was undertaken during
the year with the editing and binding of many thousands of hospital returns covering the
period from 1917 to the present day.
The new method of filing correspondence relating to delayed registration of birth
applications, which was introduced in 1955, has proved to be very satisfactory and among
other things has now made possible a count of the number of delayed-registration applications in hand. At the present time over 800 such applications are under active
consideration.
DOCUMENTARY REVISION
Unlike most records, vital-statistics registrations are not static but are continually
subject to amendment and notation as a result of adoptions, divorces, legal changes of
name, legitimations of birth, and corrections. This phase of the Division's work has been
termed " documentary revision," and is carried out by a group of specially trained persons,
constituting the Documentary Revision Section. It is the responsibility of this Section to
receive and file copies of all adoptions and divorces which are granted in the Supreme
Court of this Province and to locate the original registration involved in order that the
appropriate notation may be made upon it. If the divorce or adoption relates to a marriage or a birth which took place in another Province, the information is transmitted to
that Province under a reciprocal agreement.
Another important duty undertaken by the Documentary Revision Section is the
processing of legitimation of birth applications. Under the " Legitimation Act," a child
is deemed to have been legitimate from birth once its natural parents have intermarried.
The " Vital Statistics Act" provides that under such circumstances a new registration may
be substituted for the registration originally filed, the new registration showing the child
to be legitimate. However, before such applications may be accepted, satisfactory
evidence of paternity must be obtained. The Division assists the applicants as far as
possible in obtaining the necessary evidence. Hospital returns and physicians' notices of
birth are searched to ascertain whether or not the putative father's name was stated at the
time of birth. With the parents' consent, the Division will contact any welfare agency
which might have information of value contained in its records. The Division works in
close liaison with the Child Welfare Branch in matters affecting legitimation.
When the legitimation application has been approved, a new registration is prepared
and placed on file. The original registration is removed from the registration volume and
placed in a sealed file along with the correspondence relating to the application. The
birth index is then amended to show the changed name of the child, the microfilm record
is deleted and replaced by a photograph of the new registration, and the new registration
is assigned the same registration number as the original.
Legitimations effected during 1956 totalled 207, a 2-per-cent increase over the
previous year. Divorce orders totalled 1,620, a 6-per-cent increase from 1955, while
adoption orders increased by 12 per cent to a total of 1,255.
LEGAL CHANGES OF NAME
Another major responsibility of the Division is the administration of the " Change
of Name Act." The principal requirements for a legal change of name are that the
applicant be 21 years of age or over, a British subject, and domiciled in this Province. W 84 BRITISH COLUMBIA
An application for change of name may cover more than one individual in a family.
Thus, a married man need file only one application to cover a change of surname and
(or) given names for himself, his wife, and any unmarried minor children in his family.
An interesting feature of the Act is that the only person who is entitled to change the
surname of a child is a married man, thus it is impossible for a widowed or divorced
person, or for an unmarried mother to change the surname of a child.
Legal changes of name granted during 1956 totalled 449, a 6-per-cent increase over
the previous year.
ADMINISTRATION OF THE "MARRIAGE ACT"
The administration of the " Marriage Act" also falls within the jurisdiction of the
Division of Vital Statistics. This Act covers all phases of the Province's control 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 to the licensing
of individual ministers and clergymen with the authority to solemnize marriage in British
Columbia. Denominations which have not previously been recognized under the " Marriage Act" of this Province must meet certain requirements before their clergymen may
be eligible for licensing under the " Marriage Act." The Division also appoints Marriage
Commissions for the purpose of solemnizing the civil marriage ceremony in this Province.
It is usual for this appointment to be vested in the District Registrar of Births, Deaths,
and Marriages, although in a few areas of the Province additional civil Marriage Commissioner appointments have been made to meet local needs.
Because of the legal importance of the marriage contract and of the qualifications
which are required of the parties to the intended marriage, marriage licences are issued
only by specially appointed persons, known as " Issuers of Marriage Licences." This
provision, which restricts the issuance of marriage licences to a limited number of specially appointed persons, is one of the several safeguards written into the " Marriage Act"
as a protection to the public. It is the duty of the issuer of marriage licences to be reasonably satisfied that the persons seeking a marriage licence are properly qualified before
the licence may be issued.
Four new religious groups were recognized under the "Marriage Act" during 1956,
while inquiries as to the qualifications for recognition were made by six others. Twenty
orders permitting remarriage, pursuant to section 47 of the " Marriage Act," were issued.
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. Six caveats were lodged during the year and these were immediately made known to all Marriage Commissioners and Marriage Licence Issuers within
the Province.
REGISTRATION OF NOTICES OF FILING OF A WILL
By an amendment to the "Wills Act," assented to in 1945, it became possible for
testators to file with the Division of Vital Statistics a notice which records the location of
the will and the date of filing. This service is gaining in popularity each year with an
increasing volume of wills notices being filed. Over 5,200 notices were received during
1956, bringing the total now registered with the Division to approximately 33,000. The
processing of these notices within the Division is demanding an increasing amount of
clerical time, since each notice must be carefully filed and adequately indexed in order
to be available for subsequent searching. There is no charge for the filing of a wills notice,
although a statutory fee of 50 cents is required for a search of the records prior to the
probate of a will. Searches of the wills notices may not be undertaken until the death of
the testator has been proven to the satisfaction of the Division. DEPARTMENT OF HEALTH AND WELFARE, 1956 W 85
Although there was an increase in 1956 in the number of wills searches carried out,
this increase was not in proportion to the increased number of new notifications received.
The reason for this is that the wills searches are related to the death rate rather than to
the number of notifications on file.
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.
Whenever certified copies of any registration of a birth, death, or marriage are
required, such certified copies are prepared in photo-copy form rather than by transcribing from the original registration as was formerly the practice. This method of issuing
certified copies has proven to be the most satisfactory and has the singular advantage of
eliminating the possibility of error in the preparation of the copies. It has also eliminated
the need for intensive checking from the original to the copy.
Most photographic copies issued by the Division are prepared in reduced size from
the corresponding microfilm image. However, the Division also has equipment capable
of producing full-size copies of any documents for which the microfilm is not yet available.
Hence, certified photographic copies may be issued of any document at any time following
its receipt by the Division.
The microfilm camera continued to be used during the year as time permitted for
the filming of files and documents other than vital-statistics registrations. These included
delayed-registration declarations, divorce Court orders, and alteration of surname files.
In addition, a large number of blue-prints were filmed on behalf of the Division of Public
Health Engineering.
DISTRICT REGISTRARS' OFFICES
Changes in Registration Districts and District Offices
The increased industrial development in the northern part of the Province made it
apparent that consideration should be given to expanding the vital-statistics registration
facilities in that area. Accordingly, two new registration districts were established during
the year; namely, the registration district of Kitimat and the registration district of Cassiar.
These new registration districts were created by subdividing the existing districts of Prince
Rupert and Telegraph Creek.
During the year it became necessary to transfer the vital-statistics duties at Campbell
River from the Clerk of the Village of Campbell River to a private agency. The Village
Clerk, having held the appointment of District Registrar for more than three years following the transfer of duties from the Royal Canadian Mounted Police, found that the
duties of District Registrar interfered with his commitments with the Village Corporation
and for this reason asked to be relieved of his appointment. The co-operation of The
Corporation of the Village of Campbell River in allowing the Village Clerk to carry the
vital statistics for these several years enabled uninterrupted service to the community and
appreciation is expressed for the work done by the Village Clerk.
When the Deputy District Registrar's office at Keremeos was closed in 1951, it was
deemed necessary to retain a Marriage Commissioner in that village. However, since
that time very few civil marriages have been performed and the appointment of Marriage
Commissioner at Keremeos has now been rescinded.
Early in the year the remuneration paid to those District Registrars operating on a
commission basis was increased by Order in Council from 50 cents to 75 cents per registration. This adjustment was made to bring the payments to commission agents into line
with the services they perform. W 86 BRITISH COLUMBIA
Inspections
The regular inspection programme of the Division was curtailed during 1956 in
order to allow the Supervisor of Vital Statistics to serve on a special survey team reviewing administrative and recording procedures in local health units. Consequently, the
Inspector of Vital Statistics was required to assume additional central office duties for
the period of the survey.
Nevertheless, twenty-three offices and sub-offices covering Vancouver Island, the
northern part of the Province extending from Prince Rupert to Prince George, the Peace
River district and the Central Cariboo district, from Quesnel to Williams Lake, were
visited during the year by the Inspector or the Supervisor.
The standard of work being performed by the District Registrars continued to be
most satisfactory during the year and the Division is grateful for the co-operation of its
local representatives throughout the Province.
At the close of the year there were ninety-one district offices and sub-offices operating in seventy-three registration districts. In addition, there was a Marine Registrar
and seventeen Indian Superintendents serving ex officio as District Registrars of Births,
Deaths, and Marriages for Indians. Forty-one of the district offices were located in
Government Agencies or Sub-Agencies, while twenty-three were served by Royal Canadian Mounted Police personnel. Five offices were operated by other Government employees, while twenty-two offices were handled by private individuals on a commission
basis.
Vancouver Office
The office of the District Registrar of Births, Deaths, and Marriages in Vancouver
is operated by full-time employees of the Division. Because of the concentration of
population in the Vancouver registration district, this office handles over 40 per cent of
all registrations received in the Province.
The first full year of operation of the Vancouver office at its new location in the
Provincial Health Building, at 828 West Tenth Avenue, showed very satisfactory results.
The removal of the office from the centre of the city appears to have presented more
advantages than disadvantages to the public being served.
STATISTICAL SERVICES
Further progress was made during 1956 in the development of the statistical services of the Division. Certain internal changes, designed to improve the organization
of the Statistical Section and to formalize the working arrangements which have been
developed were made during the year. A separate section known as the Research Section was set up with a Senior Research Assistant in charge. It is anticipated that this
change will result in greater co-ordination of the statistical projects of the Division, and
will increase the effectiveness of this phase of its activities.
The fact that the staff of the Research Section was not at full strength during the
year, coupled with the work loss due to the training of new employees, somewhat limited
the activities of the section. All new employees require a certain amount of orientation
in their duties before they are able to contribute effectively, and this is particularly true
in the field of public health statistics. The requirements of the work are unusual and
there is at the present time a virtual absence of prospective employees with training in
this field. For clerical workers, training is required so that they may become familiar
with the medical terminology employed, with coding procedures, with the presentation
of tabular material, and with certain other special features of the work. The professional
employees require the same familiarization with the aforementioned features and, in
addition, a considerable knowledge of the medical and statistical aspects of public health
programmes. DEPARTMENT OF HEALTH AND WELFARE,  1956 W 87
The training of two new research assistants in the Victoria office was carried on
during the year. All routine commitments were met and a number of special projects
were undertaken.
Dental-health Statistics
Most notable among the new assignments undertaken during the year was the production of an extensive set of statistical indices relating to the level of dental health in
three selected areas of the Province. The planning and organization of this project was
outlined in last year's Annual Report. The examinations and recording by the dentists
commenced in January of 1956. By the end of March all examinations had been completed and the individual dental records were forwarded to the Division for mechanical
processing and the statistical analysis. The completed analysis of the first year's survey
was published in the Special Reports series of the Division of Vital Statistics and is
synopsized later in this Report.
This project has been planned on a continuing basis and all preparations, including
the selection of the sample, for the 1957 survey were completed during the year. The
1956 indices established base-line data on dental-health status of children in the three
areas mentioned, and will be used for comparison with indices of future years in evaluating the dental-health programmes in operation in the regions concerned. In addition,
the indices give valuable information regarding the present status of dental health among
school-children.
Tuberculosis Statistics
The Division continued to process the statistics of the Division of Tuberculosis
Control, including data on new cases examined and on admissions and separations from
tuberculosis sanataria. The annual indexes of known cases of tuberculosis and of certain
non-tuberculous chest conditions were tabulated in both alphabetical and numerical
sequences.
No changes were made in the record system of the Division of Tuberculosis Control during the year, but discussions and meetings were held respecting the development
of a one file system for the medical records of the Division. Agreement was reached on
the general form that the record would take, but implementation of the change was withheld, pending the recommendations of the Committee on Records and Statistics of the
research project in studies on the Applied Epidemiology of Tuberculosis.
The Division was extensively represented on the records and statistics committee
just mentioned and devoted a considerable amount of time to studying and evaluating
certain changes which have been suggested by other members of the committee.
The Division also had a representative on the Planning Committee for the Provincial Tuberculosis Mobile Survey Unit. This representation has proven to be most advantageous, and the policy has now been adopted of arranging the programme for the mobile
unit on the basis of special statistics prepared by the Division for this purpose. Assistance
was given to the Division of Tuberculosis Control in a statistical analysis of studies pertaining to surgery cases. This analysis was required for the evaluation of the management of surgical cases in the Division.
Special analyses were carried out in connection with a planned community wide
X-ray survey in the Oliver district. In addition, a number of special requests of the
Division of Tuberculosis Control were met, including special tabulations of new cases
and of known cases on Vancouver Island, special tabulations of reported cases involving
pleurisy and special listings of new cases in Vancouver City.
The ordering of printed forms used in the Division of Tuberculosis Control continued to be carried out by this Division and no change in the established policy was
made. However, consideration is being given to the transfer of this duty to the Division
of Tuberculosis Control now that certain procedures have been developed and tested. W 88 BRITISH COLUMBIA
Special tabulations and listings respecting Indian tuberculosis cases were prepared
for the benefit of the Indian health services.
Venereal-disease Statistics
Information relating to new notifications of venereal infection continued to be
transmitted monthly to the Division by the Division of Venereal Disease Control in
coded form. This information was processed mechanically and subjected to statistical
analysis according to the patterns established in previous years. The Division participated in a number of small studies initiated by the Division of Venereal Disease Control
and assisted in the planning and introduction of a special study on facilitation. The
results of this study are expected to be available toward the end of 1957.
Crippled Children's Registry
Supervision of the non-medical aspects of the Crippled Children's Registry is a
responsibility of this Division and occupies a major portion of the time of one research
assistant. The change-over of cases from the old record system to the new system,
which was outlined in last year's Report has been progressing during the year. This
work was curtailed considerably, due to the shortage of staff in the Registry.
It has become apparent that in many instances several members of the same family
are reported to the Registry. Consideration is therefore being given to setting up a special
register of such families. This would facilitate the study of the familial aspects of impairment amongst children.
Considerable time was spent by the research assistant in supervising certain non-
statistical functions of the Registry. These included assisting in the development of new
agencies or clinics providing services for handicapped children, lecturing to organizations
and to student groups respecting the work of the Registry, and attending many meetings
of allied organizations, such as the various divisions of the Community Chest and Council
of Greater Vancouver.
At the invitation of the Canadian Council of Crippled Children and Adults, the
research assistant assigned to the Registry addressed the annual meeting of the executive
of that organization, outlining the organization, development, and functions of the British
Columbia Crippled Children's Registry.
Mental-health Statistics
The Division continued to process the admission and separation reports of patients
moving in and out of institutions of the Mental Health Services. The extensive statistical
tabulations required for the Annual Report of the Mental Health Services were again
prepared and certain changes designed to improve the effectiveness of the statistics were
made in consultation with the Director of Mental Health Services.
The statistical records on the resident population of the Provincial Mental Hospital
at Essondale were completed early in the year and the records for Woodlands School will
be completed in the near future. These statistical records are maintained on punch-cards
and are available for tabulation and analysis. Consultant service was extended in the
planning of the records and statistics required for the new Day Centre to be opened on
January 1st, 1957. Discussions are also being held in connection with the planning of
treatment-cards for Woodlands School and from these treatment-cards cohort statistics
will be developed.
A special analysis was prepared for the Mental Health Services Annual Report. This
analysis dealt with the length of stay in the Provincial Mental Hospital of schizophrenic
patients in the period prior to the present treatment programme, compared to the situation
at the present time.   The hypothesis that treatment has relieved the accumulation of DEPARTMENT OF HEALTH AND WELFARE,  1956 W 89
schizophrenic patients in the mental hospitals was proven. Furthermore, it was demonstrated that schizophrenic patients still present a serious problem in the planning of future
accommodation facilities in the Mental Health Services.
Cancer Statistics
The British Columbia Cancer Institute continued to abstract statistical data from its
case load and to forward this information to the Division of Vital Statistics in coded form
for mechanical tabulation. The processing of the backlog records in the British Columbia
Cancer Institute is expected to be concluded during 1957, at which time all of the relevant
medical records of the Institute will be available in punch-card form for tabulation and
statistical analysis.
During the year several special tabulations were prepared from the statistical punch-
cards which have already been processed. These tabulations were required for special
studies in the British Columbia Cancer Institute and for the statistical report of annual
admissions to the Institute.
The Division continued to operate the Province-wide cancer reporting system and
to prepare statistics on the reported incidence of malignancies in British Columbia. These
statistics were summarized in a special report published in the series "Division of Vital
Statistics Special Reports."
