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Division of Venereal Disease Control DEPARTMENT OF HEALTH AND WELFARE ANNUAL REPORT FOR THE YEAR 1956 British Columbia. Legislative Assembly [1958]

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 PROVINCE OF BRITISH COLUMBIA
Division of
Venereal Disease Control
DEPARTMENT OF HEALTH AND WELFARE
ANNUAL REPORT
FOR THE YEAR
1956
VICTORIA, B.C.
Printed by Don McDiarmid, Printer to the Queen's Most Excellent Majesty
1957  Victoria, B.C., September 4th, 1957.
To His Honour Frank Mackenzie Ross, C.M.G., M.C., LL.D.,
Lieutenant-Governor of the Province oj British Columbia.
May it please Your Honour:
The undersigned has the honour to present the Report on Venereal Disease in the
Province of British Columbia for the year 1956.
ERIC MARTIN,
Minister oj Health and Welfare.
2 Department of Health and Welfare (Health Branch),
Victoria, B.C., September 4th, 1957.
The Honourable Eric Martin,
Minister oj Health and Welfare, Victoria, B.C.
Sir,—I beg to submit the Annual Report on the work of the Division of Venereal
Disease Control of the Department of Health and Welfare for the year January 1st to
December 31st, 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),
Division of Venereal Disease Control,
828 West Tenth Avenue,
Vancouver 9, B.C., September 4th, 1957.
G. F. Amyot, Esq., M.D., D.P.H.,
Deputy Minister of Health, Victoria, B.C.
Sir,—I beg to submit the Annual Report on the work of the Division of Venereal
Disease Control of the Department of Health and Welfare for the year January 1st to
December 31st, 1956.
I have the honour to be,
Sir,
Your obedient servant,
A. A. LARSEN, B.A., M.D., D.P.H.,
Director, Division of Venereal Disease Control. TABLE OF CONTENTS
Page
1. List of Tables  6
2. List of Charts.  6
3. Organization Chart  7
4. Administration  9
5. Clinics  10
6. Epidemiology  11
7. Social Services  12
8. Education  13
9. Statistical Section  14
- STATISTICAL SECTION
LIST OF TABLES
Table Page
I. New Notifications of Venereal Infection and Rate per 100,000 Population,
1942-56  14
II. New Notifications of Venereal Infection Classified according to Reporting
Agency, Sex, and Diagnosis, British Columbia, 1956  16
III. New Notifications of Venereal Infection Classified according to Age-group,
Sex, and Diagnosis, British Columbia, 1956  18
IV. New Notifications of Gonorrhoea by Age-groups and Sex, British Columbia,
1947-56  20
V. New Notifications of Gonorrhoea Reported in British Columbia, by Age-groups
and Marital Status, 1956  21
VI. Patient-visits and Procedures at Clinics of the Division of Venereal Disease
Control, 1956  22
VII. Male Contacts Named by Female Gonorrhoea Cases according to Reporting
Agency, 1949-56  24
VIII. Female Contacts Named by Male Gonorrhoea Cases according to Reporting
Agency, 1949-56  24
IX. Places of Meeting Reported as Facilitating the Spread of Venereal Disease,
1951-56  27
X. Places of Exposure Reported as Facilitating the Spread of Venereal Disease,
1951-56.:  27
XI. Contact to Venereal Infection Classified according to Result of Examination
and Reporting Agency, British Columbia, 1956  28
XII. Laboratory Examinations relating to the Diagnosis or Treatment of Venereal
Disease in British Columbia, 1952-56  29
XIII. New Notifications of Syphilis and Gonorrhoea by Health Units and School
Districts, British Columbia, 1952-56  30
LIST OF CHARTS
Chart
I. New Notifications of Venereal Infection, British Columbia, 1943-56 (Rates per
100,000 Population)  15
II. Semi-annual Gonorrhoea Indices by Sex and Reporting Agency, British Columbia,
1949-56  26 »J1
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ANNUAL REPORT FOR THE YEAR 1956
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
931 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 under way 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. C 10 DEPARTMENT OF HEALTH AND WELFARE
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
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 VENEREAL DISEASE CONTROL REPORT,  1956 C 11
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.
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 worth while.
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 here 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 1.6 female contacts were secured from every C 12 DEPARTMENT OF HEALTH AND WELFARE
infected male patient attending our clinics. For this same period about 60 per cent of
these contacts were located. Of the located female contacts, 64 per cent proved infected
when examined.
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. VENEREAL DISEASE CONTROL REPORT,  1956 C 13
