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Thirteenth Report of the DEPARTMENT OF HEALTH AND WELFARE (HEALTH BRANCH) (Sixty-second Annual Report… British Columbia. Legislative Assembly 1959

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 PROVINCE OF BRITISH COLUMBIA
Thirteenth Report of the
DEPARTMENT OF HEALTH
AND WELFARE
(HEALTH BRANCH)
(Sixty-second Annual Report of Public Health Services)
YEAR ENDED DECEMBER 31st
1958
Printed by Don McDiarmid, Printer to the Queen's Most Excellent Majesty
in right of the Province of British Columbia.
1959  Office of the Minister of Health and Welfare,
Victoria, B.C., February 20th, 1959.
To His Honour Frank Mackenzie Ross, C.M.G., M.C., LL.D.,
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, 1958.
ERIC MARTIN,
Minister of Health and Welfare. Department of Health and Welfare (Health Branch),
Victoria, B.C., February 20th, 1959.
The Honourable Eric Martin,
Minister of Health and Welfare, Victoria, B.C.
Sir,—I have the honour to submit the Thirteenth Report of the Department of
Health and Welfare (Health Branch) for the year ended December 31st, 1958.
I have the honour to be,
Sir,
Your obedient servant,
G. F. AMYOT, M.D., D.P.H.,
Deputy Minister of Health. O
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rS The Department of Health and Welfare consists of three branches—the
Health Branch, the Welfare Branch, and the British Columbia Hospital Insurance Service. Each of these is headed by an official with the rank of Deputy
Minister. All three branches come under the jurisdiction of the Minister of
Health and Welfare.
The chart on the other side of this page deals only with the Health Branch.
For convenience of administration, the Health Branch is divided into
three Bureaux. The Deputy Minister of Health and the Bureaux Directors
form the central policy-making and planning group. The Divisions within
the Bureaux provide consultative and special services. The general aims of
the Deputy Minister with his headquarters staff are to foster the development
of local health services, to provide advice and guidance to those local health
services, and to provide special services which cannot, for economic or other
reasons, be established on the local level. Included in these are the special
services provided by the Divisions of Tuberculosis Control, Venereal Disease
Control, Laboratories, Vital Statistics, Public Health Engineering, Public Health
Education, etc.
Direct services to the people in their communities, homes, schools, and
places of business are provided by " local public health personnel." These
fall into two broad groups. In the metropolitan areas of Greater Vancouver
and V ictoria-Esquimalt, they are members of the city and municipal health
departments, which, in these two cases, do not come under the direct jurisdiction of the Health Branch. (However, they co-operate closely with the
Health Branch and, through it, receive substantial financial assistance with
services from the Provincial and Federal Governments.) Throughout the
remainder of the Province the " local public health personnel" are members
of the health units (local health departments), which are under the jurisdiction
of the Health Branch. 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. Outside the two
metropolitan areas mentioned above, there are seventeen such health units
covering the Province from the International Boundary to the Prince Rupert-
Peace River areas. TABLE OF CONTENTS
Page
General Statement  9
Bureau of Administration  11
Bureau of Local Health Services  14
Bureau of Special Preventive and Treatment Services  27
Voluntary Health Agencies  27
National Health Grants  30
Division of Public Health Nursing  35
Division of Public Health Engineering  39
Division of Preventive Dentistry  43
Division of Occupational Health  48
Sanitary Inspection Service  51
Nutrition Service  53
Division of Vital Statistics  55
Division of Public Health Education  64
Division of Tuberculosis Control  66
Division of Venereal Disease Control  73
Division of Laboratories  76
Report of the Rehabilitation Co-ordinator  83
Accounting Division  86  Thirteenth Report of the Department of Health and Welfare
(HEALTH BRANCH)
Sixty-second Annual Report of Public Health Services
YEAR ENDED DECEMBER 31st, 1958
G. F. Amyot, Deputy Minister of Health and Provincial Health Officer
Most of this Annual Report has been written by the heads of the various bureaux,
divisions, and services which make up the Health Branch. Their reports, which give
detailed accounts of their programmes, appear in the pages following this introductory
section.   Some general observations may be made, as follows:—
AREA AND POPULATION OF THE PROVINCE
In 1958 the population of British Columbia was approximately 1,544,000, an
increase of some 57,000 over the figure for 1957. According to preliminary figures, the
birth rate was down slightly from the record established in 1957 and the death rate was
at its lowest point in almost a quarter of a century. The area of the Province is approximately 366,000 square miles, but about 45 per cent of the total population is concentrated in the metropolitan areas of Greater Vancouver and Victoria-Esquimalt. Vast
areas of the remainder of the Province are only sparsely populated, and great travel
distances are an important factor in the provision of public health service.
For some years now public health services have been available to practically every
citizen in British Columbia through either the metropolitan health departments or the
Provincial health services, and this desirable situation continued in 1958. Calculations
based on the non-Indian population show that approximately 45 per cent of the people
of the Province were served by the two metropolitan health departments and almost
55 per cent were served by the Provincial health services. (The Federal Government
provides services for the Indians.)
THE HEALTH OF THE PEOPLE
Each of the four leading causes of death—heart disease, cancer, intracranial lesions
of vascular origin, and accidents—recorded a decline in the number of deaths per 100,000
population in 1958. Still, these four causes were responsible for 70 per cent of all the
deaths occurring in 1958.
Mortality among infants was improved during the year, there having been a drop
in the rate, although this was still above the record low rate of 1955. The maternal
mortality rate has remained unchanged at a very low level for the past three years.
Again in 1958 there was a decline in the mortality from tuberculosis. The decline
was evident for all races, but was most marked among Indians. New cases of tuberculosis
discovered in the Province also decreased.
The year 1958 was a remarkably light one with respect to communicable-disease
incidence generally. This is particularly the case when a comparison is made of the
1958 rate with the 1957 rate. The latter figure, of course, includes a large number of
influenza cases resulting from the 1957 epidemic, but even a comparison with rates for J  10 BRITISH COLUMBIA
years before 1957 shows the communicable-disease morbidity for 1958 to have been
well below average.
An important achievement for the year was the disappearance of diphtheria from
the table of recorded diseases for the first time in the history of the Province.
Another important development was the exceedingly low incidence of poliomyelitis,
the rate having dropped to its lowest point in ten years.
Notifications of venereal disease during the year declined somewhat from the 1957
figure.
A situation which created some concern was the discovery of rabies among bats
and squirrels in certain localities of the Province. Numerous reports were received
during the year indicating that bats were acting peculiarly and biting individuals. The
victims of bites accepted prophylactic treatment by means of antirabies vaccine, and no
cases of the disease developed.
OTHER MAJOR EVENTS AND TRENDS
As predicted in last year's Annual Report, Tranquille Sanatorium was closed in
September, 1958. Progress in the care and treatment of tuberculosis patients has, in
recent years, shortened the length of the necessary stay in institution and has also
lessened the chance of the individual's suffering a recurrence requiring readmission to
institution. Any given bed was being used by a greater number of patients during the
course of a year and, so, fewer beds were meeting the needs of approximately the same
number of people. It was this development that made it possible to discontinue
Tranquille as a tuberculosis institution.
Many communities chose the construction of health centres as their projects to
commemorate British Columbia's Centenary. This impetus resulted in the construction
of twelve new buildings, the greatest number in any year to date. Financial assistance
was provided by grants from the Provincial Government, the Federal Government
(National health grants), and voluntary health agencies.
In the continued effort to care for more patients in their homes and so relieve the
burden on general hospitals, special home nursing-care programmes were instituted in
three more centres, bringing the total of such programmes to eight. (This special service
was additional to the routine service which provides short-term care in the home on
a demonstration basis.)
By the year's end it was considered that the population under the age of 19 years
was adequately immunized against poliomyelitis. It was planned to continue the programme whereby poliomyelitis immunizations are made available to the infant and child
populations through the normal channels in local health services. In addition, plans
were made to make the vaccine available to all persons up to the age of 40 years through
practising physicians.
During the year many organizations and individuals co-operated closely with the
Health Branch in the efforts to meet the health needs of the people. The Deputy Minister of Health wishes to thank most sincerely the voluntary agencies, the professional
groups, the other departments of Government, and his fellow public health workers for
their support. DEPARTMENT OF HEALTH AND WELFARE,  1958
REPORT OF THE BUREAU OF ADMINISTRATION
A. H. Cameron, Director
j ll
The Bureau of Administration consists of the administrative offices, the Division of
Vital Statistics, and the Division of Public Health Education. These three are grouped
together because they are the offices and divisions which provide services to all other
parts of the Health Branch.
The Bureau Director, as a member of the Health Branch's central policy-making
and planning group, is concerned with all aspects of public health administration. The
administrative offices are responsible for providing or, in some cases, co-ordinating the
many services, both administrative and clerical, required in the conduct of the public
health programme. Included are personnel management, the National health grants
programme (in co-operation with the Assistant Provincial Health Officer), and the
programme of reciprocal agreements with other Provinces for the treatment of tuberculosis cases. This section of the Annual Report deals with the year's experiences and
activities in this field of administration, which is principally non-medical. Separate reports of the Division of Vital Statistics and the Division of Public Health Education
appear later in this volume.
PERSONNEL
Although it is difficult to portray fully in a single table the changes and trends in
the staff situation, the following figures show the number of persons on staff at the end
of 1957 and at the end of 1958:—
Office, Division, or Service
Location
Staff
1957
1958
29
24
61
15
18
54
1
15
154
224
159
10
7
4
3
4
3
58
273
33
26
61
16
18
Vancouver   	
59
1
Division of Tuberculosis Control—
Vancouver 	
15
Willow Chest Centre   —
154
Vancouver   	
228
10
7
4
Vancouver   —
3
4
2
56
293
1,116
990
The closing of Tranquille Sanatorium was the event which had the greatest effect
on numbers of staff. There was a reduction of 159 employees at this institution. There
were small changes in other parts of the Health Branch, the most significant being that
in Local Health Services, where there was an increase of twenty employees. The increase
in population made this necessary. However, the staff of the Health Branch as a whole
was 126 less at the end of 1958 than it was at the end of 1957. J  12 BRITISH COLUMBIA
It should be emphasized that all of the above refers to employees actually on staff
as distinguished from established positions which constitute the maximum number of
positions for which financial provision has been made. As the result of administrative
surveys, some of the established positions were also deleted because Health Branch
officials could see no need for them under improved methods of management.
TRAINING
The effectiveness of the Health Branch services is dependent on the professional
and technical qualifications of its personnel. Two methods used to maintain a high
standard of operations are in-service training and academic training, usually at the postgraduate level. University training, supported by the National health grants, was given
to various members of the Health Branch. In 1958 nineteen employees completed professional training under the grants, eighteen commenced training, and ten attended short
courses. (These figures do not include the training provided to personnel of hospitals
and other health agencies.)
The National health grants also gave assistance in a training programme for thirty-
two sanitary inspectors in May of this year.
Public health knowledge of the Health Branch was kept up to date by the Annual
Public Health Institute, held in Vancouver in May, which was attended by health unit
personnel and senior members of the Branch. In Victoria, weekly meetings of the headquarters staff concerned with local health services, under the chairmanship of the Deputy
Provincial Health Officer, also aided in providing in-service training and in communicating the programmes of the various directors. Likewise, in the health units, monthly
meetings were held to discuss problems of the local staff.
NATIONAL HEALTH GRANTS
Under the direction of the Deputy Minister of Health, the Assistant Provincial
Health Officer is responsible for the National health grant programme in British Columbia. The section written by him in this Annual Report gives details of the programme
for 1958. However, the Director of Administration is also deeply concerned with policy
under the grants programme and reviews and discusses with the Deputy Minister all
proposals and project submissions. The administrative offices in Victoria work in close
co-operation with the staff of the Assistant Provincial Health Officer in preparing, recording, transmitting, and filing project submissions and related materials. One of the important developments during the year was the impact of the Federal " Hospital Insurance
and Diagnostic Services Act." As the Assistant Provincial Health Officer has pointed
out in his section, this Act made it necessary to discontinue grants' support in several
existing projects and to adopt a new policy for future projects. The projects so affected
were those supporting in-patient services in general hospitals.
RECIPROCAL AGREEMENTS (TUBERCULOSIS)
Reciprocal payments for the care of tuberculosis patients are made through agreements with other Provinces. In 1958 such agreements were in operation with Alberta,
Saskatchewan, Manitoba, Ontario, and Quebec.
During the year the number of British Columbia cases which were accepted by
other Provinces was nine (Quebec, one; Saskatchewan, two; Alberta, five; Ontario,
one). The number of cases from other Provinces accepted for treatment in British
Columbia was also nine (Saskatchewan, two; Alberta, four; Ontario, three). Although
there were some cases carried over from the previous year (1957), discharges were such
that, at the end of 1958, only one case (from Manitoba) was being cared for in British
Columbia and only four British Columbia patients were being cared for in other Provinces. DEPARTMENT OF HEALTH AND WELFARE,  1958 J 13
GENERAL
Because most of its actions are taken on behalf of the other bureaux and divisions
of the Health Branch, the Bureau of Administration has a necessarily close relationship
with them. Its aim is to assist in the development of the operational programmes and
yet help the Deputy Minister to maintain balance and control. With these ends in view,
plans were made to undertake further studies and surveys in co-operation with the programme directors. It is intended that these reviews should be concerned with the programmes themselves as well as the procedures followed in conducting the programmes.
An important aspect will be the continued efficient use of staff. J  14 BRITISH COLUMBIA
REPORT OF THE BUREAU OF LOCAL HEALTH SERVICES
J. A. Taylor, Director
HEALTH UNIT ORGANIZATION AND DEVELOPMENT
As its major function, the Bureau of Local Health Services is expected to encourage
and stimulate the development of adequate health units throughout the Province to raise
the standards of health services in the Interior parts of the Province to the level of those
available to the larger metropolitan areas. The original planning provided for seventeen
health units, which, it was felt, would provide the most efficient areas of administration of
public health services to meet the health needs of the population. Over the years sixteen
of these planned health units became completely organized, with only the Gibsons-Howe
Sound area partially organized.
While the industrial and population growth of the Province has created a need for
some expansion, it nevertheless becomes evident that the originally planned health unit
areas continue to meet adequately the essential health needs of the communities they serve.
In effect, the increased health needs of the communities resulting from the industrial and
population growth could be adequately met by adding additional personnel to the staff of
the existing health units; therefore, the inclusion of an additional public health nurse or
sanitary inspector, often with the assistance of National health grants, sufficed to supply
the framework to meet the expanding needs.
The problem of the ultimate best administrative organization to set up complete
health unit services for the Gibsons-Howe Sound area remains unsettled. It is wondered
whether administration of this area through the North Shore Health Unit within the Vancouver Metropolitan Health Service might not be an ideal approach; certainly with improved rail and road facilities to Squamish, this might look like a logical approach. On
the other hand, the difficulties of administration to the Powell River area raise a question
whether it should not be detached from the Upper Island Health Unit to become the centre
of a new administration in which the Gibsons-Howe Sound area might be included. These
are matters for future consideration.
Two areas of the Province, because of unprecedented population increases, have
attained size creating an undue administrative load upon the Director. For that reason,
it is suggested that possible increases in the staff are required in the addition of public
health physicians to serve as Assistant Medical Health Officers in the administration of
health units. Such an approach was made in the Central Vancouver Island Health Unit
with some success. It now appears advisable to effect a similar approach in the Boundary
Health Unit, where the most phenomenal population increase has occurred. Additionally, consideration must be given to the same approach in the Cariboo Health Unit, where
the population growth in a large sprawling health unit presents an undue burden for the
medical director; however, in this unit consideration must also be given to the possibility
of a division of this latter unit into two. At one time the division seemed to be the
most logical administrative change to take in this case, but with the personnel changes
that took place within the unit a year ago has come about some suggestion that the splitting of the unit might not be the ideal approach to administrative improvement. Developments in this regard are to be given additional study within the next few months to
determine what might be the ultimate solution.
During the year the continued anticipated growth within the Municipality of Kitimat
did not materialize. As a matter of fact, with the restrictions in industrial activity in the
major industry in the area, some minor decrease in population growth took place. In the
face of this development then, it was considered unwise to proceed with the negotiations
toward a complete health unit for that area but to continue on its existing basis under two
resident public health nurses, a visiting sanitary inspector, and a part-time Medical Health DEPARTMENT OF HEALTH AND WELFARE,  1958 J  15
Officer. Further discussions are to be held to determine what should be the ultimate
planning for health services for that municipality.
Some changes in administrative officers within health units occurred during the year.
The Director of the Upper Fraser Valley Health Unit, with headquarters at Chilliwack,
resigned to take up private practice. The vacancy created here was filled by the transfer
of the Director of the Cariboo Health Unit, with headquarters at Prince George, thereby
creating a vacancy within that service. The Cariboo vacancy was filled by the return of
a public health physician from postgraduate training, who immediately took over the
administration of the health services for the Cariboo area.
The Director of the North Fraser Health Unit, with headquarters at Mission City,
resigned toward the end of the year to assume an appointment as Director of the Division
of Child and Maternal Health in the Washington State Department of Health. While it
was not possible to fill this vacancy immediately, the return of another public health physician from postgraduate study in the late spring provided a replacement.
The resignation of the Director of the Selkirk Health Unit, with headquarters at
Nelson, occurred in the early fall, when he decided to return to the private practice of
medicine. The vacancy created there was not readily filled, but the Director of the West
Kootenay Health Unit, with headquarters at Trail, undertook, with some readjustment of
his administration and at some personal sacrifice in leisure time, to provide public health
physician administration of the two health units. This situation prevailed at the close of
the year, but it was becoming evident that it was creating an undue load for a single
physician to cover both areas, and that a new appointment would have to be made as soon
as available. The subject was reviewed with the Union Board of Health during its
November meeting, and its views on the matter obtained.
In order to meet the need for additional public health physicians, to fill vacancies
and to provide assistant public health officers in the mentioned health units, a recruitment
programme was developed toward the close of the year. As a result of advertisements
appearing in the leading medical journals, a number of applicants were obtained, with
whom negotiations were proceeding as the year ended.
In the metropolitan areas in Vancouver and Victoria, public health service continued
along the lines of organization of the past years. In the Greater Vancouver metropolitan
area, the revised agreement covering the amalgamation of the health services was accepted by the member municipalities endorsing the principle of an organized metropolitan
health committee while permitting a greater degree of local control by the participants in
their own municipal service. Contingent upon this, however, is a requirement that there
be some modification of the " Health Act," and certain negotiations toward a revision of
that section were conducted. It is likely that this will result in a legislative change becoming necessary, which is being planned for the near future.
In the Greater Victoria area, the discussions on amalgamation of the public health
administration of the numerous municipalities again became stalemated. Reorganization
of the health service has been considered in which the Victoria-Esquimalt Health Unit
and the Saanich and South Vancouver Island Health Unit would come under a joint
administration. It seems a desirable move in any case, since the present split administration in this metropolitan area creates some administrative problems, particularly as
boundaries traverse educational administrative units.
COMMUNITY HEALTH CENTRES
The plan, which came into being in 1951 as a result of the impetus given to its
establishment through National health grants, to provide financial assistance toward
construction of more adequate office and clinic accommodation for local health services
has continued to demonstrate its value as more and more communities adopt it. The
proposals originally advanced were that the provision of a community health centre J 16 BRITISH COLUMBIA
should be originated in the community, either by the municipal authorities or by some
service club, to spark a drive to raise community funds for the construction. Once the
community interest was established and negotiations well under way in the planning of a
building, a formal request was presented for Provincial and National assistance through
Provincial grants and National health grants toward financing the construction. In addition to the grants available through the senior governments, grants from voluntary health
agencies have been forthcoming from the Tuberculosis Society, the British Columbia
Cancer Society, the Canadian Red Cross Association, St. John Ambulance Association,
and others. These funds augment the financing and permit construction of somewhat
larger buildings, which make it possible to house offices and workrooms for the voluntary
health agencies in the same building that provides administration and clinic accommodation for the official health agency. This means that the community health centre then
becomes a central point for the administration of all the community health services, both
official and voluntary, and permits co-ordination of those services in the community
interest.
During British Columbia's celebration of its centennial year many communities
endorsed community health centres as their Centennial project for that year. As a result,
there were more community health centres constructed during 1958 than in any single
year previously; twelve new community health centres came into being, which, added to
the twenty-seven community health centres previously constructed, provides thirty-nine
newly or recently constructed offices housing the community health services. The newly
constructed buildings arose in Summerland, Vernon, Greenwood, Grand Forks, Vanderhoof, McBride, Williams Lake, Trail, Pemberton, Ucluelet, Port Alberni, and an addition
to the office in Haney. As the year ended, four other community health centres were in
the process of construction at Kitimat, Smithers, White Rock, and Whalley, while six were
in the negotiation phase at Quesnel, Burns Lake, Dawson Creek, Prince Rupert, Kimberley, and South Vancouver, and six others were under discussion at Creston, Nelson, Coquitlam, Castlegar, Golden, and Field.
SCHOOL HEALTH SERVICES
School health services constitute a major feature of the total community health services, consuming a major amount of the time of public health personnel, the public health
nurse in particular. Health is a primary objective of modern education. A recent report
has stated: "An educated person knows the basic facts concerning health and disease—
works to improve his own health and that of his dependents—and works to improve community health." With this objective in mind it is desirable that school health services be
devised to provide a very definite measure of health education in so far as the school pupil
is concerned. Every school has tremendous opportunities to promote the health of its
pupils and, through them, of its community. From early childhood to early adulthood,
most children are enrolled in schools in which they are under the supervision of school
personnel for a substantial part of the day, for approximately half the days of the year.
The conditions under which they live in school, the help which they are given in solving
their health problems, the ideals of individual and community health which they are
taught to envisage, and the information and understanding that they acquire of themselves as living organisms are factors which operate to develop attitudes and behaviour
conducive to healthy, happy, and successful living.
Review of school health services has been the subject of repeated discussion by the
administrative personnel of the health units at the Health Officers' Council, convened
twice each year. It has been reiterated at each of these meetings that the routine physical
examination of school-children does not serve to fulfil the need in school health services,
and that far more value accrues from the examination of specially selected children on the
basis of teacher-nurse conferences.   When a teacher, from the physical appearance or DEPARTMENT OF HEALTH AND WELFARE,  1958 J  17
action of a child, suggests that he or she needs medical attention, then the pupil is referred
to the school medical officer for investigation. In most school grades, priority has been
given to children referred to the school medical officer in this way; however, routine examination of the pre-school and Grade I child, with the parent present, is recognized as a
desirable feature of the school health service for the beginner. It is suggested that at this
stage, a transition period in the life of the child, the discovery of any remedial defect is
advisable while the ability of the child to cope with the school environment can be
assessed.   Thereafter, routine physical examinations yield doubtful results.
At the same time, continuing research into improvements in school health services
has been undertaken. One of these has been investigation into height-weight relationships
in the development of the school-child, which originated through a study of the Wetzel
Grid in the school health programme in the Central Vancouver Island Health Unit, and
has been continued in study of a new growth curve, which was developed to an analysis of
more than 10,000 records built up over the past ten years. In this latter study the Professor of Paediatrics at the University of British Columbia has been particularly interested
and has encouraged continuation of the study in the hope that something concrete and
practicable could be developed from it. Much credit is due the Division of Vital Statistics,
through its Director, who has assisted materially in analysing charts and graphs submitted,
and in obtaining breakdowns of the figures collected during the National height-weight
survey conducted by the Division of Nutrition within the Department of National Health
and Welfare three years ago. The figures obtained on British Columbia residents were
particularly useful as a guide in determining the graph that could be anticipated to be
most applicable to British Columbia students. However, as the year drew to a close, the
final report on this study was being prepared and the results did not appear encouraging;
it seemed apparent that it would not yield information of any practical value in so far as
the physical status of the child was concerned. In other words, the amount of work required in preparation of a graph on each pupil did not show sufficient results to warrant
its continuation, and it seemed likely that the hours involved could be spent to better
advantage in some other aspect of the school health programme.
The effect of school environment on the well-being of school occupants cannot be
overlooked, and in this field the sanitary inspectors throughout the Province conduct a
detailed annual inspection of the school plant. Their reports form part of the report
presented to each School Board annually, indicating where alterations and improvements
in the school plant could be made in the interests of improving the environment. Additional school buildings are still necessary to cope with the continuing growth of the school
population; these newer schools are a considerable improvement, environmentally, over
the former older buildings, and reflect the attention of the School Boards, the Department
of Education, and the many others interested in this situation.
It has become evident that there is a very definite need for development of a more
practical mental hygiene programme within community health services which could concentrate a major portion of its interest in the school health services programme. The
need is pointed up repeatedly at meetings of the Health Officers' Council and in correspondence with individual Health Unit Directors, stressing the fact that many children
require guidance along mental-hygiene lines. Thus far, the best approach to this has been
made within the Vancouver Metropolitan Health Service, in which there is a Division of
Mental Hygiene, devoting major attention to children. The solution would seem to rest
upon the development of a similar programme for other areas of the Province. This is
not meant to imply that mental hygiene is entirely overlooked, since it is a feature of the
complete assessment of each school pupil, and is receiving attention by teachers and
public health nurses. In many schools there are mental-hygiene counsellors attached
to the school staff. These are teachers who are particularly interested in this subject and
who have received special training in the mental-hygiene programme of the Vancouver
Metropolitan Health Service. J 18 BRITISH COLUMBIA
Within the numerous sections of this Annual Report dealing with dental-health
services, nutrition services, sanitation services, and health education will be found reference to other services relating to the school health services programme. It must again
be emphasized, however, that much of the public health services supplied as a community
health service has a direct bearing on the school health services, from which it cannot be
entirely divorced as the school-child is duly influenced by conditions within the community itself.