Western Rehabilitation Centre Statistics
The Division rendered assistance to the Western Rehabilitation Centre in the designing of a statistical system which would yield information required for administrative
purposes and for programme evaluation. This is a relatively new field of statistical activity
and it was necessary to devise a new pattern of statistics and statistical procedures to meet
the peculiarities of rehabilitation work. It is anticipated that the new system may become
operative early in 1957. The Division of Vital Statistics has undertaken to use its
mechanical equipment to process the statistical records of the Rehabilitation Centre and
to assist in the anlysis of the statistics which will be produced.
Infant and Maternal Morbidity and Mortality Statistics
In previous Annual Reports the special infant-mortality studies of the Division,
which are based on data abstracted from birth registrations, death registrations, and
physicians' notices of birth, have been described. In order to ensure a maximum utilization of the statistical resources available in this connection a special committee was
established with representation from the Department of Paediatrics, the Department of
Obstetrics, and the Department of Public Health of the University of British Columbia,
as well as from the Division of Vital Statistics. This committee met several times during
the latter months of the year and planned a programme of statistical releases which it is
hoped will be of interest and value not only to the Health Branch and to the Departments
of the University mentioned, but also to the practising physicians throughout the Province.
A special study of neo-natal mortality in British Columbia was made during the year
and was presented at the annual meeting of the Canadian Public Health Association.
Several aspects of neo-natal mortality not previously measured or assessed in this Province were brought out in the study.
The Division was also represented on the committee which has been planning a
comprehensive study of obstetrical cases and newborns in Vancouver General Hospital.
The privilege of participating in this study is greatly appreciated since it makes possible
certain correlations with other statistical data being prepared by the Division. W 90 BRITISH COLUMBIA
Child Growth and Development Charts
At the request of the Director of the Central Vancouver Island Health Unit a number
of sources of height-weight data for children were investigated to determine their suitability in developing a simplified height and weight chart. Such a chart would be used
in the school health programme as a screening device.
It was found that no sufficiently large body of data of the type required for this
purpose was readily available and it was therefore decided that the information would be
obtained by compilations based on the height and weight records of the children in the
Central Vancouver Island Health Unit. It was estimated that these records contain
approximately 100,000 individual height and weight measurements and would constitute
a most satisfactory basis for the height-weight charts. A programme of abstracting the
health records of the Central Vancouver Island Health Unit to obtain these data was
developed, based on the use of mechanical tabulation equipment in the Division. By the
end of the year approximately 50 per cent of the records had been processed and it is
anticipated that the project will be concluded early in 1957.
Epidemiological Statistics
The recording and statistical aspects of the Province-wide notifiable-disease reporting
system constitute another responsibility of the Division. The routines established in connection with this statistical system are such that weekly totals by disease and by health
units are available on the Friday following the week of reporting. During periods of
increased incidence of poliomyelitis, an up-to-the-minute record is maintained in the
central office based upon telegraphic reporting.
The Division assisted in the planning of the poliomyelitis vaccination programme
by deriving estimates of the number of children by age-groups and health units.
An analysis of Salmonella infections was made during the year as a result of a
significant increase in the number of cases reported.
The new typhoid fever carrier registry referred to in last year's Report was finalized
and made operative during the year.
Periodic listings of deaths from staphylococcus infections were prepared during the
year and made available to the special committee appointed to study the extent of this
infection throughout the Province.
Periodic listings of deaths from poisonings were made available to the Director of
the Division of Environmental Management. These lists are used in determining the
extent and nature of poisoning fatalities occurring in the Province.
Morbidity Statistics
Morbidity statistics were compiled from the claims records of the British Columbia
Government Employees' Medical Services. These statistics were released in the Special
Reports series of the Division, and are described under that heading. A number of special
analyses respecting utilization of the medical services were prepared for the executive
board of the organization.
Other Assignments
The annual Medical Inspection of Schools Reports, covering all schools in the
Province, were again processed by the Division and the required analyses prepared.
Assistance was given to the Director of the Division of Public Health Nursing in the
analysis of the public health nurses time study and in the compilation of statistics respecting the several home-care programmes in operation in the Province.
Statistical inquiries from the public and from commercial firms were handled by the
Research Section. department of health and welfare, 1956
Procedure Manuals
w 91
With the expanding scope of the statistical work of the Division and the increasing
variety of projects undertaken, it was considered necessary to develop procedure manuals
for each of the important statistical assignments carried. Several additions were made to
this set of manuals during the year and a number of existing manuals were revised.
Vital Statistics Special Reports
Seven reports were issued in the Vital Statistics Special Reports series during 1956.
The purpose of these publications is to provide a medium for the presentation of statistical data not appearing elsewhere, which is considered to be of sufficient interest to public
health personnel in this Province and to others to make its release in this form worthwhile.
The following is a synopsis of the material contained in the reports issued during 1956:—
Report No. 13 was entitled " Statistics on Malignant Neoplasms in British Columbia,
1955." It contained data on cancer cases as reported through the cancer registration
system and also on cancer deaths as registered with the Division of Vital Statistics.
Report No. 14, entitled "Accidents in British Columbia," presented two addresses
given at the Public Health Institute by members of the Research Section of the Division.
The first paper outlined various measures of the accidental-death problem in British
Columbia. The second paper discussed some of the circumstances surrounding accidental
deaths in the Province, and included a discussion of the main causes according to age-
group and place of occurrence.
Report No. 15, entitled "Morbidity Statistics of the British Columbia Government
Employees' Medical Services, December, 1954, to November, 1955," gave data on the
incidence and cost of illness for conditions for which the members of the Medical Services
received professional advice during the period indicated. The rate of illness in the scheme
was found to be 1,134 per 1,000 males and 1,400 per 1,000 females. Services utilized
for each 1,000 males numbered 3,341, and for each 1,000 females, 4,316. Cost per
person was $17.30 for males and $25.41 for females.
Amongst males, injuries, respiratory infections, and conditions in the category diseases of the skin, diseases of the skeletal system, and congenital malformations were the
leading causes of illness, accounting for over 50 per cent of the total. For females, respiratory conditions, diseases of the genital urinary tract, and conditions in the category
diseases of the skin, diseases of the skeletal system, and congenital malformations were
the leading causes, resulting in over 40 per cent of the total.
Report No. 16 was entitled "Health Unit Statistics, British Columbia, 1955." It
was the fifth in a series presenting certain vital-statistics data on an annual basis for the
various health units of the Province.
Report No. 17, entitled "British Columbia Dental Health Survey, 1956, Part I,
Procedure with Special Reference to Sampling Methods," contained a description of the
procedure and sampling methods used in the selection of samples for the 1956 Dental
Health Survey.
Report No. 18 was entitled "British Columbia Dental Health Survey, 1956, Part II,
Dental Health Indices for Greater Victoria, Greater Vancouver, and the Fraser Valley."
It set forth the results of the survey which was carried out amongst school-children in the
selected areas of the Province. The results were presented separately for each region and
also for the combined regions, and were cross-classified by age. The analyses revealed
significant differences in the dental-health indices for each region, although the pattern
by age was similar in each area, exhibiting a gradual decline in dental health from the
younger to the older ages.
Report No. 19 was entitled "Health Unit Statistics, British Columbia, 1948-51 and
1952-1955."    This report was similar in format to the special reports on health-unit
1 W 92 BRITISH COLUMBIA
statistics previously issued, except that it gave average rates for the two four-year periods
mentioned. Frequencies and rates based on the experience of a number of consecutive
years are less subject to chance variations and therefore serve as a more reliable index of
the situation existing in each health unit.
SUMMARY OF 1956 VITAL STATISTICS
Preliminary figures indicated that the birth rate continued at a high level in the
Province during 1956. The rate recorded was 25.8 live births per 1,000 population.
The preliminary death rate stood at 9.8 deaths per 1,000 population, only slightly changed
from the previous year's figure. The excess of births over deaths, referred to as the
natural increase, amounted to about 22,400, or a rate of 16.0 per 1,000 population.
For stillbirths a rate of 11.5 per 1,000 live births was recorded.
Principal Causes of Mortality
Preliminary figures indicate that there was a fairly substantial reduction in the mortality rate from the two leading causes of death, namely, diseases of the heart and cancer.
The death rate amongst the non-Indian population attributed to diseases of the heart
dropped from the 1955 figures of 379.6 per 100,000 population to 359.3 per 100,000
population in 1956. The death rate ascribed to cancer dropped from 163.7 per 100,000
population to 153.2.
Little change occurred in the death rate from the third leading cause of death,
namely, vascular lesions of the central nervous system. The death rate from this cause
stood at 106.3 per 100,000 population.
The three causes mentioned above accounted for approximately two-thirds of all
deaths in the Province, and these deaths occurred mainly at the older ages. However, the
fourth leading cause of death, namely, accidents, continued to take its toll at all ages, and
constituted the leading cause of death between 1 and 39 years of age. The death rate due
to accidents increased considerably during 1956 to 76.0 deaths per 100,000 population,
compared to only 61.4 in 1955. Over one-quarter of this mortality was due to motor-
vehicle accidents, while 18 per cent resulted from falls, and 9 per cent from drowning.
Deaths due to pneumonia were approximately 20 per cent greater than in the previous year, the death rate being 40.5 per 100,000 population. This was the highest death
rate recorded from pneumonia since 1943.
Diseases of the arteries accounted for 21.0 deaths per 100,000 population and
suicides for 12.3 per 100,000 population. The suicide death rate was slightly above that
for 1955, but among the lowest for many years.
The infant death rate in the population, excluding Indians, was 22.5 per 1,000 live
births, compared to 21.6 in 1955. The maternal death rate was unchanged at 0.4 deaths
per 1,000 live births. Throughout the whole Province only fifteen deaths were ascribed
to maternal causes in the non-Indian population. DEPARTMENT OF HEALTH AND WELFARE,  1956 W 93
REPORT OF THE DIVISION OF PUBLIC HEALTH EDUCATION
R. H. Goodacre, Director
This Division has been active during the year in revising the programme in order
to shift the focus of effort from the craft aspects of public health education to the professional approach, utilizing the concepts and methods of the behavioural sciences as well
as the natural and biological sciences. This appears to be a logical move, since public
health deals primarily with people.
REVISED PROGRAMME
The first and most important of the three bases of the present programme is that of
applying the behavioural sciences to public health education by assessing the educational
value of current public health programmes in order that the content and approach of
public health education may be reconciled with the basic principles of learning as they
apply to a community composed of people whose attitudes and behaviour toward personal
and community health vary widely. This analysis is directed toward public health activity
in the three broad areas of child and maternal health, school health, and community
health, in order to determine whether the activities are indeed educational.
It is felt that of the methods of providing public health education consultation and
direction to personnel within the official public health agencies of this Province, the most
efficient and economical is that of staff education. Staff education or in-service training
is a major and vital function of public health practice. At the present time, Health
Branch consultants and divisional directors are indeed engaged in staff education of their
counterparts in local health units throughout the Province. However, training needs
must be constantly re-evaluated and the training programme revised to meet these needs
if maximum results are to be obtained. In order to maintain continuous supervision
over the variety of training programmes within a health department, a new unit is being
developed in an increasing number of health departments, particularly in the United
States, to co-ordinate the training programme. Only a small full-time staff is apparently
required to administer the co-ordination of training programmes, as the actual conduct
of the training itself must be considered a function of the public health workers who are
in supervisory positions. Although some state health departments maintain both a Division of Public Health Education and a Division of Training, the British Columbia Health
Branch does not require within its organization both divisions at the present time, although
it does require the type of service provided by both. Therefore, it is felt that the present
Division of Public Health Education is in a logical position to develop and co-ordinate
an over-all systematic programme of staff education, integrating within it public health
education services in addition to those provided by other Health Branch consultants.
The third main function of the Division is that of administration of facilities for the
provision of educational aids for use in local health-unit programmes for staff education
and public health education. These facilities include the Health Branch library of books,
professional journals, and other reference material; an extensive film and filmstrip
library; and supplies of posters and pamphlets.
The aforementioned constitutes, in general, the revised programme of the Division.
However, to date, implementation of this programme has been completely out of the
question, since it has been necessary to devote a great deal of professional time to duties
which are both clerical and semi-skilled in nature. The clerical duties have been undertaken by public health educators, because of unfortunate sickness experiences with
clerical workers in the Division.
Three steps must be taken before members of this Division can be in a position to
provide a true public health education service. The first of these pertains to the improvement of procedures and systems concerning the administration of the clerical and crafts W 94
BRITISH COLUMBIA
functions of the Division of Public Health Education, namely, the library, the library of
films and filmstrips, and the pamphlet and poster supplies. It is encouraging to note that
approximately 75 per cent of these procedures are now working quite smoothly. Secondly, it is necessary to obtain sufficient and competent clerical assistance on a continuous
basis, which will eliminate the clerical functions now assumed by public health educators.
Thirdly, it is imperative that the emphasis in the crafts of public health education be
shifted from the professional public health educators to a semi-professional or technical
type of person who is equally as capable of editing and writing publications as public
health educators. It is encouraging to note that authority has now been given to enable
the hiring of one person to undertake the supervisory aspects of the Division's clerical
procedures and to assume the responsibilities for the crafts operations of the Division,
heretofore undertaken by health educators.
FEDERAL-PROVINCIAL CONFERENCE
The Department of National Health and Welfare convened the Sixth Federal-Provincial Conference on Health Education in Ottawa, October 10th and 11th. Called
every two years, these meetings serve to bring together representatives in health education from all ten Provinces and from the Federal Government's counterpart, Information
Services Division. Following this two-day meeting, the Director spent a productive week
with the Departments of Sociology and Public Health at Yale University, and at the Office
of Public Health Education of the New York State Health Department. It was quite
evident from the above-mentioned conference and visits to Yale and Albany, that this
Province is not alone in being faced with problems with respect to public health education.
STAFF EDUCATION
Each year this Division organizes, for the Deputy Provincial Health Officer, the
annual Public Health Institute, at which time public health workers throughout the Province meet for a four-day period following Easter. This year's session was held at the
Hotel Georgia in Vancouver and was addressed by the guest speaker, Dr. Charles Smith,
Dean of the University of California's School of Public Health. Completing the agenda,
very capable speakers were obtained to present talks or discussions on such topics as
public health law, accident prevention, stress, and mental retardation, to mention a few,
and similar topics designed to keep staff informed on current trends and advances in
public health.
In keeping with the concept that the Division of Public Health Education should be
concerned with the co-ordination of a staff-education programme, the Director cooperated with the Chief Sanitary Inspector in preparing a course for selected sanitary
inspectors, which would provide them with the theory of plumbing. This two-week
short course, made possible through the availability of National health grant funds, was
given by P. Ballam, formerly Plumbing Inspector with the City of Victoria.
During the year the inclusion of prenatal classes within the local health-unit programmes gained ground. Forty-one areas in the Province are now giving, or planning
for, a series of classes for expectant mothers. The Division continued to select, in conjunction with the Division of Public Health Nursing, reference texts and audio-visual aids
for the conduct of these classes, and was able to provide a majority of these items from
the Maternal and Child Health Grant.
Local agencies sponsoring community preventive dental clinics have been encouraged to provide not only a dental-treatment programme but also a dental-health education programme conjointly. With this in mind, plans were begun toward the beginning
of the year to provide to these sponsoring agencies, and to local health services, an outline providing a basic plan for dental-health education within the community.    This DEPARTMENT OF HEALTH AND WELFARE,  1956 W 95
outline considered those people and groups within the community who have the opportunity to undertake dental-health education; for example, the practising dentist, the
physician, and the school-teacher. This outline was also prepared to include suggested
educational content for each group concerned. Unfortunately, this outline remains
incompleted and will probably remain so until such time as the clerical situation within
the Division has been improved.
For a number of years it has been recognized that the Health Branch library in
Victoria, the library in the Provincial Health Building in Vancouver, and the health-unit
libraries are utilizing inadequate systems of cataloguing and subject headings. Negotiations with the Provincial Librarian have resulted in the seconding of a reference librarian,
employed by the Provincial Library, to the Health Branch for the purpose of completely
reorganizing the library facilities. This is a most encouraging development and will
result in better and more efficient utilization of the library facilities which have been established for the benefit of public health personnel, both on the Provincial and local level.
The revision of the Health Branch library in Victoria will, in time, be extended to the
holdings of the Vancouver divisions and ultimately to the small basic libraries maintained
in every health-unit main and branch office in the Province.
EDUCATION OF THE PUBLIC
The Report for 1955 mentioned that a film was prepared depicting the role of the
Poliomyelitis Pavilion in the total picture of the care and management of poliomyelitis
patients in this Province. This film, produced initially for showing at the official opening of the pavilion in June, 1955, was subsequently revised in order to demonstrate the
role of an acute general hospital, the Poliomyelitis Pavilion, and the Western Rehabilitation Centre, ending with a sequence centring around polio vaccine as a hopeful preventative. The approach to the film was formulated by the Division after discussion
with the Deputy Minister of Health. The services of the Photographic Branch of the
Department of Trade and Industry were made available by the Deputy Minister of that
Department. Because of the shortage of polio vaccine encountered during the summer
months, release of the film which is entitled " The Road Home " was delayed until October, at which time local health units were advised of the availability of this new production. The film has already been shown in the Provinces of Saskatchewan and Quebec
and was also reviewed by representatives at the Federal-Provincial Conference on Health
Education, where it was received with great favour.