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
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 Intern Board of
the Vancouver General Hospital, whereby each first-year intern 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. C 14
DEPARTMENT OF HEALTH AND WELFARE
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C 15
The downward trend in the number of cases of syphilis reported has continued at
a satisfactory rate. This year only 11 patients were found to have the disease in an
infectious stage, compared with 14 the year before and 677 ten years ago. There was
also a decrease of 54 cases of latent or late symptomatic syphilis reported, which, of
course, is to be expected now that so few new cases of syphilis are occurring.
For the first time in ten years there was a marked increase in both the rate and
number of cases of gonorrhoe reported. We were notified of 931 more cases this year
than last, which increased the rate from 191.7 to 244.9 per 100,000. This upward trend
has been apparent for several years in many parts of the United States and Canada and
was not unexpected here. A general tightening-up of all our control procedures appears
to be called for in order to prevent the increase from getting out of hand.
Nine cases of chancroid were reported during the year, which is approximately the
same number that occurred in 1955.
CHART I.—NEW NOTIFICATIONS OF VENEREAL INFECTION, BRITISH
COLUMBIA, 1943-56
(Rates per 100,000 population) C 16
DEPARTMENT OF HEALTH AND WELFARE
TABLE II.—NEW NOTIFICATIONS OF VENEREAL INFECTION CLASSIFIED
ACCORDING TO REPORTING AGENCY, SEX, AND DIAGNOSIS, BRITISH
COLUMBIA, 1956.
Reporting Agency
Gonorrhoea
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Totals
_T
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F.
_T.
M
F.
_T.
M.
F.
„T.
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Vancouver City Gaol Clinic T.
M.
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Clinics, total
Vancouver
Victoria .
Oakalla
Juvenile Detention Home .
M.
F.
_T.
M.
F.
Girl's Industrial School  T.
M.
F.
Metropolitan Health Committee
Clinics  T.
M.
F.
Other sources, total  - T.
M.
F.
Private physicians .
Indian Health Services
_T.
M.
F.
_T.
M.
F.
Department of National Defence  T.
M.
F.
Hospitals
Other
_T.
M.
F.
T.
M.
F.
3,425
2,693
732
1,355
884
471
734
554
180
52
37
15
91
5
86
94
16
78
15
15
13
13
356
272
84
2,070
1,809
261
1,641
1,455
186
21
14
7
70
69
1
3
3
335
268
67
3,425
2,693
732
1,355
884
471
734
554
180
52
37
15
91
5
86
94
16
78
15
is
13
13
356
272
84
2,070
1,809
261
1,641
1,455
186
21
14
7
70
69
1
3
3
335
268
67
191
124
67
54
35
19
37
20
17
9
7
2
137
89
122
77
45
100
55
45
23
12
11
19
8
11
2
2
3,625
2,825
800
1,411
921
490
773
576
197
61
44
17
91
5
86
102
24
78
15
_
13
13
356
272
84
2,214
1,904
310
1,764
1,533
231
22
14
70
69
1
10
10
348
278
70 VENEREAL DISEASE CONTROL REPORT, 1956
C 17
Each year sees more and more cases of venereal disease being diagnosed and treated
by doctors in private practice as compared with cases handled by clinics of the Division.
This year almost half of the newly reported cases of gonorrhoea and over 63 per cent of
all cases of syphilis were first seen by doctors in private practice. This is all to the good,
even though it does pose new problems to the Division in relation to contact-tracing.
Despite this trend, all the clinics operated by the Division still appear to be very
productive of new cases. Our clinics operated in the various custodial institutions continue to tap sources of infection which were not available by any other means. Again this
year the clinic operated at Health Unit No. 1 in down-town Vancouver showed an increase
in new cases of gonorrhoea diagnosed. One hundred and twenty-nine more cases were
diagnosed there than were seen the year before.
The ratio of male to female cases reported by our clinics this year is still 1.6 to 1,
while the ratio reported by private physicians remains at 5.5 to 1. Females, whom we
feel form the reservoir of infection, are obviously not being treated with the frequency that
they should be. As a greater percentage of all venereal-disease cases are treated privately,
this will become an increasing problem.
As can be seen from this table, the Department of National Defence and the Indian
Health Services, too, carried out an active venereal-disease control programme. TABLE III. —NEW NOTIFICATIONS OF VENEREAL INFECTION CLASSIFIED ACCORDING TO AGE-GROUPS, SEX, AND DIAGNOSIS, BRITISH
COLUMBIA, 1956.
Gonorrhoea
Syphilis
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T.
M.
F.
3,425
2,693
732
	
