PROVINCE OF BRITISH COLUMBIA
Sixty-fourth Annual Report of the
Public Health Services
of British Columbia
HEALTH BRANCH
Department of Health Services and Hospital Insurance
YEAR ENDED DECEMBER 31st
1960
Printed by A. Sutton, Printer to the Queen's Most Excellent Majesty
in right of the Province of British Columbia.
1961
Wy2
The Honourable Eric Martin, Minister of Health Services and Hospital Insurance.
Office of the Minister of Health Services
and Hospital Insurance,
Victoria, B.C., February 21st, 1961.
To Major-General the Honourable George Randolph Pearkes,
V.C., P.C., C.B., D.S.O., M.C.,
Lieutenant-Governor of the Province of British Columbia.
May it please Your Honour:
The undersigned respectfully submits the Sixty-fourth Annual Report of the
Public Health Services of British Columbia for the year ended December 31st, 1960.
ERIC MARTIN,
Minister of Health Services and Hospital Insurance.
Department of Health Services and Hospital Insurance
(Health Branch),
Victoria, B.C., February 21st, 1961.
The Honourable Eric Martin,
Minister of Health Services and Hospital Insurance,
Victoria, B.C.
Sir,—I have the honour to submit the Sixty-fourth Annual Report of the Public
Health Services of British Columbia for the year ended December 31st, 1960.
G. F. AMYOT, M.D., D.P.H.,
Deputy Minister of Health.
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The Department of Health Services and Hospital Insurance consists of
three branches—the Health Branch, the Branch of Mental Health Services,
and the British Columbia Hospital Insurance Service. Each of these is headed
by a Deputy Minister under the jurisdiction of the Minister of Health Services
and Hospital Insurance.
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 Victoria-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 11
Bureau of Administration 14
Bureau of Local Health Services 16
Bureau of Special Preventive and Treatment Services 35
Voluntary Health Agencies 3 5
National Health Grants 39
Division of Public Health Nursing 46
Division of Public Health Engineering 54
Division of Preventive Dentistry 59
Division of Occupational Health 61
Sanitary Inspection Service 70
Nutrition Service 74
Division of Vital Statistics 76
Division of Public Health Education 85
Division of Tuberculosis Control 88
Division of Venereal Disease Control 99
Division of Laboratories 102
Registry and Rehabilitation Services 110
Accounting Division 114
Sixty-fourth Annual Report
of the Public Health Services of British Columbia
HEALTH BRANCH
Department of Health Services and Hospital Insurance
YEAR ENDED DECEMBER 31st, 1960
G. F. Amyot, Deputy Minister of Health and Provincial Health Officer
The Department of Health Services and Hospital Insurance consists of three
branches—the Health Branch, the Mental Health Services, and the Hospital Insurance Service. This Report deals with the Health Branch and, in the sections beginning on page 14, sets forth the year's events and trends as described by the heads
of the various bureaux and divisions. Some general observations are as follows:—
AREA AND POPULATION OF THE PROVINCE
The population in 1960 was estimated as 1,606,000. This was 36,000 above
the figure for 1959. Preliminary figures indicate that for the third successive year
the birth rate was slightly below that for the previous year, the death rate being
substantially the same as in 1959. The infant death rate declined to a new record low.
The total area of the Province is about 366,000 square miles, but by far the
greatest concentration of population is in the Lower Mainland area and the southern
tip of Vancouver Island. The population density in Census Division 4, which
includes Greater Vancouver, is close to ninety per square mile, while that for Census
Division 5, Vancouver Island, is slightly over twenty-two per square mile. Nowhere
else in the Province does the population density exceed ten per square mile, and in
the northern areas it is less than one. Despite the travel distances necessary to
render public health service in these areas of low population density, virtually everyone in the Province is served either by the public health facilities of the Province
or by one of the two metropolitan health departments of Greater Vancouver or
Victoria-Esquimalt. For the non-Indian population of the Province, about 45 per
cent is served by the metropolitan health departments and 55 per cent by the Provincial health service. All Indians, except those who have been enfranchised, are
provided service by the Federal Government.
THE HEALTH OF THE PEOPLE
There were only minor changes in the mortality rates for the principal causes
of death in 1960 compared with 1959. The 1960 rates per 100,000 population
were 350.0 for heart disease, 148.6 for malignancies, 103.5 for intracranial lesions
of vascular origin, and 65.2 for accidents.
Of the accidental deaths during 1960, 29 per cent were caused by motor-
vehicle accidents, 19 per cent by falls, 10 per cent by drownings, and 8 per cent by
poisonings. Over one-third of the non-transport accidents leading to death occurred
in the home.
For the third year the infant mortality rate was down from the figure for the
previous year, the 1960 rate being 24.6 per 1,000 live births compared with 24.9
in 1959.
11
K 12 PUBLIC HEALTH SERVICES REPORT, 1960
The maternal mortality rate in 1960 was 0.5 per 1,000 live births, slightly
above last year's rate of 0.4.
The mortality rate for tuberculosis was 3.7 per 100,000, compared with the
1959 rate of 3.4. This minor interruption is the first in the steady downward trend
of tuberculosis mortality since 1955.
There were twelve deaths from poliomyelitis this year, one less than in 1959.
No major outbreaks of communicable disease occurred. Several of the more
important diseases continued to be reported with increasing frequency, however.
There were 165 cases of paralytic poliomyelitis, an increase of thirty-three
cases over the number for 1959. Bacillary dysentery was responsible for the
greatest increase in morbidity with 1,192 cases, including one death. Salmonella
infection, principally from the eating of contaminated food, occurred with increasing
frequency, with 434 cases being reported. For the third year in succession there
were no confirmed cases of diphtheria. A total of twenty-five persons developed
typhoid or paratyphoid fever.
OTHER IMPORTANT EVENTS AND TRENDS
During the year it was possible to meet the requests of a further fifteen communities for the inclusion of home nursing-care programmes in their regular generalized public health nursing service. This brought to twenty-six the number of centres
receiving the additional service, which emphasizes rehabilitation in the community
rather than in hospitals or institutions.
The home nursing-care programme was co-ordinated with the service provided
by the Victorian Order of Nurses in certain areas, and financial assistance was given
to the Order for this purpose.
National Health Grants, matching Provincial Government funds, and contributions from municipal governments, service clubs, and voluntary agencies were again
used in the construction of community health centres. Seven such centres were
completed in 1960, bringing to fifty the number built under this plan since it was
brought into effect in 1951. In addition, five other communities started construction of health centres during the year.
For a number of years the Employees' Health Service has been available to
Provincial Government employees in Victoria. The service is designed to assist
employees to attain and maintain good health in order to promote job efficiency.
It includes advice and consultation on all health matters of employees and their
families. Toward the end of the year, National Health Grants were used to employ
another public health nurse and purchase the equipment necessary for conducting
the programme in Vancouver, where there is also a relatively large concentration of
Provincial Civil Servants. As soon as adequate accommodation is made available,
the service should develop quickly in meeting the needs of employees and their
supervisors.
Over nine years ago the Registry for Handicapped Children was established as
part of the Provincial health services. In addition to providing a valuable measure
of the nature and extent of the problems and pointing up the facilities required for
dealing with them, it has stimulated appropriate action in the care and management
of cases which might otherwise have gone unattended. During 1960 two changes
were effected. First, the age limit of 21 years was eliminated and the title changed
to the Registry for Handicapped Children and Adults. Second, the Registry was
integrated with the rehabilitation programme and a Director of Registry and Rehabilitation Services was appointed.
GENERAL STATEMENT
K 13
«S»g&!'a«J§§
The public health nurse and a typical British Columbia community.
In the field of rehabilitation itself, vigorous study and planning were continued
during the year. In preparation for developments in this important work, the
Director of Registry and Rehabilitation Services visited the United Kingdom and
other European countries, with the aid of National Health Grants, to confer with
world leaders in rehabilitation and to observe their programmes in operation.
The end of 1960 saw the completion of one full year's experience with the
programme of minimal patient-care in the Division of Tuberculosis Control. Under
this plan the patients take as much responsibility as possible for their own care.
The results have been beneficial. The rehabilitation process and preparation for
discharge have been speeded up, to the advantage of the patient. The cost of
patient-care has been reduced without lowering the standard of service.
Again the voluntary agencies, the professional groups, local authorities, and
the other departments of Government provided great help and co-operation in their
relations with the Health Branch. To these and to his fellow-workers of all categories in the Health Branch, the Deputy Minister of Health expresses his sincere
appreciation.
The sudden death of Dr. Stewart Murray, Senior Medical Health Officer of
the Greater Vancouver Metropolitan Health Committee, occurred on September
23rd, 1960. For many years he was one of Canada's best-known public health
leaders, and his relationships with the British Columbia Provincial Government
health services were particularly close. His great ability and experience in public
health, together with his unfailing kindness and good humour, make his loss a
serious blow.
K 14 PUBLIC HEALTH SERVICES REPORT, 1960
REPORT OF THE BUREAU OF ADMINISTRATION
A. H. Cameron, Director
As the chart on page 7 shows, the Bureau of Administration includes the central administrative offices, the Division of Vital Statistics, and the Division of Public Health Education. These are grouped together because they serve all other
parts of the Health Branch. Separate reports concerning the Divisions of Vital
Statistics and Public Health Education appear elsewhere in this volume, however.
The Bureau Director, who is a member of the Health Branch's central policymaking, planning, and administrative group (the Deputy Minister and the three
Bureau Directors), is concerned particularly with non-medical administration.
During the year the Department of Public Works did much to improve the
physical accommodations in certain Health Branch buildings. As anticipated in
last year's report, the seventh (top) floor of the Health Branch's Provincial Health
Building in Vancouver was completed, and some of the offices have been occupied
by the Deputy Minister of Mental Health and his headquarters staff. From the
Health Branch point of view, one great advantage has been the even closer working
relations with the Mental Health Services.
Another welcome improvement took place at Pearson Hospital in Vancouver
in the fall, when landscaping was undertaken. This has undoubtedly improved the
morale of the patients of the Tuberculosis Hospital and the adjacent Poliomyelitis
Pavilion. Other developments included alterations to the ambulance entrance and
the apparent solution of a problem of leaking roofs.
At the Poliomyelitis Pavilion, a temporary storage building was constructed.
This has done much to alleviate the problem stemming from the fact that some
patients in the Pavilion require three types of bulky equipment—ordinary hospital
bed, rocking bed, and respirator—which must be readily available.
Also at the Poliomyelitis Pavilion, improvements were effected in the system
of electrical supply, a most important feature in any hospital and a particularly
important feature in this hospital, in which the operation of the respirators depends
upon the electrical system.
In the Victoria offices, the main problem continued to be a shortage of space.
Some relief from this was brought about near the end of the year when alterations
at the Topaz Avenue vault made it possible for the Division of Vital Statistics to
store more of its records there.
The growing population and the extension of the home care programme
required increases in the staff of local health services. The additional appointments
were casual in nature, the salaries being derived from National Health Grants or
the soecial Provincial budget item for home care.
The efficiency of the professional, technical, and administrative services in any
organization is improved by training. Since the inception of the National Health
Grants programme in 1948, the Health Branch has been fortunate in having funds
available for this purpose.
In 1960 fourteen Health Branch employees completed postgraduate training
at university and sixteen employees commenced such training. (These figures do
not include training provided to personnel of hospitals, the Mental Health Services,
and other agencies.)
As in previous years, in-service training in the form of weekly or monthly staff
meetings helped to raise the level of staff knowledge. The Annual Public Health
Institute, held in Victoria in April, was a more formal means of achieving this aim.