THE HEALTH OF THE SCHOOL-CHILD
The major objective of the school health programme is to promote optimum health
for the school-children throughout British Columbia, and it seems desirable in an annual
analysis of the school health programme to attempt to determine whether the health of
the school-child has benefited thereby. So many features affect physical status it is
difficult to determine any definite reason for minor fluctuations in the health of the
school-child, since it is difficult to find a satisfactory measure of health status. Over
recent years, analysis of the health of the school-child has been based on immunological
status, physical status, and morbidity figures of notifiable diseases. In the absence of a
better measuring-tool and for the purposes of comparison, it is probably advisable to
continue the same analysis this year for school-children as a group.
The school health programme operates within the academic year, so that the analysis
in this report is based on the programme from September, 1957, to June, 1958, during
which school health services were provided in the 1,147 schools included in the eighty-two
school districts. While there were 277,249 school-children enrolled in those schools,
there were only 272,499 pupils enrolled in the grades examined. This represents an
8.6-per-cent increase over the enrolment in the previous year. Out of the 272,499
enrolled in the grades examined, only 42,947 (15.8 per cent) received medical examinations, a figure which is admittedly low, but which is explainable by the fact that special
attention is being offered to those referred by teacher-nurse conferences. This is not as
alarming as it appears, since it was evident in earlier reports on school health services that
"pproximately 85 per cent of the children examined routinely were in satisfactory physical
condition. Under the new programme, attention is being concentrated upon those pupils
who are more likely to have a physical, mental, or emotional condition, requiring some
remedial action, which is probably the group upon which medical attention should be
concentrated.
A study of the results of the medical examinations by grades reveals a more reassuring situation, in which it is shown that of the 30,893 pupils in Grade I, 23,397
(75.7 per cent) received a complete medical examination.
Usually this was done with the parent present and was productive of greater results,
as the parent endeavoured to prepare the child for that transition toward school commencement. In the later grades, screening methods were adopted solely as the selection
for medical attention; in the elementary grades, somewhere between 5 and 10 per cent
of the pupils were selected for intensified examination. However, in Grade IX, in which
there is another transition to the high-school grades, there was further concentration on
routine examinations; of the 19,882 pupils enrolled, 6,126 (30.8 per cent) received
medical examinations. As the pupils progress through the high-school grades, screening
selection on the basis of teacher-nurse conferences is continued, and it is evident that
the pupils approach adulthood with less and less need for medical attention, and the
percentages referred decrease grade by grade to a minimum in Grade XIII.
The results are presented in detail in the various statistical tables:— DEPARTMENT OF HEALTH AND WELFARE, 1958
J 19
Table I.—Summary of Health Status of Pupils Examined according to
School Grades, 1957/58
Total
Pupils,
All
Schools
Examined
in Grades
Special
Classes
Item
Grade
I
Grades
II-VI
Grades
VII-IX
Grades
X-XIII
Other
Total pupils enrolled in grades examined ...
272,499
42,947
15.8
85.8
11.5
3.4
1.5
0.7
0.2
0.3
0.1
0)
0.2
30,893
23,397
75.7
85.4
11.9
4.1
1.5
0.6
0.2
0.2
0.1
C1)
0.1
138,633
7,385
5.3
85.3
13.6
2.9
1.6
1.0
0.1
0.1
0.1
63,776
9,039
14.2
90.5
7.7
2.2
0.7
0.4
0.1
0.1
O)
36,438
1,990
5.5
82.7
12.1
1.4
0.3
0.4
0.1
1,844
540
29.3
53.0
21.9
10.9
20.0
6.3
0.7
16.5
0.2
0.2
12.0
915
596
Percentage of enrolled pupils examined
Percentage examined with  minor or no
physical, emotional, or mental defects
Percentage of pupils examined having specified type and degree of defect—
Physical 2          	
65.1
75.7
18.5
Emotional 2	
Mental 2 	
1.5
0.8
0.7
Emotional 3  	
0.2
Mental 3   	
0.2
0.1
0.5
O)
O)
	
1.5
1 Less than 0.1 per cent.
Table II.—Health Status of Total Pupils Examined in Grades I, IV, VII, and X for the
Year Ended June 30th, 1958
Total pupils enrolled in grades examined  97,040
Total pupils examined  28,679
Percentage of enrolled pupils examined       29.6
Percentage examined with minor or no physical, emotional,
or mental defects        85.4
Percentage of pupils examined having specified type and
degree of defect—
Physical 2       11.8
Emotional 2
Mental 2	
Physical 3 ___
Emotional 3
Mental 3	
Physical 4 ___
Emotional 4
Mental 4 _____
3.7
1.4
0.5
0.2
0.2
C1)
i1)
0.1
1 Less than 0.1 per cent.
Table III.—Health Status by Individual Grades of Total Schools, 1957/58
Item
All
Schools
Grade
I
Grade
II
Grade
III
Grade
rv
Grade
V
Grade
VI
Grade
VII
Total pupils enrolled in grades examined	
Total pupils examined 	
Percentage of enrolled pupils examined	
Percentage 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  	
272,499
42,947
15.8
85.8
30,893
23,397
75.7
85.4
11.5
11.9
3.4
4.1
1.5
1.5
0.7
0.6
0.2
0.2
0.3
0.2
0.1
0.1
C1)
C1.
0.2
0.1
29,432
1,932
6.6
84.4
15.0
2.4
2.2
1.1
0.2
0.1
0.1
0.1
28,694
1,385
4.8
85.5
14.1
3.3
2.0
0.9
0.1
0.1
0.4
27,925
1,786
6.4
85.9
13.3
2.4
0.8
0.6
0.2
0.2
0.1
27,873
1,241
4.5
84.8
12.4
3.8
1.6
1.1
0.1
0.1
0.2
24,709
1,041
4.2
12.8
3.0
1.2
1.5
0.2
0.1
22,379
2,038
9.1
10.2
2.8
1.8
0.4
0.1
0.2
C1) J 20
Table III.-
BRITISH COLUMBIA
—Health Status by Individual Grades of Total Schools, 1957/58—Continued
Item
Grade
VIII
Grade
IX
Grade
X
Grade
XI
Grade
XII
Grade
XIII
Special
Classes
Other
21,515
875
4.1
91.9
8.0
2.7
0.6
0.3
0.3
19,882
6,126
30.8
91.6
6.9
2.0
0.3
0.4
0.1
O)
15,843
1,458
9.2
82.0
11.6
1.4
0.3
0.2
0.1
11,430
290
2.5
88.1
9.8
2.1
0.7
8,401
235
2.8
81.7
17.9
0.4
0.9
0.4
764
7
0.9
85.7
14.3
1,844
540
29.3
53.0
21.9
10.9
20.0
6.3
0.7
16.5
0.2
0.2
12.0
915
596
65.1
Percentage examined with minor or no physical, emotional, or mental defects	
Percentage of pupils examined having specified type and degree of defect—
Physical 2..	
75.7
18.5
1.5
Mpnfal 2
0.8
0.7
0.2
Mental 3   .                         .           	
0.2
0.5
1.5
1 Less than 0.1 per cent.
Table IV.—Number Employed and X-rayed amongst School Personnel, 1957/58
Item
Number employed..
Number X-rayed.	
Total
Organized
7,039
2,621
1,368
496
Unorganized
5,671
2,125
Table V.—Immunization Status of Total Pupils Enrolled,
according to School Grade, 1957/58
Grade
Total
Pupils
Enrolled
by Grades
Smallpox
Diphtheria
Tetanus
Poliomyelitis
Number
Per Cent
Number
Per Cent
Number
Per Cent
Number
Per Cent
Totals, all grades
Grade I 	
272,499
30,893
29,432
28,694
27,925
27,873
24,709
22,379
21,515
19,882
15,843
11,430
8,401
764
1,844
915
173,133
23,090
20,784
19,790
18,264
19,373
17,268
13,499
11,598
10,035
9,102
5,130
3,595
273
1,023
309
63.5
74.7
70.6
69.0
65.4
69.5
69.9
60.3
53.9
50.5
57.5
44.9
42.8
35.7
55.5
33.8
189,627
24,626
23,313
21,937
20,107
20,283
18,455
14,964
12,961
10,885
10,091
6,248
3,938
359
953
507
69.6
79.7
79.2
76.4
72.0
72.8
74.7
66.9
60.2
54.7
63.7
54.7
46.9
47.0
51.9
55.4
160,051
24,410
23,021
21,349
18,877
17,946
15,092
10,584
8,678
6,524
6,108
3,550
2,428
193
788
503
58.7
79.0
78.2
74.4
67.6
64.4
61.1
47.3
40.3
32.8
38.6
31.1
28.9
25.3
42.7
55.0
233,741
24,512
25,747
25,305
24,689
24,486
21,487
18,952
18,415
16,927
13,858
9,805
6,871
600
1,260
827
85.8
79.3
Grade II    _   	
87.5
Grade III...
88.2
Grade IV	
88.4
Grade V	
87.8
Grade VI      	
87.0
Grade VII 	
84.7
Grade VIII...        	
85.6
Grade IX	
85.1
Grade X	
87.5
Grade XI   	
85.8
Grade XII 	
81.8
Grade XIII	
78.3
68.3
Other. _	
90.4
An analysis of these tables is revealing, since it becomes evident within Tables I,
II, and III that the physical status of the school-children, as shown by the medical
examination of these selected pupils, presents them in good physical condition clinically,
85.8 per cent of all pupils examined being placed in that category. It is evident that
there is a higher proportion of pupils in the special and other classes who have defects
of one kind or another; this is to be expected, since these classes are designed for pupils
unable to cope with the normal school situation. The situation is brought out most
forcibly in Table III, in which it is revealed that a considerable portion of the children DEPARTMENT OF HEALTH AND WELFARE,  1958 J 21
examined in the special classes, which include classes for mentally retarded children,
have physical defects (28.4 per cent), emotional defects (11.8 per cent) or mental
defects (48.5 per cent). Actually, it is somewhat amazing to see that a considerable
number have a major mental condition classified as Mental 4 (12.0 per cent).
The encouraging fact revealed by these figures is the low percentage of emotional
and mental defects apparent among the pupils in the regular school grades.
This year, in contrast to last, there is no significant difference in the amount of emotional conditions discovered among Grade X pupils, whereas last year in that grade there
was a significantly higher proportion of emotional disturbance. Actually, this year there
is some contrast in the number of emotional defects among Grade I pupils, it being the
grade showing the highest proportion of this condition over all other grades.
Another aspect of the analysis is the amount of emotional and mental defects revealed for all grades, somewhat significantly higher than shown in the previous Annual
Report. It must be recognized that this newer classification of health status of the pupil
commenced only three years ago, and it is possible that the changing trends in the figures
are the result of better experience with the classification. On the other hand, it may be
the result of a better selection of pupils for referred examination, resulting from the
teacher-nurse conferences improving in their selectivity.
In any case, for the regular school grades the average health of the pupils is at a
fairly high standard, somewhere over 85 per cent in each grade exhibiting minor or no
defects; this is all the more significant when it is realized that, with the exception of Grade
I, these were selected from pupils who might be expected to have some major defects to
account for their referral, or medical examination.
The immunization status of the school pupils, as exhibited by Table V, would indicate that the majority of the pupils (more than 60 per cent of each group) are immunized
against such diseases as smallpox, diphtheria, tetanus, and poliomyelitis. While the
majority of the school pupils maintain their immunization status throughout their school
life, it is evident that the status tends to decrease with age, indicating that possibly some
further emphasis is needed to encourage the high-school pupil to accept booster doses.
An exceedingly sad note is the significantly low proportion of children immunized in the
special and other classes, a group of children who should definitely be adequately protected against these communicable infections. It is rather revealing how poliomyelitis
immunization has been accepted amongst these groups in contrast to their acceptance of
other forms of immunization.
This feature is evident throughout all grades, in which there is more whole-hearted
acceptance of immunization to poliomyelitis than to the other immunizing agents, since
the figures average well over 85 per cent in the instance of poliomyelitis as contrasted to
somewhere in the 60 per cents for the other immunizing agents. This is probably a
reflection of the fear of the crippling effect of poliomyelitis which has persisted as a result
of recent epidemics, whereas the fear of other diseases is less real as immunizations over
the years, having done away with epidemics, have reduced the incidence to almost zero.
It is possible that poliomyelitis may attain this latter situation as immunization procedures
continue into the future.
An encouraging trend in immunization is the marked increase that has become evident in the numbers immunized to tetanus, which principally is due to combined antigens
being administered in the form of diphtheria-tetanus toxoid. Further combinations of
antigens are forecast for the future, in which poliomyelitis vaccine will be combined with
diphtheria-tetanus toxoid. This will promote a lessening in the number of inoculations
to which a pupil is subjected during his school life and, if the present apprehension to
poliomyelitis is continued, may promote an increase in the immunological status of the
pupil to diphtheria and tetanus. It will be interesting to contrast the figures over the
years to see if this develops. J 22 BRITISH COLUMBIA
The incidence of communicable diseases presents another guide to the health of the
school-child, since a considerable majority of the communicable infections occur in childhood. The results of these are shown in Table VII, indicating that, with the exception
of chicken-pox, pertussis, and scarlet fever, the incidence of communicable diseases is
considerably below that of the previous year. The incidence of influenza was down
from the peak of the epidemic of a year ago. In 1958 the rate was 32.7 per 100,000
population, in contrast to a rate of 11,528.5 per 100,000 population last year. The
exposure to rubella, mumps, and rubeola was lessened, since the incidence of these infections was definitely much lower during 1958 than 1957. This was a reassuring situation
in the health of the school-child.
The other cheerful element was the further decrease in poliomyelitis incidence, in
which 13 cases were reported, or a rate of 0.9 per 100,000 population, in contradistinction to a rate of 2.9 per 100,000 population the previous year, when the lowest
rate in five years was recorded. The further decrease this year is a remarkable achievement and a hopeful sign that control over poliomyelitis may be anticipated.
Streptococcal infections, as seen in scarlet fever, septic sore throat notifications,
displayed an increase to a rate of 82.2 per 100,000 population, as contrasted to a rate
of 29.6 per 100,000 population the previous year. However, streptococcal infections
do not occasion the alarm that used to exist, since the type of infection is now so mild
and no particular after-effects are recorded. Chemo-therapeutic agents and antibiotic
drugs have brought about a decrease in the number of severe complications that previously existed in this field of communicable disease.
GRANTS TO RESIDENT PHYSICIANS
This programme is designed primarily to assist small communities in the provision
of medical care through local resident physicians or through visits from a physician resident in a near-by community. The grant in itself is not large, merely serving to reimburse the physician to some extent for the out-of-pocket expenses incurred by him in
providing the necessary medical supervision to the ill members of the community. The
community itself is expected to assume some responsibility to ensure that necessary office
space and facilities are provided to the physician to serve his needs in fulfilling that objective. The physician is expected to present a report on a quarterly basis of the services
provided, following which a quarterly payment of the grant is rendered. During the year,
grants were continued to twenty-one physicians in the administration of medical care to
thirty communities.
The only significant administrative change that took place was in respect to the
physician at Stewart, where, as the result of industrial shut-downs, it was contemplated
the physician would have to leave the community. In order to maintain his residency
there, an increase in the grant was effected to offset to some extent the decrease in
income; in this way the community was assured of continuing medical care in the hope
that a readjustment in industrial activity would occur which would restore medical care
to a self-sufficient economic basis. As the year ended, however, this was not yet evident,
and some decision was required concerning the length of time that the grant could be
continued on its increased basis.
A somewhat larger grant was also effected in so far as services on the Queen Charlotte Islands is concerned. Previously a grant had been paid to the resident physician
at Queen Charlotte City, to provide for residency there and travel to certain outlying
hamlets. When a second physician was added to the complement there, a plea was made
that an additional grant should be established for the service that was to be provided to
Masset; after negotiations by correspondence, it was agreed that the grant should be
increased in view of the extraordinary situation, which required that the physician would
have to be absent from his home community for some time and would have to undertake
travel, often under hazardous conditions. DEPARTMENT OF HEALTH AND WELFARE,  1958
J 23
Apart from these two major administrative adjustments, the grant continued in
operation on a routine fashion, with the exception of minor transfers to incoming physicians taking over the practice of outgoing physicians.
DISEASE MORBIDITY AND STATISTICS
If disease morbidity is any criterion, the people of British Columbia have enjoyed
one of the most healthful years on record; the disease morbidity rate for 1958 was
1,720.7 per 100,000 population, in contrast to the highest rate ever recorded, that of
1957, when it reached a peak of 14,192.7 per 100,000 population. A comparison of
the rates between 1958 and 1957 is hardly valid, since the rate for 1957 was heavily
weighted by the unusual influenza epidemic occasioned as a result of the world-wide
pandemic of Asian influenza. It is more reasonable, therefore, to compare the 1958
disease morbidity rate with the pre-existing years, as is brought out in Table VII. Even
here, however, it is evident that the Province experienced an exceedingly light year in so
far as disease incidence was concerned.
Actually, the pinnacle of achievement was the complete obliteration of diphtheria
from the table of recorded diseases, since, for the first time in the history of notifiable
infections, diphtheria failed to record a single case. This is a goal toward which all
health departments strive, emphasizing the value of immunization as a control measure.
While diphtheria had been recorded in very few numbers over recent years, it had never
been possible before to complete a year without at least one case being recorded, such
as occurred in 1956. While the record for this year is commendable, it is too much to
expect that it will be continued, since it is evident from the study of the immunological
status of the school pupils that not enough young adults maintain their immunity to the
disease. It can be anticipated that we are likely to have minor outbreaks of diphtheria
in future years, although it would be desirable that this year's record continue on throughout the years to come.
The second achievement of note was the exceedingly low incidence of poliomyelitis,
at a rate of 0.9 per 100,000 population, the lowest rate to be recorded in the last ten
years. This, too, bears some reflection on the progress that has been made in the control of this particular disease through poliomyelitis vaccine, but it is not possible to give
full credit to that prophylactic measure. Certainly, the record established is in direct
contrast to that in Manitoba, where equally as much immunization did not prevent an
epidemic in certain regions. Thus it appears evident that it is as yet too early to determine the full effect of a poliomyelitis immunization programme. Future experience will
govern a decision on its efficacy. Examination of past records will show that poliomyelitis occurs in epidemic cycles, and it may well be that this was just one of those
years in which a low incidence could have occurred cyclically regardless of poliomyelitis
vaccine.
Table VI.—Poliomyelitis Case Fatality Rates, British Columbia
Year
Cases
Deaths
Case
Fatality
Rate
1927  	
182
102
43
34
42
313
584
787
211
224
84
43
13
37
19
13
8
11
12
37
26
6
3
3
3
20.3
1928 -  	
18 6
1929                                         .          	
30 2
1930                         -  	
23 5
1931                                -                          	
1947 —	
3 8
1952              -	
6 3
1953
3 3
1954	
2 8
1955
1 3
195fi
1957  .        _
1958                         	
23 1 J 24
BRITISH COLUMBIA
Unfortunately, the happy situation in so far as poliomyelitis incidence was concerned was not reflected in its mortality, as three cases resulted in death. This, unfortunately, promotes a case fatality rate of 23.1, which is one of the highest recorded in
recent years, and stems partly from the fact that the case incidence was exceedingly low.
The cases in which death was recorded were all non-immunized persons. It cannot be
said, however, that the disease incidence was confined entirely to non-immunized persons, since actually the records show that a few of the thirteen cases had received some
immunization.
The attained results in poliomyelitis incidence are a credit to a wide group of persons
and organizations. Firstly, one must give credit to the staffs of the various health units in
the urban and rural areas throughout the Province, who so willingly absorbed the load of
immunization of such large groups of the population. Certainly, the population under 19
years of age is now adequately immunized to poliomyelitis, and it remains only to maintain their immunity status; the need to immunize all adults under 40 years of age must
be the next step in the programme.
Credit also must be given to the National health grants, which have continued to
underwrite half the cost of poliomyelitis vaccine used in this Province; this has not been
an insignificant figure, since it has cost $120,000 to purchase the vaccine during the fiscal
year 1957/58.
The British Columbia Foundation for Poliomyelitis has also provided financial assistance in the provision of grants earmarked to assist in the immunization programme in the
matter of purchase of equipment, such as syringes and needles; grants were made both to
the Vancouver Metropolitan Health Service and to the Provincial health service for that
purpose.
These three agencies alone, however, could not supply the complete answer to control features in poliomyelitis for this Province without the assistance provided from such
other groups as the Connaught Medical Reasearch Laboratories; the G. F. Strong Rehabilitation Centre; the Royal Canadian Air Force 121 Communication and Rescue Flight,
Sea Island; the Canadian Medical Association, British Columbia Division; the various
community hospitals; and the individual physician. As a result of their combined actions,
it is possible to provide such services as immunization procedures, diagnostic techniques,
consultative assistance, emergency evacuations, treatment and rehabilitation facilities, all
of which play a part in the prevention and treatment of poliomyelitis.
Table VII.—Notifiable Diseases in British Columbia, 1954-58 (Including Indians)
(Rate per 100,000 population.)
1954
1955
1956
1957
1958
Notifiable Disease
Number
of
Cases
Rate
Number
of
Cases
Rate
Number
of
Cases
Rate
Number
of
Cases
Rate
Number
of
Cases
Rate
1
3
7
3,600
6,085
64
7
605
1
1,220
78
0.1
0.2
0.5
278.0
469.9
5.0
0.5
	
4
3,115
7,113
115
1
1
1
2
4,103
5,785
190
0.1
3
2
4,150
4,872
106
5
4
132
1
393
171,429
1
11,807
35
6,241
0.2
0.1
279.1
327.6
7.1
0.3
0.3
8.9
0.1
26.4
11,528.5
0.1
794.0
2.4
419.7
0.1
Brucellosis 	
13
3,556
4,947
134
8
2
293
2
841
15,601
1
8,160
48
2,922
1.0
265.0
368.6
10.0
0.6
0.2
21.8
0.2
62.7
1,162.5
0.1
608.0
3.6
217.7
0.3
222.8
508.8
8.2
0.1
0.1
265.7
Chicken-pox ~.
Conjunctivitis	
374.7
12.3
6
936
2
558
504
2
3,534
25
1,930
0.4
Bacillary (Shigella)
Encephalitis, infectious
Hepatitis, epidemic 	
Influenza, epidemic . 	
46.7
0.1
94.2
6.0
507.5
3.6
274.0
342
9
343
4,021
1
5,616
45
6,768
24.5
0.6
24.6
287.6
0.1
401.7
3.2
484.1
60.6
0.1
36.1
32.7
0.1
Measles 	
6,572
47
3,548
228.9
1.6
125.0 DEPARTMENT OF HEALTH AND WELFARE,  1958
J 25
Table VII.—Notifiable Diseases in British Columbia, 1954-58
(Including Indians)—Continued
Notifiable Disease
1954
Number
of
Cases
Rate
1955
Number
of
Cases
Rate
1956
Number
of
Cases
Rate
1957
Number
of
Cases
Rate
1958
Number
of
Cases
Rate
Pertussis  	
Poliomyelitis.	
Psittacosis 	
Rabies   	
Rubella	
Salmonellosis—
Typhoid fever	
Paratyphoid fever	
Unqualified 	
Streptococcal infections—
Erysipelas	
Scarlet fever .._	
Septic sore throat	
Tetanus  	
Tick paralysis  	
Trachoma 	
Trichinosis _	
Tuberculosis _ _	
Tularaemia 	
Venereal disease—
Gonorrhoea 	
Syphilis (includes non-
gonorrhceal urethritis,
venereal)	
Chancroid _ 	
Vincent's ang'na  	
Totals 	
1,096
211
832
11
36
173
21
1,355
179
1
1,434
1
2,668
784
36
12
84.6
16.3
64.3
0.8
2.8
13.4
1.6
104.6
13.8
0.1
0.3
110.7
0.1
206.0
60.6
2.8
0.9
1,683
224
768
8
40
92
12
757
352
4
6
1,414
2,508
I      ,1
125.4    987 |
16.7    84 |
765
7
11
30,692 | 2,370.0 I 45,179
57.2
0.6
3.0
6.8
0.9
56.4
26.2
0.3
0.4
105.4
186.9
57.0
0.5
0.8
3,366.5
11,297
32
32
187
21
645
171
3
1
2
TJ331
1
3,442
763
6
4
46,502
70.6
6.0
808.1
2.3
2.3
13.4
1.5
46.1
12.2
0.2
0.1
0.1
95.2
0.1
246.2
54.6
0.4
0.3
3,326.3
941
63.3
43
2.9
13
0.9
4,202
282.6
6
0.4
10
0.7
259
17.4
17
1.1
325
21.9
115
7.7
2
0.1
10
0.7
1,355
91.1
3,806
256.0
748
50.3
2
0.1
10
0.7
1,427
13
1
833
22
292
3
2
1,092
3,426
582 |
3 I
3 I
92.4
0.9
0.1
54.0
0.5
1.4
18.9
11 0.7
1,098 71.1
172 I  11.1
1 |   0.1
0.2
0.1
70.7
221.9
37.7
0.2
0.2
211,045 114,192.7 | 26,568 | 1,720.7
Certain other morbidity conditions, not revealed in the table, had their effect as
potential creators of human disease and required much investigation throughout the year.