3,425
2,693
732
191
124
67
8
8
3
2
1
32
22
10
100
55
45
12
9
3
32
25
7
2
2
2
1
1
—
9
8
1
3,625
2,825
800
Under 1 year	
.T.
M.
F.
-   .     „T.
1
1
	
1
1
—
	
	
	
1
1
—
	
	
	
	
1- 4 years 	
1
1
1
M.
F.
1
r~
1
—
	
	
	
1
5- 9    „
 T.
M.
F.
T.
M.
F.
3
3
12
—
3
3
12
—
	
	
	
	
	
3
3
10-14     „
—-
	
	
	
	
	
	
	
—
12
12
12
12
15 19     „     	
.. .  T.
M.
F.
311
153
158
311
153
158
2
2
—
1
i
	
	
	
1
1
—
313
153
160
20-24    „      	
_      .  T.
M.
F.
968
756
212
—
968
756
212
9
6
3
2
2
	
6
4
2
1
1
	
	
—
5
4
1
982
766
216
25-29     „     	
_     _T.
M.
F.
806
668
138
—
806
668
138
14
7
7
2
?.
9
4
5
3
1
2
	
	
820
675
	
	
145
30-34    „     ..
.  T.
M.
F.
505
442
63
—
505
442
63
14
11
3
3
3
2
2
5
4
1
3
1
2
1
1
	
—
1
1
520
454
66
35-39     „     	
T.
M.
F.
265
230
35
265
230
35
21
10
11
	
1
1
5
4
1
14
5
9
	
1
1
—
1
1
287
241
46
40-44     „     	
      T.
M.
F.
171
138
33
—
171
138
33
14
5
9
	
2
2
9
1
8
	
3
2
1
	
1
1
186
144
42
45-49    „    	
T.
M.
F.
98
71
27
—
98
71
27
21
9
12
	
	
1
1
15
5
10
1
1
4
2
2
	
—
	
119
80
39
50-59     „       -
T.
M.
F.
106
83
23
—
106
83
23
35
26
9
1
1
1
1
24
17
7
2
2
7
5
2
	
	
—
141
109
32
60-69     „     -	
 T.
M.
F.
14
13
1
14
13
1
33
30
3
—
	
	
17
16
1
6
5
1
8
7
1
2
2
	
—
47
43
4
70-79     „	
.   .      T.
M.
F.
4
3
1
—
4
3
1
9
8
1
	
3
3
2
1
1
4
4
	
—
	
13
11
2
80 years and over	
T.
M.
F.
.. T.
2
2
158
133
25
—
2
2
158
133
25
4
3
1
15
9
6
	
	
	