ADMINISTRATION
K 15
The principal speaker was Dr. H. L. Dunn, Chief, National Office of Vital Statistics,
U.S. Public Health Service.
The Federal Government effected some reorganization of the National Health
Grants structure in 1960. Two grants, the Venereal Disease Control Grant and the
Laboratory and Radiological Services Grant, were, in effect, absorbed into the
General Public Health Grant. The Medical Rehabilitation Grant and the Crippled
Children Grant were combined.
The Assistant Provincial Health Officer, who is stationed in Vancouver, has
the prime responsibility for the administration, in British Columbia, of the National
Health Grants programme under the direction of the Deputy Minister of Health.
Details of the 1960 experience are presented in the Assistant Provincial Health
Officer's report, which appears later in this volume. However, it is interesting to
note here that approximately 25 per cent of the gross expenditures of the Health
Branch for the fiscal year ended March 31st, 1960, were made using National
Health Grants.
During 1960 reciprocal agreements for the care of tuberculosis patients were
continued with Alberta, Saskatchewan, Manitoba, Ontario, and Quebec. The per
diem rate in each case remained unchanged at $8.
For varying lengths of time during the year seventeen British Columbia cases
were hospitalized in other Provinces (Alberta, ten; Saskatchewan, one; Manitoba,
one; and Ontario, five). At the end of the year, only three of these were still in
hospital. The number of cases from other Provinces who received care in British
Columbia tuberculosis institutions was eight (Alberta, three; Ontario, two; Manitoba, three). At the end of the year, none of these was in hospital.
K 16 PUBLIC HEALTH SERVICES REPORT, 1960
REPORT OF THE BUREAU OF LOCAL HEALTH SERVICES
J. A. Taylor, Director
ORGANIZATION AND DEVELOPMENT
The objective of a uniform standard of public health service for the Province
as a whole has continued to be the goal of the Bureau of Local Health Services.
This administrative function requires that numerous contacts be established and
maintained between the several areas of field service at the local level and the various specialized divisions within the Health Branch, with an over-all consultative,
supervisory, and advisory role through this Bureau. In the performance of this
service, consultants attached to the individual divisions throughout the Department
make periodic visits to each health unit area to confer on specialized programmes
while proffering advice and guidance on the many routine services.
Administration of local health services through an organized health unit was
first introduced into this Province in 1921 and has since spread to all areas of the
Province containing centres of population. The seventeen Provincial health units
plus the autonomous city health departments in Vancouver and Victoria and the
public health nursing districts serving Kitimat and Ocean Falls constitute the public
health services for British Columbia. The concept of a union of municipal and
school health services to serve several municipal areas and several school districts
was designed primarily to provide full-time health services to towns and school districts that, because of size, could not of themselves provide a basically recognized
standard of public health services and preventive medical programmes to their
people. Adaptation of this same concept to a city health department was early
contemplated and applied to a metropolitan health department in the development
of the Greater Vancouver Metropolitan Health Service, which became organized
in 1936. This organization provided for the City of Vancouver, the City and District Municipality of North Vancouver, the Municipality of West Vancouver, the
Municipality of Burnaby, the Township of Richmond, and the school districts in
those areas the unification of their health services under a Metropolitan Health Committee and the administration of these services through six health units. This innovation in metropolitan health service administration, loosely conceived through a
metropolitan health agreement and viewed with some skepticism by health administrators, has developed an enviable record in service to the Greater Vancouver
residents, keeping pace with the population growth and the changing trends in preventive medical practices. In large part, success in this was due to the splendid
leadership and administrative guidance of the late Dr. Stewart Murray, whose ability
to weld divergent groups in a concerted coalition did so much to promote the project
and demonstrate its effectiveness. His sudden death was a sad loss to public health
as he was recognized as being one of the noted public health leaders, not only in his
own city, but also throughout Canada and in the United States. The Greater Vancouver Metropolitan Health Service remains as a monument to his memory.
A demonstration of the effectiveness of a metropolitan health administration
shown by the Greater Vancouver Metropolitan Health Service led to consideration
of a similar type of administration for the Greater Victoria area. Several previous
proposals could not gain sufficient support to permit serious negotiations; however,
the latest move, commencing over a year ago as a result of the avowed desire of
the Greater Victoria School Board (School District No. 61) for some uniform
administration of school health services, led to prolonged negotiations, which were
LOCAL HEALTH SERVICES
K 17
continued throughout the year at meetings chaired jointly by the Deputy Minister
of Education and the Deputy Minister of Health. While organized public health
services are available to the communities and school districts throughout the Greater
Victoria area, it is felt co-ordination of these services is desirable in the interests
of uniformity in administration, and it is proposed that a metropolitan health service
be developed to provide co-ordinated health services to the 162,000 residents in
the Lower Vancouver Island area, which would include:—
Location
Population
Present Service
64,000
11,500
15,700
46,000
2,700
1,600
20,800
\ Victoria-Esquimalt Health Department.
1
1 Saanich and South Vancouver Island Health
r Unit.
J
Village of Sidney
Unorganized area
In the interests of a co-ordinated administration, the municipalities and School
Boards would execute an arrangement for a metropolitan board of health, composed of representatives from the already existing Union Boards of Health (Victoria-
Esquimalt, Saanich and South Vancouver Island) in association with representatives
from the Municipality of Oak Bay and the School Board for School District No. 61.
Following the organization of a metropolitan health department, personnel employed
within the existing services would be absorbed into the department as far as possible, with the addition of some senior administrative personnel. Actually, it is
proposed the staff would consist of a Senior Medical Health Officer, two Assistant
Medical Health Officers, a Medical Examiner, a Director of Public Health Nursing,
a Supervisor of Public Health Nursing, two Senior Public Health Nurses, thirty Staff
Public Health Nurses, a Chief Sanitary Inspector, seven Staff Sanitary Inspectors,
and fourteen Clerical Assistants. It is estimated that this type of administration
would cost $355,000 annually, but as present costs amount to approximately
$313,000 annually, there would be about $42,000 additional funds necessary to
finance the proposal, which, it is proposed, would be raised from National Health
Grants in the interests of the expanded health services. The negotiation in respect
to these proposals became completed toward the close of the year and were ratified
by the Councils and School Boards concerned in the premise that the new administration could become organized early in the new year.
The health units administered through the Health Branch displayed the usual
turnover in staff as resignations and transfers occurred in the usual number, particularly among the ranks of the public health nurses, as shown in the report of that
Division. However, some changes occurred in the ranks of public health physicians,
posing problems in negotiating administrative adjustments within those health units.
Affected were the Upper Island, East Kootenay, North Fraser, Selkirk, Peace
River, and South Okanagan Health Units, whose Directors changed positions, and
the Central Vancouver Island, Boundary, and Cariboo Health Units, in which the
positions of Assistant Director were vacant for at least part of the year.
RESIDENT PHYSICIANS GRANTS
The Health Branch maintained supervision of a programme of grants-in-aid to
resident physicians, designed to encourage physicians to take up residence in remote
communities and to provide service on a periodic schedule of visits to neighbouring
communities not sufficiently large enough in themselves to support a physician.
2
K 18 PUBLIC HEALTH SERVICES REPORT, 1960
This has been in operation for a number of years, based upon a definite formula
inversely proportionate to the population and directly proportionate to the distances
of travel. At present, grants are being paid in thirty-one locations within the Province to thirty-one physicians.
The one area that has had a major problem in provision of medical care is
Stewart, where, since the closure of industrial operations, it has been found difficult
to attract a full-time resident physician for any lengthy period. As a result, there
have been two or three changes in physicians during the year, as the volume of
medical practice was hardly sufficient to maintain professional interest. As the
year ended, the community was again in the throes of disorganized medical care,
endeavouring tc attract a semi-retired physician who might be expected to remain
longer in the community. Their situation is particularly grave as the problem of
medical care is linked to that of hospital care to the degree that without a resident
physician it is doubtful that the hospital could maintain operations.
During the year no new areas were brought into the plan, which seemed to be
providing adequate coverage to the existing remote areas of the Province where
financial aid was deemed desirable.
SCHOOL HEALTH SERVICES
Over the past ten years concepts of school health services have shown a gradual
material change. There was first the realization that the school-child could not
be considered separately from the rest of the community, as he was actually a definite member of a family group within the community. Acceptance of this fact
led logically to the conclusion that the health of the school-child was dependent
on the health services provided for the commmunity as a whole rather than on the
provision of a separate school health service. It became increasingly apparent
that the more effective and more extensive a general health service is, the fewer
health problems there would be in the schools.
Concomitantly, evidence pointed to the need for concentrated services to
selected individual children, and it became evident that the time spent on routine
inspections and examinations, which supposedly gave the administrator a cross-
section of the health status of the whole school population, really revealed little
about the well-being or the progress of the individual child.
At this same time the efforts at quarantine were demonstrated as outmoded in
the control of many of the communicable diseases, while problems related to the
prevention of rheumatic fever, dental caries, and other fields posed challenges for
the application of preventive measures.
The concentration on the physical status of the school pupil gave ground to
the need of the school health programme to include something indicative of the
emotional and mental status of the school pupil. As these concepts gained weight,
demonstrative of the parallel between community health service and the health of
the school-child, it was apparent that without the co-operative functioning of all
of the services, the school pupil could hardly be expected to achieve well-being.
The school health programme, as it is developing, has several objectives:—
(1) It is designed to present an appraisal of the child—physical, mental, emotional, and social. What are his assets, his liabilities? What needs to be
done to help this child achieve a level of health commensurate with his
potentialities for health?
(2) How can each child in school be considered as an individual? Unless
a way is found to accomplish this end, the knowledge of the principle of
the individual differences is to no avail.
LOCAL HEALTH SERVICES K 19
(3) How can the school environment be improved so that the growth and
development of the child cannot be impeded? The concern here lies
with both the physical and emotional environment; that is to say, the
emotional environment of the classroom, including such factors as the
effect of the teacher's personality, the routines and disciplines imposed on
the children.
(4) Flow can an educational programme be developed in the school which
enables a child to learn how to make judgments which affect health
behaviour?
These, then, are the main considerations in a school health programme—
health service, health guidance, health instruction, and school environment. In
order to accomplish this, the education and the school health personnel are required
to re-orient their efforts so that consideration is given to the needs of the children in
developing a programme that meets the mental, emotional, social, and physical
needs of this age-group.
The classroom teacher is the foundation stone in programme success. The
good teacher's observations can be valuable to a school physician. The teacher
should not be content with a cursory " morning " inspection for rashes or dirty
finger-nails; she should be constantly alert for signs of deviation from normal.
Such signs may be transient and dramatic—a flushed face in the afternoon that may
indicate fever and an oncoming infection, or they may be gradual and obscure, such
as the slowly growing inattentiveness in a child whose hearing or vision is failing,
or whose home situation is becoming difficult. It is becoming increasingly clear
that the teacher has much to offer to the physician, and that she should be encouraged to make more careful observations, not to make diagnoses such as enlarged
tonsils, but to note these things that can be observed, such as the child commencing
to squint when he looks at the blackboard, leave the room more frequently to urinate, or to change his normal patterns of behaviour.
These observations can be imparted to the public health nurse, who can
correlate them with her knowledge of the case-history of the child and the home
conditions. The teacher-nurse conference may provide sufficient information leading to satisfactory treatment, but in other instances the support of the parents, family
physician, and others will be required. The public health nurse serves to link up
the school with the health and welfare of the community.