One of these arose from the shell-fish toxicity experience of last year, in which oysters and
clams were incriminated as the cause of illness among forty-nine consumers of this shellfish. At that time detailed investigations on a joint basis of the National Department of
Fisheries, Provincial Department of Recreation and Conservation, Health Branch of the
British Columbia Department of Health and Welfare, and Engineering Division, Department of National Health and Welfare, resulted in closure of certain coastal waters to shellfish harvesting. At the same time, regular collection of shell-fish was arranged for samples
to be submitted to the laboratory of the Department of National Health and Welfare in
Vancouver to test for toxicity levels. As the levels fell, it became possible to open the
closed areas to the harvesting of oysters, but it was necessary to maintain the closure over
the entire area to the harvesting of clams. This closure remains in effect as testing is
continued; although toxicity levels are decreasing, they have not yet been reduced to the
allowable maximum to permit harvesting of clams to be resumed. Indeed, during the
year there were an additional four or five cases of shell-fish toxicity among consumers of
clams indiscriminately harvested in the closed area. Studies of the situation will have to
continue for some time longer.
Another situation that was revealed during the year was the discovery of rabies
among bats and squirrels in various localities throughout the Province, including the Cariboo, the Okanagan Valley, the Lower Mainland, and Vancouver Island areas. Bats were
first noted in an incident that occurred in Vancouver, in which a lad attempted to pick up
a bat lying under a rock on the school-ground and was bitten on the forefinger. Laboratory examination of the bat remains revealed the presence of Negri bodies, presumptive
evidence of the bat being infected with rabies virus.   Anti-rabies vaccine was administered J 26 BRITISH COLUMBIA
to the patient. Some months later numerous reports came in from the Okanagan Valley
of bats acting in a peculiar fashion, biting several individuals. Presumptive evidence of
rabies was again established among captured animals, and it was presumed the uncaptured
animals would have revealed the same situation. As a result, anti-rabies vaccine was
administered to an additional few patients.
Certain additional events concerning peculiarly acting bats in the Greater Vancouver
area and in the Central Vancouver Island Health Unit occurred, wherein the sequence of
events was established, the victims of bites accepting prophylactic treatment through anti-
rabies vaccine. Concurrent with this history of rabies among bats was established a
similar story of peculiarly acting squirrels, particularly in the Cariboo area, the Lower
Mainland area, and the Upper Vancouver Island area. Here again the odd person was
bitten and later laboratory investigation established presumptive evidence of rabies among
captured squirrels. Thus it becomes evident that there is rabies occurring among our
sylvatic animals, exposing man unduly to a heretofore rare hazard. It is evident that
rabies is more prevalent throughout the country, since reports have appeared in medical
journals indicating its occurrence among gophers in Manitoba and a large incidence among
foxes in Ontario. It indicated that there will have to be increasing vigilance on the part
of authorities concerned with the health of humans and animals.
In a study of morbidity and mortality events, much attention has been devoted to the
annual toll created by traffic accidents. During the year a number of conferences have
been held with officials in the Motor-vehicle Branch, and arrangements have been established whereby physicians in this Department act as medical consultants to the Motor-
vehicle Branch in connection with medical examinations of applicants for drivers'
licences. In undertaking this task, it was necessary to establish a set of minimum physical standards which would be adjudged as basic to the refusal of a driver's licence. In
creating these standards, numerous references were utilized and discussions were held
with a traffic advisory committee of the British Columbia Division of the Canadian Medical Association.
While a programme has been worked out whereby the Motor-vehicle Branch has
frequent consultation with the medical consultants of this Department, there remains
definite criticism offered by a number of individual physicians. For that reason, negotiations are continuing with the British Columbia Division of the Canadian Medical Association in the hope that a revision of the basic standards can be established which would
be more acceptable to the medical profession of the Province generally, while it is further
argued that it is desirable there should be a board of referees established which could pass
on the validity of rejected applicants and the reasons for the rejection. It is deemed
desirable to at least make a start in endeavouring to exclude from the road those drivers
who are judged incapable, physically or mentally, to be operating a motor-vehicle. DEPARTMENT OF HEALTH AND WELFARE,  1958 J 27
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 programmes of certain voluntary health agencies which have a close relationship with the
work of the Health Branch.
ADMINISTRATION
In the fall of 1957 the Tranquille Sanatorium was closed in so far as the care of the
tubercular patient was concerned. This was accomplished with a minimum of difficulty
due to a well co-ordinated plan and the whole-hearted co-operation of all within the
Health Branch concerned with this rather complicated closure. A continuous review of
the programme of the Division of Tuberculosis Control was carried out, and further dividends of this review will be found elsewhere in this Report.
There was a good deal of time devoted to the study of the programme of the Division
of Laboratories during 1958. The practice of medicine in recent years has shown increasing demands on laboratory services. Each new request for increased services from this
Division must be reviewed most carefully. The primary function of the Division of
Laboratories is to assist local health services in the protection of the health of the public.
To a lesser extent, and only in certain diseases which are accepted as a responsibility of
public health, should the Division become involved in laboratory diagnoses which are
concerned with individual diseases or clinical laboratory diagnoses as opposed to public
health laboratory diagnoses. Each and every request for a new service must be carefully
studied since, otherwise, a danger exists that true public health laboratory diagnostic
responsibility will be neglected.
The Division of Venereal Disease Control operated a well-integrated programme,
with the programme being under constant review.
The multitude of the Bureau's responsibilities in the over-all health picture remained.
The Personnel Officer carried on with his second year of study at the University of British
Columbia, but, following the earlier practice, spent three afternoons a week in his office
at the Bureau and was on full duty throughout the summer months. There has already
been evidence of the value of this training.
The excellent relationship mentioned in the 1957 Report continued with the Faculty
of Medicine, University of British Columbia, and, in particular, the Department of Pa_di-
atrics maintained its most valuable advice in the planning of the child-care programme in
the Province.
VOLUNTARY HEALTH AGENCIES
The Bureau of Special Preventive and Treatment Services has the major responsibility in the interpretation of the policy of the Health Branch to the many voluntary health
agencies active in this Province. Some of the voluntary health agencies receive direct
financial assistance from the Province of British Columbia, and although in many instances
it is Health Branch expenditures that give this assistance, there are other departments of
Government that also make direct grants. It is not possible to discuss the work of all
voluntary health agencies in this report. The following sections deal only with those
voluntary health agencies on which the Health Branch has official representation or to
which the Health Branch or some other department of Government makes grants. J 28 BRITISH COLUMBIA
Alcoholism Foundation of British Columbia
In 1958 the foundation, through the facilities of its out-patient clinic for men and
women and rehabilitation residence for men, gave skilled treatment services to alcoholics
and problem drinkers who requested assistance. The average intake of new patients at
the clinic was fifty per month.
The foundation was very active during the year in the field of health education. The
programme which began in the early days of the foundation was greatly expanded and
made more effective with the appointment of a director of education in late 1957.
British Columbia Cancer Foundation
The British Columbia Cancer Foundation in 1949 was designated by the Provincial
Government to be the recognized agent for the diagnosis and treatment of cancer in the
Province of British Columbia. Operations at the British Columbia Cancer Institute, the
Victoria Cancer Clinic, the twelve consultative cancer clinics at centres throughout the
Province, and at the 36-bed boarding home attached to the Cancer Institute in Vancouver
are the responsibility of the Cancer Foundation. Operational expense is provided by the
Cancer Control Grant of the National health grants and by a matching grant from the
Provincial Government, plus fees from private patients.
The consultative cancer services are to be increased by the establishment of a clinic
at Dawson Creek early in 1959.
British Columbia Medical Research Institute
This non-profit organization was founded in 1948 in order to make specialized laboratory facilities available for use by qualified individuals in the Province who wish to undertake various medical research projects. Financial support is derived from a variety of
private and governmental sources, including a Provincial grant-in-aid which was made
available for the first time in 1956.
From its inception the work of the institute has been co-ordinated closely with the
research activities of the Faculty of Medicine of the University of British Columbia. As
these activities expanded with the growth of the faculty, it became increasingly apparent
to the medical board and trustees of the institute that many advantages would result if the
laboratories of the institute were combined with those of the faculty in the new Medical
School and Pathology Building at the Vancouver General Hospital. Accordingly, under
the terms of an agreement which was signed in March, 1958, the University agreed to
make an addition to the top floor of the Medical School in order to provide improved
accommodation for the research projects now going on in the laboratories of the institute.
The new laboratory, which will be ready for occupancy early in 1959, will be an integral
part of the Faculty of Medicine, the equipment having been donated to the University by
the trustees of the institute. It will be known as the G. F. Strong Laboratory for Medical
Research, in honour of the former chairman of the medical board of the institute, the late
Dr. G. F. Strong.
Although the trustees of the institute have not yet announced their plans for the
future, there is every reason to expect that the British Columbia Medical Research Institute will continue to function as a non-profit organization dedicated to the support of all
types of medical research in the Province.
Canadian Arthritis and Rheumatism Society (British Columbia Division)
A supervised Provincial treatment programme, as nearly complete as staff, facilities,
and funds will allow, is now in operation for those in British Columbia who have rheumatic disease. A survey of 2,444 cases treated in one year showed the following results:
Complete remission in 17 per cent of the cases, much improved in 33 per cent of the cases,
improved in 36 per cent of the cases, and unimproved in 14 per cent of the cases. DEPARTMENT OF HEALTH AND WELFARE, 1958 J 29
A two-year follow-up survey of thirty-four cases treated at the Canadian Arthritis
and Rheumatism Society medical centre showed the change in employment status from
five out of thirty-four working at admission, compared with nineteen in full-time and
eight in part-time employment, with only seven being out of work at the end of the two
years.   The average age was 39 years.
For problem cases and for assessment and referral to the medical centre, medical
consultative clinics are arranged at the request of doctors outside the Vancouver and
Victoria areas. At the medical centre an intensive treatment programme by the team of
social worker, physiotherapist, occupational therapist, nurse, and doctor aims to restore
patients to maximum function.
The society relies to a great extent on established facilities for job training and
placement, and although maximum function has been restored physically, total rehabilitation cannot be achieved in some cases because present facilities cannot meet the demand.
The medical educational programme was fostered this year, as in the past, through
the annual Canadian Arthritis and Rheumatism Society lectureship, the medical reports
on research, clinical projects, and consultation visits.
The Narcotic Addiction Foundation of British Columbia
During 1958 the long search of more than two years for a suitable residence to house
administrative headquarters and residence for ex-addicts was continued. The agency was
successful in obtaining such a building at 835 West Tenth Avenue, and this was opened
in May, 1958. Unfortunately, for various reasons, including neighbourhood opposition
in the past, it was not possible to obtain a building large enough to accommodate more
than four male in-patients, as against approximately 20 beds which had originally been
hoped for, and including both male and female patients.
With the appointment of Dr. R. Halliday as Director at the beginning of September,
and the further appointment of both professional and household staff, the residential part
of the therapeutic programme was initiated at the beginning of December, 1958. The
out-patient programme for both male and female patients was carried on throughout the
year, and in all a total of 204 persons (137 men and 67 women) were interviewed for
various services up to the end of October, 1958.
The staff of the foundation maintained the close liaison previously established with
the authorities at Oakalla Prison Farm and with other agencies interested in this problem.
G. F. Strong Rehabilitation Centre
In 1958 the centre experienced the highest utilization of its services and facilities
since its inception in 1949. In comparing the first ten months of 1958 with the same
period last year, there was an increase of 3,759 work units shown (one work unit represents one half-day of training per patient). This denotes a 19-per-cent increase in work
units. The number of in-patient days for this period increased by 1,520 or 14 per cent,
and the number of out-patient admissions increased by 21 per cent.
The cerebral palsy programme, which is conducted co-operatively with the Cerebral
Palsy Association of Greater Vancouver, increased its active patient load from 205 to
267, being an increase of 30 per cent.
After an unfortunate delay as a result of staff turnover, the centre's statistical service
was put into operation.
The preliminary plans of the centre's proposed multi-story addition are now nearing
completion, and it is hoped that an early start on this project can be made. J 30 BRITISH COLUMBIA
NATIONAL HEALTH GRANTS
In July, meetings were held in Victoria and Vancouver with officials of the Department of National Health and Welfare, British Columbia Hospital Insurance Service, and
the Provincial Health Branch to review the " Hospital Insurance and Diagnostic Services
Act," which became effective July 1st. As a result of this Act, in-patient services in
hospitals previously supported under the grants were discontinued and became subject to
assistance under the new Act, which will be administered through the British Columbia
Hospital Insurance Service.
The total amount of funds available to British Columbia for the fiscal year 1958/59
was $5,328,711, being an increase of $405,430 over that appropriated in 1957/58. This
excluded the Public Health Research Grant, which was allocated in Ottawa.
Total expenditures for the fiscal year ended March 31st, 1958, were $3,774,304,
or 74.6 per cent of the total funds available to this Province, compared with $3,155,245,
or 66.5 per cent of the total available for the previous fiscal year. The average percentage
of expenditures for 1957/58 for all Provinces was 62.8. Excluding the Public Health
Research Grant, 83.1 per cent of British Columbia's total allotment was approved for
specific expenditures, compared with 72.6 per cent for all Provinces.
Crippled Children's Grant
The amount allocated to this grant for 1958/59 was $46,774. Assistance was
given to the three branches of the Cerebral Palsy Association of British Columbia—
namely, Greater Vancouver, Lower Vancouver Island, and Lower Fraser Valley. The
cerebral palsy unit at the Children's Hospital, Vancouver, also continued to receive
support.
Professional Training Grant
The allocated funds for this grant amounted to $46,774, but it became necessary
during the year to transfer $36,430 to this grant in order to meet the increased requests.
Assistance was provided for trainees in the Canadian Hospital Association extension
course in hospital administration and medical records, and continued assistance in postgraduate training was given to hospital and professional public health personnel. The
Registered Nurses' Association of British Columbia received assistance to carry out two
institutes for nurses in hospitals and public health agencies in order to improve in-service
educational programmes and operating-room techniques.
Hospital Construction Grant
The greatest portion of this year's grant was again used by general hospitals,
although a larger percentage than in previous years was used for community health
centres. Funds committed for the 1958/59 fiscal year included: General hospitals,
$1,756,851; health centres (health unit accommodations), $147,758; and mental hospitals, $216,000.   By December 31st, 1958, the grant was fully committed.
Venereal Disease Control Grant
This grant, amounting to $46,774, is on a matching basis, with the total amount being
paid to the Province. Expenditures by the Province on the general venereal-disease programme are considerably in excess of the grant. Through this grant the Division employed private physicians to provide free treatment and drugs to patients in many parts
of the Province where there were no clinics. Assistance was also provided by supplying
venereal-disease literature to physicians and medical students in the Province.
The report of the Division of Venereal Disease Control appears in another section
of the Health Branch Report. DEPARTMENT OF HEALTH AND WELFARE,  1958
J 31
Mental Health Grant
Funds allocated to this grant were $650,811, with a further $30,000 being transferred
during the year. Most of the projects submitted under this grant are initiated by the Provincial Mental Health Services, Department of the Provincial Secreary. As in former
years, the greater portion of the grant was devoted to the provision of staff and technical
equipment for the Mental Health Services institutions.
The 300-bed admission and infirmary unit was constructed for the Home for the
Aged at Port Coquitlam, with provision also being made for technical equipment for the
wards, examination-rooms, laboratories, and the X-ray department.
Professional training in psychiatry was again provided to two members of the medical staff, and a successful four-day institute on psychotherapy was held in November.
Other projects covering the training of social workers at the University of British
Columbia, the provision of assistance to the psychiatric services of the Vancouver General
Hospital and the Royal Jubilee Hospital, and the Metropolitan Health Committee of
Greater Vancouver mental-hygiene programme were also assisted, as in former years.
The course in mental-health training for senior school counsellors, sponsored by the
Vancouver School Board, commenced its fourth year in September, with the salary of the
co-ordinator being derived from this grant.
Tuberculosis Control Grant
The majority of the tuberculosis services are provided by the Provincial Government, and the largest proportion of the grant, therefore, is used by the Health Branch's
Division of Tuberculosis Control. Funds allocated to this grant amounted to $376,915,
and projects included the provision of equipment in health units and general hospitals,
vocational training for tubercular patients, payment for special out-patient investigations
in general hospitals, and anti-microbial therapy. Personnel, supplies, and equipment
required for the stationary and mobile X-ray units were supplied, together with assistance
for the special tuberculosis surveys. Personnel at the Vancouver Preventorium continued
to receive assistance. Specialized postgraduate and short-term training was provided to
staff of the Division, and educational material on tuberculosis was again supplied to
physicians, medical students, and organizations. The project for the hospital admission
X-ray programme provided for admission X-ray equipment for general hospitals and
payment for films taken on hospital admissions and community surveys.
The research conducted by the Faculty of Medicine of the University of British
Columbia on the antibiotic control of tubercle bacillus infections continued.
Detailed information regarding the services of the Division of Tuberculosis Control
appears in a later section of this Health Branch Report.
Public Health Research Grant
Two one-year research projects which were carried out by the Faculty of Medicine
at the University of British Columbia were completed this year. One new project was
commenced by the Department of Pathology, entitled, " Studies in Rheumatoid Arthritis:
Antigen-antibody Reactions at Tissue Level Utilizing Fluorescein Labelled Globulins."
Three research projects were continued—namely, " Determination of Human Blood
Patterns and Metabolism of Adrenal Steroid Hormones," " Study of the Epidemiology
and Control of Infections Caused by Staphylococcus Pyogenes in Patients in the Pajdiatric
Department of a General Hospital," and "Growth and Fate of Lymphocytic Choriomeningitis Virus in Acute and Latent Infection."
General Public Health Grant
The amount allocated to this grant was $743,500. However, it was necessary to
make a further transfer of $209,600 to this grant in order to meet requests received for
equipment for the Metropolitan Health Committee of Greater Vancouver and the G. F. J 32 BRITISH COLUMBIA
Strong Laboratory for Medical Research and to help purchase Salk vaccine required to
carry out the extended immunization programme.
Assistance was continued to the Metropolitan Health Committee of Greater Vancouver toward personnel and equipment, and also the Victoria-Esquimalt Union Board
of Health. Twenty-six incubators and other infant-care equipment were purchased for
general hospitals.
The general public health programme as carried on by the local health services
received assistance, and detailed information regarding these services appears in the early
part of this Health Branch Report.
Two research projects were completed by the Faculty of Medicine, University of
British Columbia, and a new study was commenced by the Department of Bacteriology
and Immunology into the distribution of Clostridium botulinum in soils and sea muds of
British Columbia. The Department of Surgery undertook research into the investigation
of some metabolic and technical aspects of extracorporeal circulation.
The project whereby third-year medical students from the University of British
Columbia have been placed in health units and divisions of the Health Branch again
proved of great benefit.
The British Columbia Hospital Insurance Service and the Health Branch sponsored
a five-day course at Cranbrook for cooks and cook managers of small hospitals, receiving
assistance from this grant.
Assistance has been continued to the Vancouver Vocational Institute in the teaching
of practical nurses and supervision in their field experience in hospitals and public health
agencies.
Cancer Control Grant
The operations of the British Columbia Cancer Foundation, which are financed
jointly by this grant and matching Provincial funds, are outlined earlier in this report in
the section " Voluntary Health Agencies."
The funds allocated to this grant were $322,635 for the year 1958/59. With the
introduction of the " Hospital Insurance and Diagnostic Services Act," the funds previously provided under this grant for the biopsy service were terminated as at July 1st, and
this programme came under the jurisdiction of the British Columbia Hospital Insurance
Service.
The work of the cytology laboratory at the British Columbia Cancer Institute
increased again this year, there being a total of 17,784 examinations carried out free of
charge for the first six months of 1958, compared with 3,765 for the first six months
of 1953.
Assistance was provided for the training of a physicist, who will be placed in the
Victoria Cancer Clinic, and technical equipment was supplied for its expansion.
Laboratory and Radiological Services Grant
The amount allocated to this grant was $743,500.
Laboratory Services
The Regional Laboratory Services for the Lower Fraser Valley area proved so successful that five more hospitals entered into the scheme this year, making a total of nine
hospitals. These laboratories came under the jurisdiction of the pathologist of the Royal
Columbian Hospital in New Westminster. This same scheme was instigated for the South
Cariboo area, with the pathologist of the Royal Inland Hospital in Kamloops supervising
the laboratories of five hospitals in that area. Two laboratories in the Trail-Tadanac area
were planned by the regional pathologist, who continued to extend the services offered to
the hospitals in that region. A committee in the Okanagan was unsuccessful in appointing
a pathologist to set up this type of service in this district. DEPARTMENT OF HEALTH AND WELFARE, 1958 J 33
The shortage of fully qualified medical technologists was not as acute this year, due
mainly to an increased number of graduates from the training-school which was established in the University of British Columbia Medical School Building at the Vancouver
General Hospital. A refresher course which was given for medical technologists from the
hospitals that have no pathologists helped to strengthen the diagnostic services.
The Laboratory Advisory Council gave advice in planning to all projects connected
with clinical laboratories, including equipment on which National and Provincial grants
were requested. The Deputy Minister asked that this group continue to act in an advisory capacity, even though grants on equipment had become the responsibility of the
Hospital Insurance Service. He also asked that this council continue to plan any new
project which would be beneficial to the diagnostic services in this Province.
Radiological Services
The Radiological Advisory Council spent a very busy year reviewing and approving
applications for grants toward the purchase of X-ray equipment. One of the major applications was a study of the necessary equipment to set up angio-cardiographic and other
related diagnostic procedures in two of the largest hospitals, and thus allow diagnosis and
treatment to be carried out in this Province. Equipment grants were approved for more
than twenty institutions with a cost value of $282,653, compared with the approved grants
of the previous year of $68,834.
Last year's report mentioned the position of Technical Adviser, Radiological Services. In 1958 an appointment was made to the position in the Health Branch. Under
the direction of the Radiological Advisory Council, he instituted a detailed study into all
X-ray installations and personnel in the Province. The Council likewise set up committees to study and bring in detailed recommendations on technician-training programmes.
A detailed study was commenced into all sources of ionizing radiation and its related
hazards to public health, which is a very important and timely undertaking in light of the
rapid advances in radioactive isotopes in medicine and nuclear power in industry.
Medical Rehabilitation Grant
The funds available under this grant amounted to $90,330. Assistance was continued to the G. F. Strong Rehabilitation Centre in its general programme of physical
rehabilitation.
Funds for medical rehabilitation services for indigent persons referred to the Rehabilitation Service of the Health Branch were again provided, when no other means of
financial assistance were available.
The employment of a part-time physician as medical rehabilitation consultant to the
Rehabilitation Service of the Health Branch was continued. This physician maintains a
constant liaison with those responsible for actual physical rehabilitation treatment of
patients referred from the Rehabilitation Service and acts in an advisory and consultative
capacity to the Health Branch on the over-all programme.
Equipment was provided to the Department of Physical Medicine at the Vancouver
General Hospital for its physiotherapy and occupational-therapy services. The Traumatic
Surgical Unit at the Vancouver General Hospital continued to receive support from this
grant in order to further investigate the factors into the cause of injuries and to study the
question of the rehabilitation of injured people.
Child and Maternal Health Grant
The amount appropriated to this grant was $139,707. Assistance was continued to
the Metropolitan Health Committee of Greater Vancouver for the salary of a specialized
person in maternal health services.   An additional public health nurse was provided to J 34 BRITISH COLUMBIA
the New Westminster area of the Simon Fraser Health Unit to increase the child and
maternal health programme, including the establishment of expectant parents' classes.
Many Provincial health units were supplied with demonstration equipment, teaching aids,
and reference texts because of the renewed interest and enthusiasm amongst the staff in
extending the programme of classes to expectant parents. A grant was also approved for
a programme to be established by the Faculty of Medicine at the University in order to
train medical students, university nursing students, public health nurses, and other medical personnel in the advanced programme of supervision of child care.
The Health Centre for Children and the Metropolitan Health Committee of Greater
Vancouver continued to receive assistance for specialized personnel in child and maternal
health services. A paediatrician of the Health Centre for Children was given the opportunity of reviewing modern hasmotology laboratories in the East, and these services have
since been inaugurated at the centre, with funds also being supplied for equipment.
The appointment of a senior audiologist at the Health Centre for Children has provided an experienced person to direct the stationary and mobile audiology services within
the Province. With the continuation of assistance for a public health nurse and a paediatrician, acting in a consultant capacity for handicapped children, the liaison between the
children's services and public health personnel was maintained.
The Registry for Handicapped Children, which was outlined in detail in the 1955
Report, continued to receive support. The programme remains much the same, with an
average of 150 cases being reported each month. The registry office is under the jurisdiction of the Assistant Provincial Health Officer, although supervised by the Division of
Vital Statistics.
Five research projects carried out by the Faculty of Medicine at the University of
British Columbia were continued. One new project was commenced, entitled " Neurological Development of the Newborn Infant in Relation to Earlier Detection of Cerebral
Palsy and Mental Retardation." This study included the services at the Vancouver General Hospital, the Health Centre for Children Out-patient Department, and the Metropolitan Health Committee of Vancouver. DEPARTMENT OF HEALTH AND WELFARE,  1958 J 35
REPORT OF DIVISION OF PUBLIC HEALTH NURSING*
Monica M. Frith, Director
The Division of Public Health Nursing functions under the Bureau of Local Health
Services. It performs a dual role in providing guidance and consultative assistance to
public health nursing staff of local health units while at the same time it assumes an
administrative function in assessing the need for service, and maintaining a high standard
of performance through the recruitment, placement, and training of public health nurses.