Various publications and posters were produced during the year in co-operation
with the Divisions of Public Health Nursing, Environmental Management, and Preventive Dentistry. Reference to these items will be found elsewhere in the Health Branch
Annual Report.
In addition, the Department of Education was approached to ascertain whether
there would be merit in the preparation of a manual on public health services, which
would benefit teachers in training and those now teaching health in the schools throughout the Province. This suggested manual was received with some enthusiasm by the
Department of Education and an outline of the content was subsequently prepared and
approved in principle by the Assistant Deputy Minister of Education. However, for the
same reasons outlined previously, progress in the preparation of this manual has ceased
temporarily.
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.   Annually, improvements are made in this display, to the point where, during W 96 BRITISH COLUMBIA
Pacific National Exhibition week, it competes quite favourably with other Government
displays. However, 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 contents of each exhibit.
In August, 1953, the Health Branch Bulletin "B.C.'s Health" was discontinued in
accordance with Government policy. Since that time the Health Branch has been contributing monthly articles for the new Government publication, "British Columbia
Government News," which replaced all publications previously issued by the various
departments. During the current year single issues have been devoted to the activities
of one department. The Health Branch had the opportunity of submitting articles and
pictures illustrating the work of health services, both Provincial and local, in the October
issue of this publication. Practically the entire issue was written by a public health
educator in this Division. Under the revised programme, this type of function will be
transferred from the professional public health educator to the new semi-professional
position which is in the process of becoming established.
PERSONNEL
This section of the Report has for the past few years reflected a note of pessimism.
Nothing has occurred during the current year to result in any change. In fact, there is
now one less public health educator in this Province, namely D. K. MacDonald, who
resigned from the Victoria-Esquimalt Health Department where he was also serving the
Saanich and South Vancouver Island Health Unit on a part-time basis, to enter the
University of British Columbia's Faculty of Medicine as a student. There remain at the
present time three trained public health educators engaged in public health in British
Columbia, two employed with the Provincial Health Branch and one with the Greater
Vancouver Metropolitan Health Committee.
It appears that the general staff situation within the Division will be alleviated shortly
with the employment of a semi-professional worker to undertake duties as outlined earlier
in this Report. The Division will then consist of one clerical worker dealing with the
library and with pamphlet supplies; one clerical worker concentrating her efforts on film
bookings; a semi-professional worker supervising the facilities and, in addition, assuming
the writing and editing activities of the Division, and two public health educators, one of
whom is the Director. With this combination there is every reason to believe that the
Division's programme can be extended. DEPARTMENT OF HEALTH AND WELFARE,  1956 W 97
REPORT OF THE BUREAU OF SPECIAL PREVENTIVE
AND TREATMENT SERVICES, VANCOUVER
G. R. F. Elliot, Assistant Provincial Health Officer
The Bureau of Special Preventive and Treatment Services includes the Divisions of
Laboratories, Tuberculosis Control, and Venereal Disease Control. The Assistant Provincial Health Officer, who directs this Bureau, is primarily concerned with matters of
policy respecting these Divisions, including co-ordination between these Divisions and
the voluntary health agencies, as well as between them and the local health services.
This Bureau also has the responsibility of working with and co-ordinating the responsibilities of certain voluntary health agencies who have a close relationship with the
work of the Health Branch. These agencies include the Alcoholism Foundation of British
Columbia; British Columbia Cancer Foundation; Canadian Cancer Society; Canadian
Arthritis and Rheumatism Society, British Columbia Division; the Narcotics Addiction
Foundation of British Columbia; Western Rehabilitation Centre (formerly Western Society for Rehabilitation); British Columbia Poliomyelitis Foundation, and the Canadian
Red Cross Society, British Columbia Division.
A consultant in public health nursing seconded to the Vancouver area by the Bureau
of Local Health Services is located in the Provincial Health Building, where the Assistant
Provincial Health Officer has his offices. Also located in this building is the Vancouver
Section of the Division of Vital Statistics, which includes representatives of the Statistical
Section of this Division. The policy of having these representatives of the Division of
Vital Statistics located in this building continues to prove more valuable each year. The
offices of the Co-ordinator of Rehabilitation and the Medical Consultant in Rehabilitation
are also located in this building.
The Provincial Health Building, at 828 West Tenth Avenue, Vancouver, which was
opened in 1955, has enabled the various Divisions within the Bureau to operate much
more efficiently, not only in improved services to the people but also in co-ordination
between this Bureau and local health services.
ADMINISTRATION
During the year, due to changes in personnel, substantial reorganization of administration was necessary. The sudden death of Miss Jean Gilley, research assistant, in
October, was a tremendous loss not only to this Bureau but also to the entire Health
Branch. Miss Gilley had been with the Provincial Government Service for twenty-two
years and had made many notable contributions to the public service of this Province.
Within the Division of Laboratories, 1956 was marked by the resignation of the
Director and Assistant Director. The Director, who had held the position of part-time
Director for twenty-one years, resigned in September to assume full-time employment
at the University of British Columbia. The Assistant Director, who had been with the
Division of Laboratories for twenty-five years, resigned in April, 1956. The loss of these
two senior and most capable employees was a serious one, particularly at the time that the
Division of Laboratories had moved into more spacious and satisfactory facilities and is
in the process of expanding laboratory services. A full-time medical specialist joined the
Division of Laboratories in early 1956, and has been appointed Acting Director. The
Technical Supervisor of Clinical Laboratory Services, on the staff of the Bureau headquarters, assumed part-time responsibilities in the Division of Laboratories as Assistant
Director, in addition to continuing his duties relative to the Laboratory and Radiological
Services Grant. These additional responsibilities of the Technical Supervisor and the fact
the new Acting Director of Laboratories is experienced in clinical laboratory services will
more closely co-ordinate clinical laboratory and public health laboratory services within
this Province. W 98 BRITISH COLUMBIA
The recruitment of technical personnel within the Division of Laboratories continues
to be difficult, but it would appear this problem is diminishing somewhat, perhaps due to
more satisfactory quarters which the Division of Laboratories now occupy. The passage
of the " Milk Industry Act" has brought additional demands upon the Division of Laboratories, but it is hoped these additional demands will be met entirely in the near future.
The programme of the Division of Tuberculosis Control continues to be subject to
continuous, critical review. It has also been possible to continue the reduction in the
budget of the Division of Tuberculosis Control as the problem of tuberculosis gradually
lessens.
Plans have been made whereby the beds operated by the Division of Tuberculosis
Control in Victoria will cease to operate as tuberculosis beds by March 31st, 1957. It
has also been possible to make further reductions in the beds being operated at Tranquille
Sanatorium.
The Division of Venereal Disease Control continues to consolidate the gains it has
made in the past few years in venereal-disease control. This Division operates with a
minimum of difficulties and is most efficient.
In both the Divisions of Venereal Disease Control and Tuberculosis Control continuous studies are being carried out on the epidemiology of the specific disease. It is
only by such methods that progress will be made toward the eventual eradication of
these diseases. A particularly interesting study is under way regarding the epidemiology
of tuberculosis. This study is being financed by the British Columbia Tuberculosis Society
and over-all direction has been assumed by the Associate Professor of Public Health,
Faculty of Medicine, University of British Columbia, in close co-operation with the Consultant Epidemiologist, the Division of Vital Statistics, and the Division of Tuberculosis
Control.
The close relationship with the Bureau of Local Health Services continues as in
previous years. This relationship has been strengthened as the Committee on Tuberculosis Practices and the Committee on Communicable Disease Control continue to meet
and determine policy. The Bureau of Special Preventive and Treatment Services continues to assume the co-ordination of all agencies concerned with the care of poliomyelitis patients, as well as the distribution of the Salk vaccine and gamma globulin used by
the local health services. The presence of the consultant in public health nursing in this
Bureau, on attachment from the Bureau of Local Health Services, has done much to
co-ordinate and interpret the responsibilities of this Bureau, its divisions, and the voluntary health agencies to local health services.
FACULTY OF MEDICINE, UNIVERSITY OF BRITISH COLUMBIA
Continuous close co-operation is maintained with the Dean of Medicine and the
various departments. Relationship with the Department of Paediatrics and the Department of Preventive Medicine is particularly close. Of great value was a one-week
refresher course organized by the Department of Preventive Medicine for health officers
planning to write their examination for certification as specialists in the fall of 1956.
The Department of Paediatrics, as the official consultant to the Health Branch in child
care, continues to be a most valuable adjunct to the services of the Health Branch.
VOLUNTARY HEALTH AGENCIES
The responsibility of this Bureau in interpreting the policy of the Health Branch
to voluntary health agencies continues to grow. The services of the voluntary health
agencies are many and varied, but their aims and objectives must be co-ordinated with
the plans and policy of the Health Branch if possible. It has been the responsibility of
this Bureau to endeavour to carry this out. DEPARTMENT OF HEALTH AND WELFARE,  1956 W 99
Only a few of the voluntary health agencies receive direct financial assistance from
the Province of British Columbia and, in particular, the Health Branch. Some of the
voluntary health agencies can be considered as agents of the Government, since they have
assumed major responsibility for certain programmes. It is not possible to discuss the
work of all voluntary health agencies in this Report; rather only brief reports will be
given relative to those which receive financial assistance from the Government.
Alcoholism Foundation of British Columbia
This agency, incorporated under the " Societies Act" in 1953, has continued to
make notable progress in the development of treatment and rehabilitation facilities for
those suffering from alcoholism and to promote research and education concerning alcohol and its use. In December, 1955, limited residence facilities were opened in the
proximity of the Foundation's clinical services which, during the past year, have proven
a valuable adjunct in the treatment and rehabilitation of patients. A limited research
project was undertaken by the Foundation during the year, in co-operation with the
University of British Columbia.
The board of directors of the Foundation includes one representative from the
Department of the Attorney-General; one from the Mental Health Services, Department
of the Provincial Secretary; and one each from the Health and Welfare Branches of the
Department of Health and Welfare.
British Columbia Cancer Foundation
The British Columbia Cancer Foundation was designated by the Provincial Government in 1949 to be the recognized agent for the treatment and diagnosis of cancer in
the Province. Operating expenses are provided by the Cancer Control Grant of the
National health grants, which is matched by a Provincial Government grant, and from
private patients' fees.
The foundation operates the British Columbia Cancer Institute located in Vancouver, to which is attached a thirty-six bed boarding home. Complete diagnostic and treatment facilities are available to the people of British Columbia at this centre. In addition,
a cancer clinic is located at the Royal Jubilee Hospital in Victoria, where treatment facilities are provided. Consultative cancer services have been established at various centres
throughout the Province in co-operation with the local health services of the Health
Branch, Department of Health and Welfare. The purpose of these services is to assist
in the diagnosis of patients referred by the medical profession, to make recommendations
in respect of treatment, and to provide follow-up services for those patients who have
had treatment at the British Columbia Cancer Institute or the Victoria Cancer Clinic.
Radiotherapists from the Institute make regular visits to each centre throughout the year.
British Columbia Medical Research Institute
The British Columbia Medical Research Institute is a non-profit organization which
was incorporated in 1948 under the " Societies Act." It was conceived by a group of
Vancouver citizens who sought as their objective the establishment of a major medical
centre in the vicinity of the Vancouver General Hospital where essential facilities for
medical research could be provided. The Institute operates in close co-operation with
the medical profession in the Province, the Vancouver General Hospital, the University
of British Columbia, and other organizations interested in this field of basic medical
research.
Financial assistance has been made available to this Institute through the support
of research projects from funds of the National health grants. In addition, in April, 1956,
a further grant was made available to this organization by the Provincial Government. W 100 BRITISH COLUMBIA
Canadian Arthritis and Rheumatism Society (British Columbia Division)
The physiotherapy, medical consultant, and other special services offered by this
Society were extended to the Prince Rupert, Terrace, Princeton, Lytton, and Grand
Forks areas of the Province during the year. Thus, a network of Canadian Arthritis
and Rheumatism Society services is available, at the request of the family physician, for
patients with rheumatic disease, in all parts of British Columbia except in Golden, Dawson Creek, Burns Lake, and Williams Lake areas.
A most significant development in the work of this organization during the year
has been the integration of all departments and facets of the work to provide, as far as
personnel and financial resources permit, the complete teamwork approach to rehabilitation.
In the field of education, an annual medical lectureship in the rheumatic diseases
is being financed by this Society at the University of British Columbia. Members of the
Society's Medical Advisory Board lecture regularly to medical students and nurses at
the University. Orientation courses are given regularly and a lecture series for general
practitioners was given in November of this year. All these resulted in increased interest
in and understanding of the care of the rheumatic patient by doctors and nurses throughout the Province. Short postgraduate courses have been provided for several staff members and the Medical Director and Physiotherapy Supervisor have given papers on the
work of the Society in New York and in Eastern Canada.
Members of the medical profession of Vernon, Victoria, and Nanaimo participated
in public forums on arthritis during the year.
Over three thousand patients in the Province received treatment during 1956.
Problem cases have continued to be referred to the travelling medical consultants who
have visited each unit outside Vancouver and Victoria twice during the year. Special
cases are sent as in-patients to the Vancouver Medical Centre where they receive physiotherapy, occupational therapy, social casework, and nursing procedures and, where
necessary, vocational training. Ten beds, sponsored by the Canadian Arthritis and
Rheumtism Society, are reserved at the Western Rehabilitation Centre for this purpose
and, in addition, six are usually occupied by patients needing longer periods of care at
the Holy Family Hospital, Vancouver.
Late in 1955, the Arts and Crafts Department was opened at Provincial headquarters and the value of this additional service has been well established during the past year.
Its purpose is to provide psychological stimulus by the satisfaction derived from creative
effort, to bridge the gap between convalescence and the return to normal living, and to
provide a source of income.
Research projects reported previously are being continued. A report on the serological project is being published.
Narcotics Addiction Foundation of British Columbia
The most recent voluntary health agency to be formed in this Province is the Narcotics Addiction Foundation of British Columbia. It was formed in September, 1955,
for the purposes of developing programmes of treatment and rehabilitation of narcotic-
drug addicts, to stimulate research into the problems of narcotic-drug addiction, and to
promote community education regarding this problem. The Foundation is supported by
a financial grant from the Provincial Government. The Board of Directors of the Foundation includes the following representation from the Provincial Government services:
One from the Department of the Attorney-General; one from the Health Branch, Department of Health and Welfare; one from the Welfare Branch, Department of Health and
Welfare; and one from the Mental Health Services of the Department of the Provincial
Secretary. DEPARTMENT OF HEALTH AND WELFARE,  1956 W 101
In January, 1956, an executive director was appointed and shortly thereafter the
services of a social worker and office secretary were added. Development of the Foundation's programmes during the year has been limited, because of problems encountered in
acquiring suitable accommodation.
Many public-spirited citizens who have given so freely of their time and energy to
the development of this Foundation are to be commended. Their continued support of
the Foundation ensures the success of this organization in future years.
Western Rehabilitation Centre
It should be noted that the name of this organization has been recently changed
from Western Society for Rehabilitation to Western Rehabilitation Centre. However, the
purpose of the organization to provide a comprehensive rehabilitation programme in the
medical, psychological, social, and vocational areas remains unchanged. Rehabilitation
services are provided on an in-patient and out-patient basis under full-time medical
supervision. Fifty-three beds are available for in-patient care. Twenty of these beds are
nursing beds staffed with graduate nurses and experienced orderlies.
During the year the occupational therapy department has been substantially expanded, both with respect to staff and facilities. Added to this department is a woodworking room, a ceramics room, and a completely equipped training kitchen to assist in
the rehabilitation of disabled homemakers.
Plans are being developed to institute, early in 1957, a broad statistical system.
Statistical data will be used both for reporting on the work being done in the Centre and
for programme evaluation. Future plans for 1957 also include provision for the engaging
of a vocational placement officer and the addition of a second speech therapist.
The general picture for the current year has been one of increased activity. Residential patient-days in the first nine months of this year have increased 40 per cent over
the corresponding period last year. This substantial increase has resulted primarily from
the inauguration of the nursing service in October, 1955. Work units (one-half day of
service per person) have increased 22 per cent over last year.
Canadian Red Cross Blood Transfusion Service
Reference was made in last year's Report to the fact that the Red Cross Blood
Transfusion Service moved to quarters made available in the Provincial Health Building
during September, 1955. This move represented the realization of an agreement between
the Canadian Red Cross Society and the Government of the Province of British Columbia
whereby the Society undertook to provide the Blood Transfusion Service without charge
to the people of British Columbia, and the Government undertook provision of the
necessary accommodation without charge to the Society. Previously, the Government
had made a grant to this Society in lieu of provision of accommodation, pending completion of the Provincial Health Building.