Many services are designed in the interests of the school pupil in the fields of
dentistry, nursing, nutrition, health education, sanitation, and so forth. Parts
played by these services in their contribution to the school health programme are
ably presented in the individual reports of the divisions of the Health Branch in
other sections of this Report; they should be read and digested to understand fully
the extent of the services being provided to the schools throughout this Province.
HEALTH OF THE SCHOOL-CHILD
The school health programme is planned to provide health services to the
pupil for the academic year, and the analysis of the health status of the children
in the various grades within the schools is collated on that basis from September,
1959, to June, 1960, during which school health services were provided in the 1,214
schools included in the eighty-two school districts and the sixteen small school areas.
In these schools there were 11,700 classrooms.
Within the grades examined there was an 11.1-per-cent increase in pupils
enrolled during 1959/60, there being 309,993 that year compared with 279,040
the previous year.
K 20
PUBLIC HEALTH SERVICES REPORT, 1960
In those grades, 37,175 pupils were examined—only 12 per cent of the children in those grades. This is a further decrease in the number examined, approximating 1.7 per cent from the previous year, when 38,174 children were examined;
it is indicative of the decline in the volume of routine physical examinations. However, there was an increase in the number of Grade I pupils examined, as shown in
Table I. From it there is evidence that 25,658 pupils in that grade (73.4 per cent)
were examined, as against 25,394 (79.5 per cent) for the previous year. Thus,
while there was an increased number of pupils examined, the increased enrolment
in the grade actually represented a percentage decrease in the number receiving
physical examinations. This examination, occurring at a transitional period in the
child's life as he leaves the home to become part of the community, is usually conducted with the parent present and is therefore productive of greater results, since
the co-operation of the parent can be anticipated in preparing the child for school.
In later grades, screening methods are adopted solely as a selection for medical
attention. In the elementary grades the percentage receiving examination fluctuated between 3 and 7 per cent of the pupils, and in the high-school grades the
volume of medical examinations continued to be based on selectivity and showed
a consistent decrease with each higher grade.
There continued to be a great deal of medical attention devoted to children
enrolled in special classes, which include classes for mentally retarded children.
Of the enrolment in all special classes, 20.8 per cent received examination. In
other types of classes there was demonstrated a greater need for medical attention
in that 51.8 per cent were given complete examinations.
The results are presented in detail in Table II. Table III shows the health
status by individual grades in the Greater Vancouver Metropolitan Health Area.
Among other things, it shows that the amount of attention devoted to physical
examinations is greatest in Grade I.
Table I.—Summary of Health Status of Pupils in All Grades in All Schools
in British Columbia, 1955 to 1960
Item
1955/56
1956/57
1957/58
1958/59
1959/60
230,433
44,211
19.2
76.6
17.6
3.8
1.3
1.2
0.2
0.2
0.1
C1)
C1)
251,005
43,010
17.1
78.9
15.8
1.0
0.1
4.3
0.2
C1)
1.9
0.3
0.3
272,499
42,947
15.8
85.8
11.5
3.4
1.5
0.7
0.2
0.3
0.1
C1)
0.2
279,040
38,174
13.7
84.5
10.9
3.8
1.8
0.8
0.2
0.3
0.1
0.1
0.2
309,993
37,175
12.0
Percentage of pupils examined with minor or no
84.5
Percentage of pupils examined having specified type
and degree of defect—
10.8
3.7
1.8
Physical 3
0.8
0.2
0.4
C1)
C1)
0.4
1 Less than 0.1 per cent.
LOCAL HEALTH SERVICES
K 21
Table II.—Health Status of Individual Grades of Total Schools, Including
Greater Vancouver Metropolitan Health Area, 1959/60
Item
All
Grade
Grade
Grade
Grade
Grade
Grade
Grade
Schools
I
II
III
IV
V
VI
VII
Total pupils enrolled in grades
309,993
34,949
25,658
32,714
1,518
30,329
1,073
29,629
1,435
29,331
891
28,604
836
29,747
37,175
2,208
Percentage of enrolled pupils
examined
12.0
73.4
4.6
3.5
4.8
3.0
2.9
7.4
Percentage examined with minor
or no physical, emotional, or
mental defects
84.5
85.4
80.3
84.4
82.0
84.3
85.5
86.0
Percentage of pupils examined
having specified type and
degree of defect—
Physical 2 .
10.8
9.6
15.5
13.0
15.3
14.0
11.5
10.0
Emotional 2 ,
3.7
3.5
5.0
3.1
2.9
2.9
3.1
3.7
Mental 2 ...
1.8
1.5
2.5
1.6
1.3
1.6
1.0
1.9
Physical 3 .
0.8
0.7
1.1
0.9
1.0
1.1
1.0
0.7
Emotional 3
0.2
0.2
0.3
0.1
0.5
0.3
0.4
0.1
Mental 3
0.4
0.1
0.1
0.5
0.3
0.1
0.4
C1)
C1)
O)
C1)
0.3
0.1
0.1
C1)
Emotional 4
0.2
(!)
0.4
0.1
0.1
0.1
0.1
Item
Grade
VIII
Grade
IX
Grade
X
Grade
XI
Senior
XII
Senior
Matric.
Special
Classes
Other
Classes
Total pupils enrolled in grades
25,053
729
2.9
84.2
11.9
3.2
0.8
0.7
21,216
907
4.3
83.0
14.9
3.3
0.9
1.0
0.2
18,258
836
4.6
87.9
10.9
1.2
0.7
15,071
316
2.1
88.3
12.7
1.3
0.3
6.3
11,232
181
1.6
90.1
7.7
3.3
1,076
7
0.7
100.0
2,784
580
20.8
49.8
25.5
22.6
24.8
3.6
2.6
14.3
0.3
0.3
23.4
2,822
1,461
Percentage of enrolled pupils
examined _
Percentage examined with minor
or no physical, emotional, or
51.8
81.0
Percentage of pupils examined
having specified type and
degree of defect—
Physical 2
13.9
5.3
Mental 2
1.2
Physical 3..
Emotional 3
Mental 3
0.8
0.7
0.3
0.1
Emotional 4.
0.2
1 Incidence of less than 0.1 per cent.
L
K 22
PUBLIC HEALTH SERVICES REPORT, 1960
Table III.—Health Status by Individual Grades of Total Schools,
Greater Vancouver Metropolitan Health Area, 1959/60
Item
All
Grade
Grade
Grade
Grade
Grade
Grade
Grade
Schools
I
II
III
IV
V
VI
VII
Total pupils enrolled in grades
108,132
11,591
11,097
10,218
10,002
10,040
9,826
10,319
Total pupils examined
16,158
10,882
713
566
513
481
461
603
Percentage of enrolled pupils
examined ~
14.9
93.9
6.4
5.5
5.1
4.8
4.7
5.8
Percentage examined with minor
or no physical, emotional, or
mental defects
86.9
88.5
83.0
84.3
88.3
87.1
85.2
86.2
Percentage of pupils examined
having specified type and
degree of defect—
Physical 2
8.6
7.4
10.4
9.4
9.4
10.0
11.1
9.6
Emotional 2
4.1
4.1
6.0
3.4
3.3
2.9
3.9
3.5
Mental 2
1.2
1.0
2.0
2.1
1.0
1.5
0.9
1.3
Physical 3
0.5
0.5
0.6
0.5
0.4
0.6
0.4
0.5
0.3
0.3
0.4
0.2
0.2
0.6
0.7
0.3
Mental 3
0.2
0.1
0.4
0.2
0.4
0.2
(*)
0)
0.4
Emotional 4
0.1
0.1
0.2
0.2
0.3
0.1
Item
Grade
Grade
Grade
Grade
Grade
Senior
Special
Other
VIII
IX
X
XI
XII
Matric.
Classes
Classes
Total pupils enrolled in grades
8,807
7,462
6,835
5,933
4,554
172
1,276
1,642
Total pupils examined ___.
417
529
301
228
148
7
309
852
Percentage of enrolled pupils
ex amined
4.7
7.1
4.4
3.8
3.2
4.1
24.2
51.9
Percentage examined with minor
or no physical, emotional, or
83.2
83.4
84.1
89.5
89.9
100.0
54.0
80.8
Percentage of pupils examined
having specified type and
degree of defect—
Physical 2
10.6
13.4
13.0
10.5
7.4
20.7
12.6
3.4
0.7
3.2
0.8
2.0
4.1
12.3
7.8
7.0
Mental 2
1.6
Physical 3 ,
0.2
0.8
0.7
1.6
0.6
Emotional 3-
.
2.3
0.9
Mental 3—
0.4
4.5
0.5
Physical 4
0.4
0.6
0.1
Emotional 4
13.6
0.1
Incidence of less than 0.1 per cent.
LOCAL HEALTH SERVICES
K 23
Table IV.—Health Status of Individual Grades of Total Schools, Excluding
Greater Vancouver Metropolitan Health Area, 1959/60
Item
All
Schools
Grade
I
Grade
II
Grade
III
Grade
IV
Grade
V
Grade
VI
Grade
VII
Total pupils enrolled in grades
201,861
23,358
14,776
63.3
83.1
11.2
3.1
1.8
0.8
0.1
0.2
C1)
C1)
C1)
21,617
805
3.7
77.9
20.0
4.1
3.0
1.6
0.1
0.1
0.2
20,111
507
2.5
84.6
17.2
2.8
1.0
1.4
~~0.6
0.2
19,627
922
4.7
78.4
18.7
2.6
1.4
1.3
0.7
0.4
0.1
19,291
410
2.1
81.0
18.8
2.9
1.7
1.7
0.2
0.2
18,778
375
2.0
85.9
12.0
2.1
1.1
1.6
0.3
0.3
0.3
19,428
21,017
10.4
82.7
12.5
3.5
2.3
1.0
0.2
0.5
0)
C1)
0.5
1,605
Percentage of enrolled pupils
8.3
Percentage examined with minor
or no physical, emotional, or
85.9
Percentage of pupils examined
having specified type and
degree of defect—
Physical 2
10.2
3.8
Mental 2
2.1
Physical 3
Emotional 3
0.8
Physical 4
0.1
Mental 4
Item
Grade
Grade
Grade
Grade
Grade
Senior
Special
Other
VIII
IX
X
XT
XII
Matric.
Classes
Classes
Total pupils enrolled in grades
examined
16,246
13,754
11,423
9,138
6,678 904
1,508
1,180
Total pupils examined ..
312
378
535
88
33
271
609
Percentage of enrolled pupils
examined
1.9
2.7
4.7
1.0
0.5
18.0
51.6
Percentage examined with minor
or no physical, emotional, or
mental defects
85.6
82.5
90.1
85.2
90.9
45.0
81.4
Percentage of pupils examined
having specified type and
degree of defect—
Physical 2 —
13.8
16.9
9.7
18.2
9.1
31.0
15.8
Emotional 2
2.9
3.4
0.7
4.5
34.3
2.8
1.0
1.3
1.1
1.3
0.7
1.1
44.3
5.9
0.7
Physical 3 ...
1.0
Emotional 3
3.0
0.3
25.5
Emotional 4
0.7
34.7
0.3
Incidence of less than 0.1 per cent.