Due to an increasing population in the areas served by public health nursing staff,
it was necessary this year to establish nine additional nursing positions. There is now a
total of 186 positions for full-time public health nursing staff. Of these, 181 are public
health nursing field positions in local health units; one is a qualified nurse, resident in a
remote area, who has assumed the duties of public health nurse in that area; one the
occupational health nurse, Parliament Buildings, Victoria; one consultant public health
nurse located in Vancouver, with one consultant public health nurse and the Director of
Public Health Nursing located in Victoria. In addition, six nurses serve on a part-time
basis in centres where it is not feasible to employ full-time public health nursing field staff.
PUBLIC HEALTH NURSING CONSULTANT SERVICE
The public health nursing consultants try to visit the health units and nursing districts twice a year to assist in evaluating the work being conducted by the nursing staff
and to provide guidance and advice in carrying out various public health nursing activities. During the year there was an unusually large number of senior and supervisory
nurse changes, so that special attention was directed toward assisting the newly appointed
nurses to assume their administrative and supervisory responsibilities. As usual, a study
of the case loads carried by each public health nurse was completed in order that detailed
information might be available in the health units and in the central office. Through a
study of the individual case loads, it was possible to reallocate certain services and territories so that each public health nurse carried a work load of a similar size. An analysis
of the case loads pointed out the distribution of the work load and indicated where consideration should be given in adjusting service by the provision of additional public health
nursing staff.
A time study was completed by each public health nurse during a three-week period
to determine how they distributed their time in the conduct of the various health pro-
programmes and services. Through information obtained in this study and in previous
studies, it was possible to obtain some improvement in the use of the public health nurse's
time. For example, the time studies showed that 4 per cent of each public health nurse's
day was being spent in activities related to the preparation of equipment which could
have been done by a person with less training at a lower cost. As a result, it was possible
to employ a limited number of health unit aides to do certain of these duties, thus making
more professional nursing time available for activities for which the public health nurse
has special training. Similarly, time studies have shown that each public health nurse
spent 4.8 per cent of her time on non-professional clerical duties. As some additional
clerical assistance has become available since the study, it is hoped that the amount of
time spent on non-professional activities will decrease, with a resulting improvement in the
amount of direct public health nursing service available to the public. Time studies provide a useful tool in indicating the trends in service and may provide a guide for the local
health unit in evaluating the service being provided. One example of an unfavourable
trend was the gradually decreasing amount of time spent by the public health nurses in
* This report concerns the services provided by public health nurses under the jurisdiction of the Provincial Health
Branch, and does not include the services provided by the metropolitan health departments of Greater Vancouver,
Victoria-Esquimalt, and Oak Bay. J 36 BRITISH COLUMBIA
home visits.   In the health units where this happened, work plans were reviewed and an
effort made to give more emphasis to home visiting.
To help the public health nursing staff in the best use of time, certain other activities
were carried on by the public health nursing consultants. An active Public Health Nursing Records Committee met under the chairmanship of a public health nursing consultant
to review and revise public health nursing records and instructions for their use so that
recording may be simplified. This year major changes were made in simplifying the
general record, consent cards, and public health nursing reports. Many new sections
were added to the Policy Manual so that the field staff would have the latest information
on such matters as recommended immunizations, new community health resources, etc.
The former Tuberculosis Manual was revised and has become part of the Policy Manual.
Work is going forward in setting up standard methods of sterilizing equipment used in the
health units and also in setting out recommended procedures, particularly in relation to
immunization and nursing care. The public health nursing consultant, located in Vancouver, continued to represent the public health nursing service on the School Health
Services Committee and to be available for liaison with the voluntary health agencies and
to act in an advisory capacity in nursing to the Bureau of Special Preventive and Treatment Services.
TRAINING PROGRAMMES
As public health nursing is a highly technical skill, it is necessary to have nurses
with special university preparation to carry out the work. Public health nurses are fully
trained as hospital nurses, and in addition have a diploma or degree in public health
nursing granted by a university. However, to meet the need for service, it has been
necessary to take on staff a limited number of nurses who do not have university preparation. The number of nurses in this category was slightly larger than last year, and
amounted to 18 per cent of the field staff. These nurses were given a concentrated
orientation programme in the health unit to fit them to carry out a minimum service in a
full-sized public health nursing district. A new orientation guide was drawn up and has
been used to assure uniformity in in-service training. The orientation programme is
similar to the programme offered students from the University of British Columbia. All
newly appointed public health nurses also go through a short orientation programme in
order to become proficient in public health nursing techniques and to prevent errors from
lack of understanding of the objectives of the public health service.
The provision of field experience for nursing students plays an important part in the
training of nurses both for specialization in the field of public health nursing and in the
general education of the nursing student who may enter some other branch of nursing.
During the year fifty-three student-nurses from the University of British Columbia had
field-work experience ranging in time from one month to two weeks, while two nurses
were accepted for a month's field work from the University of Alberta. As the nursing-
schools in British Columbia now recognize the need for every student-nurse to have some
background of experience in public health nursing, certain health units adjacent to nurses'
training-schools provided two- to five-day observation periods for undergraduate nurses.
The Saanich and South Vancouver Island Health Unit had 60 students; Boundary Health
Unit, 21; Simon Fraser, 8; while the South Central accepted 20 students. As the result
of this programme, it is hoped that more nurses will learn more about community health
resources and thus will co-ordinate their nursing activities with those being carried out
by other health agencies.
Opportunities were granted for selected nurses to have educational leave of absence
in order to complete university courses. Nine nurses were enrolled in the diploma course
in public health nursing at the University of British Columbia, while two senior nurses
commenced the course in public health nursing supervision and administration at the
University of Toronto.   Ten nurses returned from university following completion of the DEPARTMENT OF HEALTH AND WELFARE,  1958 J 37
diploma programme, while one returned from advanced training at McGill University.
With the exception of two nurses, all are receiving or have received financial assistance
through National health grants to assist them in taking the university courses.
Public health nurses continued to receive some training in civil defence nursing
through participation of some members of the staff in special courses. Five senior nurses
attended the nurse specialist course at Arnprior, Ont., and five staff nurses attended a
special course arranged through the Civil Defence Health Services and the Provincial
Civil Defence Co-ordinator.
LOCAL PUBLIC HEALTH NURSING SERVICE
The public health nursing programme is similar throughout the service, as each
public health nurse provides a generalized public health nursing programme which is
based on policies developed on a Provincial basis.
Emphasis continued to be placed on the prenatal programme, as the prenatal period
is recognized as extremely important in affecting the health of the new-born child, mother,
and total family. The numbers of centres holding classes for expectant parents increased
as more parents took advantage of the service this year. Relaxation exercise classes were
offered, as well as lectures and discussion on maternal and infant health. Public health
nurses also visited expectant mothers at home to supplement the medical care offered by
the private physician.
The guidance which the mother receives in the care of her new baby has an important effect on the future health of the child. The public health nurse tried to make at
least one visit to the home soon after the birth of the baby to assist the mother in meeting
the first problems which arise after returning home from hospital. Additional visits were
made according to need. The mother may bring her infant and pre-school children to
child health conferences for further guidance. Child health conferences are held at regular intervals in the various communities served by the public health nurse. They may be
held in health centres, schools, community halls, or private homes, whenever there are
sufficient numbers of infant and pre-school children to justify the setting-up of a conference or clinic. Immunization as well as health teaching and guidance are available to
parents at these conferences. Children needing medical treatment are referred to their
private physicians for care. The smooth running of child health conferences has been
made possible in many centres by excellent volunteer help from interested community
workers.
The public health nurse conducted a busy health programme in the schools in her
area. She visited her school regularly to act as health adviser to the teachers and to provide certain services on behalf of school-children. Children requiring special medical or
nursing follow-up were located by screening methods such as teacher-nurse conferences,
vision and hearing tests. The public health nurse assisted with the medical examinations
in the schools and made visits to the homes to investigate health conditions or to advise
parents on needed care or treatment. Immunizations were carried out as recommended
for the school-child.
The public health nurse's role in the communicable-disease programme involved
carrying out approved immunization procedures at child health conferences and during
clinics at school. Immunizations were carried out in connection with the prevention
of such diseases as poliomyelitis, whooping-cough, diphtheria, tetanus, smallpox, and
typhoid fever. Prophylactic injections, such as anti-measles serum, were also given to
susceptible familial contacts to the disease. In addition, the public health nurses visited
numerous homes and held many office consultations with parents in connection with the
control of communicable diseases.
The venereal-disease programme received particular emphasis in the Cariboo, South
Central, and Skeena Health Units, where the incidence was higher than in other health J 38 BRITISH COLUMBIA
units. Patients were able to receive advice and treatment through visits to the public
health nurse in the office and at the time of her investigations.
Although the number of tuberculosis patients hospitalized in institutions has
decreased, the work of the public health nurse has increased as more patients are now
living at home and require health supervision. The public health nurse visited certain
tuberculosis cases regularly and provided required treatment, such as streptomycin injections. She assisted with rehabilitation planning so that the patient could make a good
recovery. The public health nurse investigated contacts of tuberculosis cases to help
eliminate the spread of this infection. During the year there was an increased emphasis
on tuberculin testing as a case-finding method, and this involved more public health
nursing time than mass X-ray surveys.
Nursing care in the home continued to be provided routinely by all public health
nurses on a short-term and demonstration basis. The volume of nursing care has been
gradually increasing. More intensive nursing-care services were offered in health units
which made arrangements for this special service. The units with the special programmes,
were the Saanich and South Vancouver Island Health Unit in the Saanich Municipality,
the Upper Island Health Unit at Courtenay and Powell River, the North Okanagan
Health Unit at Vernon, the South Okanagan Health Unit at Kelowna and Penticton, and
the Boundary Health Unit at Ladner and Langley. It was possible to institute the home
nursing-care service in the three latter districts during 1958. Plans have gone forward
to commence a similar service in the Central Vancouver Island Health Unit at Qualicum
in the new year.
The number of services rendered in assisting persons with mental-health problems
continued to increase as more emphasis was placed on this part of the programme.
Adults received more help this year in dealing with specific health problems related both
to themselves and their family. DEPARTMENT OF HEALTH AND WELFARE,  1958
J 39
REPORT OF THE DIVISION OF PUBLIC HEALTH ENGINEERING
R. Bowering, Director
The Division of Public Health Engineering is concerned with environmental conditions that may affect health, particularly where engineering techniques may be brought
to bear on the problem.
WATER-SUPPLY
The control of water-supplies is one of the major functions of the Division. The
"Health Act" requires that all plans of new waterworks systems, alterations, and
extensions to existing systems be submitted for approval. Before approvals are made,
the plans, engineering reports, and specifications are carefully reviewed. In many cases,
field inspections are made; also, results of both bacteriological and chemical tests are
considered. During 1958 seventy-one plans in connection with waterworks construction
were approved. This compares with sixty-five plans the year before. In addition to the
approval of the plans, engineers visit waterworks systems in the Province from time to
time for the purpose of checking on sanitary hazards and to give advice toward their
improvement. Field visits were paid to all health units in the Province except two during
the year 1958.
Generally, in British Columbia the water-supply sources are good, and expensive
treatment of the water is not usually required. Where treatment is required, chlorination
is the usual method. It is estimated that nearly 80 per cent of the population of the
Province uses water protected by chlorination. There are only three domestic water-
supply systems in the Province where the water-filtration method is used, and in one of
these systems the water-filtration plant was rebuilt during the year.
By the end of 1958 there were six communities fluoridating the water, all using
sodium silico fluoride. Reports are received regularly with respect to the amount of
fluoride added to the water, the amount of water used, and reports on testing of the
water for fluoride. There have not been any major problems involved in adding fluoride
within the required degrees of tolerance. The fluoridation plants are visited from time
to time for the purposes of checking on their operations.
In order to keep a constant check on the bacteriological quality of water-supplies,
regular frequent samples of water are taken by the local health service personnel and
examined by the Division of Laboratories. Copies of the reports are sent to the Division
of Public Health Engineering. During the year the Division of Laboratories tested
a considerable number of water samples chemically. The requests for chemical analyses
were screened by this Division.
Each year the Division receives a number of inquiries concerning private water-
supplies. These are referred to 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 local health unit officials on various water-supply problems.
No known water-borne epidemics resulting from the use of public water-supplies
were reported during the year. This fact is evidence of the care being taken by the
various water authorities to provide a safe water-supply for the citizens. This record
can only be maintained by constant vigilance on the part of local health authorities and
engineers of this Division.
One problem with respect to water-supply quality that is a serious one is the
combined irrigation and domestic water-supply systems. The bacteriological quality for
irrigation-water does not need to be as good as that for domestic water. Where the
systems are combined, the cost of treating the whole volume of irrigation-water just to
protect the water used for domestic purposes is very high. This is a problem that will
have to be overcome in the future. J 40 BRITISH COLUMBIA
SEWAGE-DISPOSAL
It is required by the " Health Act" that plans, specifications, and engineering
reports concerning all new sewerage construction and extensions be approved before
construction may commence. Also, it is necessary for preliminary plans and reports
to be approved before communities may vote on the money by-laws needed for their
construction. During the year fifty-six approvals were given in connection with sewerage
work, compared with a total of eighty-nine in 1957 and sixty-five in 1956. In many
cases the consulting engineers employed to prepare the plans discuss the whole problem
with officials of the Division of Public Health Engineering before they put their plans
on paper and before they write their report. This practice speeds up the work of
approval considerably.
Study of the plans for approval includes study of the profiles and plans of appurtenances so that a good standard of sewage work is constructed. The study also includes
treatment-works, if any, and studies of the receiving body of water in order to determine
the degree of treatment required.
Owing to the expansion of the population of the Province, particularly in the
Greater Vancouver area, there are a large number of subdividers developing building
lots for prospective home-builders. One of their great difficulties is in servicing of the
lots, particularly with sewers. During 1956 and 1957 a number of these privately built
sewerage systems were completed. Several more were completed during 1958. With
experience gained from sewerage systems built by private subdividers, it is felt now that
when a privately owned and financed subdivision is planned to be built in a municipality,
plans of the proposed system should be submitted to the Health Branch by the municipality rather than by the private builder. This gives the municipality better control of
sewers built within its boundaries, and it makes the continued operation of the sewerage
system and treatment plant a responsibility of the municipality.
There will always be a large portion of the population served by individual sewage-
disposal systems serving private homes. The actual installation of these private systems
comes within the purview of the local health service. However, the plans and specifications and consulting service are provided by the Division of Public Health Engineering.
The usual method of private sewage-disposal is by septic tank and ground absorption
field. During the year several mechanical oxidation plants were installed for small
installations. The operation of these will be watched carefully to see whether or not
they will meet a need for the disposal of sewage from homes and small businesses where
septic tanks are not applicable.
One of the methods of sewage treatment coming to the fore in the last few years
is the method of using " sewage lagoons " or " stabilization ponds." There were seven
of these in service in British Columbia by the end of 1958. This method of sewage
treatment is only useful for smaller communities, but where they are possible they provide
a reasonably good sewage treatment at a relatively small cost. One difficulty is that
exact design criteria have not been developed yet. Following a study of all the existing
lagoons in the Province this year, a paper was presented by the Director of the Division
at the annual meeting of the Municipal Engineers' Division of the Association of
Professional Engineers of British Columbia.
STREAM POLLUTION
The general problem of stream-pollution control is one of the major items dealt with
by the Division of Public Health Engineering.
Stream pollution is caused by the discharge of sewage and industrial waste 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 waste and the DEPARTMENT OF HEALTH AND WELFARE,  1958
J 41
quality and volume of the receiving body of water. The net result of such discharges,
however, may make the water less desirable and less useful.
At the present time there are no pulp-mills discharging waste into fresh water in
British Columbia. It is probable that one will be built on the Columbia River within
the next two or three years. The best method of preventing serious harm to the river is
being studied at the present time. Stream pollution in the Province is not extensive
at the 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. Control
of pollution by sewage, under legislation presently in existence, 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 control of certain types of pollution.
This type of control has not been sufficient to prevent all types of pollution, and
for this reason the Pollution-control Board was established.
THE POLLUTION-CONTROL BOARD
This Board, which was set up late in 1956 to control the discharge of sewage, is
taking up more and more time of the Division of Public Health Engineering. Administration of the Act was made the responsibility of the Minister of Municipal Affairs. The
Pollution-control Board consists of three Civil Servants, one former Civil Servant, and
three members from the Greater Vancouver area. Under the Act, responsibility for
technical advice is laid upon the Health Branch. The Director of Public Health Engineering acts as secretary of the Pollution-control Board and as technical adviser to the Board.
The area over which the Pollution-control Board has jurisdiction is the Lower Fraser
Valley below Hope, together with the contiguous salt-water areas, including Boundary
Bay, Roberts Bank, Sturgeon Bank, Burrard Inlet, and Howe Sound.
During the year eight permits for discharge of waste were issued. Most of the
permits were made valid for only five years, during which time it is hoped that adequate
studies of the capacities of the area to receive pollution, together with studies of existing
discharges into the river, would be made.
Perhaps the most important decision made by the Pollution-control Board was the
permit issued to the Greater Vancouver Sewerage and Drainage District to build a high-
rate primary-sewage plant on Iona Island with the effluent to be discharged upon Sturgeon
Bank to the west of Sea Island. The permit had six conditions attached to it. The permit
was appealed to the Lieutenant-Governor in Council by The Corporation of the Township
of Richmond. Following the appeal, the permit was amended to include five additional
conditions, which means that the Greater Vancouver Sewerage and Drainage District
will have to operate the plant in a very efficient manner.
During the year, because of pollution of English Bay, the swimming-beaches on the
south side of English Bay were closed by the Vancouver Parks Board on advice from
the City Health Officer. The building of the Iona plant, which might take two or three
years, should clear up most of the contamination in English Bay.
There were two important applications before the Board at the end of the year.
One of these was an application of the Greater Vancouver Sewerage and Drainage District
to discharge primary effluent and digested sludge into the First Narrows of Burrard Inlet,
and the other was from the same organization requesting permission to discharge
untreated sewage into Port Moody Bay.
A large number of samples were taken through the co-operation of the local health
unit from Burrard Inlet. These samples indicated that pollution was fairly widespread
in Burrard Inlet. J 42 BRITISH COLUMBIA
A great deal of intensive survey work will have to be carried on in the next two or
three years so that sufficient information will be on hand to rule intelligently on the
question of reissuing permits that were only issued for five years in the first place. It is
expected that the work of the Pollution-control Board will occupy a considerable amount
of the time of the Division of Public Health Engineering for some years to come.
SHELL-FISH SANITATION
The Division of Public Health Engineering has the responsibility of enforcing the
shell-fish regulations. 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 within their area.
Studies are also made of the shellfish-growing areas as all applications to lease areas
for shellfish-culture purposes have to be approved by the Health Branch. Practically all
of the oysters produced commercially in British Columbia are grown on leased ground.
There is complete co-operation between the Provincial Health Branch and the
Department of National Health and Welfare with respect to the shell-fish industry. The
Department of National Health and Welfare has the responsibility for approving shell-fish
operations where the product is sold outside the Province of British Columbia. In the
1957 Report, an outbreak of paralytic shell-fish poisoning was reported. The further
developments which have taken place in connection with this outbreak are described in
this 1958 Report in the section devoted to the Bureau of Local Health Services.
GENERAL
The Division of Public Health Engineering provides a consultation service to other
divisions of the Health Branch and the local health units on many matters dealing with
engineering in public health. During 1958 all the health units in the Province except
two were visited. During the visits to the health units, problems requiring engineering
knowledge for their solution were examined in the field.
The work entailed by the frozen-food locker-plant regulations was greatly reduced,
there being only two approvals of locker plants during the year 1958. It is not anticipated that this work will increase in the future. The day-to-day inspection of the locker
plants is a responsibility of the local health units.
The position of Chairman of the British Columbia Examining Board for sanitary
inspectors was again filled by the Director of the Division.
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. One meeting of this Committee was attended
during the year 1958.
The Division carried about half the lecture load in a two-week refresher course for
senior sanitarians held at the University of British Columbia in May, 1958. DEPARTMENT OF HEALTH AND WELFARE, 1958 J 43
REPORT OF THE DIVISION OF PREVENTIVE DENTISTRY
F. McCombie, Director
During the past year the preventive dental services of this Province have continued
to expand steadily. There have been no major changes in the policies of the Division of
Preventive Dentistry. Two additional communities commenced the controlled fluoridation of their water-supplies. Research included the epidemiological study of the present
dental-health status of the children in the three health unit areas of Vancouver Island.
The over-all availability of private-practitioner dental services to the people of British
Columbia likely continues to decrease.
PREVENTION
Within the areas of Greater Vancouver, Greater Victoria, and the Central Vancouver
Island Health Unit, preventive dental services were carried out by full-time dental officers
in nine school districts, as shown in the following table:—
Table I.—Full-time Preventive Dental Treatment Services in British Columbia, Shown
by Local Health Agency, School-years 1953/54 to 1957/58
o-a
0,8
u 3
Wo
■u 3
OH
za
h
SIS
&§|
Ph-oU
Grade I Pupils
School-year
c
•55
T3
U
SE
OU
(1)
Requiring No
j3 Treatment
^ when
Examined
C
'•3 J? .2
(3)
o g n
ls__
rs UT3
o"S
s'Ss
O H O
hOU
1953/54.	
1954/55_ 	
1955/56    •
1956/57   	
21
19
15
14
1,641
1,853
1,815
2,022
15,200
13,506
13,423
13,761
5,065
4,213
3,878
3,726
4,013
3,945
4,710
5,106
2,435
1,749
3,202
3,271
11,513
9,907
11,790
12,103
2,303
1,566
318
1957/58—
Central Vancouver Island Health Unit
Greater Vancouver Metropolitan
3
5
1
374
1,808
31
11,698
2,017
're-school
3,110
94
programn
4,566
1,021
ie
2,483
725
10,159
1,840
436
Board of Trustees, Greater Victoria
45
Totals— _ 	
9
2,213
13,715
3,204
5,587
3,208
11,999
481
Information not available.
The local agencies in the metropolitan areas who provide these services are autonomous, but received, through the Provincial Health Branch, significant grants-in-aid toward
the annual operating costs of these services. In the area of the Central Vancouver Island
Health Unit, the programme was sponsored by the Boards of Trustees of the school districts receiving this service, but with the greater share of the costs being borne by a
National health grant.
In addition, to improve further the quality of services being provided in the two
metropolitan areas by National health grants, various items of equipment were purchased.
To both were made available further dental X-ray units to assist in the early detection of
dental caries and of abnormalities of growth and development by the teeth and jaws. Also,
to Greater Victoria was provided a high-speed air-rotor dental unit which, it is believed,
will make possible more dental treatment to more children. This will be the subject of
further study.
Comparisons are rewarding between the records of the schools served by full-time
preventive dental clinics during the past school-year 1957/58 and for the school-year
1953/54—that is, four years ago when the present systems of recording were first effectively utilized. J 44 BRITISH COLUMBIA
In 1953/54, at the time of examination of Grade I pupils of such schools, 26.4 per
cent of these children did not require dental treatment. In 1957/58 this percentage was
40.7 per cent.
In 1953/54, of the Grade I pupils attending schools served by full-time preventive
services, 75.7 per cent either did not require dental treatment or subsequently received
the necessary treatment from their family dentist or the school dental clinic. In 1957/58
this percentage was 87.5 per cent.
There has, during these years, also been a most desirable trend in the change of
attention from the pupils of senior grades to the pre-school children. In 1953/54 the preschool children comprised 18.2 per cent of all children attending such clinics, and the
pupils of Grade II and above, 25.6 per cent. In 1957/58 these percentages were respectively 37.5 and 8.2 per cent.
In addition to these 2,213 pre-school children who received complete dental treatment during the past school-year at the full-time preventive dental clinics, a further 4,442
were dentally inspected. Of all pre-school children examined, 37.7 per cent did not require treatment. With these pre-school children, 3,506 parents attended and received
advice regarding the prevention of dental disease, especially dental decay.
The pre-school children attending these clinics for treatment each required and received, on an average, two hours and five minutes of a dentist's time for the necessary
treatment to be completed. They required, on an average, 8.9 tooth surfaces to be restored and 0.3 deciduous teeth to be extracted. Of these children, 57.5 per cent had
never before visited a dentist.
The Grade I pupils attending these clinics for treatment during the past school-year
required, on an average, two hours and twenty-three minutes to be completed. They
required, on an average, 11.3 tooth surfaces to be restored and 0.76 deciduous teeth to be
extracted.   Of these children, 51.1 per cent had never before received dental treatment.
In 1953/54, of the children attending the full-time preventive dental clinics, 87.3
per cent of the pre-school children and 58.0 per cent of the Grade I pupils had never before visited a dentist.
The quality of these services during the past school-year may be rated by comparing
the average number of tooth surfaces restored (the teeth being " saved ") with the average number of teeth extracted. More than seventeen tooth surfaces were restored for
every tooth, deciduous or permanent, extracted.
However, such is the demand and such is the need for these services that, although
the clinics operated to capacity, 30 per cent of the children applying for treatment could
not be accepted by these clinics.
In addition to the full-time preventive dental services, during the school-year 1957/58
community preventive dental clinics (Table II) operated on a part-time basis in each of
the seventeen health unit areas of this Province. These clinics were carried out in fifty-
two of the seventy school districts served by the health units, in one further organized
school district, and in three unorganized school districts. A full-time dental officer (as
noted above) provided preventive dental services to a further three school districts in the
Central Vancouver Island Health Unit.