2
2
1
1
1
1
4
3
1
	
	
—
1
1
6
5
1
	
	
2
2
9
4
5
174
M.
F.
143
31
C 18 VENEREAL DISEASE CONTROL REPORT, 1956
C 19
In all parts of the continent the greatest number of cases of venereal disease are
reported in the 20-24-year age-group, and British Columbia is no exception to this rule.
This year 982 patients in that age-group were reported to us, which constituted more than
one-quarter of all the patients notified. The fact that more boys and girls in their teens
are being reported as having a venereal disease is of increasing concern to us. In 1955,
231 cases of gonorrhoea were reported in the 10-20-year age-group, of which 134 were
in the female. This year 323 cases were reported in this age-group, of which 170 were
in the female.
Only 5 per cent of all syphilis reported this year was infectious, which means that
few, if any, people are being added to our reservoir of undiagnosed latent cases. The
majority of the latent cases, too, were discovered in the over-50-year age-group and
came from the reservoir of undiscovered cases built up before venereal-disease control
services became as active as they are now. Twenty-three per cent of the new non-infectious cases of syphilis reported this year had already developed symptoms of heart or
brain damage at the time they were diagnosed. C 20
DEPARTMENT OF HEALTH AND WELFARE
TABLE IV.—NEW NOTIFICATIONS OF GONORRHCEA BY AGE-GROUPS
AND SEX, BRITISH COLUMBIA, 1947-56
(Rates per 100,000 population.)
Age-group
1947
1 1948
1
1949
1950
1
1951
1
1952
1 1953
1
1954
1955
1
1956
0- 4 years  _
 T.
3
6
5
6
4
1
4
2
1
M.
4
5
	
2
	
1
1
F.
2
8
10
10
7
3
9
3
1
5- 9 „ 	
T,
15
9
6
9
2
2
4
4
5
2
M.
2
2
	
	
2
F.
28
16
12
18
4
4
7
9
10
5
10-14 „	
 T.
4
7
7
29
15
5
2
5
10
11
M.
3
6
3
3
2
2
F.
6
9
11
58
28
10
5
9
20
23
15-19 „ 	
 T.
533
446
407
480
412
359
280
267
273
359
M.
474
354
309
377
436
304
266
267
235
346
F.
590
539
507
585
386
415
293
266
313
372
20-24 „ . _   .. ..
.. T.
1,545
1,270
1,346
1,305
1,196
1,259
1,062
975
829
1,158
M.
2,197
1,765
1,759
1,686
1,697
1,652
1,545
1,497
1,240
1,818
F.
950
796
956
939
708
873
579
460
423
505
25-29 „    	
...T.
978
914
927
894
845
827
797
639
669
825
M.
1,541
1,427
1,355
1,281
1,335
1,281
1,301
1,067
1,071
1,394
F.
441
423
517
532
399
407
329
232
282
277
30-34 „  	
. T,
487
476
457
487
526
502
462
432
395
493
M.
793
755
717
751
872
795
737
741
671
904
F.
181
203
200
241
217
239
216
153
144
118
35-39 „	
. -T.
399
377
368
353
290
277
252
213
192
255
M.
625
596
544
549
459
451
440
361
326
458
F.
155
153
190
165
124
108
72
73
66
65
40-44 „
. _ T.
261
250
282
232
236
235
173
167
155
176
M.
418
379
398
352
366
359
290
286
263
282
F.
76
103
153
104
94
102
53
46
46
68
45-49 „   .
 T.
199
190
188
212
164
170
141
126
109
120
M.
300
299
292
343
273
271
213
207
147
165
F.
79
65
70
58
33
51
58
35
66
70
50-54 „  _
T.
107
102
118
107
110
121
105
81
66
78
M.
190
164
193
167
174
207
172
139
104
122
F.
12
30
33
40
39
25
27
17
23
28
55-59 „
T.
61
49
61
78
69
41
40
55
75
84
M.
107
76
102
132
120
64
59
92
134
119
F.
4
15
11
16
16
15
18
15
11
47
60-64 „
.  _T.
50
30
49
36
36
50
46
47
9
16
M.
83
54
82
62
63
89
80
89
18
27
F.
5
	
8
4
4
4
8
4
65-69 „
 T.
24
31
19
26
21
17
17
31
23
9
M.
38
53
33
42
37
30
31
46
43
17
F.
6
5
	
	
13
	
	
70 years and over	
 T.
14
11
13
9
7
15
7
3
3
6
M.
23
20
21
16
12
28
13
6
6
10
F.
... T.
4
. . .
3
	
	
	
	
	