K 24
PUBLIC HEALTH SERVICES REPORT, 1960
Table V.—Immunization Status of Total Pupils Enrolled, According to
School Grade, 1959/60
Total
Pupils
Enrolled
by Grades
Smallpox
Diphtheria
Tetanus
Poliomyelitis
Grade
Number
Per
Cent
Number
Per
Cent
Number
Per
Cent
Number
Per
Cent
309,993
34,949
32,714
30,329
29,629
29,331
28,604
29,747
25,053
21,216
18,258
15,071
11,232
1,076
2,784
2,822
227,735
28,218
26,529
23,303
21,186
22,634
22,951
21,164
15,677
15,562
12,324
9,420
6,347
651
1,769
1,312
73.5
80.7
81.1
76.8
71.5
77.2
80.2
71.1
62.6
73.4
67.5
62.5
56.5
60.5
63.5
46.5
240,567
30,723
28,823
25,376
23,457
23,211
23,874
22,483
17,176
16,075
12,371
8,388
6,217
655
1,738
1,674
77.6
87.9
88.1
83.7
79.2
79.1
83.5
75.6
68.6
75.8
67.8
55.7
55.4
60.9
62.4
59.3
216,942
30,684
28,727
25,155
23,262
22,950
22,855
19,026
12,876
11,664
8,185
5,847
3,687
405
1,619
1,650
70.0
87.8
87.8
82.9
78.5
78.2
79.9
64.0
51.4
55.0
44.8
38.8
32.8
37.6
58.2
58.5
275,339
29,913
29,137
26,719
26,800
26,506
26,091
26,284
21,957
19,020
16,464
13,555
9,916
919
2,058
1,788
88.8
Grade I
Grade II
Grade III
85.6
89.1
88.1
Grade IV
Grade V ~ ,
90.5
90.4
Grade VI _
91.2
Grade VII
88.4
Grade VIII
Grade IX
Grade X .
87.6
89.6
90.2
Grade XI
Grade XII-
89.9
88.3
Grade XIII.
85.4
Special classes
Other-
73.9
63.4
The additional tables ably demonstrate that the physical condition of the
pupils, even those selected pupils, is at a fairly high standard, as 84.5 per cent of
those examined exhibited either minor or no physical defect. In the Grade I classrooms, where routine physical examination is the rule rather than the exception,
85.4 per cent were in good physical condition. Thereafter, only referred pupils
were given intensive medical examinations because of some suspected medical
reason, yet a high percentage, never lower than 82 per cent, were found to be
physically sound. These findings are justifiable demonstrations for the change that
has occurred in the school health programme toward a decrease in routine physical
examinations for all pupils. Certainly, if only a small proportion of those selected
for reason of possible physical, emotional, or mental defect are found to be medically defective, it seems obvious that the great majority of pupils enrolled must
enjoy a fairly high standard of normal health.
Some mention should be made of the findings of the examinations amongst
pupils in the special and other classes; the table reveals that these pupils, already
handicapped, show the greatest proportion of physical defect (29.4 per cent), emotional defect (25.5 per cent), or mental defect (62.5 per cent). The much greater
increase in the findings of mental defectiveness is probably the result of the increased
enrolment in these special classes, which has grown by 45 per cent from an enrolment of 1,923 the previous year to an enrolment of 2,784 this past year. It is a
further reflection on the efforts being made in the existing educational system to
provide educational opportunities for these children.
The amount of mental and emotional trauma in the regular grades in school
becomes apparent through the newer classification of health status of the pupil
now in operation for five years; it permits comparisons of this year with past years.
In making this comparison it is evident that some adjustment on the part of the
examiners was reflected in the earlier years as the amount of emotional and mental
defect showed a consistent increase year by year, but for the past two years it has
become almost constant.
It is evident that the number of children selected for examination for reasons
of mental or emotional instability does not vary greatly from grade to grade. It
should also be noted that the pupil seems to be able to adjust to the school pro-
LOCAL HEALTH SERVICES K 25
gramme without any undue upset, maintaining a fairly constant emotional equilibrium throughout.
The immunization status of the school pupil has shown further improvement
this year over that of previous years. It is evident from Table V that the majority
of the pupils (over 70 per cent in each category as compared with over 65 per cent
in each category for last year) have become immunized, the greater proportion
against poliomyelitis. The poliomyelitis immunization is a reflection of the increased
incidence of that disease that was occasioned in the latter part of 1959 and the
early part of 1960, resulting in greater emphasis being directed toward complete
immunization to that disease; to this must also be added the increased use of multivalent vaccine, which has been additionally reflected in the increase in the numbers immunized against diphtheria and tetanus. A very gratifying increase in the
number immunized to smallpox has been shown (73.5 per cent this year as compared to 69.6 per cent the previous year); this is probably indicative of concentration on immunization by local health services throughout the Province, who have
been carrying on an encouraging educational programme to increase the immunity
status of the total population.
However, complacency in respect to immunization must not be allowed to
develop, since, even although there is a larger proportion of the pupils immunized,
there still remains a considerable non-immunized reservoir of approximately 25
per cent in all categories. It is amongst this group that disease incidence can
develop as a threat to the community health generally. Therefore, continued emphasis upon immunization for all pupils is desirable if the community is to remain
free from major communicable infections.
The minor communicable infections common to childhood are no longer routinely reportable; it is known that these are prone to occur cyclicly every four or
five years, decreasing as an immune population develops from experience with the
infection. They do create a consistent volume of school absenteeism but do not
constitute a major threat to the health of the average school-child. Some of them
are complicating factors in pregnancy, and the likelihood of the pupil's transmitting
the infection to expectant mothers always poses a community problem. For that
reason, consideration now being directed toward development of biologicals for
control of these infections merits attention and is being viewed with some interest
in the medical literature.
The major communicable infections—streptococcal, staphylococcal, diohtheria,
and poliomyelitis—are a challenge to the health of the people. Poliomyelitis was
of serious consequence in certain areas of the Province during 1960, recording
165 cases (a rate of 10.3 per 100,000 population), as against 132 cases the previous year (a rate of 8.4 per 100,000 population). There were also recorded twelve
deaths. This general Provincial incidence was reflected in the school population
as forty-two of the cases and three of the deaths occurred in this age-group. This
was the highest incidence rate for poliomyelitis since 1955 and leads to some conjecture as to what the situation might have been had not poliomyelitis immunization
been available. It is known that poliomyelitis immunization does not confer complete protection. Of the forty-five school-aged patients who did develop the paralytic disease, thirty-two were credited with a complete series of poliomyelitis vaccine.
While there was a drop in the incidence of scarlet fever from the high of
244.5 per 100,000 population last year to a rate of 98.1 per 100,000 population
for this year, nevertheless streptococcal sore throat maintained a fairly consistent
high rate at 39.4, slightly lower than the rate of 46.1 of last year, and, after that
figure, the highest in the Province on record. The reasons for this disparity are
K 26 PUBLIC HEALTH SERVICES REPORT, 1960
probably based on the use of antibiotics and chemotherapeutic drugs which restrict
the infection to the sore throat phase, preventing it from progressing to the scarlet
fever phase. In general, the outbreak remained mild and did not create the complications formerly associated with this infection, although it did create some school
absenteeism. In any case, the gradual increase in the rheumatic fever prophylaxis
programme is seemingly justified, since streptococcal infections are basically the
factor behind the rheumatic fever condition. Antibiotics are limited in usefulness
in the treatment of the acute stages of rheumatic fever but are very useful in preventive recurrences to which these patients are prone. Thus the protection of the
patient from further attacks of streptococcal infections which might again aggravate
the rheumatic condition to the extent of permanent heart damage is well justified.
The experience garnered over the past year and a half has indicated the value of
this programme, and it has now been extended to the Province as a whole, receiving
support from the Canadian Medical Association (British Columbia Division) and
financial assistance through the National Health Grants, which permits purchase
of the necessary drugs. It is an additional service geared to the protection of the
health of the school-child, amongst whom rheumatic infections are most likely to
occur.
Infectious hepatitis occurred this year in almost the same degree as in the past
year, with a rate of 57.5 per 100,000 population, compared to a rate of 57.7 the
previous year. It is also a creator of school absenteeism and a factor influencing
school health. Gamma globulin has been distributed as a control medium, but its
use is restricted and it is not available for individual protection.
Gastrointestinal infections of the Salmonella-Shigella type were of major consideration throughout the year. Salmonella infections, with a rate of 27.0 per
100,000 population, were increased over the rate of 22.6 during 1959, while Shigella infections showed the highest rate of the past five years at 74.2 per 100,000
population. In an incidence of this degree there are many childhood patients, and
these have their reflection on the health of the school pupil, causing a considerable
degree of illness among them. Fortunately, complications are rare and their effects
are not lasting, the major consideration being the carrier state that follows, posing
problems to the community population generally.
For the third consecutive year no cases of diphtheria were recorded, possibly
again resultant from the higher levels of immunity status now being recorded to this
infection.
COMMUNITY HEALTH CENTRES
The plan to provide financial assistance toward the construction of community
health centres, which had its origin in 1951 through the policy originating with
National Health Grants, continues to provide new accommodation for health unit
services throughout the Province. The proposal provided that designs for such
construction should originate in the community, sparked either by municipal authorities or some service club, who would undertake to raise community funds for
the construction. With community interest definitely established and negotiations
under way in the planning of a building, a formal request was presented in each
case 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 British Columbia Tuberculosis Society, the British
Columbia Cancer Society, Canadian Red Cross Association (British Columbia
Division), the British Columbia Foundation for Child Care, Poliomyelitis and
Rehabilitation, St. John Ambulance Association, and others. These funds augment
LOCAL HEALTH SERVICES
K 27
the financing to permit construction of health centres in which offices and workrooms for the voluntary health agencies are provided in addition to the administration and clinic accommodation for the official health agency. This means that the
community health centre then becomes the focal point for the administration of all
community health services, both official and voluntary, permitting co-ordination of
these services in the community interest.
■'Mr^W'r---: ■ * ■•':-};z ■'■:■'''.
(Photo by D. McD. Ramsay.)
At Quesnel in the Cariboo Health Unit is a typical new health centre,
officially opened on March 12th, 1960.
During this past year further construction of community health centres brought
the total to date to fifty. This has entailed a total capital outlay of $2,649,094.95,
of which National and Provincial grants have contributed $1,005,231.32. Construction of community health centres within the Greater Vancouver Metropolitan
Health Service has provided seven community health centres in that area at a total
cost of $927,484.67, while the rest of the construction has been attained in the
headquarters and sub-offices of the various health units throughout the Province.
During the year just concluded, newly constructed accommodation became
available at Health Unit No. 4 in South Vancouver, Creston and Kimberley in the
East Kootenay Health Unit, Quesnel in the Cariboo Health Unit, Ladysmith in the
Central Vancouver Island Health Unit, Coquitlam in the Simon Fraser Health Unit,
and at Kitimat in the Kitimat Public Health Nursing District. At the close of the
year, construction was well under way on new accommodation at Golden, Michel-
Natal, and Field in the East Kootenay Health Unit, at Matsqui-Sumas-Abbotsford
in the Upper Fraser Valley Health Unit, at Prince Rupert in the Skeena Health Unit,
while planning for new accommodation was under way at Princeton in the South
The official opening of the new Creston Health Centre by the Minister of Health
Services and Hospital Insurance, the Honourable Eric Martin, May 11th, 1960. The
Minister is shown exchanging handshakes with Mr. Ed Reber, Chairman of the Building
Committee of the local Kiwanis Club.
The Minister of Health Services and Hospital Insurance, the Honourable Eric Martin,
pauses during his tour of the new Creston Health Centre to inspect the exhibit of the
Canadian Cancer Society, May 11th, 1960. Others in the group are, left to right: Mr. J. B.
Yuill, member of the East Kootenay Union Board of Health; Mr. C. W. Allan, Chairman
of the Creston Village Council; Mr. Harry Erskine, Chairman, East Kootenay Union Board
of Health; and Dr. J. A. Taylor, Deputy Provincial Health Officer.