Within the eighty community preventive dental clinics which operated during the
past school-year, 114 privately practising dentists co-operated on a part-time basis. The
majority of these dentists provided their services to the clinics in their own dental offices.
Other dentists either visited regularly from a neighbouring larger centre (once a week or
once a month) or stayed in the community for a definite period (a week to several
months) to provide the services necessary to the clinic. Such visiting services were made
possible by the issuance on free loan of transportable dental equipment purchased through
the National health grant programme. DEPARTMENT OF HEALTH AND WELFARE,  1958
J 45
Table II.—Part-time Preventive Dental Treatment Services (Community Preventive
Dental Clinics) in British Columbia, School-years 1953/54 to 1957/58
School-year
ber of Local
th Unit
s in Which
cs Operated
ber of
ol Districts
lich Clinics
ated
j.
o
*—i Is
00
a, +3 o.
•C.2'3
e 1 School
lment of
c Areas
e 1 Pupils
ally
pleted
Com-
d, Pre-
.1, Grades
and III
verage Grant
:r Child
Is 81
3 OJ C3
3o - a
i'HSS
Sc'S
"c_
rt J..S
nnS
i. u o
<_ £ Oh
za<u
Zk.SO
ZOO
ZQB.
Cm-cU
o«u
oao
H13»H
<a
1953/54	
16
29
49
58
n
3,906
(x)
4,055
$7.74
1954/55 	
15
35
55
64
1,553
5,166
2,601
5,777
7.78
1955/56 	
14
37
59
74
1,753
7,888
3,260
6,444
7.73
1956/57	
16
45
74
96
1,871
8,497
4,115
7,641
8.59
1957/58.   	
17
53
80
114
2,277
11,214
4,999
8,793
9.58
1 Information not available.
During the school-year 1957/58 a total of 8,793 children received all necessary dental treatment and chairside dental-health education through the community preventive
dental clinics. This was more than twice the number so treated and advised four years
ago during the school-year 1953/54, when there were forty-nine such clinics operating
in twenty-nine school districts.
Of the 11,214 Grade I pupils in the schools served by community preventive dental
clinics, 4,999 received complete dental treatment through these clinics. Such treatment
included examinations, with X-rays if necessary, prophylaxis, and all decayed teeth
either restored, if at all possible, or, if not, the necessary extractions. In addition, all
such children and very often at least one of their parents received advice as to how
dental disease and especially dental decay might be very greatly reduced. Many more
Grade I pupils received similar services from their family dentists as private patients.
In addition, through these community preventive dental clinics, a further 2,277
pre-school children were similarly treated and many of their parents counselled, and
also 1,517 pupils of Grades II and III.
However, of all children attending community preventive dental clinics during the
past school-year, only 6 per cent were recorded as not requiring treatment.
For the pre-school children, the average time required by the dentist to complete
the necessary treatment and counselling was one hour and forty minutes. For the
Grade I pupils the average time was two hours and five minutes; for the Grade II pupils,
one hour and twenty-five minutes; and for the Grade III pupils, one hour and thirteen
minutes.
It must be noted that the vast majority of pupils of Grades II and III had previously been dentally rehabilitated when in Grade I, if not as pre-school children, and the
Grade III pupils had also been treated when in Grade II. The average times for the
treatment of pupils of Grades II and III therefore approximate the time required to treat
dental disease which had occurred solely during the previous twelve months. If these
times are multiplied by the total school population of this Province, then some indication can be seen of the vast costs of endeavouring to provide, by any programme, dental
treatment to the 285,000 school-children of this Province.
The costs of community preventive clinics are borne by a local agency, often the
School Board, and such agency in some cases collects registration fees from parents of
children attending the clinic. All such sponsoring groups are reimbursed by grants-in-
aid from the Provincial Health Branch to the extent of 50 per cent of their remuneration to the participating dentists. This remuneration, as recommended by the British
Columbia Dental Association, was increased part way through the school-year 1956/57
and became universally accepted at the higher rate during the whole of the school-year
1957/58.   This increase is reflected in the average grant per child, which was $7.73 in J 46 BRITISH COLUMBIA
the school-year 1955/56, but $8.59 in 1956/57 and $9.58 in 1957/58. National health
grants have assisted to a considerable extent in making moneys available toward the
Provincial Health Branch share of the costs of these clinics.
Not only do children attending these climes and many of their parents receive
dental-health guidance in the dentists' offices, but also in conjunction with each such
clinic is carried out a programme of community dental-health education. Such programmes pay considerable attention to the teaching of dental health in the schools, especially in the primary grades. Assistance is provided to the teachers in the form of up-
to-date reference material, pamphlets for the children, posters, and the loan of suitable
films and filmstrips. Speakers from the local health unit staff or the local dentists are
arranged for P.-T.A. and service club meetings. Displays at schools, at appropriate
conventions, at fall fairs, and in store windows are promoted. In some areas, articles
are prepared for the local press, and interviews and talks presented by the local radio
station.
The calibre of these community dental-health educational programmes, of course,
varies. However, in reviewing the descriptions of all such programmes carried out during the past school-year and those planned to be carried out during the current year,
one cannot but be impressed by the improvement in the scope and quality of these educational programmes.
Perhaps, to some very considerable extent, this improvement may be attributed to
the assistance now being provided to the community preventive dental clinics by the
regional dental consultants. At the conclusion of the past year there were four such
dental officers providing consultative services to fourteen of the seventeen health unit
areas of the Province. It is hoped that during next year it may be possible to appoint
a fifth dental officer to provide similar services to the three northern health unit areas
of the Province. In these areas the preventive dental services now operating could, it is
believed, be similarly made more effective.
During the past year greater use has been made of part-time salaried clerical workers
to assist in the efficient administration of the larger community preventive dental clinics.
Thereby more effective utilization of the time of the participating dentists has been
achieved. These dental clinic co-ordinators assisted the educational programme by
providing to schools and participating dentists suitable dental-health educational aids,
such as pamphlets, posters, and reference material.
In summary, during the school-year 1957/58, preventive dental services were
organized in the two larger metropolitan areas and in each of the seventeen health unit
areas of the Province. These services were available in sixty-two of the eighty-two
organized school districts of the Province and in a further three unorganized school districts. Whereas the total Grade I population of the Province was 31,122 children, preventive dental services were available to 24,929—that is, 80 per cent. The Division
of Preventive Dentistry was first established close to ten years ago, early in 1949. At
that time, school dental services were operating only in Greater Vancouver and in
Greater Victoria.
RESEARCH
In 1955 a method was established whereby the dental-health status of children of
this Province could be efficiently determined and statistically evaluated. In 1956 this
method was applied to representative samples of children of Greater Vancouver, Greater
Victoria, and the Fraser Valley. In 1957 this method was further improved and reapplied to children of these three regions. The results were encouraging. It was therefore
decided that during the next three years this method should be applied to cover the
entire Province. Thereby will be made available, for the first time, base-line data to
establish the dental-health status of the school-children of this Province.   These surveys DEPARTMENT OF HEALTH AND WELFARE, 1958
J 47
will be continued in future years. Then will be possible the evaluation of the effectiveness of the preventive dental services of this Province.
During the past year, such surveys were carried out in Greater Vancouver and in
the areas served by the three health units of Vancouver Island. Plans have been finalized for such surveys to be carried out early in 1959 in the Fraser Valley and the areas
served by the three health units of the Kootenays. In 1960 it is planned to complete the
initial Province-wide survey by examining representative samples of children of Greater
Victoria, the area served by the Okanagan and South Central Health Units, and the
area served by the three northern health units of this Province.
Complete details of last year's survey have been prepared and published in cooperation with the Division of Vital Statistics in Special Reports Nos. 30 and 31, and
entitled "British Columbia Dental Health Survey, 1958," Parts I and II.
DENTAL PERSONNEL
Five years ago, in 1953, the ratio of dentists to population in British Columbia was
one dentist to every 2,041 persons. In 1958 the ratio was one dentist to every 2,360
persons. In other words, by 1953 standards, this Province in 1958 was short more than
100 dentists.
This situation may be alleviated to some degree by the more effective utilization
of ancillary personnel within the dental offices; also by the ever-increasing use of highspeed and ultra-high-speed dental equipment. However, it is believed unlikely, with
the ever-increasing population in British Columbia, that the availability of dental services
to the people of this Province will significantly improve until facilities for the training
of dental students are established at the University of British Columbia.
In the meantime the College of Dental Surgeons of British Columbia is continuing
to endeavour to attract adequately qualified dentists from overseas, especially Great
Britain, to emigrate to this Province. In addition, they constantly bear in mind the specific rural areas of the Province which are most inadequately served and endeavour to
encourage dentists to locate therein.
GENERAL REMARKS
During the past year a field dental officer returned to duty from postgraduate training. All four full-time dental officers of this Division have now received postgraduate
training and provide consultative services to the majority of the health units and community preventive dental clinics of the Province. The services, during the past school-
year, of the family dentists co-operating with these clinics were the equivalent of a further twenty full-time dental officers.
The present gap between the rate at which dental disease and abnormalities, especially dental decay, is to-day occurring in British Columbia and the services the dental
profession at its present strength can provide is a most serious problem.
Answers to this problem are available but await implementation. The demands
for their carrying-out must arise from all those citizens of this Province who believe that
the health of the future citizens—the children—is a goal worthy of their untiring efforts. J 48 BRITISH COLUMBIA
REPORT OF THE OCCUPATIONAL HEALTH DIVISION
J. L. M. Whitbread, Director
During 1958 steps were taken to clarify the position of the Occupational Health
Division of the Bureau of Local Health Services. The name of the Division was changed
from Environmental Management to Occupational Health.
The services given by this Division are varied. The four major spheres of endeavour
are: (1) Occupational Health, (2) Radiation Services, (3) Civil Defence Health Services, and (4) Employees' Health Services.
OCCUPATIONAL HEALTH
Many departments of the Federal and Provincial Governments are interested in
industrial firms, either with regard to a particular industry such as mining or for a specific
reason such as compensation. Lists of inspectors of other departments have been sent to
all local health units in order to assist them to contact these inspectors regarding their services and to offer any assistance and advice from the aspect of the over-all community
health.
In order to make available public health services to the working adult population
and to develop an integrated occupational-health programme in all firms, it has been
found necessary to introduce industry to local health departments. Personnel of local
health units have made a survey of all firms to obtain information about:—
(1) The existence of occupational-health facilities.
(2) The presence of any occupational hazards.
(3) The distribution and size of various industries throughout British Columbia.
This survey has familiarized the industrial firms with existing health facilities in the
community and has enabled the health unit director to become aware of the unmet needs
of occupational health in his area. To assist the staff in their survey, kits have been sent
out containing information on occupational hazards and advice on methods of developing
occupational-health programmes in various-sized industrial firms. These kits have also
been issued to all large firms employing industrial nurses. The results of the survey will
be available in 1959.
An investigation was made into the health requirements at the Oakalla Prison Farm
and the Haney Correctional Institution.
A pamphlet was prepared and issued to directors of health units on the construction
of new health unit buildings and has proved of considerable assistance during 1958 to
health unit directors, architects, and this Division.
RADIATION SERVICES
The issue and control of radioactive isotopes in Canada is the responsibility of the
Atomic Energy Control Commission, which acts on the advice of the Radiation Services
of the Department of National Health and Welfare. Information regarding the issue of
radioactive isotopes is sent to this Division and distributed to all local health units.
Copies are sent to the Workmen's Compensation Board. There are forty-two users of
radioactive isotopes in British Columbia, but most of these are research institutions or
departments of the University. Only thirteen industrial firms use radioactive isotopes
for industrial purposes. Considerable improvement has resulted in the control of the
use of radioactive isotopes due to the periodic check of the reports of the Monitoring
Film Badge Service. A team of the National Radiation Services, Ottawa, carried out
surveys in Vancouver and Victoria of some of the industrial firms using radioactive
isotopes.
All health units have been supplied with kits containing information about the various sources of radiation, their control, and the monitoring film service used to detect exces- DEPARTMENT OF HEALTH AND WELFARE,  1958 J 49
sive radiation from X-ray machines and radioactive isotopes. The Monitoring Film
Badge Service is supplied by the Department of National Health and Welfare (Radiation
Services) to all users of radiation sources for their protection against excessive exposure.
It has become more extensively used due to the efforts of the local health units in educating the hospitals and industrial firms in the need for such control.
Of the ninety-eight acute hospitals in British Columbia, seventy-two are using the
monitoring film service. Reports have been received and copies sent to all health unit
directors as well as to the Workmen's Compensation Board. Whenever there is evidence
of excessive exposure, investigations are made in the first instance by the Medical Health
Officers, and then later, if necessary, assistance is given to the health unit directors by
the Provincial Health Branch.
One danger to which the public may be exposed is the use of shoe-store fluoroscopic
machines. Due to an educational approach made by health unit staff throughout the
Province to the owners and managers of shoe-stores, a decrease in the use of these fluoroscopic machines from seventy in October, 1957, to thirty-eight in October, 1958, has resulted. These fluoroscopic machines are dangerous and are of little value in fitting shoes.
A gradual decline in their use is continuing due to the efforts in educating the public, as
well as shoe-store operators, in the disadvantages and dangers.
CIVIL DEFENCE HEALTH SERVICES
A plan was developed in 1958 to outline the civil defence health service requirements
throughout British Columbia. This plan included the evacuation of hospitals from target
areas to reception areas, the health care of evacuees en route and in reception areas, and
the establishment of advance treatment centres and casualty collecting units throughout
British Columbia to care for casualties that might result from either a local disaster or a
national disaster. The aim has been to plan for an integrated and co-ordinated civil defence health service throughout British Columbia.
In order to encourage the development of hospital disaster plans, exercises have
been held in local communities to practise hospital expansion. In a survey made during
the latter part of 1958, it was found that over one-third of the acute hospitals in British
Columbia had disaster plans for use in both local and national disasters. Hospitals
with disaster expansion plans will be supplied with some kits of emergency equipment
to assist them in coping with the extra load on their hospital.
A survey of all water, sewage, and garbage facilities in communities throughout
British Columbia was completed in November, 1958. This gives a picture of existing
facilities to all Civil Defence Health Services personnel and indicates the need for possible expansion of such facilities if and when evacuees are received in the community.
At the request of the Department of National Health and Welfare, copies of this information have been forwarded to them.
EMPLOYEES' HEALTH SERVICES
The reorganization of the Employees' Health Services has proved satisfactory.
Through the Civil Service Commission all employees were asked to fill in a form with
their health record. This applied only to employees of the Provincial Government working in Victoria. There were 2,102 cards received. This is approximately two-thirds of
the number of employees in the Victoria area. However, all new employees are required
to fill in this form, and a gradual accumulation of information will result. At present,
information is now readily available to the occupational-health nurse and to the physicians to enable correct treatment to be given if an employee becomes suddenly ill and
requires urgent treatment.
During 1958 assistance was given to the Canadian Red Cross Society Blood Donor
Service and two clinics were held in the Parliament Buildings—one in June and one in J 50 BRITISH COLUMBIA
December. One thousand two hundred and twenty immunizations against smallpox,
typhoid, diphtheria, and tetanus were given to employees. Of these, 510 were vaccinations against smallpox. Special clinics were held for employees whose vaccination status
indicated that a booster was necessary. Conferences are given to employees by the staff
of the centre to advise them on health problems, whether mental, emotional, or physical.
Limited treatments are given to patients on the request of private physicians. DEPARTMENT OF HEALTH AND WELFARE,  1958 J 51
REPORT OF THE SANITARY INSPECTION SERVICE*
C. R. Stonehouse, Chief Sanitary Inspector
Correction of existing nuisances, which was once the major problem in the sanitary
inspection field, is no longer the prime task of the inspector; the main emphasis is now
on preventive programmes. During the past year such programmes in the areas of food
safety, better housing, and improved community environment continued to develop and
expand, and the establishment of sanitary inspectors was increased to meet the demand
for increased service.
In order that the inspectors may keep abreast of recent technical advances in various
related scientific fields, which have a bearing on the conduct of their programmes, an
advanced training course was arranged. This was a two-week course at the University
of British Columbia, under the auspices of the Faculty of Medicine with the co-operation
of the Department of University Extension. Subject-matter included public health engineering, bacteriology, statistics, and ionizing radiation. The material on radiation was
preliminary to that which will be given in a further short course on civil defence radiological health to be held early in 1959.
MILK-CONTROL
The local Medical Health Officer and sanitary inspectors are milk inspectors under
the " Milk Industry Act." As stated in last year's report, the office of the Chief Sanitary Inspector provides liaison between these milk inspectors and the Deputy Minister
of Agriculture and the personnel of his Department in the enforcement of the bacteriological requirements of the Act. The arrangement worked with continued success during the past year. The bacteriological evaluations indicate a general improvement in
the quality of the milk available throughout the Province.
It was only necessary to prosecute five vendors for infractions, and the majority
of vendors are to be congratulated for their interest and co-operation which resulted in
the improvement.
FOOD-CONTROL
The spread of disease through food channels has been kept to a minimum, due in
large part to the fine record of performance exhibited by restaurants and other food
outlets. The sanitary inspectors continued to assist the restaurants to maintain this high
standard by carrying out routine inspections and participating in food-handlers' classes.
They also assisted the Travel Bureau, Department of Industrial Development, Trade,
and Commerce, in courses for tourist-camp personnel.
It is important that the inspectors be aware of developments of new methods of
merchandising as the techniques involved; for example, utilization of antibiotics and
radiation may have a bearing on food-protection practices. The inspectors in the field
were supplied throughout the year with relevant information by this office with the cooperation of the Division of Health Education.
SLAUGHTER-HOUSES
Annual inspections of slaughter-houses were carried out by local sanitary inspectors, and seventy-three certificates of approval were issued.
These approved certificates govern the sanitation within the slaughter-houses to
ensure that meat is prepared and dressed under sanitary conditions.
* This report concerns the services provided by sanitary inspectors under the jurisdiction of the Provincial Health
Branch and does not include the services provided by the metropolitan health departments of Greater Vancouver,
Victoria-Esquimalt, and Oak Bay. J 52 BRITISH COLUMBIA
INDUSTRIAL CAMPS
There were only two complaints about industrial camps during 1958, and this gives
a good indication of the high standard of accommodation and messing facilities in the
camps of this Province. The sanitary inspectors, however, continued to carry out routine inspections to assure that these standards were maintained, and gave advice and
guidance to those requesting it concerning standards for proposed new camps.
SUMMER CAMPS
The number of inspections of summer camps increased during the year. However,
a decrease in the percentage of those classified as good and an increase in the percentage of those classified as unsatisfactory pointed up a situation that will have to be carefully examined in the future if a higher over-all standard is to be obtained.
TOURIST ACCOMMODATION AND TRAILER COURTS
Throughout the year it became increasingly difficult to carry out responsibilities in
connection with this type of accommodation in unorganized areas. In addition, even
in organized areas, some difficulty was encountered with the problem of maintaining
sanitary requirements in the environs of trailer courts.
The situation was examined by the Health Branch, and the study resulted in the
promulgation of standards. It is now proposed that these standards become regulations,
and it is hoped that their enforcement will ensure a high sanitation standard in tourist
and trailer courts throughout the Province.
GENERAL
The Municipalities of Enderby, Castlegar, and Glenmore submitted health and
sanitation by-laws for approval as required by the " Municipal Act." The City of
Courtenay, by resolution of the Council, made the Sanitary Regulations applicable to
that municipality. DEPARTMENT OF HEALTH AND WELFARE, 1958 J 53
REPORT OF THE NUTRITION SERVICE
Joan Groves, Consultant
Nutrition is accepted as an important factor in the general health of people of all
ages, and health education is not complete without attention being given to nutrition as
part of its programme.
In British Columbia the Nutrition Consultant provides assistance and guidance to
those individuals and key groups who come into contact with and give direct service to the
public.
CONSULTANT SERVICE TO PUBLIC HEALTH PERSONNEL
Nutrition education is carried out by the public health nurse in prenatal classes, child
health conferences, home visits, and as health adviser to the teachers in schools. Assistance was given by visits to the health units, through departmental circulars, and by correspondence on such subjects as planning low-cost adequate meals, prenatal nutrition,
weight-control, infant-feeding, feeding the handicapped child, and on food selection in
general.
Rat-feeding demonstrations were encouraged as a means of showing children that
good food promotes health. These were carried out in various schools throughout the
Province and were arranged through the co-operation of the Animal Laboratory, University of British Columbia. Food-habits studies turn children's attention to the food they
eat and show where improvement is needed.
In co-operation with the nutrition consultant of the Greater Vancouver Metropolitan
Health Committee, the list of the names and prices of some vitamin supplements and baby
foods was revised for the use of the public health nurses.
CONSULTANT SERVICE TO HOSPITALS AND INSTITUTIONS
With the assistance and co-operation of the British Columbia Hospital Insurance
Service, increased service was given in this field. In addition to advice by correspondence
and personal visits to small hospitals, instruction in the form of a 4^-day institute for
food-service personnel was organized and held in Cranbrook. The institute consisted of
lectures, films, demonstrations, and discussions on nutrition, menu-planning, special diets,
food-purchasing, cost-control, sanitation, food preparation, and tray service. Valuable
assistance was given by the local health unit staff in dealing with sanitation, and by members of the regional group of the British Columbia Dietetic Association with lectures and
discussions. National health grants were used to assist in paying travelling and lodging
expenses of participants, relief cooks, and incidental expenses. The convenience of
accommodation in the nurses' residence, kindly made available by St. Eugene Hospital,
Cranbrook, added to the success of the project. The class consisted of seventeen full-time
and six part-time participants. Nineteen of these were from general hospitals, two from
private hospitals, and two from boarding homes. On several occasions, assistance was
also given by corespondence to summer camps, nursing homes, and a mining camp.
At the request of the Hospital Construction Division of the British Columbia Hospital Insurance Service, assistance was given with six hospital kitchen plans, and on several
occasions meetings were attended with architects and hospital administrators.
OTHER GOVERNMENT DEPARTMENTS AND AGENCIES
At the request of the Welfare Branch, assistance was given in the meal service of the
Provincial Home, Kamloops. A great deal of credit is due in this project to the former
dietician of Tranquille Sanatorium, who co-operated and assisted. In addition, the Welfare Branch received advice and material on low-cost food budgeting.   The British Colum- J 54 BRITISH COLUMBIA
bia Alcoholism Home, Haney Correctional Institution, the Dominion-Provincial Vocational Training School, Naniamo, and the G. F. Strong Rehabilitation Centre, Vancouver,
have all in the past year made use of the consultant service available to them.
OTHER ACTIVITIES
Co-operative activities still continue with the Vancouver nutrition group, which is
made up of nutritionists from the University of British Columbia, Greater Vancouver
Metropolitan Health Committee, Vancouver General Hospital, and other agencies. This
group works and plans together to deal with common nutrition problems.
A two-day nutrition conference on family nutrition was attended in July at the University of Washington, sponsored by the Schools of Home Economics and Nursing and
the Washington State Department of Health. DEPARTMENT OF HEALTH AND WELFARE,  1958
J 55
REPORT OF THE DIVISION OF VITAL STATISTICS
J. H. Doughty, Director
Two broad types of service are provided by the Division of Vital Statistics to the
general public and to other branches of government. The first of these deals with matters
of civil registration as laid down by the " Vital Statistics Act," the " Marriage Act," the
" Change of Name Act," and the " Wills Act." These Acts set forth a wide range of
registration and certification responsibilities which the Division must administer. The
second main function of the Division is to provide an extensive statistical service to the
Health Branch, to the Mental Health Services, to the British Columbia Cancer Institute,
and to other associated health agencies. The Division also compiles the formal vital statistics of the Province as derived from the registrations of birth, death, stillbirth, and
marriage.
The volume of work in most of the registration services of the Division was not
greatly different from that of the previous year. During 1958 over 67,700 certificates of
birth, death, marriage, and stillbirth were issued, a slight increase over the output of the
previous year. The majority of these documents were birth certificates, of which 56,316
were issued.   Over 6,900 death certificates and 4,500 marriage certificates were issued.
The number of new registrations received during the year decreased slightly from
1957. This was the first time since 1944 that there has not been an increase in the annual
volume of registrations received. Total registrations in 1958 numbered 69,031, compared with the figure of 69,855 for 1957.
Revenue-producing searches numbered 35,359, a small decrease from the 35,884
carried out in 1957. However, there was a marked increase over the preceding year in
the number of non-revenue searches. These numbered 46,564 in 1958, compared to
39,660 in 1957. Total revenue collected by the central office was $65,577, a slight
decrease from that for the previous year.
"VITAL STATISTICS ACT"
The registration of births, stillbirths, deaths, and marriages proceeded in a very
normal manner throughout the year, and indications are that virtually all vital events
occurring in the Province now become registered, as required by the " Vital Statistics
Act." Births which might otherwise go unregistered usually come to the Division's
attention through the Physician's Notice of Birth, and are followed up by the District
Registrar in whose area the events have occurred. Periodically, outstanding registrations
are investigated by the Inspector of Vital Statistics, and only in rare instances is it impossible to obtain the registration.
Applications for delayed registration of births which took place many years ago, at
a time when the registration requirements were less well known by the public, continue to
be received. The volume of these delayed registrations of birth during 1958 reached a
total of 473, compared with 380 during 1957. In most of these cases the birth occurred
prior to 1920. All applications for delayed registration of birth must be accompanied by
an independent verification of the date of birth and the parentage. In handling these
applications the Division adheres to the Canadian Minimum Standards of Evidence for
Delayed Registration, which were drawn up in 1944 as a means of ensuring the accuracy
of such registrations and their acceptability to other agencies.