2
All ages. . .
388
333
332
319
286
266
241
211
191
249
M.
539
458
435
416
412
368
356
325
283
378
F.
225
199
220
217
154
160
121
92
96
107 VENEREAL DISEASE CONTROL REPORT,  1956
C 21
This table shows the reversal in the rates per 100,000 population for all age-groups
that occurred in 1956. It is apparent that the rate for males increased considerably more
than that for females. Examination of the table shows also that there was a very marked
increase in the rate this year in the 15-19-year age-group and in the 20-24-year age-
group. This increase is shown in almost all other age-groups as well, though not to the
same extent. Notice, too, that in the years from 10 to 20 the rates for females surpassed
those for males.
TABLE V.—NEW NOTIFICATIONS OF GONORRHCEA REPORTED IN BRITISH
COLUMBIA, BY AGE-GROUPS AND MARITAL STATUS, 1956
Age-group
Single
Widowed and Divorced
Married1
Male
Female
Male
Female
Male
Female
141
682
819
197
56
22
2
141
146
92
10
4
1
1
22
13
5
4
1
1
16
15
8
3
8
57
244
146
51
20
3
11
20-24   „     	
60
75-34    „
91
35-44    „    	
40
45-54    „    	
24
55-64   „     _
10
65-69    „   	
1 Includes separated.
This table shows that most of the cases of gonorrhoea reported in British Columbia
come from the group of single males between the ages of 20 and 34 and the group of
single females between the ages of 15 and 24. C 22
DEPARTMENT OF HEALTH AND WELFARE
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c c VENEREAL DISEASE CONTROL REPORT,  1956
C 23
This table is presented for the first time in 1956. A list of all the procedures carried
out at clinics of the Division was compiled, and each clinic under the direction of the
Division now records the number of each of these procedures that they carry out. A comparison of this table from year to year will allow us to adjust staff to work load with
considerably greater accuracy than has been possible heretofore. The use of Table II
recording new notification of disease by clinics in conjunction with this new Table VI
will allow us to assess the value of each of our clinics year by year and in that way help
assure maximum efficiency in our operations. C 24
DEPARTMENT OF HEALTH AND WELFARE
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VENEREAL DISEASE CONTROL REPORT,  1956 C 25
These tables and the accompanying chart show the results obtained by interviewing
patients who have been diagnosed as having gonorrhoea. The purpose of these interviews
was to elicit from the patients information about the source of their infection and the
names of others to whom they might have given their disease.
For each sex, indices have been derived for patients reported by private physicians
and for patients reported by the clinics of the Division of Venereal Disease Control.
These indices are:—
(a) A contact index, which shows the ratio between the number of cases of
gonorrhoea reported and the number of contacts named by these cases
(expressed in terms of the number of contacts per 100 new cases of
gonorrhoea).
(b) An epidemiologic index, which shows the ratio between the number of
cases of gonorrhoea and the number of contacts (new and previously
known) who, when located, were found to be infected (expressed in
terms of the number of infected contacts per 100 new cases of gonorrhoea).
(c) A brought-to-treatment index, which shows the ratio between the number
of cases of gonorrhoea and the number of contacts (new only) who, when
located, were found to be infected (expressed in terms of new infected
contacts per 100 cases of gonorrhoea).
These indices, when properly interpreted, measure the effectiveness of contact-
tracing as a method of control of gonorrhoea and measure also the effectiveness of the
work being done by the investigating staff of the Division.
Tables VII and VIII and the accompanying charts compare the results of interviews
with cases of gonorrhoea in the clinics of the Division as opposed to interviews conducted
by private physicians. The arrow on the chart indicates the introduction of the speed-
zone technique in the clinics as a method of increasing contact-tracing efficiency.
It can be seen that for male cases the contact index has been increasing considerably
faster for the clinics than for the private physicians since the speed-zone technique was
introduced. This does not hold true for female cases because the clinics have, to a degree,
relaxed their efforts to locate their male contacts since it is known that most males seek
treatment if they develop symptoms. In contrast, experience has shown us that many