LOCAL HEALTH SERVICES
K 29
Okanagan Health Unit, Campbell River and Powell River in the Upper Island
Health Unit, at Hope in the Upper Fraser Valley Health Unit, at Castlegar in the
West Kootenay Health Unit, at 100 Mile House in the Cariboo Health Unit, and
at Saanich in the Saanich and South Vancouver Island Health Unit. In addition,
negotiations toward community health centres were under way at Nelson, the headquarters of the Selkirk Health Unit; at Chilliwack, the headquarters of the Upper
Fraser Valley Health Unit; at Sechelt, the headquarters of the Howe Sound Nursing Area; and at Clinton, a proposed new sub-office in the South Central Health
Unit. In addition, some negotiation had been undertaken toward the planning of
a new Chest Centre in Victoria for the Island Travelling Clinic. This means that,
with the planning that is now under way, priority lists have been established well
into the fiscal year 1962/63.
In two instances the official opening of community health centres led to them
honouring the names of two pioneers in public health in this Province who had
contributed so much toward the growth of public health, one in the field of public
health nursing and the other in the field of public health administration, both of
whom had sparked community interest toward the construction of the health centres.
The first was the Eileen Ramsay Memorial Health Centre at Quesnel in the Cariboo
Health Unit, named to honour Mrs. Eileen Ramsay, senior public health nurse in
the Quesnel area for the past fourteen years. The second was the Stewart Murray
Community Health Centre in South Vancouver, honouring the senior administrator
of the Greater Vancouver Metropolitan Health Service for the past twenty-two
years, who had contributed so greatly to its development in its formative years and
latterly in its developmental years as it enlarged to provide service to a mushrooming population.
DISEASE MORBIDITY AND STATISTICS
No major outbreaks of communicable disease occurred in British Columbia
during the year just past. The increased incidence of poliomyelitis (from 132 cases
in 1959 to 165 in 1960) and bacillary dysentery (from 336 cases in 1959 to 1,192
in 1960) are of particular interest. The 724 cases of food poisoning doubled the
1959 figure of 366. Viral or aseptic meningitis showed an increase from 82 cases
in 1959 to 257 cases in 1960. Streptococcal infections, manifesting themselves as
sore throats or frank scarlet fever, were diagnosed only half as often as during the
previous year. This reversed the trend of the previous two years.
The total reported disease morbidity for 1960 was 1,030.1 per 100,000, which
was not significantly different from the previous year. In spite of the fact that all
of the more serious communicable diseases are reportable to the Medical Health
Officer of the area in which they occur, some cases are never brought to his attention. The disease picture of a Province is therefore influenced to a considerable
extent by the degree of completeness in reporting. In recent years a number of
steps have been taken which, it is felt, now make notification reasonably complete
for most conditions.
Physicians are no longer asked to report the minor diseases such as chicken-pox
or rubella, and the Health Branch offers the private physician diagnostic tests, free
treatment, or prophylactic drugs for a growing number of the more important diseases, which act as an incentive to reporting.
There were 165 cases of paralytic poliomyelitis reported, which is 33 more
than in 1959. Suspect non-paralytic poliomyelitis was not recorded as such, but
was grouped with other meningitides that appeared to be of viral origin. The identity
of the responsible virus was determined in only a few such cases; nevertheless, it
was apparent from Medical Officers' reports that many of the immediate contacts to
K 30
PUBLIC HEALTH SERVICES REPORT, 1960
patients with paralytic poliomyelitis were suffering from a non-paralytic form of the
same disease. Twelve deaths occurred from this disease, giving a case fatality rate
of 7.3, which is an improvement over the previous year.
Paralytic Poliomyelitis Case Fatality Rate, British Columbia
Year
Paralytic
Cases
Deaths
Case
Fatality
Rate
1953 .
439
107
143
37
25
12
132
165
26
6
3
3
3
14
12
5.9
1954
5.6
1955
2.1
1956
8.1
1957 ...
1958 - ....
25.0
1959
10.6
1960 ..
7.3
Again this year, poliomyelitis was concentrated in the rural parts of the Province, with only 22 cases (13.3 per cent of the total) occurring in Metropolitan
Vancouver, New Westminster, and Victoria.
The Royal Canadian Air Force continued to offer its services for air evacuations, and all poliomyelitis patients on the Mainland with respiratory involvement,
who were well enough to be moved, were transported to the poliomyelitis centre in
Vancouver. A new type of respirator supplying air under positive pressure to the
patient's lungs through a tracheotomy was put into use and undoubtedly contributed
much toward making the flight less of a shock to these desperately ill patients.
The two poliomyelitis centres in Vancouver and Victoria continued to function
well, though at times both were hard pressed to find accommodation for all who
needed care. In Vancouver it was found necessary to reconstitute the Poliomyelitis
Committee under the chairmanship of the late Dr. Stewart Murray in order to coordinate the activities of the various city hospitals caring for these patients.
The Children's Hospital, the G. F. Strong Rehabilitation Centre, Princess
Margaret Children's Village, and the Queen Alexandra Solarium in Victoria all
deserve great credit for the way in which they have accepted patients past the acute
stage of their illness from the poliomyelitis centres, thus making sure that beds were
always available at the latter for acutely ill cases.
Throughout 1960 poliomyelitis vaccine was offered to citizens of all age-
groups. In infants, pre-school and school children, this vaccine was combined with
routine immunization, and all children have made available to them the initial
immunization and also booster doses at least every five years.
Adult immunization clinics were conducted in many centres throughout the
Province by both health unit personnel and private physicians, who generously contributed their time. The British Columbia Foundation for Child Care, Poliomyelitis
and Rehabilitation continued to supply funds and lay assistants for the operation of
the clinics and, in addition, conducted a very extensive advertising campaign. The
Victoria Medical Association conducted a very successful immunization clinic on
its own initiative in that city.
During the year 691,124 doses of vaccine were supplied, and it is estimated
that probably close to 90 per cent of our population under 18 years has now
received the recommended three doses of poliomyelitis vaccine.
Again this year half the cost of the poliomyelitis vaccine was taken from
National Health Grants, thereby allowing the Province to offer this product on an
unrestricted basis.
1. SERVICE ROOMS
;.- »:
SouATtoN.. unit**:;;
2. NURSES STATION
to:
PARALYTIC WARD
3 MALE LUNG <i*B5
r t.
THERAPY ■ RO&M
4, FEMALE LUNG WARS
12.
STORAGE ETC.'
S. OPERATING, SUITE
13.
KITCHEN
6. WOMAN'S" AUXlCfARY
. 14.
STAFF BOOMS
7. CONTROL. AREA
IS.
RESPIRATOR PARK
8. &QCTORS OFFICE AREA
"y\ ■ ■
-""" '*'; : i-*""
s-^s-sw^-
Architect's "cut-away" drawing of Poliomyelitis Pavilion.
^il
The Poliomyelitis Pavilion houses major equipment for treatment of convalescing patients.
The rocking-bed, which facilitates respiration, is here shown in use.
K 32 PUBLIC HEALTH SERVICES REPORT, 1960
The incidence of infection hepatitis continued at its usual high level, and the
Health Branch continued to issue immune serum globulin free of charge as a prophylactic measure to contacts of this disease. An investigation has been initiated in
a rural health unit where this disease is particularly prevalent with a view to determining the effectiveness of this product at the dosage now being used.
For the third year in succession British Columbia has not recorded a single
proven case of diphtheria. This does not, of course, mean that mild cases of this
disease have not occurred, but does indicate the extremely low level of infection that
has been reached. It should not be assumed that this state of affairs has come about
through immunization procedure alone, since, on the average, only 78 per cent of
our school-children are protected, and in the senior grades this drops to as low as
55 per cent. Most adults used to be immune to diphtheria from repeated minor
childhood infections that slowly built up their protection. Their immunity was continued throughout life by frequent casual contacts with the diphtheria bacillus.
Such is obviously no longer the case, and many adults are now susceptible to diphtheria because their immunity, given artificially at school, has not been kept up.
The time has come when adults should be urged to renew their immunity regularly,
particularly if they travel to areas not as free of diphtheria as is this Province.
This year there has been a marked increase in the number of cases of bacillary
dysentery, which has been of particular interest to the Health Branch: 1,192 cases
of the disease were reported, compared with 336 cases in 1959 and 293 in 1955.
Many more mild cases undoubtedly occurred as well. In nearly every instance the
responsible organism has been Shigella sonnei, and few areas of the Province have
been free. Among adults the condition is usually mild, but in infants the loss of
fluid and toxic effects are more serious. There was one infant death. The cause of
this rapid increase in cases this year is not clear. Numerous summer-camp outbreaks in the past years have, without a doubt, been responsible for seeding the
Province with mild cases or convalescent carriers serving as local foci. It has been
suggested that imported fruit and vegetables might be the source of infection; however, this seems unlikely as the Province of Alberta and the State of Washington, who
secure similar shipments, have not had an excessive number of cases of shigellosis.
The other gastrointestinal infection that has shown an increase is salmonellosis,
with food as the vehicle of infection in most instances. This year 434 cases were
reported, which is an increase of 22.3 per cent over 1959. A typical outbreak
involving sixty-nine guests and caterers at a wedding supper occurred in a rural
centre during the year. As a result, the bride and groom, as well as a good number
of the guests, required hospital care. Two different strains of Salmonellce were
isolated, and the turkey, ham, and pastry served were all found to be contaminated.
The fact that these outbreaks continue to occur so frequently at banquets prepared
by untrained caterers points to the need for and value of constant supervision of
food-handling establishments by trained sanitary inspectors.
Two related organisms, Salmonella typhi and Salmonella paratyphi, which are
the cause of typhoid and paratyphoid fever, were also isolated more frequently this
year, with 25 cases in all being reported.
During the past few years some outbreaks of typhoid fever have been traced to
roadside-ditch water contaminated by direct discharges from septic tanks connected
to houses inhabited by chronic typhoid carriers. It is possible that this type of
contamination will continue to be a potential danger as long as suburban developments are allowed to spring up without provision being made for water-carried
sewage-disposal.
LOCAL HEALTH SERVICES
K 33
There were 962 cases of pertussis reported, which, although up from 1959, is
considerably below the average for the last five years. Every infant receives pertussis vaccine as part of his routine immunization, and an attempt is now being made
to see that a final booster is given to every child at the time of starting school so that
absenteeism through this disease in the early school years will be reduced to a
minimum.
While the incidence of streptococcal infection in Canada more than doubled in
1960 as compared with 1959, British Columbia showed a decrease in these reports
from 4,563 cases in 1959 to 2,209 cases this year. It should be noted that the
number of these infections tends to fluctuate from year to year.
Seven cases of trichinosis were reported this year, to mark the first important
occurrence of this disease in British Columbia for some time. All the cases were
related to the eating of uncooked pork obtained from a single source in Vancouver.
Through the co-operation of Federal, Provincial, and municipal health authorities,
the suspect pork has been traced to the farm of origin, and tests are now being conducted to determine whether more pigs are infected.
Table VI.—Notifiable Diseases in British Columbia, 1956-60 (Including Indians)
(Rate per 100,000 population.)