In last year's Report reference is made to some difficulties being encountered at that
time by the Transfusion Service in their new quarters and it is a pleasure to report now
that these have been almost entirely overcome.
NATIONAL HEALTH GRANTS
General
With the exception of the Tuberculosis Control Grant the total of each of the grants
made available to British Columbia for the fiscal period ending March 31st, 1957,
increased slightly over that made available in the preceding fiscal year. The total of all
grants, exclusive of the Hospital Construction and Public Health Research Grants,
amounts to $2,860,705 for the current fiscal year, which represents an increase of
approximately $100,000 over that appropriated for the 1955-56 fiscal year. W 102
BRITISH COLUMBIA
The appropriation for new construction projects under the Hospital Construction
Grant for the current fiscal year amounts to $558,155, as compared to $555,931 in the
preceding fiscal year. In addition, there was a revote of $1,324,673 for this year, as
compared to $403,928 in the last fiscal year.
The Public Health Research Grant is maintained as a central fund in Ottawa, and
is allocated by Federal authorities.
In September, the Mental Health Grant was increased by the amount of $70,000 by
a transfer of this amount from the Laboratory and Radiological Services Grant. At the
same time the General Public Health Grant was similarly increased in the amount of
$176,000. The transfer of funds to the Mental Health Grant was made to permit purchase
of certain equipment and to assist with postgraduate training of staff. The funds transferred to the General Public Health Grant were required to assist with staff training, to
provide staff and equipment for expanding local health services, to assist cardiac research,
and to permit purchase of vaccine and equipment for the prevention and treatment of
poliomyelitis.
Administration
The administration of the National health grants programme in the Province has
been, again this year, very materially assisted by the co-operation and assistance accorded
local officials by representatives of the Department of National Health and Welfare. It
was a pleasure to have an opportunity to confer with D. M. Herron of the Federal department's administrative staff during his visit to this Province in June of this year.
x Grants Received for the Year Ended March 31st, 1956
Total expenditures for the year ended March 31st, 1956, were $2,426,390, or 56.6
per cent of the total available, as compared with $2,938,220, or 69 per cent of the total
grants available in the year ended March 31st, 1955. The decreased use of the National
health grants is due mainly to lower expenditures under the Hospital Construction Grant.
For various reasons there was a delay in commencing some of the proposed construction,
so that claims could not be submitted as planned. Moreover, certain claims which were
submitted in 1955-56 were paid out of funds allocated for the succeeding year. Another
reason for the decreased rate of expenditure was the fact that much of the equipment
ordered under the Mental Health Grant for the newly opened Child Guidance Clinic and
Day Hospital for the Provincial Mental Health Services was not received by the end of
the 1955-56 fiscal year.
Comparison of Amounts Approved and Actual Expenditures with Total Grants
for the Year Ended March 31st, 1956
Grant
Total Grant
Approved
Actual Expenditures
Amount
Per Cent
Amount
Per Cent
$43,754
43,754
1,493,801
43,754
606,628
366,070
34,494
783,000
299,857
356,400
84,658
132,491
$24,358
41,490
941,527
43,754
606,025
313,060
34,494
766,423
234,341
98,569
57,553
19,903
55.6
94.8
63.0
100.0
99.9
85.5
100.0
97.8
78.1
27.6
67.9
15.0
$22,055
37,965
415,941
43,754
499,928
282,738
29,934
726,280
216,421
81,631
51,851
17,893
82.4
77.2
22.9
61.2
13.5
$4,288,661
$3,181,497
74.2
$2,426,390
56.6 DEPARTMENT OF HEALTH AND WELFARE,  1956 W 103
Excluding the Public Health Research Grant, 73.9 per cent of British Columbia's
total allotment was approved for specific expenditures. The amount actually spent by
British Columbia was 56.3 per cent of the total available to the Province.
Crippled Children's Grant
This grant is used to assist in programmes for the prevention and treatment of
crippling conditions in children, including rehabilitation and training. The amount made
available for the fiscal period ending March 31st, 1957, is $43,913.
Under this grant, the Crippled Children's Registry was established about four years
ago and is located in the offices of the Assistant Provincial Health Officer. The operations
of this Registry were reported on in some detail in last year's Report. It is interesting to
note that the case load of the Registry continues to increase, at the rate of approximately
150 cases reported per month. This is a reflection of the excellent co-operation provided
by the medical profession in the Province, since the reporting of disabilities by the
physicians is on a voluntary basis. At the end of 1956 the total number of cases registered will number approximately 9,000.
During the year, liaison between the Registry and the Provincial Rehabilitation
Co-ordinator was further developed, with a view to assisting in the future planning of
rehabilitation services for certain of the disabled children. Close liaison continues as well
between the Registry and the Local Health Services in the Province.
During the year, financial assistance was made available under this grant to permit
the employment of a part-time speech therapist and audiologist at the Health Centre for
Children. Assistance for this Centre was also continued in respect of the employment
of an orthoptical supervisor and an orthoptical assistant.
Assistance was also continued under this grant to the Cerebral Palsy Association of
British Columbia. One medical social worker, three physiotherapists, and limited driver
service are thus made available to this Association.
Professional Training Grant
This grant, amounting to $43,913 this year, was utilized to provide graduate training
for various professional public health and general hospital personnel, primarily physicians,
nurses, and dentists. Assistance was also provided for a number of trainees in the
Canadian Hospital Council extension courses in hospital administration and medical
records. Short-term courses were provided for thirty personnel engaged in the health
field in the Province. This included provision for the attendance of twelve medical health
officers at a refresher course in Vancouver, sponsored jointly by the Department of Public
Health, Faculty of Medicine, University of British Columbia, and the Health Branch.
Hospital Construction Grant
Funds available for the current year total $1,882,828 as compared with $1,493,801
last year. Of the current year's funds, $1,324,673 consists of a revote of funds unexpended in previous years. Submissions approved to date total approximately $487,156
for general hospitals, $58,559 for health units, and $662,189 for mental hospitals.
There still remains a considerable amount of hospital and health-centre construction
to be undertaken in this Province, and we have been informed by the Federal officials that
assistance under the Hospital Construction Grant will be available for a further period
beyond March 31st, 1958.
Venereal Disease Control Grant
There has been no change in the utilization of this grant during the year, as the total
amount is allocated to the Division of Venereal Disease Control, Health Branch, to match
Provincial funds expended for this programme.   Although the total funds expended for W 104 BRITISH COLUMBIA
this programme were decreased again this year, the amount appropriated from Provincial
funds remains considerably in excess of the amount of this grant.
The report of the Division of Venereal Disease Control appears elsewhere in this
Health Branch Report.
Mental Health Grant
Most of the projects submitted under the Mental Health Grant are initiated by the
Provincial Mental Health Services, Department of the Provincial Secretary. The greater
portion of the grant is devoted to the provision of staff and technical equipment for
Mental Health Services institutions. A considerable sum is used to support research in
the mental-health field by the Faculty of Medicine, University of British Columbia.
The grant for 1956-57 amounts to $608,954, but this has been found to be too
little for the needs of this particular period.
It has therefore been necessary to transfer $70,000 from the Laboratory and Radiological Services Grant, thereby making the sum of $678,954 available for mental-health
projects.
The Provincial Child Guidance Clinic occupied its new quarters in January. The
equipment authorized for purchase with grant funds in 1955-56 was not all received in
that fiscal period, thus it became necessary to continue the project to this year. Deliveries
continue to be slow, but it is hoped that all approved items will be received before the
grant expires.
The Mental Health Centre is to be inaugurated in January, 1957. The equipment
for this unit was authorized for purchase with Mental Health Grant funds in 1955-56,
but there were virtually no deliveries in this period. The project was resubmitted for
continuation in 1956-57, and the bulk of the equipment has now been received.
A dental clinic has been established in the North Lawn Building of the Provincial
Mental Hospital, Essondale, for the care of the tuberculous mental patients domiciled in
this unit.   The equipment was provided by a Mental Health Grant project.
In the West Lawn Building of the Mental Hospital a ward for men with severe
neurological disabilities has been established. A physiotherapy service for this group of
patients has been provided. The necessary physiotherapy apparatus was obtained with
Mental Health Grant assistance.
The consultant services in general surgery, neurosurgery, and orthopaedic surgery for
the Mental Health Services continue to be supported by the grant. This year a consultant
service in internal medicine has been added.
At the Woodlands School, New Westminster, a unit to accommodate in excess of
300 patients is in the final stages of construction. The basic equipment for this building
has been authorized by a project submitted under the Mental Health Grant.
Several pieces of equipment have been secured for the Provincial Homes for the
Aged this year. An Admitting and Infirmary Unit for the Home for the Aged, Port
Coquitlam, is under construction. It is anticipated that grant funds will be used for basic
technical equipment next year.
Further surgical equipment has been provided for the operating-room in the Crease
Clinic.
Several of the research studies being conducted in the Department of Neurological
Research were concluded this year. The final reports are being prepared for publication.
The narcotic-addiction studies have also been concluded and a comprehensive report has
been prepared.
A number of new research problems have been attacked this year. Mention should
be made of the studies on the etiology of mental deficiency, utilizing the case material of
The Woodlands School.   It should be noted that considerable attention is being directed
J DEPARTMENT OF HEALTH AND WELFARE,  1956 W 105
to the problems of schizophrenia, the most crippling of all mental illnesses. This year
three studies have been undertaken, each of which is concerned with a special aspect of
the biochemistry of schizophrenia. It is expected that these studies will be continued
next year.
Assistance was provided to bring Dr. Karl Menninger to Vancouver to lecture at the
Summer School of the Vancouver Medical Association. He also lectured to the assembled
staff of the Mental Hospital and Crease Clinic and later conducted a clinic on schizophrenia for the medical staff.
The psychiatric services of the Vancouver General Hospital received increased
assistance through the appointment of a clinical psychologist and the expansion of the
occupational therapist's schedule to full time.
Assistance was continued to the Royal Jubilee Hospital to support the occupational-
therapy service in their Department of Psychiatry.
The Canadian Mental Health Association (British Columbia Division) was given
financial support again, but in a smaller amount, this being the last year that a grant will
be made. The Association has continued to thrive. The Mental Health Services have
been well served by the volunteer services of the Association and special attention should
be given to the successful operation of the apparel shops for men and women patients.
Professional training in psychiatry and clinical psychology for selected staff members
has been continued.
The mental-health programme of the Metropolitan Health Committee of Greater
Vancouver was supported as heretofore. The first group of senior school counsellors
completed the course in mental hygiene and is now engaged full time in counselling in the
various schools.   Another course has been commenced for a second group of counsellors.
Tuberculosis Control Grant
The major responsibility for tuberculosis control in this Province rests with the
Health Branch's Division of Tuberculosis Control, and most of the funds provided under
this grant were allocated to programmes operated by this Division. These programmes
include the free hospital-admission X-ray service throughout the Province, assistance in
the provision of antimicrobials for the treatment of tuberculosis, community chest X-ray
surveys, rehabilitation service, and some assistance in the provision of staff and equipment. In addition, some assistance is made available to the Vancouver Preventorium
and the Greater Vancouver Metropolitan Health Committee for staff salaries.
The activities of the Division of Tuberculosis Control during the year are reported
in detail in another section.
Public Health Research Grant
The research studies being supported under this grant include the study of antibiotic
and hormonal control of tubercle-bacillus infection which was started in 1952 and is being
sponsored by the Faculty of Medicine, University of British Columbia; investigation of
diagnostic criteria of neo-natal haemolytic disease due to foetal-maternal ABO incompatibility, and ABO foetal-maternal incompatibility as a cause of foetal death; determination
of human blood patterns and levels of adrenal-steroid hormones; the study of the etiology
of non-specific urethritis by means of human-tissue culture, which was referred to in some
detail in last year's Report. The research study relating to certain aspects of hospitalization in the Province was completed during the year. This study was started in 1953.
New studies commenced during the year include a survey of the incidence of intestinal
entozoa in British Columbia; a study of the growth of lymphocytic choriomeningitis virus
in acute and latent infection; and studies on maternal mortality, maternal morbidity, and
certain aspects of foetal wastage in British Columbia. W 106 BRITISH COLUMBIA
General Public Health Grant
The National health grants regulation that not more than 75 per cent of certain
grants can be committed for continuing services again caused some difficulty with the
General Public Health Grant, since a large percentage of this grant is required for the
provision of staff, which is a continuing service.
Due to past difficulties in keeping the recurring commitments within the required
limits it was agreed in 1954-55 that the Province would absorb, over a three-year period,
the salaries of certain Provincial Health Branch personnel which were provided for under
two projects. At the end of the current fiscal year the salaries of these persons will be
paid entirely from Provincial funds.
In the latter part of 1955 a new research project was commenced in Victoria under
this grant, entitled "An Investigation into Factors Modifying the Ballistocardiograph
Pattern." In 1956 support was given under this grant to the establishment of a glaucoma
clinic in the out-patient department of the Vancouver General Hospital and to the
institution of a training plan in the Simon Fraser Health Unit to give student practical
nurses supervised experience in homes.
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. Assistance is also continued to the Metropolitan Health Committee of
Greater Vancouver and the Victoria-Esquimalt Board of Health.
Cancer Control Grant
This grant is used to assist in approved programmes for the detection and treatment
of cancer. All allocations from this grant are required to be at least matched by
Provincial funds.
The major portion of this grant is made available to the British Columbia Cancer
Foundation, which is the recognized agent in this Province for the treatment and diagnosis
of cancer. The operations of the British Columbia Cancer Foundation are outlined in
a preceding section in this Report.
Additional assistance was provided to the British Columbia Cancer Institute for the
purchase of replacement Cobalt 60 Beam Therapy Source.
Financial support was continued for the Provincial Biopsy Service. The total
number of all biopsy examinations continues to increase quite markedly, there being
a total of 13,347 such examinations during the first six months of 1956.
The cytology laboratory of the British Columbia Cancer Institute has continued to
examine an increasing number of specimens during this year.
Laboratory and Radiological Services Grant
The Advisory Councils appointed last year have each continued to study and plan
programmes in diagnostic services for the Province of British Columbia, and the Health
Branch has found their advice invaluable. As a result of their recommendations, service
programmes are being developed and some have been instituted this year.
Laboratory Services
Applications for assistance toward the purchase of equipment for laboratory services
have this year been reviewed by a technical sub-committee of the Laboratory Advisory
Council, and its specific recommendations are made to the Health Branch for action.
Equipment applications for expansion of laboratory services have thus been approved
for twenty-three hospitals this year. DEPARTMENT OF HEALTH AND WELFARE,  1956 W 107
One of the first problems which faced this Advisory Council was the shortage of
trained technical personnel, and this deficiency has been under careful study this year.
A survey of hospital laboratory personnel requirements conducted this year illustrated
that the present demand greatly exceeded the supply, and a concerted effort was therefore
made to institute additional training facilities. Approval has now been received for the
first phases of a new training programme to be conducted at the Vancouver General
Hospital, and it is expected that the first classes will begin training in 1957. This programme envisages a new concept in laboratory training in this Province, since it will
present a concentrated course of didactic lectures and laboratory exercises for six months,
to be followed by a second six-month term of hospital externship, at which time the
candidates will write qualifying examinations for registration (CSLT).
Continued studies by this Council of the means by which rural areas of the Province
might best be given good laboratory diagnostic services have now produced data for
programmes of regional laboratory services. Two new regional services have been
planned, one for the Lower Fraser Valley and the other for the Okanagan Valley, and
the projects are now under review for final approval. The important features of the
plans are that they call for direction by a pathologist, and strong technical support, neither
of which is always easy to achieve in every hospital. Support has been continued for the
pathological service at Trail-Tadanac Hospital, and here again regional responsibilities
are gradually being assumed.
In co-operation with the Hospital Construction Division of the British Columbia
Hospital Insurance Service, plans for laboratories in proposed hospital construction have
been reviewed and recommendations made. In 1956, review and recommendations were
made for twelve such laboratory plans.
Radiological Services
One of the first subjects given consideration by the Advisory Council on Radiological
Services was the criteria for approval of requests for new equipment. It was agreed that
consideration should be given to the qualifications and ability of the personnel available,
both for operating the equipment and reading films, as well as the geographical location
of the hospital and the type of medical practice in the area. Greater emphasis is placed
on personnel and service than on equipment. However, the suitability of particular types
of equipment is carefully investigated, and in one particular instance during the past year,
assistance was recommended for three of the smaller hospitals to purchase a new type
of X-ray unit on the understanding that information would be made available on the
performance of this particular type.
As a result of a request from Kimberley and District Hospital and physicians in the
East Kootenay area, the possibility of making available to the East Kootenay area the
services of a radiologist is at present under active consideration. Basic information has
been obtained, and a survey by a radiologist member of the Radiological Services Council
is planned for an early date. With the continued co-operation of the physicians and the
hospitals in the area it is hoped that it will be possible to finalize a plan for this service
which will be satisfactory to all concerned.