females can be infected and yet have no symptoms.
As the number of contacts named per 100 cases of gonorrhoea increases, the total
number of such contacts found to be infected rises. The ratio of named contacts found
to be infected to newly diagnosed cases is called by us the " epidemiologic index," and
also has been rising since the introduction of speed-zone technique. This same trend is
not apparent for private physicians as far as female contacts named by their male patients
are concerned. However, the private physicians have far surpassed the clinics in relation
to male contacts found to be infected who were named by their female patients. Because
of this the Division is now endeavouring to elicit more contact information from its
female cases.
The brought-to-treatment index measures the accomplishments of the Division's
investigating staff, and in addition measures the adequacy of the information about the
contacts supplied to them by private physicians as compared to the information that the
Division is able to elicit from patients attending its own clinics. If we assume that the
investigators pursue contacts named by the patients of private physicians with a zeal equal
to that used for pursuing contacts of clinic patients, a comparison between the two of
the number it is possible to bring to treatment will give an idea of the relative adequacy
of the contact information supplied.
There is reassuring evidence that investigation of female contacts to male cases is
continuing to be successful. Such information is important because it is a major factor
in the success of the Division's control programme. It is known that a small group of
infected females are responsible for a high percentage of the cases of gonorrhoea that
occur. Our ability to locate these females and to treat them is a major factor in the
Division's control programme. C 26
DEPARTMENT OF HEALTH AND WELFARE
CHART II.—SEMI-ANNUAL GONORRHOEA INDICES BY SEX AND
REPORTING AGENCY, BRITISH COLUMBIA, 1949-56
SEMI-ANNUAL GONORRHOEA CONTACT INDEX—MALE
BY REPORTING AGENCY, BRITISH COLUMBIA, 1949-56
Per .100 mate coses
V.D. CONTROL CLINICS __
PRIVATE PHYSICIANS ___
/
I    111     III UU L
1
lxJ UJ l_i_L
1949 1950 1951 1952 1953 1954 1955 1954
YEAR
SEMI-ANNUAL GONORRHOEA EPIDEMIOLOGIC INDEX—MALE
BY REPORTING AGENCY, BRITISH COLUMBIA, 1949-56
V.D. CONTROL CLINICS
PRIVATE PHYSICIANS _
J 111      111 l_L
1 L
194?    1950   1951   1952   1953   1954.   1955   1956
YEAR
Per  100 female
SEMI-ANNUAL GONORRHOEA CONTACT INDEX—FEMALE
BY REPORTING AGENCY, BRITISH COLUMBIA, 1949-56
J I   I   I       I   ■   I UJ L
J UJ UJ U.
I L
<r
1949 1950 1951      '   1952 1953 .   ' 1954 ■       1955 1956
"YEAR
SEMI-ANNUAL GONORRHOEA EPIDEMIOLOGIC INDEX—FEMALE
BY REPORTING AGENCY, BRITISH COLUMBIA, 1949-56
Pee   100  female eases.
A
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V.D. CONTROL CLINICS  __                1    \
PRIVATE PHYSICIANS                /     1               /
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1949 1950 1951 1952 1953 1954 1955 1956
YEAR
SEMI-ANNUAL GONORRHOEA BROUGHT TO TREATMENT INDEX—FEMALE
SEMI-ANNUAL GONORRHOEA BROUGHT TO TREATMENT INDEX—MALE
BY REPORTING AGENCY. BRITISH COLUMBIA, 1949-56
Per 100 male cases
60
V.D. CONTROL CLINICS
PRIVATE PHYSICIANS _
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C 27
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DEPARTMENT OF HEALTH AND WELFARE
The figures given in Tables IX and X show the places of meeting and places of
exposure given to us by patients who are diagnosed as having a venereal infection. It is
apparent that the places of meeting most often mentioned are beer-parlours, cafes, and
hotels in that order. The places of exposure named most frequently are hotels and
rooming houses.
During the winter of 1956 a very active campaign was begun in Vancouver in
co-operation with the city police, city health authorities, Hotels' Association, Liquor
Control Board officials, and city licensing officials which, we hope, should show results
early in 1957. This campaign is designed to make it more difficult for infected females
to find a place where they can transmit their disease to healthy males.
TABLE XL—CONTACT TO VENEREAL INFECTION CLASSIFIED ACCORDING TO RESULT OF EXAMINATION AND REPORTING AGENCY,
BRITISH COLUMBIA, 1956.
Reporting Agency
° i-
2o$
,
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Result of Examination
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7
	