1956
1957
1958
1959
1960
Notifiable Disease
Number
of
Cases
Rate
Number
of
Cases
Rate
Number
of
Cases
Rate
Number
of
Cases
Rate
Number
of
Cases
Rate
"6.3
222.7
C1)
0.1
24.5
C1)
O)
13.4
C1)
24.5
0.1
(a)
(»)
C1)
(*)
3.2
(J)
70.6
2.6
46.1
12.2
0.2
93.7
0.1
2.3
2.3
246.1
54.6
0.4
3
2
4,150
(')
5
4
132
C1)
(x)
259
(*)
393
1
C1)
O)
C1)
C1)
35
13
O)
941
25
0.2
0.1
279.0
0)
0.3
0.3
8.9
(x)
C1)
17.4
C1)
26.4
0.1
O)
O)
O)
(*)
2.4
0.9
O)
63.3
1.7
21.9
7.7
0.1
90.0
0.4
0.7
256.0
50.3
0.1
1
2
4,103
C1)
6
936
C1)
(J)
292
C1)
558
2
C1)
C1)
C1)
O)
25
_____
1,427
12
1
1,098
172
1
2
1,128
8
22
3,426
582
3
0.1
0.1
265.7
(J)
~04
60.6
O)
C1)
18.9
C1)
36.2
0.1
C1)
C1)
C1)
O)
1.6
O)
92.4
0.8
0.1
71.1
11.1
0.1
0.1
73.1
~05
1.4
221.9
37.7
0.2
3
4,347
24
2
1,192
319
238
434
52
924
3
137
36
1
83
16
5
962
165
1,576
633
2
7
1,173
__
20
3,573
609
2
4
3,115
C1)
1
6
3,968
53
0.4
252.7
3.4
0.1
21.4
3.9
0.5
22.6
0.2
57.7
02
270 7
Diarrhoea of the new-born.—
1.5
Dysentery, amoebic
Bacillary.
Unspecified
Food poisoning—
Staphylococcal intoxica-
1
336
62
8
355
3
907
.. .
342
O)
C1)
187
0)
343
1
C1)
C1)
O)
C1)
45
74.2
19.8
14 9
Salmonella infections
Unspecified— _ .
27.0
3.2
57.5
Meningitis, viral or aseptic—
3
23
56
31
1
3
680
132
0.2
1.5
8.5
Due to Coxsackie virus
Due to ECHO virus
2.3
0.1
Other and unspecified
Meningococcal infections
3.6
2.0
0.1
0.2
43.3
8.4
5.2
1.0
Pemphigus neonatorum
O)
987
37
0.3
59.9
Poliomyelitis, paralytic
10.3
645
171
3
325
115
2
3,839
724
3
1,200
4
12
3,353
545
6
244.5
46.1
0.2
98.1
Streptococcal sore throat
Tetanus..
39.4
0.1
0.4
1,311
1
32
32
3,442
763
6
1,338
6
10
3,806
748
2
76.4
73.0
0.3
0.8
213.5
34.7
0.4
0.3
1.2
Venereal disease—
222.5
Syphilis (includes non-
gonorrhoeal urethritis,
37.9
0.1
11.468
820.0
12,315
828.2
13.807
894.2
16,314
1,039.1
16,543
1,030.1
Not notifiable prior to 1959.
3
K 34 PUBLIC HEALTH SERVICES REPORT, 1960
Over the past three or four years, seven bats, of the hundreds examined in
British Columbia, have been found to be infected with rabies virus. No human
cases have occurred despite the fact that a number of these bats have been handled,
and a few people have been bitten by these infected mammals. No other animals
have been found to be infected in British Columbia for a number of years.
Morbidity can occur from other things than communicable disease, and an
important factor is accidents. The Health Branch has this year been active in two
particular aspects of this problem.
The British Columbia Poison Control Council and the local health services of
the Health Branch, together with thirty-four urban and rural hospitals, are collaborating in an active poison-control programme. Information centres have been
established in most hospitals, where details of the constituents of and antidotes to
most poisonous substances are recorded. In addition, an educational programme,
which includes home visits by public health nurses to victims of poisonings, is being
undertaken. A detailed statistical record of all accidental poisonings is also being
kept.
In the field of motor-vehicle accidents a most interesting study is being carried
out at the University of British Columbia by a team led by a Provincial health unit
director on leave of absence from his regular duties, and under the sponsorship of
the Department of Preventive Medicine, Faculty of Medicine. Figures and data are
being compiled on all traffic accidents involving children under 16 in Vancouver
for one year. It is hoped that the information gained will be of real value in determining how best to meet this serious problem, which has become a much more
frequent killer than communicable disease.
SPECIAL PREVENTIVE AND TREATMENT SERVICES, VANCOUVER K 35
REPORT OF THE BUREAU OF SPECIAL PREVENTIVE
AND TREATMENT SERVICES, VANCOUVER
G. R. F. Elliot, Director
There have been no material changes in the basic organization structure of
this Bureau during the year. The main elements of the organization are the Bureau
headquarters and the Divisions of Tuberculosis Control, Venereal Disease Control,
and Laboratories. Within the headquarters element, a new section called the
" Registry and Rehabilitation Services " was created during the year; it reflects an
integration of the rehabilitation and crippled children's registry services, which had
previously operated as relatively independent entities. The registry function was
extended to include provision for registration of handicapped adult cases. A report
on the activities of this service is presented on page 110.
Liaison with voluntary health agencies in the Province has continued to be a
responsibility of this Bureau. Brief reports on the activities of most of these
agencies are presented below.
The cordial relationships which have existed with the Faculty of Medicine,
University of British Columbia, have continued and contribute substantially to the
development of public health services in this Province.
In June the Deputy Minister of Mental Health and some of his senior staff
moved their administrative headquarters to offices on the seventh floor of the Provincial Health Building in Vancouver. This proximity of offices of the Mental
Health Branch and Health Branch services has afforded an opportunity to extend
the close and cordial relationships which have existed for many years.
ADMINISTRATION
There have been no major changes in administration during the year. In last
year's report, brief reference was made to the introduction of a progressive patient-
care programme in the Division of Tuberculosis Control. It was started in November, 1959, and it is now evident that it has been an eminently successful venture.
The standard of service to in-patients has improved, while substantial reductions
in costs have been achieved. The reduction in salary costs alone at Pearson Hospital amounts to some $46,000 per annum. The problems involved in the introduction of this programme were very difficult indeed; that it has nevertheless succeeded so well, especially at Pearson Hospital, is a tribute to senior staff of that unit.
An interesting development in the personnel field is the extremely low turnover of personnel. There are about 575 full-time jobs in the Bureau; the monthly
number of separations has not exceeded twenty and has been as low as four during
the year. The reasons for this improved situation are difficult to determine, but it
seems probable that fewer job opportunities in the community generally and improved working conditions in the Service are major contributory factors.
On April 1st, 1960, Dr. C. L. Hunt, who had been associated with the Bureau
for many years in various part-time and full-time appointments, assumed directorship of the Registry and Rehabilitation Services.
VOLUNTARY HEALTH AGENCIES
The valuable contribution of these various agencies to the development of
public health services has continued during the year. The major activities of those
which receive direct financial assistance from the Provincial Government are briefly
reported below.
k 36 public health services report, 1960
Alcoholism Foundation of British Columbia
The Alcoholism Foundation of British Columbia received an increased grant
from the Provincial Government in 1960, and this provided for the expansion of
services in several areas. The staff of the education department was increased,
and the general programme of preventive education was stepped up. One-day
institutes on alcohol problems were held in various centres throughout the Province, often in co-operation with local health services. They were well received and
have been responsible for fostering greater community interest in treatment and
preventive programmes. The residential facuities of the Foundation were increased
in July, when arrangements were completed with a private hospital to provide several beds for female patients. The clinical services were extended when a travelling clinic service was inaugurated in July to serve the Kamloops-Okanagan area.
The travelling clinic team provides diagnostic, treatment, and health education
services throughout the area.
Throughout the Province there is a growing recognition that alcoholism is a
medical-social problem of enormous proportions, and that there is a great need for
the development of diversified resources to combat it. The Foundation offers its
technical advice and services to any community that wishes to embark upon an
alcoholism control programme.
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 thirteen consultative cancer clinics
at centres throughout the Province, and the 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.
An extensive programme of expansion is being undertaken by the Cancer
Foundation. At the British Columbia Cancer Institute in Vancouver, new permanent quarters have been constructed for the Cytology Department, the Diagnostic
X-ray Department, the Social Service Department, and the New Patients Clinic.
The boarding home has been enlarged from a bed capacity of 36 to 56 by finishing
the top floor of the building. Work is under way on the construction of larger
quarters for the Radiotherapy Department, where a second Cobalt 60-unit will be
installed as soon as the building is ready. Accommodation is also being provided
for further supervoltage equipment at a later date.
In Victoria new premises are being provided for the Victoria Cancer Clinic
at the Royal Jubilee Hospital. The Cancer Foundation is sharing in the cost of
the new building and will provide a small Cobalt 60-unit when the building is
finished.
British Columbia Medical Research Foundation
This has been the first full year of operation of the British Columbia Medical
Research Foundation since its constitution was revised to convert the organization
from one which operated its own research laboratories to one which supports medical research by making grants to medical scientists working in the University of
British Columbia and in the major hospitals in the Province. All applications are
SPECIAL PREVENTIVE AND TREATMENT SERVICES, VANCOUVER K 37
carefully reviewed by a well-qualified Medical Board, and every effort is made to
ensure that the funds of the Foundation are devoted to the support of important
research projects whose financial requirements cannot be met by the current programme of existing private and governmental agencies. In 1960 grants totalling
$47,000 were made in support of sixteen projects representing a wide range of
investigations in the fields of basic and medical research.
During the past year the Foundation's non-governmental sources of financial
support included an allocation from the Community Chest and Councils of the
Greater Vancouver area, gifts and bequests from private individuals, and a generous grant from the Leon and Thea Koerner Foundation.
Canadian Arthritis and Rheumatism Society
(British Columbia Division)
About 4,000 patients were referred to the Canadian Arthritis and Rheumatism
Society for general service during 1955, while in 1959 there were over 4,400
patients treated, and, of these, about 3,150 were new or reopened cases. In addition, 918 patients were referred for special services as described in previous reports.
Of the total patients having general service, 919 had disabilities from diseases other
than arthritis.
Statistical assessment of all patients before and after receiving physiotherapy
is made according to a functional capacity code. Improvement during 1959 was
shown in 86 per cent of those in the under-40 age-group, in 81 per cent of those in
the 40-64 age-group, and in 78 per cent of those in the over-64 age-group.
Every effort is made to restore to useful living those patients who have achieved
maximum function. Courses are arranged where needed and work found for those
able to return to remunerative employment. Some, however, are unable to work
in a competitive field, and, for 138 of these, instruction in arts and crafts has been
supplied. Thirty have achieved a sufficiently high standard of skill to produce saleable articles. These articles are sold on the open market with financial returns to
the patients, some of whom have become independent of social assistance by this
means.
An in-patient treatment programme for children with rheumatic disease has
been established for in-patients in collaboration with Princess Margaret Children's
Village. This complements the juvenile rheumatoid arthritis programme for outpatients at the Canadian Arthritis and Rheumatism Society Medical Centre. The
course of the disease is being documented and the programme supervised by the
Director, Kinsmen Laboratory of Neurological Research at the University of British
Columbia.
Because of the increased need for treatment service, a unit has been established
in the Peace River area. A full-time physiotherapist is employed who treats ambulatory patients in the health centres in Dawson Creek and Fort St. John and the
home patients by means of the mobile unit. Burns Lake also received regular visits
from the Prince George physiotherapist during 1960.
A Canadian Arthritis and Rheumatism Society research unit into the rheumatic
and connective tissue diseases has been established under the direction of an Associate Professor in the Department of Medicine at the University of British Columbia.
Canadian Arthritis and Rheumatism Society bequest funds will support this unit for
ten years, after which the University will assume responsibility.
An authority on gout from Chicago was the Canadian Arthritis and Rheumatism Society's lecturer at the University of British Columbia this year. He aroused
K 38 PUBLIC HEALTH SERVICES REPORT, 1960
considerable interest amongst the doctors, medical students at lectures, and during
ward rounds.