In 1956, the efforts of the Laboratory and Radiological Services Advisory Councils
and the Health Branch have been directed toward the fulfilment of planned expansion
in the diagnostic services and definite accomplishments have been achieved.
Medical Rehabilitation Grant
Funds provided under this grant have assisted in the development of programmes
related to the rehabilitation of disabled persons. Assistance to the Western Rehabilitation
Centre to provide staff to enable them to admit trainees requiring some nursing care has
been continued. This has proved of great benefit to trainees who heretofore could not
have been admitted as early for training. W 108 BRITISH COLUMBIA
Assistance to the Vancouver General Hospital to continue physiotherapy service to
poliomyelitis patients also has been continued, as well as support for the pilot plan for
chronic patients at Glen and Grandview Hospitals.
Funds have also been made available to provide for the employment of a physician
to act on a part-time basis as Chairman of the Rehabilitation Assessment Team and
Medical Rehabilitation Consultant. A pattern for the review of individual cases referred
to the Provincial Co-ordinator of Rehabilitation has been developed with the co-operation
and assistance of the Western Rehabilitation Centre. The Medical Rehabilitation Consultant is providing consultative service to the Health Branch on the medical rehabilitation
of these cases. In addition, he advises on general aspects of rehabilitation service which
may be provided by the Health Branch.
A new service under this grant was commenced this year to provide for medical
rehabilitation and associated services for disabled persons referred for rehabilitation
service who have a favourable rehabilitation prognosis, who are medically indigent, and
for whom no other financial assistance is available. This project has also provided for
the purchase of prostheses and other medical aids, and financial assistance for the maintenance of those who are required to live away from their homes temporarily in order to
receive rehabilitation service.
Child and Maternal Health Grant
The extension of the Child and Maternal Health Services continues to progress
satisfactorily and is supported by funds made available under this grant. A total of seven
incubators for care of premature infants was purchased, and of this number five have been
allocated to public hospitals in the Province, with the remaining two to be held in reserve
for later allocation.
Assistance was continued to the Greater Vancouver Metropolitan Health Committee
to permit expansion of a prenatal programme in the Greater Vancouver area. Funds
were made available for the purchase of certain specialized equipment for the Health
Centre for Children, Vancouver. The salaries of a consultant paediatrician and public
health nurse employed at the Health Centre for Children were also assisted under this
grant. These personnel provide specialized assistance to child health services throughout
the Province.
In 1955 prenatal group-classes were started by local health services in various areas
of the Province. The provision of certain essential equipment for this programme has
been possible by utilization of funds available under this grant.
Funds were made available to the Faculty of Medicine, University of British Columbia, for a study concerning adrenal steroids and immune reactions in pregnancy. A study
of the epidemiology and control of infections caused by staphylococcus pyogenes, undertaken by the British Columbia Medical Research Institute, also received support under
this grant. DEPARTMENT OF HEALTH AND WELFARE,  1956 W 109
REPORT OF THE DIVISION OF LABORATORIES
E. J. Bowmer, Director
This year sees the completion of the first quarter-century of the existence of the
Provincial Laboratories as a separate entity within the Department of Health and Welfare
of British Columbia, and also the first full year in its new quarters in the Provincial Health
Building. During these twenty-five years the work load of the laboratories has increased
from about 41,000 tests in 1931 to the present total of roughly 350,000 tests in 1956,
with a peak year in 1953 of 371,000. This additional work done is reflected in an
increase of staff, both technical and non-technical, from twelve in 1931 to over fifty in
1956. The experiences in the past year have demonstrated the wisdom of providing
ample accommodation for the Division of Laboratories, together with space for future
expansion.
There have been two major losses in the administrative staff of the Division, each
in its way irreplaceable. At the end of September Dr. C. E. Dolman resigned, after
twenty-one years as Director of the Division on a part-time basis, in order to devote
himself full-time to his university duties. During his tenure of appointment there was
almost a ten-fold increase in the work load and a corresponding increase in the complexity
and number of techniques used. At the end of March, Miss Donna Kerr, who had been
Assistant Director of the Laboratories since their inception in 1931, resigned. After her
long and faithful service, Miss Kerr's departure has left a gap that will be difficult to fill,
but her methods and teachings remain firmly embedded in the work of the Laboratories.
This year there has been an all-round increase in the total number of tests carried out
at the main laboratories, amounting to roughly 7 per cent of the 1955 figures. This
increase mainly affects cultural examinations for M. tuberculosis, enteric pathogens,
staphylococci, and fungi, and also the microscopic examination of faeces for intestinal
parasites. In Table I the total number of tests carried out at the main laboratories during
1956 are shown, with the comparative figures for 1955. Table II fists the tests carried
out in 1956 at the branch laboratories.
TESTS FOR THE DIAGNOSIS AND CONTROL OF
VENEREAL DISEASES
There has again been a rise in the number of specimens received for the diagnosis
or exclusion of syphilis, amounting to nearly 10 per cent compared with last year.
Although the incidence of syphilis has been greatly reduced in recent years, the number
of blood specimens submitted for serodiagnosis rises steadily because of large-scale
serological surveys, which are carried out with a view to bringing missed and latent cases
to treatment. The largest survey carried out this year was on a group of personnel of the
armed forces. Out of 1,281 persons examined, only eight have been found to give
reactions, a low incidence in a healthy young adult population. Although dark-field
examination of exudates for the presence of Treponema pallidum is a lengthy technique,
the time spent on nearly 300 examinations has been amply repaid by the finding of typical
spirochetes in six cases of primary syphilis and one of secondary syphilis.
The Treponema pallidum immobilization (T.P.I.) test is carried out for diagnosis
of doubtful cases of syphilis by the Ontario Provincial Laboratories and by the Federal
Laboratory of Hygiene. For the past four years the supervision and administration of
the programme in British Columbia has been the responsibility of the Division of Venereal
Disease Control. The Division of Laboratories has now taken over the local supervision
and administration, and notification to the medical profession of this change in procedure
has been published, together with information regarding the value and reporting of this
useful test. W 110 BRITISH COLUMBIA
In November the main laboratories began participation in the eighth of a series of
surveys of serodiagnostic procedures organized by the Federal Laboratory of Hygiene.
The object of these surveys is to ensure uniformity in testing of sera and reporting of
results throughout the Provincial laboratories of Canada. It is not physically possible
to include in this survey the other laboratories in the Province which carry out standard
tests for syphilis (S.T.S.), but a careful control of the results obtained by these laboratories is maintained by refresher courses for their technicians and by replicate testing of
their positive findings. The visit of Dr. R. H. Allen, Chief of Clinical Laboratories at the
Laboratory of Hygiene, Ottawa, in October, was of particular value for the discussion of
serological problems.
The number of specimens submitted for direct microscopic and cultural examination
for gonococci has shown a slight increase. Experiments have been carried out in collaboration with the Division of Venereal Disease Control to determine the survival time of
gonococci in the transport medium, with a view to making this method available to
physicians in areas not too remote from Vancouver.
TESTS RELATING TO THE CONTROL OF TUBERCULOSIS
There has again been a considerable increase in the number of laboratory tests for
the diagnosis and control of tuberculosis. Approximately 20 per cent more specimens
have been received requiring cultural examination, and there has also been roughly a
5-per-cent increase in other tests carried out in the tuberculosis laboratory. No less than
six bacteriologists/technicians have resigned during the year under review and in each
case this has necessitated the training of a replacement. In no other section of the
laboratory is the bacteriological hazard to the technician so high, and great credit is due
to the senior bacteriologist for maintaining the high technical standard in these difficult
circumstances.
An unusual strain of Mycobacterium tuberculosis was isolated from the axillary
gland of a woman who worked in a packing plant as an eviscerator of chickens. The
organism was atypical in its cultural characteristics and was referred to the Animal
Diseases Research Institute of the Federal Department of Agriculture at Hull, Que. The
results of the pathogenicity and tuberculin tests indicated that this organism was an avian
strain of M. tuberculosis, comparable in virulence to standard strains. These findings
are recorded in view of the extreme rarity of human tuberculosis being due to authenticated avian strains of M. tuberculosis. The extensive work carried out by the Animal
Diseases Research Institute on this interesting organism is gratefully acknowledged.
SALMONELLA-SHIGELLA INFECTIONS
This year has been one of the busiest on record for the enteric section. The number
of specimens submitted for the isolation of enteric pathogens has shown roughly a
15-per-cent rise on last year, and this figure has only been exceeded in 1954.
The Salmonellae isolated from different patients numbered roughly 300, the highest
figure so far recorded in the Province. The organisms, including S. typhi, isolated from
these patients were of eighteen different serological types. The most common, in decreasing order, were S. heidelberg (eighty-one), S. typhi-murium (eighty), S. paratyphi B
(thirty-three), and S. typhi (twenty-eight).* It was the first time that two of the serological types, S. panama and S. weltevreden, had been isolated in British Columbia. The
high incidence of Salmonellosis this year in the Province has in large part been due to
a major outbreak of infection caused by S. heidelberg, and to the continued high incidence
of S. typhi-murium infection. The major outbreak due to S. heidelberg occurred in the
maternity wings of two Vancouver hospitals during September and October.   Two infants
* Figures up to November 16th, 1956. DEPARTMENT OF HEALTH AND WELFARE,  1956 W 111
died, the organism being isolated from autopsy specimens. Bacteriological investigations
failed to reveal the source of infection, but a total of nearly sixty mothers, infants, and
nursing personnel were found to be excreting S. heidelberg, many of them without symptoms. The spread of the outbreak was curtailed by stringent hygienic measures, including
a widespread stool-sampling programme. It is of interest to note that a hospital in Nova
Scotia had an outbreak of Salmonella infection, due to S. heidelberg, affecting twenty-
seven patients in May, 1956.
S. typhi-murium has caused more outbreaks than any other Salmonella. This organism is widespread in man and animals, and human cases may often have few or no
symptoms. One small outbreak of S. typhi-murium infection occurred in a logging camp
at Attwood Bay (involving six persons). The first case resulted in death from fulminating
enteritis, the organism being recovered from the faeces before the patient died. This
organism has also been isolated during the current year from domestic ducks received
from the Animal Pathology Division, Federal Department of Agriculture, at the University
of British Columbia.
Of the twenty-eight persons found to be excreting S. typhi, twenty-three were cases
and five were carriers. In July, 1956, a small outbreak of typhoid fever occurred in
Aldergrove in a Mennonite community. The organisms isolated in this outbreak were
S. typhi, phage type T. A larger outbreak occurred in the Burns Lake area in September
and October, also in a Mennonite community, and all fifteen cases which were proven
bacteriologically were due to organisms of the same phage type. The Director of the
Cariboo Health Unit has made a careful study of the latter outbreak, which is believed
to have been caused by a carrier infected in 1955, who transmitted the infection to her
young children in 1956. The other S. typhi strains isolated during the year were recovered
from five small typhoid incidents. Organisms of five different bacteriophage types were
isolated; it is therefore certain that the typhoid incidents were not associated with the
two outbreaks already described.
The incidence of S. paratyphi B infection was higher than in any previous year.
There were, however, no major outbreaks, although two-thirds of the infected persons
were resident in the Prince Rupert area. The carrier state is more common in paratyphoid fever than in other Salmonella infections and it is not surprising that over one-
third of these occurred in carriers.
Shigella infections remained at a high level, the relatively benign Shigella sonnet
usually being the causal organism. There has however been a further marked increase
in the incidence of the usually more serious type of dysentery due to Shigella flexneri.
The maximum incidence of Salmonella-Shigella infections occurred during the
months of September and October, and it reflects great credit on all members of the staff
that this section was able to undertake a three-fold increase in the work load. The
average number of specimens examined per normal working-day is approximately forty-
five, yet the laboratory managed to examine as many as 100 to 130 specimens daily during
this intensive period. In the investigation of the Salmonella heidelberg outbreak well
over 600 specimens of faeces were examined in an attempt to limit the spread of the
epidemic.
In addition to isolating enteric pathogens this section undertakes agglutination tests
for a variety of diseases. The demand for agglutination tests for the diagnosis of typhoid
and paratyphoid fevers has shown a significant decrease, due not to a lowered incidence,
but to a growing awareness among physicians that the most satisfactory technique for
the bacteriological diagnosis of typhoid fever is isolation of the causal organism. This is
sound public health practice.
An interesting case of tularaemia was diagnosed by agglutination tests. The illness
followed the skinning of a rabbit and infection presumably entered through abrasions on
the man's fingers.   The clinical findings were typical of infection with Pasteurella tula- W 112 BRITISH COLUMBIA
rensis and the serological findings, a four-fold rise in specific agglutination titre in six
days, were considered diagnostic. This is the fourth human case to be diagnosed in
British Columbia by serological methods at the Division of Laboratories during the past
decade.
OTHER TYPES OF TESTS
Bacteriological Analysis of Milk and Milk Products and Water
There has been no further addition to the number of specimens of milk submitted
for analysis, but the actual work done has increased, due to the introduction of the
Resazurin test for raw milks required by the "Milk Industry Act," 1956. This Act
requires that milk samples shall be taken once monthly, and is expected to result in
a 25-per-cent increase in milk testing.
The shipment of milk and water samples from distant health units to the main
laboratories still presents a major difficulty. Intensive study of this problem is being
carried out, but no single solution has been discovered.
It is still found necessary on a few occasions to issue water-sampling bottles to
private individuals who live in unincorporated parts of the Province, remote from health
units. This practice is unsatisfactory, but the problem is likely to persist in isolated
parts of British Columbia.
Bacterial Food Poisoning
A three-fold increase in the number of specimens of food submitted for investigation
has occurred since last year. Coagulase-positive Staphylococcus hcemolyticus was isolated on no less than eight occasions from such widely differing foodstuffs as pork, ham,
chicken, salami, custard pie, and fish paste. This organism frequently develops an
enterotoxin which causes diarrhoea and vomiting. Other organisms isolated from foodstuffs suspected of causing bacterial food poisoning were Clostridium perfringens (welchii)
from cooked turkey and Streptococcus haimolyticus from cheddar cheese.
Diphtheria
In spite of the continued low incidence of diphtheria there has been a moderate
increase in the number of swabs submitted for exclusion of Corynebacterium diphtherial.
On only two occasions have virulent strains of C. diphtheria; been recovered. But the
clinic suspicion of diphtheria has resulted in frequent widespread collection of swabs from
contacts of the patient.
Parasitic Infestations
The increasing awareness by physicians of parasitic infestation as a cause of disability
is reflected in an increase of over 40 per cent in the number of specimens submitted for
protozoan cysts and helminth ova. The helminth ova recovered were of nine different
types, including five indigenous species and four which originated in the Orient. Four
different species of protozoan parasites of man have also been demonstrated. The
proportion of positive findings was over 20 per cent of the specimens examined, which is
a clear indication of the value of this service in the diagnosis of communicable disease
in the Province of British Columbia.
Fungous Infections
As indicated in the two previous Annual Reports, there is a continued marked
increase in requests for mycological examination. In the current year approximately
30 per cent more specimens have been received than in 1955, which indicates that there
is a real requirement for this type of service.   A large proportion of the work is concerned DEPARTMENT OF HEALTH AND WELFARE,  1956 W 113
with the differentiation of pathogenic from non-pathogenic yeasts, and approximately
20 per cent of the specimens received for this type of examination were found to contain
Candida albicans. An increasing number of specimens have also been received for the
diagnosis of systemic and dermatomycoses. Microsporum canis has been isolated from
skin lesions on seven occasions and various species of Trichophyton from twenty
specimens.
Miscellaneous Tests
The continued widespread concern of physicians over outbreaks of staphylococcal
infections in hospitals, which was referred to in the last Report, is reflected in a 25-percent increase in specimens submitted for culture. The Director has attended meetings of
the Staphylococcal Infections Committee, and it is at the request of this Committee that
facilities for the phage-typing of strains of Staphylococcus are being made available.
Nearly one-third of the specimens submitted for isolation of Staphylococci are found to
contain the variety of this organism which is pathogenic to man, namely, coagulase-
positive Staphylococcus hcemolyticus. The bacteriophage-typing of strains of Staphylococcus is a useful epidemiological tool in studying the spread of infection due to this
organism in hospitals and other closed communities. This is a highly technical procedure
requiring considerable skill and knowledge. With the assistance of National health
grants, and using phages and strains provided by the Federal Laboratory of Hygiene, it
has been possible to carry out the preliminary work necessary for opening a phage-typing
laboratory. It is hoped that this service will be available in selected outbreaks of infection
next year.
Out of some 200 specimens of blood submitted for culture, pathogens were demonstrated in approximately 5 per cent. The twelve organisms isolated were Staphylococcus
haimolyticus, coagulase-positive (six), Streptococcus viridans (three), Streptococcus
hcemolyticus (two), and S. paratyphi B (one).
A small quantity of toxoplasmin, used for the diagnosis of toxoplasmosis, has been
provided by a drug manufacturer in the United States. In one case the diagnosis of this
condition was confirmed by using the antigen.