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1,624
713
562
6
49
236
12
37
9
3
3
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236
90
115
7
5
15
2
2
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2,088
964
751
8
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230
15
20
10
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41
644
33
191
3
300
2
65
4
50
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4
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1,998
1,738
23
210
538
47
71
25
Note.—The above figures cover the period of October, 1955, to September, 1956.    No cases of primary syphilis,
lymphogranuloma venereum, or granuloma inguinale were found among contacts.
This table shows the results of examinations of alleged contacts to venereal disease.
There has been an increase of 629 contacts examined at our request over the previous
year.
Although private physicians reported more cases of venereal disease than did the
clinics of the Division (Table II), an examination of the contacts named by patients
revealed more venereal disease in clinic patients. This represents a 13-per-cent increase.
With the increase in the number of cases of venereal disease reported, more contacts have,
of course, also been reported. However, the Division has also stepped up its programme
of contact-locating. This is reflected in the increase noted above. No more patients
infected with primary syphilis were located by means of contact-tracing than were found
the year before, the main increase, as can be seen, being in cases of gonorrhoea located
by our investigators. Although physicians in private practice reported over half the
number of cases of gonorrhoea that were notified this year, far less than half the contacts
reported by them were found to be infected when they were located and examined. VENEREAL DISEASE CONTROL REPORT, 1956
C 29
TABLE XII.—LABORATORY EXAMINATIONS RELATING TO THE DIAGNOSIS OR TREATMENT OF VENEREAL DISEASE IN BRITISH COLUMBIA, 1952-56.
Agency and Examination
1952
1953
1954
1955
1956
Provincial  Laboratories  (Including   Victoria  and Nelson
Branch Laboratories)
Gonorrhoea—
Microscopic examination of smears	
Cultural examination of smears	
Syphilis—
Dark-field microscopic examinations... 	
Blood   specimens   examined   by   standard   serological
tests   	
Blood  specimens  examined   by   Treponema  pallidum
immobilization test2  	
Spinal-fluid specimens examined	
Canadian Red Cross
Syphilis—Blood   specimens   examined   by   standard   serological test (V.D.R.L. only)	
Provincial Mental Health Services
Gonorrhoea—Microscopic examination of smears	
Syphilis—
Blood   specimens   examined   by   standard   serological
tests	
28,656
6,582
283
C1)
O)
3,433
C1)
27,349
7,080
257
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O)
3,211
C1)
26,005
8,228
448
(*)
(*)
2,881
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25,445
8,563
319
(x)
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9,151
297
165,190
341
2,714
53,782
39
3,242
346
1 Data not available.
2 Treponema pallidum immobilization tests are carried out for the Provincial Laboratories by the Ontario Department of Health Laboratories and the Federal Laboratory of Hygiene.
This year, for the first time, laboratory examinations for venereal disease done by
agencies other than the Provincial Laboratories are included in our figures in order to
give a more accurate picture of the case-finding efforts that are in existence in the Province at this time. In addition, the base-line for the reporting of serologic tests for syphilis
has been altered. Previously the number of tests done on all the bloods submitted to
the Laboratories has been the basis of our annual figure. This year and in the future the
base-line will be the number of blood specimens submitted for examination.
It is hoped that in future it will be possible to correlate this revised table with the
number of cases of the various types of venereal disease that are found and in that manner
determine the efficiency of blood tests as a case-finding method in latent syphilis. C 30
DEPARTMENT OF HEALTH AND WELFARE
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C 33
A review of this table will show the areas in the Province by health units and school
districts where the venereal diseases present the greatest problem. As in past years, most
new notifications were from the Greater Vancouver area. It is of interest to note, however, that while in other years more than half of the venereal disease reported in the
Province came from the Vancouver area, this year only 49 per cent of all cases were from
the metropolitan area.
With but one or two minor exceptions, there is no health unit area in British
Columbia which has not shown at least a slight increase in the number of venereal
diseases reported. The areas from which relatively large numbers of cases came this
year are the South Central Health Unit, the Skeena Health Unit, and the Cariboo Health
Unit. The amount of venereal disease being reported in these three areas is quite out
of proportion to the population of the area.
VICTORIA, B.C.
Printed by Don McDiakmid, Printer to the Queen's Most Excellent Majesty
1957
360-657-8120   

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