Five bursaries have been awarded to enable British Columbia girls to take
physiotherapy training. Job-study prizes, slides for teaching purposes, and a refresher course in physiotherapy and occupational therapy have been arranged to
promote or improve the understanding of the use of physiotherapy and occupational
therapy in the control of rheumatic disease.
Narcotic Addiction Foundation of British Columbia
During the year 1960 there was a marked increase in the number of patients
who voluntarily requested services from the Narcotic Addiction Foundation. In
comparison with 1959, when 97 patients sought help, a total of 243 patients (175
men and 68 women) came for treatment, mostly withdrawal, from heroin addiction.
In the continuing absence of a residential treatment unit for female patients, only
male patients could be accepted for in-patient treatment and attempts at rehabilitation. In all, there was a total of fifty admissions and readmissions, and in these
patients withdrawal treatments were completed.
Unfortunately, attempts at rehabilitation are severely limited by the very great
difficulties that the addict faces in being reintegrated into society, particularly in the
area of successful employment. It is here that the community can play a major
part, if it understands the problems and the needs. A continuing programme of
community education has been carried out, but a great deal more still requires to
be done. In this field, and in the most important one of research, the needs of the
Foundation are being more clearly understood. It is hoped that in the coming year
the research and education departments will have the staff and facilities necessary to
carry out the studies essential to a fuller understanding of this difficult problem, and
that the community will be better advised on the role it must play in after-care and
rehabilitation.
G. F. Strong Rehabilitation Centre
The primary object of the Centre is to provide comprehensive rehabilitation
services, on an in-patient and out-patient basis, to disabled children and adults in
the Province of British Columbia. This object is fulfilled through the extensive and
specially designed physical facilities owned and operated by the Centre, through its
large multi-disciplined professional staff and through integrated relationships that
the Centre has with other agencies in the community.
During 1959, 21 per cent more patients were admitted to a programme of
rehabilitation than in the previous year. Based on statistics to October 31st, 1960,
it is anticipated that the Centre's level of activity for the current year will be slightly
in excess of the high level reached in 1959.
The Centre continues to provide floor space and other facilities for the Canadian Arthritis and Rheumatism Society.
The continued expansion of all services in the Centre is seriously overtaxing
the designed capacity of the building, making efficient and effective provision of
services increasingly more difficult. A large multi-story addition has been planned,
and it is hoped that a start on this project may be made in the near future.
The Centre's professional training programme provides internships each year
for physiotherapists and occupational therapists. Orientation courses in rehabilitation are regularly arranged for student social workers and physical education
instructors. Last year arrangements were made to provide, in the Centre, a year's
resident training in rehabilitation for a physician. Many of the training-hours con-
SPECIAL PREVENTIVE AND TREATMENT SERVICES, VANCOUVER K 39
tributed by Centre personnel are devoted to student-nurses, public health nurses,
psediatric and other graduate nurses, who are introduced, by a practical demonstration of the Centre's programme in operation, to the spectrum of disease and injury
treated.
as as
The Provincial Health Building at 828 West Tenth Avenue in Vancouver, opened in
1955, houses all offices of the Health Branch in Vancouver, with a connection to the near-by
offices of the Division of Tuberculosis Control. In 1960 the administrative offices of the
Mental Health Services Branch were accommodated.
NATIONAL HEALTH GRANTS
There was a rearrangement of the National Health Grants in that the Venereal
Disease Control Grant and the Laboratory and Radiological Services Grant were
cancelled, and the services previously available under these grants were transferred
to the General Public Health Grant. The Crippled Children's Grant and the Medical
Rehabilitation Grant were combined into the Medical Rehabilitation and Crippled
Children Grant. Also, professional training previously supplied under the Tuberculosis Control Grant, Laboratory and Radiological Services Grant, and the Child and
Maternal Health Grant was transferred to the Professional Training Grant. This
resulted in a redistribution of funds allocated to the grants affected by these changes.
Upon the recommendation of the Dominion Council of Health earlier in the
year, a term-grant approach was made to selected research projects from well-
established research centres, which are of a continuing nature and of uniform
quality, and lending themselves to sustained levels of assistance over a period of
approximately two years. Six research projects were recommended and accepted
as term-grant projects, but it will still be necessary for reapplication to be made for
continuation of these projects from year to year.
K 40 PUBLIC HEALTH SERVICES REPORT, 1960
The total amount of funds available to British Columbia for 1960/61 was
$4,867,542, being a decrease of $1,188,602 from that appropriated for 1959/60.
This decrease was the result of considerably less funds being available in the revote
of the Hospital Construction Grant and also in a general reduction of funds allocated
to the majority of the grants for 1960/61. This excludes the Public Health Research
Grant, which is administered in Ottawa.
Of the $4,233,522 approved for projects for the year ended March 31st, 1960,
$3,928,461 was expended, or 64.8 per cent. The reasons for unexpended funds
were largely due to the changing programme in the treatment of tuberculosis and
to the initiation of increased facilities and treatment in the Mental Health Services
Branch, which have not yet been finalized.
Professional Training Grant
The funds allocated to this grant were increased from $47,221 in 1959/60 to
$157,699 in order to cover the transfer of professional training from other National
Health Grants to this grant.
Short-term postgraduate training and university training were provided to personnel of hospitals, the University of British Columbia Faculty of Medicine, and
metropolitan and Provincial health personnel. Assistance was also provided to
sixteen hospital administrators and eight medical-record librarians who are participating in the extramural courses sponsored by the Canadian Hospital Association.
Funds were provided to personnel of the Lower Vancouver Island Cerebral Palsy
Association to attend a workship conducted in Vancouver, and also to staff members
of the G. F. Strong Rehabilitation Centre to attend a course in prosthetics held at
the University of California. Evening lectures were conducted for supervisory
nursing staff of the Royal Columbian Hospital, St. Mary's Hospital, and the Surrey
Memorial Hospital, sponsored by the Department of Extension and the School of
Nursing of the University of British Columbia and the Royal Columbian Hospital,
with National Health Grant assistance being provided.
Hospital Construction Grant
The Hospital Construction Grant for this year was fully committed by the end
of December. Construction of community health centres utilized 4.5 per cent of
the grant; the remainder, $1,650,572.86, was for general hospitals.
Mental Health Grant
There was a substantial increase in the Mental Health Grant allocation this
year, the amount available totalling $790,742.
Most projects are submitted by the Mental Health Services Branch, and, as in
previous years, the greater portion of the grant is used to provide staff and technical
equipment for the mental-health institutions operated by the Province.
The Children's Foundation, which operates the Esther Irwin Home for Emotionally Disturbed Children, was assisted by a project providing a portion of the
salary for the executive director. A new project to assist the Department of Psychiatry at the University of British Columbia was approved. This grant provides funds
for the payment of tutorial supervision of graduate students studying for the specialty
examinations in psychiatry. The grant also will assist in the purchase of basic
equipment, including office furniture and library supplies.
Once again there has been an increase in the number of bursaries provided for
professional training of mental-health personnel. There are now twelve psychi-
SPECIAL PREVENTIVE AND TREATMENT SERVICES, VANCOUVER K 41
atrists, one internist, ten social workers, five registered nurses, and two clinical
psychologists engaged in full-time graduate study. Most of these students are
enrolled at the University of British Columbia.
The psychiatric services of the Vancouver General Hospital continued to
receive support, as did the mental-hygiene programme of the Metropolitan Health
Committee of Greater Vancouver and the training course for senior school counsellors sponsored by the Vancouver School Board.
Projects to assist the research programmes in the Departments of Neurological
Research and Pharmacology of the University of British Columbia were continued,
with some increase in the funds provided for this work.
Tuberculosis Control Grant
Funds allocated to this grant were decreased by $69,549, due mainly to the
changing concepts in the tuberculosis-control programme.
The majority of the tuberculosis services are provided by the Province, and the
largest portion of the grant is used by the Division of Tuberculosis Control of the
Health Branch.
Continued assistance was supplied for equipment for health units and general
hospitals, vocational training for students, payment for special out-patient investigations in general hospitals, and to antimicrobial therapy. In addition, assistance was
given to the Metropoltan Health Committee of Greater Vancouver and to the
Princess Margaret Children's Village toward personnel in the tuberculosis-control
treatment programme.
Details of the activities of the Division of Tuberculosis Control are reported in
a later section of this Health Branch Report.
Public Health Research Grant
Three research studies were conducted by departments of the Faculty of
Medicine, University of British Columbia. Two of them were one-year projects,
and were completed, these being: adrenal steroids and immune reactions in pregnancy, and drug-induced influences on the activity of enzymes involved in energy
utilization on contractile function in cardiac tissues. The third study concerns
pedestrian traffic accidents involving children in the City of Vancouver. Reports on
the findings of all three surveys will be presented to the Department of National
Health and Welfare.
Two new research projects were undertaken by the Health Centre for Children,
one on auditory disorders in children of pre-school age and the other on a frequency
compression speech system for use with deaf children. This latter project was conducted in conjunction with the University of British Columbia, Department of
Electrical Engineering.
General Public Health Grant
The funds allocated to this grant were increased by $487,493 to include the
services previously available from the Laboratory and Radiological Services Grant
and the Venereal Disease Control Grant.
The general public health programme of the local health services staff continued
to receive assistance. Details of this programme have been reported earlier in this
Health Branch Report.
The rheumatic fever prophylaxis programme was expanded to include all the
Provincial health units, together with the Metropolitan Health Committee of Greater
K 42 PUBLIC HEALTH SERVICES REPORT, 1960
Vancouver. Patients up to the age of 18 years only have been accepted and have
been taken on the programme at this time for a period of five years.
A third food-service institute for hospital cooks was held at Nanaimo, sponsored by the British Columbia Hospital Insurance Service and the Health Branch.
The Salk vaccine immunization programme was continued, with funds being
supplied through the National Health Grants.
The speech and hearing programme of the Health Centre for Children continued
to receive assistance toward the purchase of equipment, supplies, and personnel.
Research equipment and fittings were supplied for the new medical services
buildings being constructed at the University of British Columbia.
At the request of the Minister of Health Services and Hospital Insurance, a
project was formulated to study hospital utilization in the Lower Mainland under
the direction of the Metropolitan Hospital Planning Council.
The venereal disease project is on a matching basis, with the total funds being
paid to the Province. Expenditures by the Province are considerably in excess of
the National Health Grants. The report on the Division of Venereal Disease Control appears in a later section of this Health Branch Report.
Continued assistance was provided to the Metropolitan Health Committee of
Greater Vancouver toward personnel and purchase of dental equipment, and the
Victoria-Esquimalt Board of Health also received support toward personnel.
With the further development of the glaucoma clinic servicecs at St. Joseph's
Hospital, Victoria, assistance was increased to provide additional personnel and
equipment.
The student internship programme, whereby medical students are assigned to
health units and divisions within the Health Branch, has now been in operation for
seven years and has proven to be a most successful project.
Laboratory Services
The work load of the four regional laboratories serving hospitals outside the
urban centres continued to increase; in fact, the volume increased to such an extent
in two of these regions that the Laboratory Advisory Council was called upon to
make recommendations to either curtail the work or give assistance to the pathologist. Studies were conducted in both these areas and advice was given. As other
hospitals in the Province had asked for the services of a pathologist, this Council
proposed that these should be investigated before enlarging the existing programmes.
Accordingly, a survey was made relative to pathological services for the Central and
Upper Vancouver Island areas and a Pathological Committee was formed to investigate this development.