Registrations of births, deaths, and marriages are records of vital events according
to the facts as they existed at the time of occurrence. However, supplementary information must be added to these registrations as a result of adoptions, divorces, legal changes
of name, and legitimations of birth.   Correction amendments to information originally J 56 BRITISH COLUMBIA
supplied must also be made in some instances. A notation of each such change is made
upon the original registration concerned, following which all amended registrations are
re-microfilmed and indexes amended accordingly.
In 1958, 1,362 adoptions were recorded, 1,650 divorces, and 146 legitimations
of birth.
"MARRIAGE ACT"
This Act sets forth the Province's control over the solemnization of marriage and
the legal preliminaries thereto. The issuance of marriage licences, the solemnization of
civil marriages, and the authorization and registration of ministers and clergymen to
solemnize marriage comprise the most important administrative responsibilities under
the Act.
The names of approximately 2,000 ministers and clergymen of various denominations appear on the register of those authorized to solemnize marriage. Approximately
300 names are added to the register each year as new ministers are ordained or appointed
or move into the Province. This number is nearly offset by retirements, deaths, and
movements out of the Province; a total of about 100 individual denominations are now
recognized under the " Marriage Act."
Three denominations obtained recognition under the Act during 1958, thereby
permitting their ministers to be authorized to solemnize marriage.
Fourteen orders of remarriage were issued in 1958 and three caveats were lodged.
"CHANGE OF NAME ACT"
The " Change of Name Act" sets forth the requirements which must be observed in
order that a person may change his or her name. 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. A notice of intention to apply for a change of name must be
published by the applicant in one issue of The British Columbia Gazette and one issue of
a newspaper circulating in the district where he resides.
The Act became effective in December of 1944, and up to the end of 1958, 5,799
legal changes of name had been granted.   Of these, 459 were approved during 1958.
"WILLS ACT"
By an amendment to the "Wills Act" in 1945 the Division was made responsible
for establishing and maintaining a registry for recording the location of wills. A testator
may, if he desires, file a notice with the Division stating the date and location of his will.
He may also file supplementary notices showing changes of location of the will or indicating the dates and locations of codicils to the will.
This service was little used during the first few years following its introduction, but
since the establishment of Court policy requiring that a search of the wills index be made
before the granting of probate or of letters of administration there has been a great
increase in utilization of the service. For the last several years the number of notices
received annually has exceeded the previous year's total by at least 10 per cent, and in
1958 the increase amounted to 22 per cent. Over 7,800 notices were received in 1958,
compared to 6,386 in 1957.
Upon satisfactory proof of death of the testator, an applicant may have a search
made of the wills index. The demand for wills searches also increased during the year,
with 6,966 searches having been made. This was a 7.5-per-cent increase over the
previous year's work. DEPARTMENT OF HEALTH AND WELFARE,  1958 J 57
MICROFILM AND PHOTOGRAPHIC SERVICES
The Division continued to microfilm all current registrations of births, stillbirths,
deaths, and marriages on a weekly basis and send the film to the Dominion Bureau of
Statistics in Ottawa. This is part of a contract which each Province has with the Federal Government, and which enables the Dominion Bureau of Statistics to compile national vital statistics and the national index of births, which is used for verification purposes by the Family Allowances administration.
In addition to filming all registrations, the Division has also made microfilm copies
of many supplementary records and files. During the year the monthly hospital returns
of births for 1957 were filmed, in addition to about 10,000 files of divorce orders and
miscellaneous files. Several hundred blue-prints were also placed on film for the Division of Public Health Engineering.
An important change was made in the method of splicing amendments into the
rolls of film containing birth records. This has simplified the location and identification
of individual imprints on the film rolls.
Extensive use was made of the Division's photographic services to provide photoprints of vital statistics registrations required by other agencies of government. Over
4,700 such prints were issued free of charge in 1958. In addition, 5,925 photoprints
were issued as certified copies, for which a fee of 50 cents each is collected.
GENERAL OFFICE PROCEDURES
Early in the year a new type of laminating-machine was installed as a replacement
for equipment which had been in use for ten years, and which was frequently suffering
from mechanical breakdowns. The new machine has permitted a marked improvement
in work-flow in producing the popular wallet-sized laminated birth certificates.
DISTRICT REGISTRARS' OFFICES
District Registrars of Births, Deaths, and Marriages are located in all main population centres of the Province as a means of providing vital statistics registration services
to the local residents. The same type of service is made available in a number of small
but isolated communities through the appointment of Deputy District Registrars. Population changes and patterns of travel are continually reviewed so that additional services
may be provided, if necessary, or appointments rescinded if they are no longer required.
No additional appointments were made in 1958, inasmuch as coverage was considered
to be adequate. However, the appointment of a Deputy District Registrar at Hudson
Hope was rescinded as there appeared to be no further need for a representative at that
point.
The Province is divided into seventy-three vital statistics registration districts, in
which are located ninety-two offices of District Registrars and Deputy District Registrars. The District Registrars and Deputies in forty-one offices are Government Agents
or Sub-Agents, while in twenty-four others they are Royal Canadian Mounted Police
personnel. In the remainder the District Registrar appointments are held by other Provincial Government employees, by Canadian Customs officers, and by private individuals.
In addition, the eighteen Indian Superintendents in British Columbia and the one in
Whitehorse, Yukon Territory, provide service for the Indian population in the Province.
A Marine Registrar, located in Vancouver, is responsible for obtaining registrations of
births and deaths for persons who are born or who die on board ships of British
Columbia registry while such ships are on the high seas. J 58 BRITISH COLUMBIA
VANCOUVER OFFICE
The office of the District Registrar of Births, Deaths, and Marriages at Vancouver
is located in the Provincial Health Building at 828 West Tenth Avenue and is staffed
by full-time employees of the Division.
Owing to the heavy concentration of population within the Vancouver registration
district, approximately 40 per cent of the registrations for the entire Province are received
through that office. In 1958, 12,025 births were registered with the Vancouver District
Registrar, 5,121 deaths, and 4,872 marriages. Civil marriages performed by the District Registrar numbered 867. Certificates of births, deaths, and marriages were issued
at the rate of approximately 1,000 per month.
INSPECTIONS
The offices of fifty-seven District Registrars and Deputy District Registrars were
visited by the Inspector of Vital Statistics. The areas covered by inspections this year
were the Lower Mainland, Fraser Valley, Okanagan, Kamloops, Salmon Arm, Revelstoke, and Vancouver Island.
The purpose of these inspections is to provide guidance to the District Registrars
and to ensure that the local administration of the Acts under the jurisdiction of the
Division is being correctly carried out. The visits also permit the Inspector to ensure
that medical practitioners, clergymen, funeral directors, and hospital personnel are fulfilling their responsibilities in connection with vital statistics registration.
The success with which registration services are carried out and the high standard
of registration attained in this Province are in large measure due to the splendid cooperation of the District Registrars, many of whom perform a number of other duties
in addition to gathering vital statistics. Appreciation is expressed to the District Registrars and Deputy District Registrars for their excellent work over the years.
STATISTICAL SERVICES
The Division continued to produce a wide range of vital and public health statistics and to provide a statistical service to other divisions of the Health Branch, to the
Mental Health Services, and to Government-supported health agencies. Close liaison
was maintained with the Faculty of Medicine of the University of British Columbia with
respect to the statistical aspects of several important medical studies. Several new statistical projects of considerable importance were put into operation during the year.
These included the statistical system for the new Mental Health Day Centre in Burnaby,
the statistical system for the Province-wide cytology service, and the statistical system
for the G. F. Strong Rehabilitation Centre, Vancouver. Work was carried out in cooperation with the Division of Public Health Nursing. These projects are described in
more detail below.
Toward the end of the year the efficiency of the Mechanical Tabulation Section
was improved by the replacement of an obsolescent type 405 tabulator by a more modern type 402.
As a means of promoting the more effective use of statistics produced by or available to the Division, a periodic intradepartmental bulletin was inaugurated in October.
This single-page release was published weekly for the remainder of 1958 and covered a
wide range of statistical topics pertinent to public health.
A member of the research staff of the Division returned from a year's postgraduate
study in bio-statistics at the University of Michigan. This training was financed under
a National health grant. DEPARTMENT OF HEALTH AND WELFARE,  1958
J 59
Vital Statistics
The Division is required by the " Vital Statistics Act" to prepare and cause to be
printed for public information a full statistical report on the births, deaths, marriages,
divorces, and adoptions which take place in the Province. These data for the year 1957
were prepared and it is planned to publish them as a separate report entitled " Vital
Statistics of the Province of British Columbia for the Year 1957." In addition, all of
the weekly, monthly, and annual indexes of births, deaths, marriages, stillbirths, adoptions, divorces, and changes of name which are required for the searching and certificate-
issuing functions of the Division were prepared by the Mechanical Tabulation Section.
Dental-health Statistics
Statistics of the third annual dental-health survey in the Province were prepared
by the Division and the results published in two releases in the Special Reports series
of the Division.
The sampling plan and sampling instructions for the 1959 survey were finalized
toward the end of the year. The Kootenay regions will be included in the surveys for
the first time in 1959.
The statistical techniques utilized in these surveys were presented as part of a
symposium on the British Columbia dental-health surveys at the combined meeting of
the Canadian Public Health Association and the Western Branch of the American Public
Health Association which was held in Vancouver in May, 1958. The methodology was
favourably received by the statistical and dental representatives from other parts of the
continent.
Additional service was rendered to the Division of Preventive Dentistry in assessing
the methods and the results of certain other studies which have been carried out relative
to dental health. -, „
Venereal-disease Statistics
The Division continued to produce the venereal-disease statistics of the Province,
on the basis of information which is received in coded form from the Division of Venereal
Disease Control. Statistics relating to the contact investigation activities of the Division
of Venereal Disease Control were also processed. Monthly reports of venereal-disease
notifications, quarterly reports on the investigation of contacts, and quarterly summary
reports were prepared for the Division of Venereal Disease Control.
A number of special assignments were also carried out for the Division of Venereal
Disease Control in connection with the facilitation study previously reported upon.
Public Health Nursing Statistics
With the gradual extension of home nursing-care programmes throughout the Province, a need has arisen for more complete and uniform information on this phase of local
health services. Plans were therefore made for the centralized collection and tabulation
of home-nursing care statistics, using the mechanical tabulation facilities of this Division.
The new system will go into operation on January 1st, 1959.
From this project will stem information on the number of individuals served, the
number of nursing visits made, the principal diagnoses of the patients served, and the
types of treatment service given. Although better and more complete information will be
derived from centralized statistical processing, the recording and reporting duties of the
nurses concerned will be reduced and simplified.
Arrangements were also made during the year to improve the processing and analysis of the annual time studies of public health nursing activities. The mechanical tabulation equipment of the Division will also be used in this connection, effecting a considerable
saving in clerical time and a speeding-up in the release of the results of the studies.
The Division continued to compile the routine administrative statistics respecting
the activities of the public health nursing field staff. J 60 BRITISH COLUMBIA
Cancer Statistics
The increasing attention which is being focused upon the cancer problem, particularly as a result of recent marked increases in the reported incidence of lung cancer, has
resulted in a greater demand for Canadian statistics on this disease. The National Cancer
Institute of Canada is attempting to obtain complete reporing of all cases in each Province
for at least one year in order that a complete incidence study for all of Canada might be
obtained. Fortunately, cancer statistics have been compiled in this Province for many
years, and the reporting system is designed to give a complete picture of the incidence of
the disease. However, in view of the particular requirement of the National Cancer Institute, special efforts are being made to improve cancer reporting wherever possible. The
new and simplified notification form referred to in last year's report was placed in operation on January 1st, 1958, and all physicians in the Province received a letter from the
chairman of the Special Diseases Section of the British Columbia Division of the Canadian Medical Association urging them to co-operate fully in the reporting of malignancies.
The Division provides a complete statistical service to the British Columbia Cancer
Institute and during the year prepared a number of tabulations required for a special
retrospective study at the institute. The institue made furher progress in abstracting its
files of cases treated, and it is hoped that in the near future the entire past and present
case load will be recorded on punch-cards in this Division. When this goal has been
reached, the Division will be in a position to be of greater service to the Cancer Institute in
connection with statistical studies.
Cytology Statistics
Reference was made in last year's report to the planning which had been under way
with a view to developing a statistical system for the cytology service operated by the
Vancouver General Hospital. Because of the large volume of cases handled and the
peculiar requirements of the statistical evaluation of this type of service, a number of difficult problems had to be overcome. A somewhat novel method of handling the cytology
reports for statistical purposes was recommended, and this method was put into effect on
January 1st, 1958. The system appears to be functioning quite satisfactorily, and the
few minor difficulties which were encountered at the outset were readily overcome.
The purpose of this statistical system is to provide a means whereby the efficacy of
the cytological smear technique in the detection of cancer of the cervix may be measured
and other factors relative to the work of the Cytology Laboratory may be evaluated.
Mental-health Statistics
The statistical system for the new Mental Health Day Centre in Burnaby was finalized and placed into operation during 1958. Due to the nature of the programme of the
Day Centre, the recording and statistical arrangements which are in use in the other
institutions of the Mental Health Services are not suitable for this unit. The system which
has been devised in co-operation with the medical staff of the Day Centre for the usual
administrative statistics and, in addition, will yield valuable medical information respecting treatments and results. The records of all patients who have attended the centre
since its opening in 1957 have been incorporated into these statistical records.
Although the project is specifically designed to accommodate the needs of the Day
Centre, care has been taken to ensure that the system itself, as well as the categorizations
and the coding definitions used, is in keeping with the over-all statistical programme of the
Mental Health Services. Certain features of the new system, particularly those relating
to the statistical assessment of treatments and patients, might have useful applications in
other institutions of the Services. To this end the new system is looked upon as a pilot
plan for producing these additional types of medical statistics throughout the entire Mental Health Services. DEPARTMENT OF HEALTH AND WELFARE, 1958 J 61
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.
Demographic Aspects of Mental Retardation
The Division was consulted regarding the methodology of setting up a project for
the study of institutional facilities and care for the mentally retarded in British Columbia.
An extensive investigation of the suitability of the different methods of estimating the
future population of mentally retarded individuals was carried out, and the report was
submitted to the Superintendent of The Woodlands School, New Westminster.
Tuberculosis Statistics
The extensive statistical commitments of the Division to the Division of Tuberculosis
Control were carried out during the year. Monthly, quarterly, and annual statistics on
tuberculosis were prepared and the annual indexes of known cases were tabulated in
both alphabetical and numerical form. In addition, a three-year analysis was made of
the data punched in connection with tuberculosis surgical cases.
An extensive series of statistics was prepared for the Regional Superintendent of the
Indian Health Services.
A study was carried out in the metropolitan health area of Vancouver relating to the
results of chest X-ray surveys. The data from this study were processed by the Division
and certain required statistical analyses prepared.
During the year the Division collaborated with the medical staff of North Lawn
Building at Essondale on two projects in connection with tuberculin reaction in mental
patients.
The first of these was concerned with the study of different types and concentrations
of B.C.G. vaccine in connection with their suitability for tuberculin sensitivity tests. The
population studied included patients at North Lawn and Woodlands. Considerable time
and effort was spent on the designing of a suitable code and code sheet for this programme. Punch-cards have been designed by the Division, and the data will be processed
when the work is completed.
The second of these projects was concerned with the study and the effects of age and
sex on tuberculin sensitivity in patients at the Home for the Aged, Coquitlam. The results
of this investigation were statistically analysed by the Division.
The Division was consulted by a committee consisting of representatives of the
Greater Vancouver Metropolitan Health Committee, the British Columbia Tuberculosis
Society, and the Division of Tuberculosis Control regarding a tuberculosis case-finding
project in Health Unit No. 1, which is believed to be the area of greatest prevalence in
the City of Vancouver. Again the Division was represented at most of the meetings of
this committee, and is carrying out the calculation of rates from the data that have been
collected so far.
Poison Control Centre Statistics
Arrangements were made during the year for the reports of accidental poisonings
which are received from all areas of the Province by the Poison Control Centre, Vancouver, to be forwarded to this Division for statistical processing.
Registry for Handicapped Children
The Registry for Handicapped Children now numbers over 11,000 cases. The
registry is working very closely with the Rehabilitation Co-ordinator in reviewing all
cases of children 14 years and over to determine their needs for assistance in becoming J 62 BRITISH COLUMBIA
self-supporting. Apart from the regular programme carried on in community organizations by the registry, it took active participation in preparing statistical data for the composite brief on education of the handicapped, which is being organized by the Guidance
for the Handicapped Section of the Community Chest and Council for presentation to the
Royal Commission on Education.
British Columbia Government Employees' Medical Services
The extension of the British Columbia Government Employees' Medical Services
to cover all employees resulted in approximately a 50-per-cent increase in the statistical
work which the Division carries out in connection with this service. Although the volume
of work in connection with this project will be considerably greater due to the increased
coverage, the morbidity statistics which accrue from the scheme will have a correspondingly greater value and stability.
These statistics are processed by the Division under an agreement which permits the
Division to utilize the morbidity tabulations which are prepared in resurn for providing
certain administrative statistics to the Employees' Medical Services.
G. F. Strong Rehabilitation Centre Statistics
Plans for developing a statistical system for the G. F. Strong Rehabilitation Centre
were first discussed in 1956. It was anticipated at that time that the system would
become operative in 1957. However, this was not found to be possible, and it was not
until 1958 that the system was fully set up and placed in operation. There appears to
have been very little done elsewhere in the field of rehabilitation statistics of the type
which were considered to be desirable for the Rehabilitation Centre. Consequently, a
good deal of experimentation and planning with the administrative and medical staff of
the centre was necessary in order to arrive at a workable and practical system.
The mechanical tabulation equipment of the Division is being used to process the
statistical records of the Rehabilitation Centre, and the Division will continue to give
consultant statistical help to the Rehabilitation Centre with respect to the statistics which
will be produced.
Staphylococcal Infection Pattern
The Division was consulted by a committee consisting of members of the staff of the
Health Centre for Children, the Division of Laboratories of the Department of Health
and Welfare, and the Greater Vancouver Metropolitan Health Committee regarding the
planning of a study of the staphylococcal infection pattern of families of children who are
admitted to the Health Centre for Children with overt staphylococcal infection. The
Division advised this committee on the limitations of punching this type of data and was
represented at most of the meetings. It was decided that the preliminary work would be
in the nature of a pilot study, and that the data collected would be insufficient for
mechanical processing.
Other Assignments
A number of other routine assignments which constitute an important part of the
statistical service of the Division were carried out during the year. These included the
statistics on the medical inspection of school-children, monthly statistical tabulations for
the Greater Vancouver Metropolitan Health Committee, the operation of the Province-
wide notifiable-disease reporting system, statistics of the obstetrical discharge study at the
Vancouver General Hospital, the preparation of monthly accident statistics for the British
Columbia Safety Council, and the provision of a statistical inquiry service to the general
public on all matters relating to vital and health statistics. DEPARTMENT OF HEALTH AND WELFARE, 1958 J 63
Vital Statistics Special Reports
Further additions were made to the Division's Vital Statistics Special Reports series.
These reports serve as a means of making available to public health personnel and other
interested persons statistical data prepared by the Division which do not appear in other
published reports. The following special reports were issued during 1958:—
Report No. 27, "British Columbia Dental Health Survey,  1957, Part II:
Dental Health Indices in the Health Units of Greater Vancouver and the
Fraser Valley and in the Municipality of Greater Victoria."
Report No. 28, "Statistics on Malignant Neoplasms in British Columbia,
1957."
Report No. 29, "Morbidity Statistics of the British Columbia Government
Employees' Medical Service, 1956."
Report No. 30, " British Columbia Dental Health Survey, 1958, Part I: Dental
Health Indices for Greater Vancouver and the Vancouver Island Health
Units."
Report No. 31, "British Columbia Dental Health Survey,  1958, Part II:
Dental Health Indices for Health Units in Vancouver Island, 1958, and
Greater Vancouver, 1956-1958."
Report No. 32, "Health Unit Statistics, British Columbia, 1957."
SUMMARY OF VITAL STATISTICS FOR 1958
In 1958 preliminary figures indicate the birth rate declined to 25.5 per 1,000 population from its peak of 26.1 per 1,000 population in 1957. The preliminary death rate
showed a further improvement over last year and was at its lowest point for almost a
quarter of a century. The rate recorded was 8.9 per 1,000 population, compared with
last year's figure of 9.2. The excess of births over deaths was 16.6 per 1,000 population.
The stillbirth rate was 10.9. the same as last year's record low figure. Marriages occurred
at the rate of 7.8 per 1,000 population.
For the third successive year there has been a decline in the rate of deaths from
heart disease per 100,000 population. Preliminary figures indicate a rate of 322.4,
compared with the 1957 final figures of 333.6. Cancer took 141.8 lives per 100,000
population, compared with 149.9 in 1957, and vascular lesions of the central nervous
system 99.7, the 1957 figure for this disease being 102.4. Thus there have been declines
in the rates of death for each of the three leading causes of death.
The fourth leading cause of death—accidents—also took fewer lives in 1958 than
in 1957, the rate this year being 62.4 and last year 67.7. The proportion of these accidental deaths that were due to the various specific causes did not change greatly from
1957 to 1958, except for drownings. Over 28 per cent were due to motor-vehicle accidents, 17 per cent to falls, and 7 per cent to conflagration. Drownings caused 13 per
cent of the accidental deaths in 1958 but only 11 per cent in 1957.
The death rate from pneumonia in 1958 was 42.7 per 100,000 population, down
slightly from the 1957 rate of 42.9. Diseases of the arteries took 18.9 lives per 100,000
population this year, compared with 19.5 in 1957.
Congenital malformations caused 12.3 deaths per 100,000 population in 1958,
compared with 11.8 in 1957, while suicides caused 11.1 deaths this year for each 100,000
population, almost the same rate as last year.
The rate of infant deaths in 1958, according to preliminary figures, was 27.6 per
1,000 live births, somewhat below the 1957 rate of 28.3. For three years the maternal
mortality rate per 1,000 births has remained unchanged at 0.4 death.
The tuberculosis death rate in 1958 was 4.6 per 100,000 population, compared
with 5.8 in 1957. As recently as 1952 the rate was 17.8, so that this year's rate represents a drop of about 75 per cent. J 64 BRITISH COLUMBIA
REPORT OF THE DIVISION OF PUBLIC HEALTH EDUCATION
R. H. Goodacre, Director
For this Division a noteworthy advance during the year was the employment, in
September, of a technical staff member to concentrate on the assessment of audio-visual
aids and written materials in relation to their use in public health programmes. Thus
Step No. 3 in the development of the divisional programme as outlined in the report
for 1956 was accomplished. Previously, Steps Nos. 1 and 2—namely, the introduction
of efficient systems and procedures and the acquisition of adequate clerical assistance,
both in connection with the library and the film and pamphlet operations—had been
successfully completed during 1957 and the early part of 1958.
AUDIO-VISUAL AIDS AND WRITTEN MATERIALS
Two inseparable problems in connection with publications distributed by the Department of National Health and Welfare continued to plague Information Services
Division (which produces the publications), this Division, and ultimately local health
services. These were the multiplicity of different titles and insufficient supplies to meet
Provincial requirements. The Director of Information Services Division, Department
of National Health and Welfare, fully cognizant that the national increase in population
and expansion of health education services continued to result in the diluted distribution of static quantities of publications, placed this matter on the agenda of the Seventh
Federal-Provincial Health Education Conference which met in Ottawa on October 1st,
2nd, and 3rd. At that time it was decided that each Provincial representative would
recommend to Information Services Division a list of staple items considered to be the
most educationally significant and which, it would be hoped, could be made available in
more adequate quantities. Thus funds spent on many of the current peripheral items
would, instead, be diverted to increased production of the more basic items.
This development coincided very satisfactorily with the move in this Province to
assess all educational materials distributed to and through local health units in terms of
their pertinent and productive application in organized health programmes. During the
last three months of the year, all dental-health materials were reviewed and substantial
progress made with respect to sanitation pamphlets. This assessment resulted in the
revision of some publications, the elimination of others, and, in the case of dental health,
the removal of some films and film-strips from the library. This approach, applied to
other areas in public health education, should continue to produce a further reduction
in the multiplicity of different publications both the Health Branch and the health unit
offices are required to stock.
It was mentioned in the report for 1957 that plans had been made to employ, for
a period of one year, a teacher to prepare a manual for the guidance of teachers engaged
in health instruction. The acquisition of such a person was approved by the Department
of National Health and Welfare as a project to be financed by National health grant
funds. However, following the conclusion of the recruitment competition, it became
apparent that consideration of further recruiting should be postponed until the beginning
of 1959.
IN-SERVICE TRAINING
On behalf of the Deputy Provincial Health Officer, this Division organizes the
Annual Public Health Institute, at which time public health workers throughout the
Province meet for a four-day staff-training course. As mentioned in the report of the
Bureau of Local Health Services, the 1958 institute was held in conjunction with the
combined meeting of the Canadian Public Health Association and the Western Branch
of the American Public Health Association.   Planning for the institute usually begins DEPARTMENT OF HEALTH AND WELFARE, 1958
J 65
five or six months beforehand; thus early in October initial arrangements were made
for the 1959 institute, which is scheduled for March 31st, April 1st, 2nd, and 3rd at
the Empress Hotel in Victoria. Earlier in the year Dr. J. F. McCreary, Professor and
Head of the Department of Pasdiatrics at the University of British Columbia, had been
approached to act as the main speaker.