An increasing number of blood specimens has been received for the serological
diagnosis of virus diseases, such as the Encephalitides. These tests are very time-
consuming and only on rare occasions give diagnostic results. One of the main disadvantages of the test is that an acute phase serum and a convalescent phase serum from the
patient must be tested at the same time, and the diagnosis can therefore only be confirmed
retrospectively. In five cases a diagnosis of epidemic parotitis (mumps) has been
confirmed serologically. For the laboratory diagnosis of suspected poliomyelitis, the
simplest and most conclusive test is the isolation of the virus from stool specimens taken
at a very early stage of the disease. This requires the use of the tissue-culture technique,
which is not at present available in the Division of Laboratories. The Virus Laboratory
at the Federal Laboratory of Hygiene, Ottawa, has, however, carried out this test when
requested, and this service has been much appreciated. No isolations of polio virus have
been made from suspected cases during the year.
National health grants have made possible the appointment of a full-time chemist
(Bacteriologist Grade 2) in this Division. The Chemistry Laboratory will in the new
year be able to undertake the chemical analysis of water samples and also certain specialized public health tests on the effluent of industrial and sewage plants. At the present
time there is no official laboratory at which such tests can be carried out free of charge
and this new service will meet a much-needed requirement, which up to now has been
filled on a voluntary basis by the laboratory of the Metropolitan Water Board and the
city analyst's laboratory. W 114 BRITISH COLUMBIA
BRANCH LABORATORIES
The branch laboratories at Victoria and Nelson showed no significant change in the
work load, the total number of tests being slightly lower than the average for the past five
years. The scope of their work remains similar to that of the main laboratories, but
specimens requiring confirmation are referred to the main laboratories. The senior
technician at the Royal Jubilee Hospital, Victoria, spent several days in the Division
bringing herself up to date in various techniques and discussing methods.
Plans for the new Kootenay Lake General Hospital at Nelson are still under consideration, and adequate provision has been made for a public health laboratory section
in the hospital laboratory. It is unlikely that the new hospital will be occupied within
the next year.
GENERAL COMMENTS
During the year under review, nine new positions have been added to the establishment under National health grants. Although the new projects for which these
appointments are intended are not fully operative, two bacteriologists are now employed
on staphylococcal bacteriophage typing, and one additional bacteriologist has been added
to the serology and to the enteric laboratories in order that services may be extended.
Furthermore, as already mentioned, a chemist is now available to undertake the chemical
examination of water and sewage effluents. At the time of writing, thirty-eight requisitions for bacteriologists/technicians have been raised this year, a high proportion of the
forty-two appointments now allowed in the technical establishment. It is to be hoped
that the increase in establishment and recent rises in salary will do much toward stabilizing the staff position and thereby permit extension of the services offered by this
Division. Bacteriologists on the staff continue to take an active part in the instruction
of students in the Department of Bacteriology and Immunology at the University of
British Columbia.
In February, Dr. E. J. Bowmer joined the staff as Physician Specialist and, on the
resignation of Dr. C. E. Dolman in September, he was invited to take over as Acting
Director. On November 1st, A. R. Shearer, Technical Supervisor of Clinical Laboratory
Services, was appointed Assistant Director of the Division in place of Miss D. Kerr.
While he was Director, Dr. Dolman attended the annual International North-West
Conference on Diseases in Nature Communicable to Man, which was held at the University of Utah, Salt Lake City, from August 30th to September 1st, serving as chairman
of a session for the discussion of the Encephalitides. He was elected Secretary-Treasurer
of the Conference for 1957, when its meeting will be held in Vancouver, B.C. Dr. Dolman also contributed two papers for publication: " The Staphylococcus: Seven Decades
of Research (1885-1955)" in the Canadian Journal of Microbiology (1956, 2, 189),
and " The Epidemiology of Meat-borne Diseases " to be published in a monograph by
the World Health Organization.
The present Director has carried out a preliminary survey of the bacteriological
work performed at two of the hospital laboratories of the Division of Tuberculosis Control and has taken part in the annual meeting of that Division. He has reported to the
Health Officers' Council held at Victoria in September on the laboratory diagnosis of
poliomyelitis and the Treponema pallidum immobilization test for syphilis. In December,
he attended the twelfth annual meeting of the Technical Advisory Committee on Public
Health Laboratory Services, held at Ottawa, and the laboratory section meeting of the
Canadian Public Health Association, and visited the Connaught Medical Research
Laboratories and the Ontario Provincial Laboratories in Toronto.
It is a pleasure to record the Director's appreciation of the staunch loyalty of the
senior and junior staff, both technical and non-technical, which has made it possible for
the high standard of work and progress of this Division to be maintained in spite of a
complete change in the administrative staff. DEPARTMENT OF HEALTH AND WELFARE,  1956
W 115
Table I.—Statistical Report of Examinations Done during the Year 1956,
Main Laboratory
Out of Town
Metropolitan
Health Area
Total, 1956
Total, 1955
Animal inoculations—
Tuberculosis	
Diphtheria virulence..
Blood serum agglutination tests—
Typhoid-paratyphoid group.—
Brucella group  	
Paul-Bunnell 	
Miscellaneous .
Complement fixation tests for viruses-
Cultures—
M. tuberculosis 	
Salmonella and Shigella organisms..
C. diphtherice-
H__molytic staphylococci and streptococci-
TV. gonorrhoea;  	
Fungi 	
Food poisoning  	
Miscellaneous  	
Direct microscopic examination-
N. gonorrhasai-
M. tuberculosis (sputum)	
M. tuberculosis (miscellaneous)..
Treponema pallidum- 	
Vincent's spirillum	
Intestinal parasites	
Miscellaneous 	
Serological tests for syphilis—
Blood—
V.D.RX	
V.D.R.L. quantitative-
Complement fixation.—
Cerebrospinal fluid—■
Complement fixation-
Quantitative complement fixation..
Cerebrospinal fluid—
Cell count   	
Protein   	
Colloidal reaction	
Milk-
Standard plate count-
Coli-Eerogenes	
Phosphatase	
Resazurin	
Water-
Standard plate count-
Coli-a_rogenes	
Ice-cream—
Standard plate count-
Coli-aerogenes	
Phosphatase..
Cottage cheese—Standard plate count-
Unclassified tests	
190
5
4,692
1,608
1,252
21
25
12,379
6,020
870
709
128
17
1,034
6,438
10,890
1,489
23
19
553
662
53,223
419
7,457
816
13
119
639
821
3,360
3,339
2,052
103
3
6,500
3
3
3
Totals..
70
127,967
223
2
5,336
3,936
2,213
24
87
12,574
6,331
8,420
4,364
8,894
465
39
1,392
20,981
9,401
3,173
272
204
1,737
1,203
110,333
952
14,070
1,496
22
18S
989
1,534
1,995
1,994
1,479
1,070
1,942
252
252
248
112
50
230,249
413
7
10,028
5,544
3,465
45
112
24,953
12,351
9,290
5,073
8,894
593
56
2,426
27,419
20,291
4,662
295
223
2,290
1,865
163,556
1,371
21,527
2,312
35
307
1,628
2,355
5,355
5,333
3,531
103
1,073
8,442
255
255
251
112
120
358,216"
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
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
329,971 W 116 BRITISH COLUMBIA
Table II.—Statistical Report of Examinations Done during the
Year 1956, Branch Laboratories
Animal inoculations	
Blood serum agglutination tests—
Typhoid-paratyphoid group	
Brucella group	
Paul-Bunnell 	
Cultures—
M. tuberculosis	
Typhoid-Salmonella-dysentery group 	
C. diphtheria;	
Ha.molytic staphylococci and streptococcL
N. gonorrhoea:	
Fungi	
Miscellaneous 	
Direct microscopic examinations—
N. gonorrhoea:	
M. tuberculosis (sputum and miscellaneous)
Treponema pallidum	
Vincent's spirillum	
Fungi
Intestinal parasites	
Serological tests for syphilis-
Blood—
V.D.R.L	
V.D.R.L. quantitative
Complement fixation _.
Cerebrospinal fluid—
Complement fixation __
Cerebrospinal fluid—
Cell count	
Protein 	
Colloidal reaction
Milk-
Standard plate count
Coli-asrogenes	
Phosphatase 	
Resazurin	
Water-
Standard plate count
Coli-<erogenes 	
Unclassified tests	
Nelson
456
91
114
130
132
535
269
268
17
59
3,938
34
4
63
1,250
1,250
481
24
1,393
21
Victoria
18
62
66
167
3,867
905
2,582
2,582
257
217
385
4,064
2
7
223
300
18,525
193
1,636
402
396
394
265
1,164
1,164
1,164
1,242
1,242
Totals 	
Grand total, 54,020.
10,529      43,491
■* DEPARTMENT OF HEALTH AND WELFARE, 1956 W 117
REPORT OF THE DIVISION OF VENEREAL DISEASE CONTROL
A. A. Larsen, Director
This year a marked increase in the number of venereal infections reported in British
Columbia has reversed the downward trend that began in 1947. During the past few
years many areas in the United States have reported an increased incidence of venereal
infections. Last year three Canadian Provinces also reported that venereal diseases were
becoming more prevalent. This upward trend now appears to have spread to British
Columbia.
An examination of the notifications received reveals that the increase was due to
901 more cases of gonorrhoea being reported this year than in 1955. Only eight cases of
infectious syphilis were discovered, which is a decrease of five from the year before and
only one case could be proven to be late congenital syphilis was reported, although it is
probable that some other patients, considered to have acquired their infections as adults,
were in fact born with the disease. There were 132 cases of latent or symptomless
syphilis brought to light this year by routine blood testing and forty-nine new patients
were reported as having one or other of the complications of late syphilis.
Venereal diseases other than gonorrhoea and syphilis reported included six cases of
chancroid. Contrary to the usual experience, three of these cases were apparently contracted in the Province.
The reasons for the increase in the incidence of gonorrhoea, first noticed in the latter
half of 1955, are not yet fully apparent. It is obvious from an examination of the individual reports submitted that some of the increase has come as a result of the " boom-
town " conditions created by the major construction projects underway in many areas of
the Province. There is some evidence that the venereal diseases are now being reported
more frequently by physicians in private practice than was the case in the past. A feature
of this increase which is causing concern is the growing number of young people in their
mid and late teens who are coming to our clinic with infections. Invariably the diagnosis
of a venereal infection in these young people has led to the discovery of several more
similarly infected amongst their companions.
Another factor less clearly defined, but nevertheless apparent, is the change in attitude of many of our clinic patients to their disease. Before the advent of the sure and
rapid treatment offered by penicillin, fear of acquiring a venereal disease acted as a
deterrent to many of those who are now our patients. The casual admission of infection
and request for treatment from this group is very revealing.
ADMINISTRATION
Although no major changes were made in the organization of this Division in 1956,
a number of operating procedures were dispensed with or modified. This should lead to
increased economy of operation.
Early in the year a survey of office and recording procedures was made by a team
of administrative officials from other branches of the Health Branch. A number of
changes in office routine were suggested, most of which have now been put into force.
A revision of our basic clinical recording system is now in the planning stage as is a study
of the statistical recording done for us by the Division of Vital Statistics. The elimination
of non-productive recording and statistical compilations should result in this Division
being able to operate with a minimum of administrative staff.
For the past four years the Provincial Laboratories in Ontario and the Federal
Laboratory of Hygiene in Ottawa have very kindly performed approximately eighty T.P.I.
tests for the detection of latent syphilis each month for the Division, and for the private
physicians in the Province. The handling and the reporting of these tests has, until this W 118 BRITISH COLUMBIA
year, been done by the Division of Venereal Disease Control. In December this function
was taken over by the Division of Laboratories and at the same time the directors of the
local health units throughout the Province were given the responsibility of reviewing all
requests for the tests in their area in order that the best use might be made of the limited
number available.
Full advantage was again taken of National health grants. Just under 40 per cent
of the yearly operating costs of the Division were derived from these grants which were
used for such purposes as providing free treatment services in the rural areas of the
Province and for the purchase of drugs for patients unable to afford the cost themselves.
A National Health Research Grant made to the Division allowed Dr. D. K. Ford to
continue his research on the etiology of non-specific urethritis at the British Columbia
Medical Research Institute.   A final report on this project is expected early in 1957.
The Division was again able to assist in the operation of the University Bio-Medical
Library through a National health grant made for the purpose of purchasing up-to-date
books and journals relating to venereal diseases for the library.
Again this year we were able to employ a second-year medical student for summer
relief work at the Vancouver clinic. In addition to his duties at the clinic, the student did
the initial work on two long-term projects being undertaken by the Division. The first of
these is a study of the value of the standard serologic test for syphilis as a diagnostic tool
in the light of the decreasing incidence of syphilis in this Province.
The second study, which it is planned will be used by the student for a graduating
thesis, is a survey of the facilitation processes now in operation in Vancouver and of their
importance as a factor in the spread of venereal diseases.
In May, the Director of the Division attended a week-long conference of venereal-
disease control directors held at the University of Washington under the sponsorship of
the United States Public Health Service.
CLINICS
Few changes have been made in the operation of our public clinics this year. The
practice of rotating our staff of part-time physicians on a yearly basis has been continued
in order to give as many doctors as possible in private practice an opportunity of becoming
skilled in the diagnosis and treatment of venereal diseases.
The increased attendance at our clinics, held twice a week at Health Unit No. 1 on
Abbott Street, mentioned in our last year's Report, has continued with some 400 more
patient visits being recorded this year. It was found necessary to transfer a physician
from another clinic to help carry this heavier load, and for the latter part of the year three
clinics a week have been held at Health Unit No. 1. Every effort is being made to limit
the attendance there to those who cannot or will not go to our main Vancouver clinic.
With the opening of the new Vancouver City Gaol in the spring the Division was
provided with very much improved quarters there through the generosity of the Police
Commission and the Chief Constable. It is now possible for our staff to carry out their
work at the city gaol with a great deal more privacy and with much less inconvenience to
the gaol staff.
With the decreasing attendance at our Victoria clinic, a good deal of thought has
been given to economies which might be effected in its operation without depriving the
city of the service that still seems to be necessary. No definite conclusions as to how this
might be done have as yet been reached.
The weekly clinic held in New Westminster at the Simon Fraser Health Unit by a
member of our part-time staff has been discontinued. The Director of the Health Unit
has undertaken to act as clinic physician and to see patients for us daily. The Division
has employed a nurse for two hours a day to assist at the clinics, to keep the patients'
records and to trace all contacts named by the patients who live in the City of New
Westminster. DEPARTMENT OF HEALTH AND WELFARE, 1956 W 119
The clinic held once weekly at the Girls' Industrial School has been temporarily
reinstituted as it was found that as soon as examinations by means of cultures were
stopped there, the number of new cases discovered dropped very rapidly. Ways are now
being sought to make a culture service available to the medical staff of the Girls' Industrial School. When this has been done, our clinic service to this institution will again be
discontinued.
The clinics held in the male section of Oakalla Prison Farm have been rearranged
so that one of the part-time physicians employed there could be transferred to other duties.
A regular clinic is held now only once weekly and during the rest of the week a physician
is on call, but attends only when there is a patient for him to see. A nurse from the
Vancouver clinic attends daily to take blood from all newly admitted inmates. It is hoped
that it will soon be possible to make arrangements with the medical staff at Oakalla to
take all routine admission blood specimens and to care for their own patients with
venereal diseases with the Division providing only consultative service.
The clinics held in the female section of Oakalla, the Juvenile Detention Home, the
Prince Rupert Gaol, and the Prince George Gaol have continued unchanged and still
appear to be worthwhile.
EPIDEMIOLOGY
There have been a number of administrative changes affecting the members of our
staff employed in patient interviewing and contact tracing. Recognition has been granted
to these members of our staff by the Civil Service Commission and they are now formally
designated as epidemiologic workers. Provision has been made for a senior classification
and for a training classification in addition to the regular staff positions. Two years in
the training classification are now required for any member of this section who is not
a registered nurse or does not have a university degree in an appropriate field when they
are taken on staff.
The unexpected death of Edwin Southen, a member of this section, while on duty,
was a shock to everyone in the Division. No appointment will be made to fill this vacant
position unless the remainder of the section prove to be unable to carry the additional
load.
Arrangements are under way to transfer the public health nurse seconded to the
Cariboo Health Unit, Prince George, from the staff of the Division to the staff of the
Cariboo Health Unit. It is still felt very necessary to have a nurse in the Cariboo Health
Unit who is free to spend as much time as is necessary in the patient interviewing and
in contact tracing.
During the year two meetings were held with representatives of the police, Liquor
Control Board, and Metropolitan Health Committee in regard to the part apparently
played by many hotels and rooming houses in facilitating the spread of venereal disease.
One of these meetings was also attended by the owners of the major offending hotels.