A considerable proportion of time was devoted to the preparation and processing
of material issued in both the policy and records manuals, which are designed for the
guidance of Local Health Services personnel. This Division is now represented on the
newly constituted Policy Manual Committee, a group of three persons including the
clerical consultant and a public health nursing consultant, which is responsible to the
Deputy Provincial Health Officer as Director of Local Health Services.
Following discussions at the fall meeting of the Health Officers' Council, it was
decided to utilize the recently issued guide for the filing of correspondence as a basis
for a proposed revision of the reference filing systems in health units. Although the
general classifications did not perhaps conform with accepted library practice, it was,
nevertheless, decided that the adoption of this system would result in a closer degree
of uniformity with an existing filing system, both of which are operated by health unit
clerks.
PERSONNEL
The Province lost one public health educator during the year but gained another.
One resigned from the Metropolitan Health Committee in Vancouver to accept an appointment with the World Health Organization in Rangoon, Burma. However, a trained
public health educator, formerly of the Wellington County Health Unit in Ontario,
accepted an appointment with the British Columbia Tuberculosis Society. Although no
public health educators were recruited to the Division, the employment of a person
skilled in writing and in the uses of audio-visual aids was a most encouraging development.
During the past few years it has been necessary to eliminate a number of unfilled
public health education positions from the Departmental estimates. At the present
time, two positions, including that of the Director, are filled. One vacancy now remains,
and it is hoped that this can eventually be filled. J 66 BRITISH COLUMBIA
REPORT OF THE DIVISION OF TUBERCULOSIS CONTROL
G. F. Kincade, M.D., Director
The progress that is being made in the fight against tuberculosis has been apparent
for some time, and many statistics have been shown to support this fact. Related to this
progress was the closing of Tranquille Sanatorium after half a century of continuous operation as a tuberculosis institution. One of the first sanatoria to be built in Canada, Tranquille was located on property acquired in 1907 by the British Columbia Anti-tuberculosis
Society, and in November of that year the first ten patients were admitted to the institution.
In 1921 it was taken over by the Provincial Government and operated as a public institution since that time.
The institution reached its peak of occupancy during the Second World War years
and immediately after, and at its peak was taking care of about 360 patients. Following
the advent of anti-microbial therapy for tuberculosis, the demand for tuberculosis beds
in British Columbia began to decline. It was then possible to close some of the temporary accommodation for tuberculosis patients throughout the Province, and eventually the
declining needs were reflected in empty beds at Tranquille Sanatorium. Moreover,
patients began to refuse to leave the Coast and go to the Interior for treatment of tuberculosis, chiefly because they did not wish to be separated from friends and relatives. As
modern forms of transportation developed, and were based in Vancouver, it became
more convenient to transport patients from most areas to the Coast rather than to
Tranquille.
At the beginning of 1954 there were 350 patients under treatment at Tranquille
Sanatorium. The numbers gradually diminished, and at the beginning of 1958 there were
only 126 patients at the institution. During that time the institution had been closed floor
by floor and building by building, so that for the last six months only one of the three main
buildings was occupied. Through the normal turnover of beds at the Pearson Tuberculosis Hospital and the Willow Chest Centre in Vancouver, it was possible to take care of
the admissions and gradually absorb all the patients at Tranquille in the Vancouver institutions. The beginning of September, 1958, found only a handful of patients at the sanatorium, and these were readily cared for in the sanatorium beds available in Vancouver.
The last patient was discharged from Tranquille on September 23rd, 1958.
BED OCCUPANCY
Following the closure of Tranquille Sanatorium, there was considerable pressure on
the 367 Provincially operated beds in Vancouver tuberculosis institutions. For some
weeks these beds were completely filled, but no waiting-list was built up. Gradually the
demand for beds subsided, and at the end of the year there were 12 vacant beds in
Vancouver.
Experience has shown that there has always been an increased need for beds in the
early months of each year. However, it is anticipated that the demand will be met without
the development of a waiting-list.
The lessened demand for sanatorium beds has been brought about by improved
methods of treatment, with a shortening length of stay for the average patient and because
of fewer relapses with the present-day therapy. However, it has also been possible to
shorten the length of stay in sanatorium by continuing patients on out-patient therapy
after their disease has been brought to a satisfactory state of arrest while in sanatorium.
At the present time there are throughout the Province over 1,200 cases of tuberculosis who
are continuing their treatment at home, and many of these people are gainfully employed.
Out-patient therapy for tuberculosis cases is only possible because of the well-developed
local health service that exists. It is predicated on a close supervision of the patient and
administration of their anti-microbial therapy by health unit personnel. DEPARTMENT OF HEALTH AND WELFARE,  1958
J 67
For some years an increasing trend toward an ageing of the sanatorium population
has been noted, and this continues, as is shown by the following table:—
Age Distribution in Sanatorium
Date
50 Years
of Age
and Over
Total
Sanatorium
Population
Percentage 50
Years of Age
and Over
276
251
217
189
838
615
448
332
32.9
40.8
November, 1957                                                            	
48.4
November, 1958-.   _                                           	
56.9
Persons 50 years of age and over occupied 56.9 per cent of the sanatorium beds,
almost double the figure for 1952. The predominance of males, and particularly elderly
males, is evident. The males 50 years of age and over represented 65.8 per cent of the
male population, while the females 50 years of age and over represented only 33.3 per
cent of the female population. The females represented only 25.3 per cent of the sanatorium population, while the males represented 74.7 per cent of the population. It is
interesting to compare this situation with that of a generation ago, when the typical patient
in sanatorium was likely to be a young woman in her late teens or twenties. At that
time approximately 10 per cent of patients in sanatorium were 50 years of age and over.
To-day the typical admission patient is a man 50 years of age or more who is likely to be
a homeless drifter or alcoholic. The institutional aspects of tuberculosis have therefore
entirely changed. On the one hand, the most advanced forms of medical and surgical
treatment of a highly technical nature are provided and successfully used to cure tuberculosis. On the other hand, institutional beds are being increasingly used to house older
persons who are geriatric problems and whose tuberculosis is complicated by many unrelated conditions not associated with tuberculosis. These latter have proven difficult of
disposal once their tuberculosis has been adequately taken care of. In many, their complicating conditions are more serious than their tuberculosis and require institutional or
nursing care, but not necessarily in a tuberculosis sanatorium. However, by diligent
work on the part of the social workers and with the co-operation of municipal authorities,
it has been possible to place satisfactorily most of these people for after-care.
TUBERCULOSIS FIELD SERVICE
The changing trends in tuberculosis practice continue to emphasize the importance
of the control programme in the field. This is composed of two parts—that of the follow-
up and clinical supervision of known cases of tuberculosis, and that of the case-finding
programme to discover unknown cases in the community. This phase of the programme
is carried out by the diagnostic clinics. In the three larger centres of the Province (Vancouver, Victoria, and New Westminster) the service is provided by stationary clinics,
while in all the other areas of the Province travelling clinics are responsible for the work.
Clinical Supervision
There were 17,580 known cases of tuberculosis in British Columbia, excluding
Indians, at the beginning of 1958, all of whom were registered with the Division of
Tuberculosis Control and under the supervision of the local health units. These cases
are being watched carefully and periodically examined, as required by their tuberculous
condition. While the great majority of these cases are healed, they must be followed and
examined periodically because of the significant relapse rate in tuberculosis, particularly
amongst those cases treated before the present era of drug therapy. As already indicated,
there are over 1,200 cases, for the most part recently discharged from sanatorium, still on J 68 BRITISH COLUMBIA
drug therapy who must be carefully supervised. Moreover, the family contacts and close
associates of the known cases of tuberculosis must be followed and examined because it
is in this group that tuberculosis is most likely to develop. Another aspect of the work
of clinical supervision is the chest consulting service, which is provided by the clinics
throughout the Province on a basis that many unsuspected chronic chest diseases will
prove to be of tuberculosis origin.
Case-finding
Case-finding to-day is based on the principle of directing forces toward those areas
of the Province and those groups of the population which have a known high incidence of
tuberculosis. Special case-finding surveys have been held in high-incidence areas of the
Province, such as the Skeena Health Unit and in Vancouver. Certain groups of the
population are also given special attention. Such groups are contacts of known tuberculosis cases, older age-groups, homeless transient men, racial groups of high incidence,
inmates of penal institutions, persons at occupational risk such as hospital employees,
persons admitted to general hospitals, and those with certain medical indications such as
diabetes, pregnancy, and pleurisy.
The most important instrument for case-finding is the chest X-ray, but the tuberculin
test is rapidly assuming a more important place. In the use of chest X-ray it has been
necessary to become more selective as the incidence of tuberculosis in the population
decreased. One of the big problems in the case-finding programme recently has been
that of the radiation hazard.
Over the past two years there has been a great deal of discussion about the X-ray
radiation hazard. In view of the fact that this has been reported chiefly through the lay
press, and statements were not always accurately reported, a great deal of fear and even
panic has been created, not only in the public at large, but also amongst the medical profession. This, however, has not been without benefit because it has caused those responsible for the use of X-ray procedures to take a closer look at their work and to justify what
they are doing. As a result, it has been possible to improve techniques and to reduce
greatly the amount of radiation created in X-ray procedures. It has also led to more
selectivity in choosing cases for examination and thus reducing the volume of persons who
are exposed to radiation hazard.
However, in the field of tuberculosis the Division is convinced that the X-ray programme must continue.
There has been little decrease in recent years in the number of new active cases of
tuberculosis found, and the chest X-ray is the most important instrument for the detection
of this disease. To limit the number of X-rays taken, the following principles are
applied:—
(1) Closer selection of groups for examination.
(2) Confining routine X-ray examinations to not more than one per year.
(3) Elimination of X-rays under 16 years of age without a positive indication,
such as a positive tuberculin reaction, or a medical indication.
(4) The use of large chest X-rays for younger persons where routine chest
X-ray examination is necessary, such as student-nurses or interns.
(5) Screening; of pregnant women by tuberculin testing, with X-ray examination of only those who have a positive tuberculin reaction.
A great reduction in radiation has been brought about in the X-ray procedure by
confining the amount of X-ray disseminated from the source by accurate centring of the
X-ray beam and confining the area exposed to the limits of the X-ray plate. By this
means it has been possible to reduce harmful radiation by at least 75 per cent. The use
of faster X-ray films reduced radiation by another 50 per cent. More careful inspection
of X-ray equipment for radiation leaks and the shielding of operators and those in
adjacent areas have further controlled radiation. DEPARTMENT OF HEALTH AND WELFARE,  1958
J 69
Through all these devices it has been possible to reduce the gonadal radiation dose
in miniature X-rays to 0.26 milliroentgens. It has been stated by eminent authorities
that at this point the radiation hazard becomes practically insignificant.
The future indications are that while the miniature X-ray will always be an important
tool in tuberculosis case-finding, it will have a more and more limited use. It will be
gradually replaced by tuberculin testing in large-scale surveys, and only the positive
reactors will have chest X-ray examinations. This has not been possible in the past due
to almost universal tuberculous infection in adult life, but with only one-third of the
population now reacting positively to tuberculin testing, it is possible to eliminate the
other two-thirds from the necessity of having a chest X-ray.
By weighing the proven benefits of chest X-rays against the possible dangers, it
must be concluded that under the present circumstances X-ray surveys as currently carried out are necessary and should continue.
Tuberculin Testing
Tuberculin testing in British Columbia so far has been confined chiefly to the
younger age-groups, and particularly to the school population. During the past year
several tuberculin-testing surveys were carried out in schools in those areas where total
community tuberculosis surveys were being conducted and where the adults were examined by chest X-rays.  The following school surveys were done during the past year:—
School Tuberculin-testing Surveys
Number
Tested
Positive
Percentage
Positive
3,224
332
2,295
1,452
1,442
930
69
4
87
76
32
178
2.1
1.2
3.8
5.2
2.2
19.1
While tuberculin testing is not considered productive as a case-finding method, it
is one of the most reliable tuberculosis indices and indicates the amount of infection
that is present in any community or group and provides important epidemiological information to assist in the tuberculosis-control programme. It is probable that in the future
positive tuberculin reactors will be registered, much as known cases of tuberculosis are
to-day, and these cases will be followed regularly because the positive tuberculin test
indicates the people who are infected, and these are the ones in whom tuberculosis is
liable to develop.
The further expansion of the tuberculin-testing programme into the total community
tuberculosis surveys is undoubtedly a logical sequence. While it might appear that the
arrangements for both tuberculin testing and X-raying of positive reactors would be
more complicated than for mass X-ray surveys alone, this has not proven to be the
case. However, an educational programme for the public is necessary to condition
them to this approach.
It is felt that tuberculin-testing surveys should be the responsibility of the tuberculosis-control programme because it cannot be expected that local public health authorities
should take on this added responsibility. It has, therefore, been arranged that a tuberculin-testing team be set up within the Division of Tuberculosis Control. This team is
responsible for the provision of materials, the carrying-out of the tests and their reading,
as well as for the recording and analysis of the results. They also advise on the organization of the survey, but the actual organization is done by the local health authority
and other interested groups. J 70 BRITISH COLUMBIA
THE HOSPITAL ADMISSION CHEST X-RAY PROGRAMME
The hospital admission chest X-ray programme constitutes a major effort in case-
finding in this Province. For the first time since its inception, however, the programme
did not show an increase either in the total number of X-rays taken or the percentage of
admissions X-rayed, there being a 27-per-cent decline from the previous year. This has
been due partially to a change in policy, recommended by the Division of Tuberculosis
Control, that no person under 16 years of age have a routine chest X-ray, and that no
person should have a repeat routine chest X-ray under one year. During 1958, 57,926
miniature X-rays and 20,604 standard-size X-rays were taken in hospitals. This figure
represents 44 per cent of the total admissions to hospitals. The number of new active
cases of tuberculosis found in general hospitals, in common with the experience of all
other case-finding programmes, has continued to lessen. However, tuberculosis continues to be an important problem in the general hospitals, as evidenced by the fact
that in 1957 approximately forty active previously unknown cases of tuberculosis were
diagnosed and admitted to sanatorium from one of the larger hospitals in Vancouver.
Besides tuberculosis, this programme also reveals many other significant chest diseases,
such as lung tumours and heart disease.
The case-finding effort as expressed in terms of X-rays taken both by the units of
the Division of Tuberculosis Control and associated services is as follows:—
X-rays Taken in 1958
Standard-size X-rays—
Diagnostic clinics   33,097
Referred films  11,401
General hospitals—admissions   21,455
Total     65,953
Survey (miniature X-rays)—
General hospitals—
Admissions   46,971
Out-patients   16,885
Sub-total   63,856
Mobile units—
Provincial   25,954
Metropolitan Vancouver   50,408
Sub-total   76,362
Other X-rays—
Willow Chest Centre  19,868
Vancouver Island Chest Centre    7,160
New Westminster Clinic     7,483
Pearson Hospital        647
Metropolitan Health Committee
(stationary units)   25,296
Courtenay Health Unit        758
Sub-total   61,212
Total  201,43 0
Grand total   267,383 DEPARTMENT OF HEALTH AND WELFARE, 1958 J 71
TRAVELLING DIAGNOSTIC CLINICS
There has been a reorganization of the travelling diagnostic clinics of the Division.
It has been apparent for some time that changes were becoming necessary because of
changing practices in tuberculosis-control and changing population trends. With the
closing of Tranquille Sanatorium the Interior Travelling Clinic was therefore moved to
Vancouver, and it was decided that as far as possible all the travelling clinic services
would be amalgamated. As a first step, the Interior Travelling Clinic and the Coast
Travelling Clinic were integrated, and it is anticipated that in the near future the Kootenay
Travelling Clinic will also be brought under the same arrangement. With this realignment
it will be possible to make better use of all the staff—clerical, technical, and professional
—and to standardize the procedures that are carried out, thus improving efficiency. Dr.
F. O. R. Garner, formerly Superintendent of Tranquille, has been designated as the Senior
Travelling Clinician, and it will be his responsibility to direct and co-ordinate the travelling clinic services. With the increased emphasis on out-patient services and case-finding
throughout the Province, the travelling clinics represent a very important part of the total
tuberculosis-control programme.
COMMITTALS TO SANATORIUM
The policy of committing infectious cases of tuberculosis to sanatorium, when they
are proven public health hazards in the community and refuse treatment, continued to
prove an effective measure in handling this problem in 1958. (It should be emphasized
that this method is used only as a last resort after every other method of persuasion has
failed.) Since 1953 forty-two persons have been committed, representing less than 1 per
cent of the total admissions to sanatorium. At the end of 1958 twenty-two of the committal cases had been discharged and over 50 per cent showed a marked improvement in
their condition and had been rendered non-infectious. There were eleven of these cases
still in institution, and, of these, seven had been in under one year.
STUDENT-NURSES' AFFILIATION PROGRAMME
For about ten years it has been a requirement of the British Columbia Registered
Nurses' Association that all student-nurses should have an affiliation course in tuberculosis
nursing. To meet this requirement, all student-nurses were provided with a four-week
course in the Division of Tuberculosis Control. This course included not only classroom
instruction, but also actual experience in nursing patients on the ward. With the closing
of sanatorium beds, it was not possible to provide adequate ward experience. Moreover,
tuberculosis nursing practices have changed as patients became more ambulant as a result
of drug therapy. Besides this, the problems of nursing care in sanatorium to-day include
geriatrics, emotional and behaviour problems such as alcoholism and drug addiction, and
patients from penal institutions. As a result of these changed conditions, an investigation
was carried out by the British Columbia Registered Nurses' Association, and it was
recommended that the affiliation course be reduced to one week's duration. The course
now consists of one week of classroom lectures and demonstrations. The three nursing-
schools in the Lower Mainland are provided with these lectures at the Willow Chest
Centre. The two nursing-schools in Victoria and the one in Kamloops have their lectures
at their own schools with assistance from the staff of the Division of Tuberculosis Control.
This work is carried on by one nursing instruction in the Division of Tuberculosis
Control, the other instructor position having been eliminated.
Outside the Division of Tuberculosis Control many other agencies, both official and
voluntary, contribute to the tuberculosis-control programme. A great many volunteer
groups provide assistance for clerical work and in organizing the X-ray and tuberculin
surveys; others provide entertainment and comforts for the patients.   The Vancouver J 72 BRITISH COLUMBIA
Preventorium Society provides the only accommodation that exists for the hospital care
of children suffering from pulmonary tuberculosis. The British Columbia Tuberculosis
Society plays a major role in the campaign against tuberculosis, and in the past year has
extended its educational campaign by employing a professional educator to reorganize
and revitalize its effort in the field of tuberculosis education. Two full-time organizers are
also provided by the society for the promotion of tuberculosis surveys. Indirectly much
assistance is given in providing funds for community health centres and general public
health work. A complete programme of tuberculosis-control for the native population
of the Province is provided by the Federal Government through the Indian Health Services of the Department of National Health and Welfare, and excellent results are being
achieved.
The Division of Tuberculosis Control is greatly indebted to all who assist in the
campaign and who contribute so much to the success that is being achieved.
MORTALITY AND MORBIDITY
The preliminary 1958 tuberculosis mortality figure indicates a further decline in
deaths from this disease. In 1958 there were 71 deaths from tuberculosis, with a rate of
4.6 per 100,000 population, while in 1957 there were 86 deaths, a rate of 5.8 per
100,000. In 1948 the mortality rate for the total population was 40.9 per 100,000.
While all racial groups showed a marked decline in mortality from tuberculosis, the
Indian racial group showed the most spectacular decline. In 1948 the death rate for this
group was 557.1 per 100,000, with 156 deaths having occurred, and in 1957 the rate was
44.8 per 100,000, with 16 deaths. In 1958 the death rate was 29.5 per 100,000, representing 11 deaths. The majority of deaths from tuberculosis at the present time occur in
the older age-groups. In 1958, persons over 50 years of age accounted for 58 per cent
of the tuberculosis deaths. There were only 3 deaths in persons under 25 years of age.
The incidence of tuberculosis in 1958 was 62.6 per 100,000 and represented 943
new cases of tuberculosis outside the Indian population. In 1957 there were 1,112 new
cases of tuberculosis found in the same group, giving a rate of 74.8 per 100,000. The
total number of new active cases for 1958 stands at 406, compared to 414 in 1957. In
all age-groups the incidence of tuberculosis is lower in females than in males. Out of a
total of 943 new cases of tuberculosis, 554 were males, giving a rate of 71.2 per 100,000,
and 389 were females, giving a rate of 53.4 per 100,000. DEPARTMENT OF HEALTH AND WELFARE,  1958 J 73
REPORT OF THE DIVISION OF VENEREAL DISEASE CONTROL
C. L. Hunt, Acting-Director
The number of cases of venereal disease has shown a slight decline over the past
year. This decline is due to a decrease of approximately 400 in the number of cases of
gonorrhoea reported. Most of the cases of early infectious syphilis have been spread by
homosexual activity, which has become a major problem in venereal-disease control in
the Vancouver area.
An intensive drive has been carried out, with the help of the T.P.I, test, to locate and
treat all patients who can be regarded as latent syphilitics. In this campaign, as also in
the examination and treatment of patients suffering with gonorrhoea, the co-operation of
private physicians has been most helpful, as also has the assistance afforded by public
health physicians and nurses throughout the Province.
ADMINISTRATION
Minor changes have been carried out from time to time, always in an endeavour to
increase efficiency and to reduce expense.
The Victoria clinic has been placed under the immediate supervision of the Director,
Victoria-Esquimalt Health Department, and has been located in the Victoria Health
Department Building.
Clinic services to the male section of Oakalla Prison, which were discontinued in
1957, have been reinstituted on a modified basis at the express request of the Warden
and senior medical officer of the prison, because of the recent increase of venereal disease
among inmates.
Health unit directors have taken an increasing part in the management of venereal-
disease problems in areas outside of metropolitan Vancouver, and in certain cases have
been giving treatment services for this purpose. Such centres have been in operation at
New Westminster, Prince George, Prince Rupert, and recently in Victoria.
Venereal-disease services at Health Unit 1, in down-town Vancouver, have been
reduced from three clinics weekly to two. This action has been taken partly on account
of the smaller attendances at those clinics, and partly on account of a shortage of staff
employed by this Division. The clinic operating in the near-by Vancouver City Gaol
continues to provide valuable service in blood testing and in the diagnosis and treatment
of gonorrhoea in women.
CLINICS
More than 26,000 attendances have been recorded at the various clinics operated
by this Division in Vancouver, New Westminster, and Victoria during 1958. Of these,
approximately 5,000 were persons applying for routine blood tests for United States
immigration purposes. Another 5,000 attendances were recorded in clinics operated at
the various correctional institutions in and around Vancouver.
EPIDEMIOLOGY
Efforts to stem the spread of venereal disease have been concentrated in making
greater efforts to establish the identity of contacts and the more rapid rounding-up and
treating of such contacts.
Two meetings have been held during the year with representatives from the British
Columbia Hotels' Association, the Liquor Control Board, and various social-service and
law-enforcement groups in an effort to bring greater co-ordination into the venereal-disease control programme. J 74 BRITISH COLUMBIA
The Director of the Division, Dr. A. A. Larsen, has taken a year's leave of absence
to take up further special studies in epidemiology in the School of Public Health, University of Minnesota.
The close liaison between this Division and the Greater Vancouver Metropolitan
Health Committee has been maintained and possibly strengthened over the past few
months. The follow-up of cases and contacts in the Vancouver area has still continued
to be initiated by this Division, but the assistance provided by the nurse seconded to the
Division by the Greater Vancouver Metropolitan Health Committee has proved invaluable.
EDUCATION
The nurses' training programme within the Division has consisted of short intensive
courses of lectures and practical experience throughout the year for Vancouver General
Hospital nursing students and U.B.C. public health nursing students. Lectures have also
been given to nursing students at St. Paul's Hospital, Royal Columbian Hospital at New
Westminster, and to students at the Vancouver Vocational Institute, with short orientation periods for graduate public health nurses and others employed throughout the
Province.
Physicians' education has consisted of:—
(1) A course of lectures to fourth-year medical students.
(2) Employment of practising physicians on a one-year basis for the purpose
of carrying out the regular medical duties of the Vancouver clinics.
(3) The holding of regular monthly discussions with the medical staff on
venereal-disease subjects.
(4) The presentation of three papers on venereal-disease subjects to the fall
meeting of the British Columbia Society of Internal Medicine.
(5) The development of a new and up-to-date physician's manual on the
treatment of venereal disease.
(6) The employment throughout the summer of a third-year medical student,
the purpose of which was partly to provide him with special training and
with material for his final year's thesis and partly to supply this Division
with assistance in carrying out important routine duties as well as organizing and conducting specific research projects for the Division.
RESEARCH AND SPECIAL INVESTIGATIONS
Surveys have been conducted throughout the year as follows:-—
(1) The effect of Benadryl in preventing or ameliorating "post-spinal headaches."
(2) The effectiveness of Kynex and of Azotrex in the treatment of nongonococcal urethritis and penicillin-resistant gonorrhoea.
(3) The effectiveness of Ambodryl and Dimetane in the management of nongonococcal urethritis.
(4) The use of the T.P.I, test in determining the frequency of and the type
of case showing biological false positive reactions to the standard serological tests for syphilis.