In order to determine definitely whether or not there are any establishments that
are contributing significantly to the venereal-disease problem by facilitating the meeting
and subsequent exposure of healthy and infected persons, a detailed study was begun
this year of the facilitation processes now in operation in Vancouver. Every infected
male patient and a number of infected female patients are being asked a series of carefully planned questions, which it is hoped will reveal whether a third party assisted their
meeting with or exposure to the infected person who gave them their disease.
The contact indices established by a previous director have shown that our efforts
to bring infected contacts to treatment have been more successful than ever before. In
the latter half of the year an average of 1.8 female contacts were secured from every
infected male patient attending our clinics. For this same period about 60 per cent of
these contacts were located. Of the located female contacts, 80 per cent proved infected
when examined. W 120 BRITISH COLUMBIA
Similar indices relating to the contacts of patients named by private doctors revealed
that no improvement over last year has taken place. Less than one female contact per
infected male patient was named and of these it was possible for our staff to locate only
about 22 per cent, due to the incomplete information recorded on the reports received
from private physicians.
It is a pleasure to acknowledge the assistance that has been given to us throughout
the year by the Indian Health Services, the Vancouver City Police, the Metropolitan
Health Committee staff, the British Columbia Hotels' Association, the Liquor Control
Board, the three Canadian armed services, and the Immigration Medical Services of the
Division of National Health and Welfare.
SOCIAL SERVICES
The Social Service section of the Division continued to function as an integral part
of the treatment team in the Vancouver clinic, offering a direct casework service to patients and a consultative service to clinic physicians, as well as taking an important part
in the Division's educational programme.
It has long been apparent to us that the venereal diseases which cause patients to
present themselves at our clinics are seldom the major problem, but are merely symptomatic of their other difficulties. It is, therefore, not felt appropriate to carry individual
patients on a casework programme for any length of time. Usually the service offered
is direct and short term, giving the patients help with immediate problems, followed by
a referral to an appropriate community agency.
During the year there were over 1,000 patient interviews conducted by the clinic
social worker. While many patients appeared to profit from these counselling interviews,
it is our feeling that too few referrals to other community agencies resulted. The main
reason for this appeared to be a reluctance or an inability on the part of the patients to
recognize their problems. There also appeared to be a need for expanding the community services now available to adolescents and young adults since often there was no
appropriate agency to whom our patients could be sent for the help that they needed.
During the first part of the year social work interviews were conducted on a routine
basis and every patient attending the clinic was seen at least once. In the latter half,
interviews were conducted on a selective basis with referrals being made to the social
worker by the clinic physicians when it was felt that the patient would profit from assistance. This new procedure, it is felt, has resulted in more efficient use of the social
worker's time and professional skills.
As a result of the apparent increase in the numbers of young adults and adolescents
attending the Vancouver clinic, which has been previously mentioned, several meetings
were held with community health, educational, and welfare agencies. These meetings
served as a means of exchanging information and it is hoped also as an incentive to
action on what is essentially a community problem.
The clinic social worker was also invited to address a group of school counsellors
on the topic of counselling adolescents. This provided a unique opportunity for him to
interpret the function of our clinics and the needs of adolescents in general.
With the increase in effectiveness of the medical treatment and of the epidemiological control over venereal disease, it is becoming more apparent that the root cause
of venereal disease lies in the patient's lack of personal or social adjustment and that
whatever can be done toward alleviating those conditions, which predispose the individual
toward promiscuity, will reduce significantly the total incidence of venereal disease.
EDUCATION
Attempts at venereal-disease control through individual discussions with patients
attending our clinics have been carried on for many years. It has been felt for some
time that this approach was of doubtful value in many cases.   For most of this year, with DEPARTMENT OF HEALTH AND WELFARE,  1956 W 121
some few exceptions, only patients from the younger age-groups presenting with their
first infection were interviewed. Improvements in our methods of handling the problems presented by these patients are still necessary and only time will tell whether the
efforts made by our staff will prevent these patients from becoming repeaters.
The education of student nurses, public health nurses in training, and practising
physicians in the control of venereal infections again took a considerable part of the
time of our staff.
Throughout the year three student nurses a week from the Vancouver General
Hospital School of Nursing were given an intensive three-day course of lectures, demonstrations, and practical clinical experience, together with a limited amount of field work.
In addition, a total of thirty-two lectures were given by our Superintendent of Nurses
at the Schools of Nursing at St. Paul's Hospital, Vancouver, the Royal Inland Hospital,
Kamloops, the Royal Columbian Hospital, New Westminster, and the Provincial Mental
Hospital, Essondale. Lectures were also given to the students taking practical nursing
courses at the Vancouver Vocational Institute by the public health nurse attached to this
Division from the Metropolitan Health Committee.
A number of graduate nurses taking their public health nursing diploma course at
the University of British Columbia were given a full week of training. Instruction was
given in the medical nursing, epidemiologic, social, and emotional aspects of the Division
of Venereal Disease Control programme. In addition, a three-day seminar was held,
which was attended by a group of public health nursing students who were unable to
take advantage of the regular one-week course.
During the year the Director gave lectures and practical demonstrations on the
handling of venereal-disease patients to the second-year medical students in the Faculty
of Medicine at the University and the Division's consultant in venereology, Dr. S. Maddin,
gave didactic lectures to the third-year students on the medical aspects of venereal
diseases.
The Director, the clinic social worker, and the public health nurse attached to the
Division by the Metropolitan Health Committee visited each health unit in the Metropolitan area during the year and spoke at staff meetings on the part that could be played
by the public health nurses in venereal-disease control. An excellent new film was purchased during the year, entitled " Syphilis the Invader," and has been circulated to many
city and Provincial health units where it has been very well received.
The purchasing and distribution of all pamphlets and booklets relating to venereal
disease and intended for public distribution has been transferred to the Division of Public
Health Education.
A start has been made on a full revision of the manual for physicians published by
the Division and distributed to all newly registered doctors in the Province.
During the year Dr. G. William Sleath published his paper on the results of his
work done in the Division in 1955 on a clinical survey of the relative efficiency of various
types of penicillin in the treatment of gonorrhoea.
In December of this year an arrangement was concluded with the Interne Board of
the Vancouver General Hospital, whereby each first-year interne in the hospital would
spend one full day at the Vancouver clinic of the Division in order to gain practical
experience in the diagnosis and treatment of venereal diseases. W 122 BRITISH COLUMBIA
REPORT OF THE DIVISION OF TUBERCULOSIS CONTROL
G. F. Kincade, Director
In reviewing the tuberculosis problem to-day, one cannot help but be impressed by
the encouraging results that have been achieved in the past ten years. However, these
results have been mostly confined to one phase of the tuberculosis programme, namely,
treatment. The reduction in deaths from tuberculosis and the saving of lives are well
known and, of course, to those suffering from tuberculosis and their families nothing could
be of more importance. Still, even in treatment, the greatest benefits from improved
methods have accrued chiefly to the younger age-groups.
Prevention, case finding, and rehabilitation have never at any time in tuberculosis-
control work deserved more attention than they do to-day. We cannot assume, because
of the spectacular results of treatment, that tuberculosis is rapidly on its way out and is
no longer a major health problem. The incidence of tuberculosis as shown by the new
cases found is only slowly decreasing. The need for education was never more evident
and our efforts in vocational rehabilitation are as yet only in their developmental stages.
The rapidly changing picture in tuberculosis control to-day underlines the need for
finding those undetected individuals in our population who are suffering from tuberculosis
and, being unrecognized, are the source of spread of tuberculosis to those susceptible
individuals with whom they associate. Once discovered, tuberculosis is readily treated
and the spread of disease can be prevented. When it is unrecognized we are incapable of
doing anything about it. This, of course, is not a new concept, but from past experience
we are now better able to mobilize our forces to bring these unknown cases to light.
These unknown cases constitute the reservoir which will continue to produce new tuberculosis and, unless they are detected, the eradication of the disease cannot become a
possibility. Intensive case finding, therefore, is clearly indicated. Moreover, compared
to sanatorium treatment, case finding is a relatively inexpensive procedure and the money
saved in operating even a small institution would more than pay for the most elaborate
case-finding programme that would be necessary for this Province.
CASE-FINDING PROGRAMME
The tempo of the case-finding programme was continued at a high level during 1956.
Chest X-rays totalled 387,167 during the year, which represent a slight decrease over the
previous year. Three hundred eight thousand one hundred and forty-nine were taken on
miniature films in hospitals, survey clinics of the Division, health units, and by the mobile
units. Seventy-nine thousand and eighteen standard-size X-rays were taken by the
diagnostic clinics of the Division, the hospital admission X-ray programme, and through
referred X-rays from outlying centres, which are paid for by the Division. The following
is an analysis of these figures:—
Standard-size X-rays
Diagnostic clinics     37,859
Referred films      11,678
General hospital admissions     29,481
Total, standard size     79,018
Survey (Miniature)
General hospitals—
Admissions   87,236
Out-patients   28,325
Total   115,561 DEPARTMENT OF HEALTH AND WELFARE,  1956 W 123
Mobile—
Provincial                   .          _ ~
36,905
64,267
Metropolitan Vancouver
Total, mobile               	
101,172
Other surveys—
Willow Chest Centre         	
28,539
10,598
9,621
41,382
1,276
Vancouver Island Chest Centre	
New Westminster clinic
Metropolitan    Health    Committee
(stationary units)
Health unit at Courtenay	
y
Total, other surveys _ 	
91,416
-
Total, miniature X-ravs
tai, mm                 y   .
308,149
Total, all X-rays	
  387,167
There were 308,149 miniature X-rays taken, in comparison with 307,090 the
previous year, an increase of 1,039.
As it is in most fatal diseases, the mortality rate for many years was the chief index
of progress in the fight against tuberculosis. With the low death rates that have now been
achieved, this index has become less useful and we are thinking more in terms of the
incidence of tuberculosis as shown by the new cases found each year, particularly the
new active cases.
The incidence rate for "other than Indians" has dropped from 211.1 per 100,000
in 1946 to 114.3 in 1951, and reached its lowest point in 1955 with a rate of 89.1. The
total number of cases reported in 1954 was 1,450, and in 1955 there was a drop to 1,403
cases. These included 646 active cases in 1954 and 587 active cases in 1955. Preliminary figures show that a total of 1,292 new cases of tuberculosis were reported during
1956, of which 584 were active cases. The active cases, of course, are the most significant
because of their need for treatment and the danger of infection from them. It is interesting to note that over half of the cases notified each year are in a healed condition.
The basic concepts of case-finding have not changed and it will always be necessary
that people be X-rayed to establish a diagnosis of tuberculosis.
Principles of control in tuberculosis do not differ from those used in epidemic diseases, although its insidious nature requires modified techniques. Our problem is to
direct our efforts to those individuals and groups who are most likely to be suffering from
tuberculosis. Fortunately, over the years, a good deal of experience and a considerable
volume of statistics have been accumulated which shed a good deal of light on the
problem. Naturally, further information will be required so that our efforts may be
refined and pin-pointed.
So as to direct our case-finding efforts along productive lines, a survey-planning
committee was formed and has been in operation during the past year. This group
represents the clinical, epidemiological, statistical, and organizing experience of those
concerned in tuberculosis control. Its endeavour has been to determine the high incidence
areas throughout British Columbia and to mobilize our resources for concentrated efforts
in those areas. The plan already in operation is to carry our total population X-ray surveys in those communities and to repeat these surveys at short intervals until such time
as the findings indicate that the development of new cases has been reduced to a Provincial average. As an integral part of the organization of the X-ray survey a pre-registration
of the population is carried out so that those who do not participate in the survey can be W 124
BRITISH COLUMBIA
known and later canvassed in a further effort to have them submit to a chest X-ray
examination. In this way it is hoped that most of the hard core of these non-participants
will eventually be broken down.
As would be expected, case-finding is more productive in some centres than others
and the following table shows the case-finding rates of active cases found in selected
operations.
Active Cases, 1955
Operation
Examinations
Active Tuberculosis Found
New
Previously
Diagnosed
Total
Oakalla Prison Farm-
Metropolitan Unit No. 1 (Vancouver).
General hospitals—out-patients-
Metropolitan Unit No. 4 (Vancouver)..
Courtenay Health Unit	
Willow Chest Centre	
General hospitals—admissions	
Provincial mobile	
New Westminster clinic 	
Pacific National Exhibition	
Vancouver Island Chest Centre	
Metropolitan mobile (Vancouver industries)-
University of British Columbia	
5,222
20,214
28,135
7,618
1,603
30,072
83,852
41,759
10,362
11,232
9,644
63,941
4,668
4
22
6
4
1
13
26
22
5
4
4
18
1
16
3
13
1
0
5
24
2
0
1
0
6
0
20(1
25 (1
19(1
5(1
1(1
18 (1
50(1
24(1
5(1
5(1
4(1
24(1
1(1
in 261)
in 808)
in 1,481)
in 1,524)
in 1,603)
in 1,671)
in 1,677)
in 1,740)
in 2,072)
in 2,246)
in 2,411)
in 2,664)
in 4,668)
The programme to provide a chest X-ray for all patients admitted to hospital in
British Columbia continues to expand and four additional miniature X-ray machines
have been put in operation. These were in the hospitals at Quesnel, White Rock, Oliver,
and Revelstoke. The total number of hospitals so equipped now numbers forty-two,
and there are also thirty-seven hospitals doing a routine chest X-ray admission programme using their own equipment and standard-size X-ray films.
The total number of admission X-rays taken in 1956 were 116,717, a decrease of
3,802 over the previous year when 120,519 chest X-rays were taken. The percentage
of admissions X-rayed has increased from 40 per cent in 1951 to 61 per cent for the
first nine months of 1956 in those hospitals provided with miniature equipment; while in
hospitals using their own equipment the increase has been from 40.9 per cent, when this
programme was first initiated, to 57.6 per cent in the first nine months of 1956.
Many hospitals are doing an excellent job on this programme and of the forty-two
with miniature equipment, eighteen hospitals are X-raying from 50 to 70 per cent of their
admissions. In hospitals using their own equipment, fourteen out of thirty-seven are
X-raying over 70 per cent of their admissions and another nine are doing 50 to 70 per
cent of their admissions. While realizing that it is almost impossible to have a chest X-ray
for everybody admitted to a general hospital, on account of the acute nature of some of
the conditions for which they are admitted and the fact that many people have frequent
admissions and, therefore, do not need repeated X-rays on every admission, every effort
is still being made to stimulate the hospitals to do as complete a programme as possible.
The benefits of this programme are well recognized in the earlier detection of tuberculosis and in the protection of staff against unrecognized cases. There has been a marked
reduction in the incidence of tuberculosis amongst hospital employees in recent years, and
a great part of this reduction can be attributed to the admission chest X-ray programme. department of health and welfare, 1956
Analysis of Hospital Admission Chest X-ray Programme
W 125
Hospitals with Equipment for Taking Miniature Films
Hospitals Taking
Standard Films Only
Total
Admission
X-rays
Year
Number of
Miniature
X-rays
Number of
Standard-
size X-rays
Percentage
of
Admissions
Examined
Active T.B. Found
Number of
X-rays
Percentage
of
Admissions
Examined
New
Old
1951	
1953      	
1955   	
19562 	
52,919
62,492
83,852
87,236
0)
6,757
14,068
12,401
40.0
54.5
62.4
63.4
23
23
26
(a)
19
15
24
(3)
I1)
11,077
22,599
17,080
(*)
40.9
55.7
59.1
52,919
80,326
120,502
116,717
1 Not known.
2 Preliminary X-ray figures for 1956.
3 Not yet available.
MORTALITY FROM TUBERCULOSIS
Much comment has been made on the reduction of deaths in tuberculosis since the
beginning of the streptomycin era in 1946. It has previously been recorded that the
death rates declined from 57.4 per 100,000 at the beginning of this era to 9.7 per 100,000
in 1954. In 1955 there was an increase in death rates to 10.5 per 100,000 and in total
deaths from 123 in 1954 to 137 in 1955. Preliminary figures recorded for 1956 show
106 deaths from tuberculosis for a rate of 7.8 per 100,000 population, the lowest yet
recorded.
Of the 106 deaths that occurred, only thirty-one were under 50 years of age and
only three of these were under 20 years of age. All three were Indians. There were
no deaths under 5 years of age. It is not too long since children under 5 years of age
were particularly prone to develop acute tuberculous conditions, such as meningitis, and
many deaths used to be recorded in this age-group. Seventy-five deaths occurred in
persons over 50 years of age, sixty-one being male and fourteen female. Of these deaths,
forty-three were in persons over 70 years of age, thirty-seven being male and six female.
The economic implications to the Province in this saving of lives and restoration
to health of the younger age-group is of the greatest importance. This represents a tremendous saving in manpower and money, not to mention the alleviation of suffering and
saving of the family unit, so often disrupted when young parents are afflicted with chronically disabling diseases such as tuberculosis.