(5) A survey of the effectiveness of the various methods used in the diagnosis
of latent syphilis, with suggestions for the best methods of concentrating
such efforts in the future (this survey has been conducted by Mr. Leonard
Archer, fourth-year medical student at the University of British Columbia).
(6) Various minor surveys relating to work loads in the clinics of the Division.
(7) A survey, in conjunction with the Provincial Laboratories, on the comparison between the T.P.I, test and the Reiter's T.P.C.F. test. DEPARTMENT OF HEALTH AND WELFARE,  1958
J 75
(8) An investigation by Dr. Ford into the causation and nature of Reiter's
syndrome.
(9) Investigations by Dr. A. A. Larsen and Dr. A. Atkins into the homosexual
problem in Vancouver. J 76 BRITISH COLUMBIA
REPORT OF THE DIVISION OF LABORATORIES
E. J. Bowmer, Director
During 1958 the main emphasis was on studying administrative procedures and
technical methods with a view to increasing the efficiency of the services provided by
this Division and curtailing unnecessary investigations. Improvements were introduced
into the recording and reporting methods of the laboratories. While the number of
tests performed during 1958 remained approximately the same as in 1957, there was
during 1958 a marked increase in the demand for the more time-consuming and technically more difficult types of investigation. Thus, although the total number of tests
performed was approximately 4 per cent less than in 1957, the actual work load was
1 per cent greater than in 1957.
Table I shows the total numbers of tests performed at the main laboratories during
the years 1957 and 1958, together with the unit values of these tests. The work loads
of the two branch laboratories are recorded in the same manner in Table II. DEPARTMENT OF HEALTH AND WELFARE,  1958
J 77
Table I.—Statistical Report of Examinations and Work Load in 1957 and 1958,
Main Laboratory
Unit1
Value
1958
1957
Tests
Performed
Work-'oad
Units
Tests
Performed
Workload
Units
Animal inoculations—
10
6
2
1
2
2
4
10
«
7
5
5
10
5
5
5
5
5
2
2
2
3
2
3
2
1
2
2
2
2
2
2
3
4
2
3
1
2
62
25
4
20
10
10
730
4
9,148
4,185
3,585
497
51
1,139
25,777
14,574
9,785
5,581
840
9,756
723
73
3,050
7,300
24
18,296
4,185
7,170
994
204
11,390
154,662
102,018
48,925
27,905
8,400
48,780
3,615
365
15,250
434
10
9,332
4,586
3,303
146
216
4,340
60
Blood serum agglutination tests—
18,664
4,586
6,606
292
864
Cultures—
27,207
11,130
9,184
4,272
521
9,822
673
81
2,443
1,644
27,886
21,822
5,385
372
213
2,635
2,035
168,473
2,143
25,420
2,722
45
376
1,934
2,695
4,925
4,571
3,209
492
1,161
9,282
57
12
14
2
108
163,242
77,910
C diphtheria   	
Hemolytic staphylococci and streptococci - -
45,840
21,360
5,210
49,110
3,365
405
12,215
8,220
Direct microscopic examinations—
28,703
20,493
5,284
381
181
3,375
2,528
147,437
1,714
19,313
2,284
44
246
890
559
4,998
4,506
3,263
410
1,535
9,943
I            120
160
13
57,406
40,986
10,568
1,143
362
10.125
5,056
147,437
3,428
38,626
4,568
88
492
1,780
1,677
19,992
9,012
9,789
410
3,070
59,658
3,000
640
260
55,772
43,644
10,770
1,116
426
7,905
4,070
Serological tests for syphilis—
Blood—
V.D.R.L    	
168,473
4,286
50,840
Cerebrospinal fluid—
5,444
90
Cerebrospinal fluid—
752
3,868
8,085
Milk and milk products—
19,700
9,142
9,627
Resazurin  	
Water-
492
2,322
46,410
Chemistry—
Water-
Full	
1,425
Partial	
48
B.O.D    _	
280
20
93
1           930
1,080
Totals _ 	
347,971
|    889,986
1
372,993
878,376
1 1 D.B.S. unit=10 minutes of work.
2 Unit value increased from 5 to 6 on January 1st. 1958. J 78
BRITISH COLUMBIA
Table II.—Statistical Report of Examinations and Work Load during the Year 1958,
Branch Laboratories
Unit1
Value
Nelson
Victoria
Tests
Performed
Work-load
Units
Tests
Performed
Work-load
Units
10
2
1
2
6
7
5
5
5
5
5
2
2
3
2
3
2
1
2
2
2
2
2
3
4
2
3
1
2
5
10
9
26
45
152
1,131
543
1,790
1,790
277
268
90
Blood serum agglutination tests—
429
84
858
84
52
Brucella group _ —   	
45
304
Cultures—
128
730
730
896
3,650
3,650
6,786
3,801
8.950
Hemolytic staphylococci and streptococci...   __.
8,950
1,385
3,995
540
496
1,340
799
270
248
Direct microscopic examinations—
401
1,131
13
4
430
802
M. tuberculosis (sputum and miscellaneous) —   .
2,262
39
22
133
42
3,178
25
44
399
84
3,178
50
8
1,290
Serological tests for syphilis—
Blood—
V.D.R.L _                      	
18,741
170
1,063
384
348
352
70
911
847
708
213
1,445
1,491
18,741
340
2,126
18
26
51
3,400
1,128
1,035
285
20
10,150
120
768
Cerebrospinal fluid—
9
13
17
850
564
345
285
10
2,030
12
696
704
210
Milk and milk products—
3,644
1,694
2,124
Resazurin   _._ __	
Water—
213
2,890
7,455
Totals •" ____ _   _.
—
10,953
|      34,157
34,753
77,709
Grand totals: Tests, 45,706; units, 101,861.
1 1 D.B.S. unit=10 minutes of work.
TESTS FOR THE DIAGNOSIS AND CONTROL OF
VENEREAL DISEASES
The demand during 1958 for examinations for the diagnosis and control of syphilis
decreased by approximately 15 per cent compared with 1957. This was due to the
discontinuation of two types of examination—namely, the colloidal gold test on cerebrospinal fluid and the complement-fixation test on specimens from new-born infants—
and a decreased demand for the standard tests for syphilis. The method of reporting
the results of standard tests for syphilis required by the United States immigration
authorities was improved. The ninth evaluation survey of sero-diagnostic procedures
organized by the Federal Laboratory of Hygiene was commenced.
The Treponema pallidum immobilization (T.P.I.) test was carried out on 240
sera in the first ten months of 1958, compared with 280 during the same period of 1957.
Of these, 47 per cent proved positive, compared with 61 per cent in 1957. The diminished percentage of positive findings reflected the less stringent criteria for the performance of this test which were introduced during the course of the year. A further study
using the Reiter's protein complement-fixation antigen was carried out. DEPARTMENT OF HEALTH AND WELFARE, 1958 J 79
Over 300 exudates from seventy-five patients were examined by dark-field illumination for the presence of Treponema pallidum. Nine patients were found positive in
the first ten months of 1958, compared with eighteen in the same period of 1957.
As in previous years, there was a small increase in the demand for microscopic and
cultural examination for Neisseria gonorrhoea;.
TESTS RELATING TO THE CONTROL OF TUBERCULOSIS
Although there was a slight decrease in the requisitions for microscopic and cultural
examination in the diagnosis and control of tuberculosis during 1958 compared with
1957, the past year was more difficult than any previous year. This was due to many
staff changes, requiring extensive training of new personnel. Two of the more time-
consuming examinations—namely, the investigation of " atypical" organisms and the
guinea-pig virulence test—showed substantial increases of 25 and 60 per cent respectively compared with the 1957 figures. This additional work more than compensated
for a 3-per-cent decrease in the routine investigations.
The introduction of additional investigations, including further tests in the study
of the increasingly prominent " atypical " organisms and sensitivity tests for selected
strains of Mycobacterium tuberculosis, was considered in detail.
The senior bacteriologist of the tuberculosis laboratory spent three weeks visiting
laboratories in Toronto, Montreal, and Saskatchewan to discuss and observe laboratory
methods in the diagnosis and control of tuberculosis and in the identification of intestinal parasites.
SALMONELLA, SHIGELLA, AND OTHER ENTERIC INFECTIONS
The total work performed in the enteric laboratory was greatly increased compared
with 1957. The total increase was approximately 15 per cent. This was due to the
highest demand in the history of these laboratories for cultural examination of stool
specimens and the occurrence of widespread small outbreaks of Salmonella and Shigella
infection. Furthermore, acute gastro-enteritis due to pathogenic strains of Escherichia
coli became a major diagnostic problem during 1958.
The total number of Salmonella? isolated from different individuals showed a marked
rise compared with 1957. The figures for the past three years were: 1956, 300 cases;
1957, 200 cases; and 1958, 340 cases. During 1958 twenty different serological types
were isolated, compared with twenty-two in 1957. The most common types isolated
during the first ten months of 1958 compared with the same period of 1957 were:—
Organisms
1. Salmonella typhi-murium	
2. Salmonella new port 	
1957
1958
89
162
17
51
23
23
11
16
3. Salmonella heidelberg	
4. Salmonella paratyphi B	
5. Salmonella thompson  21 8
6. Salmonella typhi     8 4
The high incidence of these Salmonella infections was due to widespread small incidents throughout the Province and not to large epidemics. Shigella organisms were isolated from 500 patients, compared with 100 in 1957. The average during the past few
years was roughly 250. These figures indicate the magnitude of the Salmonella-Shigella
problem in British Columbia and suggest that there are numerous reservoirs of infection
which are a constant hazard to the health of the population.
The importance of pathogenic Escherichia coli in the aetiology of acute gastro-enteritis in infants became apparent. The past year was the first occasion on which there was
any considerable demand for cultural investigation of stool specimens for organisms of J 80 BRITISH COLUMBIA
this group. Nearly 1,000 stool specimens were received from widely separated cities in
British Columbia, and 130 infants and young children were found to be infected with one
or, on occasions, two of the eight pathogenic sero-types of E. coli so far identified in this
Province. The technical skill required in the performance of these tests is considerable,
and diagnostic reagents are expensive. Three institutional outbreaks of enteritis occurred
in Vancouver, accounting for approximately fifty of these cases. The organisms isolated
from these children were E. coli 0111 :B4 and 0119 :B14.
The requests for serological tests in connection with the diagnosis of infections such
as typhoid and paratyphoid fever, brucellosis, and infectious mononucleosis showed a
decline of about 3 per cent. The estimation of the antistreptolysin-O titre, which was
introduced on a trial basis in 1957, was requested 350 times in 1958 and will therefore
be continued.
SANITARY BACTERIOLOGY
Examination of Dairy Products
The milk-sampling programme continued smoothly throughout 1958, with no increase in the number of samples submitted. During the four-month period May 1st to
August 31st, 1958, 165 milk shipments were received in these laboratories from out-of-
town health units. Only ten of these shipments were received at temperatures in excess
of the statutory limit of 10° C, and two of these resulted from unavoidable transportation delays. Cottage cheese samples were examined from dairies in metropolitan
Vancouver.
Bacteriological Examination of Water
The public interest in beach pollution of the Greater Vancouver area resulted in a
marked increase in the number of samples of beach water submitted for bacteriological
examination. In previous years, beach samples were submitted only during the summer
months, but arrangements were made in 1958 for an extended sampling programme,
resulting in an increase in tests of 10 per cent compared with 1957.
Bacterial Food Poisoning
There was little change in the demand for bacteriological investigations on food
substances suspected of causing food poisoning.
Streptococcus viridans was isolated on six occasions from a variety of food substances, and coagulase-positive Staphylococcus aureus was isolated on seven occasions
from salmon, egg pudding, turkey, and brawn.
OTHER TYPES OF TESTS
Diphtheria
Whereas Corynebacterium diphtheria; was isolated from seven individuals during
the first ten months of 1957, this organism was isolated on only one occasion during the
same period of 1958. The number of nose and throat swabs submitted for examination
showed a slight increase during 1958.
Parasitic Infections
Requests for examination for intestinal parasites increased by 30 per cent from
2,200 in 1957 to 2,900 in 1958. The following protozoal cysts were identified: Giardia
lamblia (60), Entamoeba coli (50), E. histolytica (10), and other intestinal cysts (10).
The following helminth eggs were identified: Trichuris trichiura (68), Clonorchis
sinensis (26), Hookworm (23), Ascaris lumbricoides (14), and other worms (10).
Pinworm eggs were identified in nearly 300 of the 1,500 N.I.H. swabs examined. DEPARTMENT OF HEALTH AND WELFARE,  1958 J 81
Skin-test antigens for the diagnosis of ecchinococcosis and trichinosis provided by
the Federal consultant parasitologist were issued to health unit directors and physicians.
Fungous Infections
The demand for cultural examinations in the diagnosis of skin infections was sustained. The dermatophytes isolated during the first ten months of 1958 included
Microsporum canis (29), Trichophyton rubrum (16), T. mentagrophytes (5), M.
audouini (3), and T. discoides (2). This was the first occasion for many years on
which M. audouini, the cause of a resistant type of ringworm, was isolated in British
Columbia.
Miscellaneous Tests
A study of the spread of staphylococcal infection in hospital and in the community
was commenced in collaboration with the Health Centre for Children. The aim was to
establish the infection state of family units, members of which were admitted to the
Health Centre with frank staphylococcal disease. Organisms isolated during the study
were examined by phage-typing.
Virus Investigations
Some fifty complement-fixation tests were performed using viral antigens provided
by the Federal Laboratory of Hygiene. These tests included the following antigens:
Psittacosis, Q fever, encephalitis, and mumps. The positive findings included one case
of psittacosis and two of mumps.
Thirty frozen specimens and appropriate sera were shipped to the Laboratory of
Hygiene for virus studies. The following cytopathogenic agents were isolated: Coxsackie
B-5 (5), Coxsackie B-4 (1), Coxsackie Group A (1), Poliomyelitis (4), and ECHO
virus type 6(1). Although these laboratory diagnoses were retrospective, they were of
considerable value to the health unit directors and to the attending physicians in
establishing the epidemiological and clinical attributes of these viral agents.
Chemical Analyses
The chemistry laboratory carried out approximately four times as many tests in the
first ten months of 1958 (270) compared with 1957 (70). With this increase in work
load the chemist required additional assistance in her section.
BRANCH LABORATORIES
The move of the Nelson branch laboratory to its new quarters in the Kootenay Lake
General Hospital was delayed until the end of the year. The work load at this branch
laboratory remained constant. The Assistant Director made a visit and inspection in
October and advised on the move. Both members of the staff visited the main
laboratories to discuss problems and obtain advice.
The Director made a visit to the Victoria branch laboratory at the Royal Jubilee
Hospital to discuss technical and administrative problems. The bacteriologist from the
laboratory attended the main laboratory for instruction. In view of the increased cost
of conducting public health bacteriological tests, the financial grant to the Royal Jubilee
Hospital was increased, with effect from April 1st, 1958. J 82 BRITISH COLUMBIA
GENERAL COMMENTS
The Division's staff-training programme, now in its third year, was continued, with
lectures on public health and related matters at intervals of two weeks during the period
September to April. Four courses for the instruction of student-technicians from the
four major hospitals in the Vancouver district in the techniques of serology were carried
out. Each course consisted of one week's instruction in the serology of syphilis and
other communicable diseases. Nine members of the staff gave instruction at the University of British Columbia in the Faculty of Medicine and in the Department of
Bacteriology.
A successful joint Laboratory Section meeting of the Canadian Public Health
Association and the Western Branch of the American Public Health Association was
held in Vancouver in May. In August the Director attended the annual meeting of the
International Northwest Conference on Diseases in Nature Communicable to Man, held
at the Rocky Mountain Laboratory, Hamilton, Mont. In December the Director
represented the Deputy Minister at the fourteenth annual meeting of the Technical
Advisory Committee on Public Health Laboratory Services in Ottawa and also attended
the annual meeting of the Laboratory Section of the Canadian Public Health Association
in Montreal.
The staff are to be congratulated on a good year's work. In spite of the high rate
of turnover in junior technical staff, the seniors have as usual willingly undertaken the
additional duties of instructing new staff. DEPARTMENT OF HEALTH AND WELFARE, 1958 J 83
REPORT OF THE REHABILITATION CO-ORDINATOR
C. E. Bradbury
CASEWORK OF THE REHABILITATION SERVICE
The humanitarian value of a rehabilitation service for handicapped persons is
recognized by everyone. There can be little argument that the economic value of a
rehabilitation service has an equal significance both for the individual who suffers
a disability and the community in which he lives. The statistical information which is
included in the following analysis of the cases which were closed during the past year
will help to establish both the humanitarian and economic result of the rehabilitation
work which has been done by the Rehabilitation Service.
Case Load of the Rehabilitation Service, December 1st, 1957,
to November 30th, 1958
Cases active at December 1st, 1957     72
Cases deferred at December 1st, 1957     19
Cases accepted, December 1st, 1957, to November 30th, 1958    68
Total  159
Cases closed, December 1st, 1957, to November 30th, 1958     72
Cases active at November 30th, 1958     87
Cases deferred at November 30th, 1958     16
Active case load at November 30th, 1958  103
The Rehabilitation Service was first begun in September, 1954, and from then to
November 30th, 1957, 147 cases were closed. Of these cases, seventy-three were closed
" rehabilitated " and seventy-four were closed " not rehabilitated." The definition of
" rehabilitated " is that the individual so classified has obtained gainful employment and is
financially independent as a result of rehabilitation services. Those classified as "not
rehabilitated " also have received a variety of rehabilitation services and a subjective
improvement almost always has been obtained, but gainful employment and financial
independence was not achieved.
In the period December 1st, 1957, to November 30th, 1958, covered in this report
a total of seventy-two cases were closed, as follows: Cases closed "rehabilitated,"
forty-four, and cases closed, "not rehabilitated," twenty-eight (one deceased).
Previous to December 1st, 1957, the average number of closed cases was forty-five
annually and the percentage was approximately 50 per cent rehabilitated and 50 per cent
not rehabilitated. In the year December 1st, 1957, to November 30th, 1958, seventy-two
cases were closed and the percentage was 61 per cent rehabilitated and 39 per cent not
rehabilitated.
The age-grouping of closed cases has remained relatively unchanged. At closure
the ages of the group were:—
Under 20 years     4 41-50 years  15
20-30 years  37 51-60 years     2
31-40 years  14 Over 60 years  	 I 84 BRITISH COLUMBIA
VOCATIONAL TRAINING
If any individual is to be successful in obtaining and keeping employment, attention
must be given to investigation of the individual's innate attitudes, aptitudes, and abilities.
Further attention must be given to the development of these qualities and the acquired
qualities of skill and knowledge. The experience which the Rehabilitation Service has
had to date indicates that the majority of physically disabled persons usually are no less
qualified for gainful employment in terms of innate abstract qualities than the non-
disabled. Non-disabled persons are often able to substitute strength or agility or mobility
for skill and knowledge in employment and perform satisfactorily. When strength or
agility or mobility is lost or impaired, compensation must be made and advantage taken
of the fact that skill and knowledge can be developed.
For these reasons, adequate vocational training resources are extremely important
in the field of rehabilitation. During the last year thirty-seven of the forty-four cases
closed " rehabilitated " received vocational training under the provisions of Schedule R
or M of the Canadian " Vocational Training Co-ordination Act." It is fair to say that
had the vocational training resources not been available, the majority of the thirty-seven
individuals would not now be employed.
Sources of Support at Referral
At referral 45 or 62 per cent were receiving public assistance for their support and
the support of their dependents. Twenty-one or 29.1 per cent were supported by parents,
relatives, or private resources, and six or 8.9 per cent were receiving Unemployment
Insurance.
Source of Support at Closure
At closure forty-four or 61 per cent were gainfully employed and financially independent, seven or 9.7 per cent continued on Social Allowance, eight or 11.1 per cent
were receiving Disabled Person's Allowance, and five or 6.1 per cent continued to be
supported privately.
Dependents
It is interesting to note that the forty-four rehabilitated individuals have forty-nine
dependents. The total number of persons affected favourably by the attention given
was ninety-three.
Annual Earnings of Cases Closed "Rehabilitated"
$500 to $1,000     3
$1,001 to $2,000  13
Over $2,000  28
In every instance when a case is closed "rehabilitated," an attempt is made to
obtain accurate information about the earnings of the individual. In the majority of
cases, when such information is requested it is given freely. In a few cases, however,
the individual considers such information as confidential, which is his privilege, and
refuses to give it. The occupation in which the individual is employed is known, and in
such cases an accurate estimate of earnings can be made.
Economic Factors
The amount of public assistance received by the individual at acceptance usually is
known to the Rehabilitation Service. It is known that the amount of public assistance
paid out to the forty-four rehabilitated cases and their dependents was $30,846 per year.
Public assistance can be, and frequently is, a recurring annual expense.    The funds DEPARTMENT OF HEALTH AND WELFARE,  1958 I 85
expended to rehabilitate an individual usually are not recurring expenditures. The
earnings of the forty-four rehabilitated cases are estimated to be $103,710 per year.
The economic values can easily be seen. As stated above, a total of ninety-three
individuals have benefited. The public purse has been relieved of an expenditure of
over $30,000 per year. The purchasing power of the individuals affected has been
increased more than threefold and the standard of living raised considerably, thus
improving the health and welfare of a group more than twice as large, because of
dependents, as the group to whom the services actually were given.
Three cases, not included in the statistical material presented above, are worthy of
mention. The Rehabilitation Service was asked for advice in these cases, in which the
bread-winner and husband suffered a disability that was severely handicapping and for
which medical science does not yet have an answer. In each case, with the advice and
assistance of the Rehabilitation Service, the usual role of the husband and wife was
reversed. Vocational assessment and vocational training for the wife were provided
under Schedule M to enable the maximum development of her earning potential. In each
case the wife and mother is now the bread-winner. The total number of individuals
affected in the three families is thirteen. While the income of each of the families is less
than it was, in each instance it is considerably better than the alternative of social
assistance, and the morale and financial independence of the families have been maintained. Consideration of the dependent handicapped person's family as a unit is an
aspect of rehabilitation which needs further examination and development.
Co-ordination
The casework activity of the Rehabilitation Service continues to receive major
attention because it is felt that the information gathered and the lessons learned through
casework are important and valuable in achieving co-ordination of services. The
Rehabilitation Service does not provide services directly to referred individuals but does
study the cases individually and recommends and arranges appropriate attention on behalf
of the patient from one or more agencies, government or voluntary. The Rehabilitation
Service then follows the patient through the rehabilitation process until a conclusion
is reached.
Through this method of operation considerable progress has been made in coordinating the rehabilitation activities of the various agencies on a practical basis to the
benefit not only of patients known to the Rehabilitation Service, but to other disabled
individuals as well.
Both the Rehabilitation Co-ordinator and the Medical Rehabilitation Consultant
are active in community committees and various official committees and boards which
have an interest in furthering rehabilitation work in the Province. In addition, regular
meetings are held with such agencies as the Registry for Handicapped Children, the
G. F. Strong Rehabilitation Centre, and the Training Selection Committee of the Department of Education. Meetings also are held with personnel of such agencies as the Social
Welfare Branch and the National Employment Service and other agencies as required.
In the latter part of the year the Rehabilitation Co-ordinator visited the North
Okanagan and South Okanagan Health Units. General questions pertaining to rehabilitation in British Columbia were discussed with the staff, and conferences were held with
respect to specific rehabilitation cases in which the health units were interested. It is felt
that the visit was most useful, and it is hoped that visits to other health units may be
planned for the future. J 86
BRITISH COLUMBIA
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 expenditure, process accounts for payment, account for revenue, forecast
expenditures, and prepare the Departmental estimates of revenue and expenditures in
their final form.
The gross expenditure of the Health Branch for the fiscal year 1957/58 amounted
to $7,632,756, being a decrease of $34,136 from the figure for the fiscal year 1956/57.
In the main, the decrease in expenditures was due to the discontinuation of in-patient
care services within the Vancouver Island Chest Centre, which responsibilities were
assumed by the Willow Chest Centre and the Pearson Hospital.
The following is a breakdown of costs of the main services, expressed in dollars
and as a percentage of total, comparing the years 1956/57 and 1957/58:—
Service
Gross Cost
Percentage of
Gross Cost
1956/57
1957/58
1956/57
1957/58
$3,437,921
1,827,067
775,371
355,563
451,924
205,830
259,143
253,160
100,913
$3,078,650
1,999,027
838,423
374,199
355,990
348,299
274,957
263,623
99,588
44.9
23.8
10.1
4.6
5.9
2.7
3.4
3.3
1.3
40.3
26.2
11 0
General administration and consultativ
. services  _
4.9
4.6
4.6
3.6
3.5
Division of Venereal Disease Control ___	
1.3
Totals    _	
$7,666,8921
$7,632,756!
100.0
!      100.0
1 This figure includes expenditures utilizing National health grant funds.
The Mechanical Superintendent and his assistant made quarterly visits throughout
the Province checking the mechanical condition of all Health Branch motor-vehicles.
There were 157 of these vehicles at March 31st, 1958, and during the year 1957/58 they
travelled a total distance of 1,087,092 miles in all types of weather and road conditions.
In addition, during the year Health Branch employees operated ninety-eight privately
owned vehicles on a mileage basis. They travelled a total of 696,902 miles in the course
of their daily duties.   The total mileage travelled for the year was 1,783,994.
The Mechanical Superintendent and his assistant continued to stress safety in the
operation of Branch vehicles on their trips throughout the Province.
Printed by Don McDiarmid, Printer to the Queen's Most Excellent Majesty
in right of the Province of British Columbia.
1959
630-1158-6578    

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