BED OCCUPANCY
The decline in bed occupancy throughout the Division of Tuberculosis Control,
which has been apparent over the last three years, continues its downward trend at an
almost constant rate, with only a few upward fluctuations. At the end of 1954 the seasonal increase caused a rise in occupancy of forty-seven beds, but the downward trend
continued in the spring, summer, and fall of 1955, with an increase of only twenty-seven
beds in the first three months of 1956. Since then the trend has continued to be downward with no apparent rise this fall. The bed occupancy was 866 in lanuary, 1954;
757 in January, 1955; 603 in January, 1956; and 536 in November of 1956. This
shows a decrease of 330 persons in the beds operated by the Division of Tuberculosis
Control in a three-year period. During this time Jericho Beach Hospital was closed,
the tuberculosis beds at St. Joseph's Villa were converted to other uses, and at Tranquille
the Main Building, and East Pavilion are no longer in use.
In 1954, provision was made for the operation of 935 beds within the Division,
while at the present time provision is made for the operation of 672 beds, and this will
be decreased to 571 beds at the beginning of the next fiscal year—an over-all reduction W 126 BRITISH COLUMBIA
of 364 beds in slightly over three years. This is a reduction of 38.9 per cent. During the
year all of the tuberculosis patients have been cleared from Shaughnessy Chest Unit and
all those tuberculosis patients who are the responsibility of the Department of Veterans'
Affairs are now being taken care of by the Division of Tuberculosis Control.
Bed Occupancy
Beds Operating Bed Occupancy
January, 1954  935 866
January, 1955  788 755
January, 1956  680 602
January, 1957  672 499
Budgeted for 1957-58  571
The reduction in bed occupancy at Tranquille Sanatorium has been particularly
apparent. There were 341 patients in Tranquille Sanatorium in January, 1954, and in
November, 1956, there were 188 patients. The decline in occupancy in that institution
has been gradually downward for three years, except in the early part of 1955 when,
due to the seasonal increase and the transfer of many patients from Jericho, when it
closed, there was a definite up-trend. However, at the present time it is almost impossible to persuade patients from the metropolitan centres of the Coast to go to the Interior
for treatment, so that Tranquille is used mainly for patients from the Interior of the
Province. With the decreasing numbers of patients in the Interior needing treatment,
the occupancy of the institution declines and will apparently continue to do so. The
decreasing bed complement at Tranquille has created an administrative problem in
staffing the institution. Every endeavour has been made to avoid partially occupied
wards and to transfer patients so that wards could be closed and the staff reduced as
quickly as possible. In spite of this and because of the impossibility of making much
reduction in the maintenance and general upkeep services, the per diem rate has increased.
However, there has been a marked reduction in the total budget for the institution.
The aging of the population of the sanatoria has for some time been apparent and
again this year the percentage of persons in sanatorium over 50 years of age continues
to increase. While the total bed occupancy decreased rather rapidly during the past
year from 615 to 533 patients, those beds occupied by persons over 50 are showing very
little decrease, with the decline being only from 251 to 241. At the present time, 241
of the 533 patients, or 45.2 per cent are over 50 years of age. This has increased from
40.8 per cent in 1955 and from 32.3 per cent in 1952. Only thirty of the 241 patients
over 50 years of age are female, representing a ratio of 7 to 1 of males to females. This
has decreased slightly from 8 to 1 a year ago and, in fact, there has been a slight increase
in the female patients over age 50 from twenty-eight to thirty in numbers. Tranquille
Sanatorium has the highest percentage of these older people, with 93 out of 188 patients,
or 49.4 per cent, while Pearson Hospital has 101 out of 233 patients, or 43.4 per cent.
Recently a spot check was made of the patients in our institutions to determine how
many no longer need institutional treatment for tuberculosis and would normally be discharged if accommodation were available. It was felt that many of the older patients
who, although they had some tuberculosis, were suffering from other diseases and conditions that were of much more significance than their tuberculosis and required more
care and attention. Having been diagnosed as tuberculous and being very difficult to
manage, they were not acceptable to general hospitals and nursing homes, so had been
admitted to sanatorium because of a need for medical and nursing care.
Of 536 patients in sanatoria at the time of the survey it was found that thirty-six
patients fell into this category. These people were of the older age-group and practically
all males. They ranged in age from 58 to 94 and twenty-five of them were 70 years of
age and over.   Thirteen had positive sputum tests and twenty-three were considered to DEPARTMENT OF HEALTH AND WELFARE,  1956 W 127
be negative.   It was felt that ten of these people could be discharged to boarding homes
but that twenty-six of them would require nursing-home care.
Out of the 101 older persons at Pearson Hospital it was found that only twenty-
seven had been in the institution over a year. There were 100 of the older age-group in
Pearson Hospital one year before and of these thirteen had died. This indicates that
sixty others had been discharged from the hospital during the year. Actually, there is a
considerable turnover in the older-age patients in our institutions and every effort is
being made to treat them and restore these patients to their normal activities and surroundings—with considerable success. The increasing number of these cases in our
institutions is due to the fact that tuberculosis is now recognized as a serious problem
in the older person, with more attention being paid to this group and more cases being
found which need sanatorium care.
COMMITTALS TO SANATORIUM
The power of the Deputy Minister of Health to commit to sanatorium patients who
are infectious and refusing treatment for tuberculosis has been enforced now for three
years. In all, seventeen patients have been committed to our sanatoria, but the order
was only used on four occasions in 1956. In one instance the patient made a hasty exit
from the Province before the order could be served.
Of the sixteen actual committals, six have been discharged and ten remain in our
institutions. Three of the discharges followed successful resectional surgery. One has
been discharged to his home on probation when arrangements satisfactory to the local
health officer had been provided for the man. Two of the patients who were admitted
with very far advanced disease in 1955 died in 1956. At the present time there are seven
patients under committal at Tranquille, two in Victoria, and one in Pearson Tuberculosis Hospital. Two of the patients at Tranquille Sanatorium are of necessity confined
in a restraining area because of the fact that they will not co-operate and in the past
have shown a defiance to the committal order and have left sanatorium without permission. For the most part the other patients are reasonably co-operative and have not
shown themselves to be a security problem.
The regulations for the committal of patients have been responsible for many others
taking treatment who did not wish to do so. The order is only used as a last resort and
every method of persuasion is used to convince the patient of the necessity of treatment
before recourse is made to actual committal.
We have been very fortunate that most of those committed have become co-operative
after committal, because within the Division there is very little accommodation available
to handle patients of this type when they become hostile. There are several patients
who are infectious and refusing treatment who would create a real problem in handling
if it were not for the fact that they are the criminal element who are no sooner out of a
penal institution than they commit another offense and are soon apprehended. This
group is completely anti-social and impossible to handle in our sanatoria.
NATIONAL HEALTH GRANTS
The total amount of the National health grant for tuberculosis control in British
Columbia is slightly less for the fiscal year 1956-57, being $360,190, as compared with
$366,070 in the previous year. In 1955-56, projects were submitted and approved in
the amount of $313,070, or 85.5 per cent of the grant. Actual expenditures, however,
amounted to $282,738, or 77.2 per cent of the grant. This was due to the fact that it is
impossible to estimate accurately the amounts that will be spent in our larger projects,
such as payment for admission chest X-rays. We are pleased to report that the under
expenditure was not due to delay in delivery of approved equipment.
This year projects have been submitted and approved in the amount of $319,992,
or 88.6 per cent of the amount available.
Under the Tuberculosis grant there are eighteen projects with the largest being that
for the hospital admission X-ray programme, which covers for the most part payments W 128 BRITISH COLUMBIA
for X-ray examinations and provides free chest X-rays for all persons admitted to hospitals in the Province. The total amount of this project is $101,750, of which $90,000 is
for the payment of chest X-rays. This fiscal year only one new miniature X-ray machine
has been provided, that being in Smithers. Under National health grants throughout the
years over a quarter of a million dollars has been spent on the provision of forty-two
miniature X-ray machines in hospitals and health centres. All hospitals with over 2,000
admissions a year have been provided with these machines, so that this phase of tuberculosis control is considered to be practically complete.
Other large projects are: $48,000 for the provision of antimicrobials for the treatment of tuberculosis, $34,068 for community X-ray surveys, $41,962 for the provision
of staff and equipment at the Willow Chest Centre, and $19,599 for the Rehabilitation
Project.
All the projects during the current year have been continuations of projects from
previous years, there having been no new projects initiated. Through an extension of the
project for staff and equipment for the Willow Chest Centre it has been possible to extend
the services of the Respiratory Physiology Department. When this work was first initiated
the investigations were confined to the patients of the Division of Tuberculosis Control.
The importance of this work was recognized and requests were obtained from general
hospitals for investigation of their patients and some were accepted. In view of the fact
that this is a highly specialized department, which requires the services of a specially
trained physician, as well as specially trained technicians, and with the need for this work
increasing in Vancouver, it was felt that the services of this laboratory should be extended
to any patient who needed this type of investigation. Moreover, it would not be justifiable
to duplicate these services in Vancouver. It has, therefore, been arranged that non-
tuberculous patients from other hospitals in Vancouver and, in fact, throughout the
Province, as well as out-patients, will be investigated by this department, provided that
this investigation will assist in the diagnosis or treatment of their conditions.
Of the total budget, $94,839 has been allocated for salaries of personnel, all within
the Division of Tuberculosis Control, except for two nursemaids at the Vancouver Preventorium and four X-ray technicians with the Metropolitan Health Committee.
Under the Professional Training Grant, four nurses were given postgraduate training
during the past year and five short-term postgraduate training courses were provided—
four for the medical staff and one in the rehabilitation department.
We would again thank all those groups and agencies that have helped so much in
carrying on the various phases of activities throughout the Division. Much is contributed
in time, money, and effort on the part of innumerable people throughout the Province.
Many groups contribute to the comfort and entertainment of patients in all of our institutions. Others assist in the organization and operation of our X-ray surveys and, indeed,
the surveys could not be carried on successfully without them. In the voluntary agencies
the British Columbia Tuberculosis Society gives strong support in all our endeavours and
meets many needs that could not otherwise be taken care of. The Vancouver Preventorium Society provides the only hospital accommodation for the treatment of children
suffering from pulmonary tuberculosis. The Canadian Red Cross Society contributes
greatly, not only in the blood that is so vital in such large quantities for the type of chest
surgery that we are doing, but also in comfort and entertainment to the patients in our
institutions.
Many of the official agencies contribute to the operation of this Division and our
relationships with them have been of the highest order. Mention should be made of the
close co-operation that exists between this Division and the Department of National
Health and Welfare through its Indian Health Service, which co-operates so closely and
provides such an excellent service in tuberculosis for their wards.
The keen and enthusiastic support and the high level of service that is exhibited by
the staff of the Division of Tuberculosis Control is also recorded and much appreciated. DEPARTMENT OF HEALTH AND WELFARE,  1956 W 129
REPORT OF THE REHABILITATION COORDINATOR
C. E. Bradbury
In planning a programme for the rehabilitation of disabled persons in British
Columbia, it has always been considered that two broad areas of development should
initially receive close attention.
First, it was felt that it was essential that the existing voluntary and public agencies,
particularly in the fields of health, welfare, and education, co-ordinate services for the
benefit of the handicapped person who sought rehabilitation.
Second, as rehabilitation is a highly individual process which must be related to
the needs of each handicapped person accepted for service, it was felt that a rehabilitation casework programme should be developed so that the patient, once started on the
road to personal independence and self support, would not be delayed in his progression
from one specialized service to the next.
The experience gained in the last two years has shown these methods of approach
are sound. In the past, almost all the special agencies have found that, working alone
it was difficult, if not impossible to assist those for whom they were responsible to become
independent. It has been notable in this Province that, as the philosophy of co-ordination is recognized, there is a distinctly developing tendency to broaden services and
appreciate the value of inter-agency relationships. There is also apparent an increasing
appreciation and comprehension of each agency's function in the rehabilitation process
and an understanding of each other's capabilities and limitations.
A major part of the responsibility has been to accept individual referrals for rehabilitation service. In June, 1955, a beginning was made to maintain case records in the
office of the Provincial Co-ordinator with a modest twelve cases. In the time that has
elapsed since that date the number of handicapped persons referred has increased to two
hundred and seventy-three. The advantage of maintaining case records has been threefold. First, it has enabled the Rehabilitation Service to obtain and record background
information, including the medical history, social and education background, and vocational experience of each referred person for the rehabilitation assessment team to study
and make recommendations for a suitable course of action. Second, by case example
it is demonstrating the need and effectiveness of teamwork between the various individuals and agencies concerned and, third, it has made possible the planning of a statistical programme from which information can be obtained which will be valuable and
necessary for future planning.
The productiveness of a rehabilitation programme is greatly dependent on the proper
selection of suitable candidates for subsequent study and attention. However, this statement must be qualified. Proper selection must also be related to the breadth and depth
of service available in the community, and as the services broaden, the meaning of proper
selection changes. Gradually as services develop, more applicants who present a difficult
picture can be considered. A year ago certain applicants would necessarily have been
deferred.   To-day some are being accepted.
No referrals made directly have been summarily rejected. All have received as
close scrutiny and study as possible and many, in our view, have been assisted toward
increased mobility and personal independence, but not rehabilitation. It has been considered that a successfully rehabilitated person is one who, as a result of the various
integrated services he has received, has been able to obtain suitable gainful employment
and is financially self-supporting. Acceptance of referrals, however, is not decided on
the basis of a certainty that a successful closure in terms of gainful employment and
financial independence will result, but whether the particular service that the individual
needs is available. W 130 BRITISH COLUMBIA
As a result of following this procedure of establishing a broad basis of acceptance
and a narrow criterion for a successful closure a higher standard of service has tended
to develop. While some clients have not become either gainfully employed or financially
independent, the attention and service they have received has resulted in a greater degree
of physical and social independence.
Acknowledgment must be made to the various government departments, both Provincial and Federal, whose assistance has been so important in the development of this
programme.
The tangible assistance which has been received from the Federal Departments of
Labour and National Health and Welfare through the Co-ordination of Rehabilitation
Agreement and the Medical Rehabilitation Grant also is gratefully acknowledged. DEPARTMENT OF HEALTH AND WELFARE,  1956
W 131
REPORT OF THE ACCOUNTING DIVISION
J. McDiarmid, Departmental Comptroller
The functions of the Accounting Division of the Department of Health and Welfare
are to control expenditures, process accounts for payment, account for revenue, forecast
expenditures, and prepare the departmental estimates of revenue and expenditures in their
final form.
During the year monthly statements of expenditure and other information were
provided to the various divisions to assist them in keeping to their budgets.
The statistical section of the Division undertook a study on meal costs for the institutions and also on the operation of Government-owned cars. This phase of the work is
being developed and results of these studies will be shown in future Annual Reports.
Several new methods were instituted in order to give the necessary service to handle
the increased volume in work. For example, a new cash system is being used, eliminating
the necessity of issuing individual receipts. Also a new air insurance policy was taken
out, automatically covering all employees of the Department and other personnel travelling on behalf of the Government without the necessity of the employees' reporting the
amount of travel. The coverage is now $30,000.
The first few sections of the payroll and accounting instructions have been distributed to all health-unit offices and we feel from the satisfactory manner in which
accounts are now being received from the field staff that it is having its desired effect.
The policy of making regular inspections of Health Branch cars by the mechanical
inspection staff of the Division was continued. During the year the 169 Government-
owned cars operated by Health Branch personnel travelled 1,089,926 miles over all types
of roads. It is noteworthy that in no case has an accident occurred due to a mechanical
defect. However, there were twenty-nine accidents, ranging from a minor nature to two
total losses. In addition, 189 privately owned cars operated by Health Branch personnel
were driven a total of 680,709 miles.
Following are two charts depicting two different aspects of Health Branch expenditure.
Chart 1 shows a division of the total Health Branch expenditure by sections. Comparing
1955-56 with 1954-55, expenditures in relation to tuberculosis control dropped from
52.7 per cent to 47.7 per cent of the total Health Branch expenditure, while expenditures
in relation to poliomyelitis prevention and treatment increased from 0.7 per cent to 6.3
per cent. The decreases in expenditures on tuberculosis control were mainly in the institutions caring for in-patients. The increase in expenditures on poliomyelitis came about
through the increased use of the Poliomyelitis Pavilion at Pearson Hospital and the Salk
vaccine programme. Chart 2 shows the division of total Health Branch expenditure by
services. It is interesting to note that treatment forms the largest part of the total Health
Branch expenditure, 59.6 per cent, while prevention utilizes only 33.1 per cent. W 132
BRITISH COLUMBIA
DIVISION OR SERVICE
1.5% Venereal Disease Control
2. 3% Research,   Training,   etc.
3. 1% Vital Statistics
3. 1% Laboratories
4. 2% Administration
6. 3% Poliomyelitis
9. 3% Cancer, Arthritis,   etc.
22. 5% Local Health Services
I—47. 7% Tuberculosis Control DEPARTMENT OF HEALTH AND WELFARE, 1956
W 133
Vital Statistics
3.1%
Administration
4.2%
VICTORIA, B.C.
Printed by Don McDiarmid, Printer to the Queen's Most Excellent Majesty
1957
685-1156-2144   

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