The laboratories in the urban centres were well staffed with technicians, due in
part to the training-school at the University of British Columbia, Medical School
Building, and the Vancouver General Hospital, which graduated twenty-five technicians this past year. The outlying districts still have difficulty in attracting technicians. Surveys indicated that there were several small hospitals where the amount
and scope of work did not warrant a full-time laboratory technician even if available,
and basic laboratory procedures have been attempted by unqualified personnel.
As this is an inevitable situation, it has been proposed that a short course be
planned to assist these individuals.
The Laboratory Advisory Council had a very active year, and two new subcommittees were formed. The Hospital Construction Division of the British Columbia Hospital Insurance Service asked for assistance in planning laboratories for
new hospitals of various sizes, and a sub-committee was formed to make a study and
SPECIAL PREVENTIVE AND TREATMENT SERVICES, VANCOUVER K 43
eventual recommendations. The second new sub-committee commenced a study of
laboratory standards for hospitals of various sizes and according to the type of
technical personnel available, and have planned to make recommendations. The
Technical Sub-committee of the Laboratory Advisory Council held several meetings
to appraise applications for grants on laboratory equipment.
A postgraduate course for laboratory technicians was given in Kamloops and
organized by the pathologist at the Royal Inland Hospital. This event, the third of
its kind, was attended by thirty-seven technicians from all parts of the Province, and
because of the success and benefits derived it has been planned to make this an
annual event.
The technical supervisor of clinical laboratory services acted as secretary to
the Laboratory Advisory Council and its sub-committees, and accumulated data
necessary for the various studies. Assistance was given to the arranging and implementation of the postgraduate course in Kamloops and also with various problems
posed by administrators and technicians, particularly those in the smaller hospitals.
Radiological Services
In 1955 the Radiological Advisory Council was established to serve in an
advisory capacity to the Deputy Minister of Health on matters affecting the development of radiological services in the Province. The Council has representation
from the British Columbia Hospital Insurance Services, the Canadian Medical Association (British Columbia Division), the Faculty of Medicine of the University
of British Columbia, the British Columbia Hospitals Association, and this Health
Branch. The Technical Adviser, Radiological Services, a Health Branch employee,
serves as Council secretary.
The Council's Technical Training Committee has again completed arrangements for two refresher courses for X-ray technicians, one on an elementary and
one on an advanced level. They will be conducted during February, 1961. The
Committee's study of the question of a two-year training course for technicians is
nearing completion; the main aspect being considered is whether more emphasis
should be placed on theoretical training.
The Radiation Committee has continued its study of radiation problems in the
Province. These problems are becoming more acute as a result of the increasing
use of radioisotopes in medicine, industry, and research, and the use of radioactive
elements in items being sold through retail outlets.
The Technical Sub-committee, which reviews requests from hospitals for
radiological equipment, approved fifty applications for such equipment, with a total
value of about $250,000.
The technical adviser visited fifty hospitals in the Province during the year,
and in most cases conducted radiation surveys. A considerable number of potentially dangerous electrical and mechanical deficiencies were disclosed, of which the
hospitals were not aware. In all cases the hospitals should be able to correct them.
Also, as a result of these visits, an expanded training programme for X-ray technicians is under consideration, and a programme of periodic visits has been instituted
to assist hospital administrators and technical staff in their technical planning and
procedures. Where the services of a radiologist were not available, these problems
tended to be more acute, and this aspect of the matter is also being studied by the
Council.
The Director, Division of Occupational Health Services and the Technical
Adviser addressed conventions of the Chiropractors' Association of British Colum-
K 44 PUBLIC HEALTH SERVICES REPORT, 1960
bia and the British Columbia Veterinary Association, at the request of these organizations. They spoke on radiation control and inspection.
The Health Branch continues to work with the Radiation Division, Department of National Health and Welfare, in its radioisotope inspection programme in
this Province.
Cancer Control Grant
The operations of the British Columbia Cancer Foundation, which are financed
jointly by this grant and matching Provincial funds, are outlined earlier in this
report in the section on voluntary health agencies.
The cytology laboratory, located at the British Columbia Cancer Institute and
under the direction of the Director, Department of Pathology, Vancouver General
Hospital, enlarged its facilities in order to meet the ever-increasing cytology examinations requested by the physicians in this Province. Additional personnel and
equipment were provided by the National Health Grants.
There were 65,000 examinations during 1959/60, compared with 13,656 in
1954/55. The major aspect of the work continues to be the detection of early
carcinoma of the cervix.
A further supply of radium was purchased for the Victoria Cancer Clinic,
together with additional equipment for its cancer programme. Also, equipment
was purchased for the British Columbia Cancer Institute in order to further reduce
radiation exposure to patients and X-ray film costs.
The programme of training radiotherapy technicians at the British Columbia
Cancer Institute has continued with assistance from the Federal-Provincial programme and the Canadian Cancer Society (British Columbia and Yukon Division).
Medical Rehabilitation and Crippled Children's Grant
This grant is on a matching basis, with $236,982 being allocated from Federal
funds for the fiscal year 1960/61.
The G. F. Strong Rehabilitation Centre and the Cerebral Palsy Association
of British Columbia received continued support toward staff.
The Health Branch operates a registry for handicapped children and adults
and a rehabilitation service for adults, receiving assistance from the National Health
Grants. The report on these services appears in a later section of this Health
Branch Report.
Child and Maternal Health Grant
Equipment was purchased for the child and maternal health programme in
the Provincial health units in connection with classes for expectant parents. Continued provision was made toward partial payment of personnel and purchase of
supplies for the expanding services of the Health Centre for Children.
The British Columbia Co-ordinating Council for Child Care continues to
function in reviewing facilities and closer integration of children's hospitals in the
Province. The operational costs are borne equally by a National Health Grant
and by the British Columbia Foundation for Child Care, Poliomyelitis and Rehabilitation.
The service being given by the Department of Obstetrics and Gynecology of
the University of British Columbia on maternal mortality, maternal morbidity, and
certain aspects of foetal wastage in British Columbia was broadened to include a
similar service for perinatal mortality.
The University of British Columbia child health programme continues to
expand its services for the children of students. Provision was made toward per-
SPECIAL PREVENTIVE AND TREATMENT SERVICES, VANCOUVER K 45
sonnel, supplies, equipment, and local travel for the public health nurse and social
worker.
Two new research projects were instigated by the Health Centre for Children
research department. One study is to investigate the metabolic disturbances in
children with mental retardation and nervous disorders, and the second project is
related to cytochemical studies on the alkaline phosphatase content of leukocytes
of infants and children.
K 46 PUBLIC HEALTH SERVICES REPORT, 1960
REPORT OF THE DIVISION OF PUBLIC HEALTH NURSING
Monica M. Frith, Director
The Division of Public Health Nursing is part of the Bureau of Local Health
Services, which provides public health nursing service to all areas of British Columbia, other than the districts of Greater Vancouver and Greater Victoria. In its
administrative role the Division maintains a high standard of public health nursing
performance on a local level, through the recruitment, placement, transfer, and
training of public health nurses. In its consultative capacity it makes available
technical help and guidance to assist public health nurses to provide public health
nursing service in an efficient and effective manner.
To co-ordinate health facilities within the Province, the Division works closely
with other official health agencies, such as the Vancouver Metropolitan Health
Committee, Victoria-Esquimalt Health Department, Oak Bay Health Department,
Indian Health Services, as well as voluntary agencies, such as the Victorian Order
of Nurses and the Red Cross Nursing Service. Thus it is possible to co-ordinate
the use of health facilities and resources to avoid overlapping and duplication of
public health nursing services.
During 1960 the public health nursing service made great progress as it was
possible to add twenty-six public health nurses to the field staff. There are now
217 full-time and ten part-time public health nurses employed in Local Health
Services. Most of the additions were casual appointments made under provisions
of the National Health Grants or the special fund for home nursing care. In addition, there are a Director, two public health nursing consultants, and an occupational health nurse in the Division, making a total of 221 full-time public health
nurses.
PUBLIC HEALTH NURSING ADMINISTRATION AND
CONSULTATION
Each year the Division undertakes certain studies to evaluate the services
being provided by the public health nurses on a local level. Among these studies
is the case-load analysis made of each public health nursing district to determine
the work load and the progress being made. From a review of the case loads, it
is possible to determine the need for revision in the area served by each public
health nurse. An analysis of the local health problems in relation to the population and area served may indicate a need for additional nursing assistance. Areas
with demonstrable population growth had fourteen additional public health nurses
assigned to them this year. The following health units had public health nurses
added: Central Vancouver Island Health Unit at Port Alberni, Skeena Health Unit
at Prince Rupert, Peace River Health Unit at Dawson Creek and Fort St. John,
South Central Health Unit at Kamloops, East Kootenay Health Unit at Cranbrook,
Cariboo Health Unit at Prince George, Simon Fraser Health Unit at Coquitlam,
Upper Fraser Health Unit at Abbotsford, Upper Island Health Unit at Campbell
River, and Boundary Health Unit at Ladner, Langley, Cloverdale, and North Surrey.
Part-time nursing assistance was made available to the East Kootenay Health Unit
at Fernie and to the Howe Sound Public Health Nursing Service at Pemberton.
By the end of the year it was possible to have an average ratio of one public health
nurse to about 4,800 population for the basic service. This is closer to a desirable
ratio of public health nurses to rural population than has been possible for some
time. Health units providing home nursing-care service along with the basic programme had an average ratio of one public health nurse to 3,400 general popula-
PUBLIC HEALTH NURSING K 47
tion. This was made possible by the assignment of twelve nurses to the following
health units which provide the organized home nursing-care service: Central Vancouver Island at Port Alberni, two nurses at Duncan for Duncan and Ladysmith;
Saanich and South Vancouver Island Health Unit at Sidney, Sooke, and Saanich;
Cariboo Health Unit at Quesnel; East Kootenay Health Unit at Kimberley; South
Okanagan Health Unit at Kelowna; North Fraser Health Unit at Haney; Selkirk
Health Unit at Nelson; and South Central Health Unit at Kamloops.
A time study is done annually by each public health nurse to determine how
much time is being spent on various activities. This provides information to determine the cost of the various services provided by the public health nurses. It also
points out trends in the use of time which may require adjustment. As a result of
this study, it has been possible to show that public health nurses were spending time
on non-professional activities, such as cleaning of syringes and needles and certain
clerical duties which could be done more economically by a less highly trained
employee. Public health nurses were spending 3.1 per cent of their time on preparation of equipment and 3.4 per cent of their time on non-professional clerical
work. It was possible to increase health unit aide and clerical time in certain health
units and thus free public health nurses for professional nursing duties.
A study was made of the results of teacher-nurse conferences, which were
designed to promote more efficient school health services. The results were gratifying on a Provincial basis as all health units showed an improvement over the last
two years. During 1960 over 80 per cent of the referrals to the public health nurse
for follow-up were completed in the elementary schools. There was less uniformity
in the conferences in the junior and senior high schools, where productive conferences often were held with high-school counsellors instead of the classroom teacher
and also individual referrals were received from teachers. The basic essentials
in this programme are being drafted into a policy proposal for inclusion in the
Policy Manual.
These studies, coupled with the monthly reports received from each public
health nurse and information garnered through field visits of public health nursing
consultants attached to the Division, serve to provide evaluation of the field service
and permit opportunity for supervisory guidance of the nursing services. The public
health nursing consultants plan to visit the health units and nursing districts twice a
year to proffer guidance and assistance to the local staff.
To provide for the continuity and expansion of service, a considerable number
of changes were required to make available public health nurses for the various
positions in local health service. Eighty appointments were made, while there were
twenty-four transfers. An additional thirteen nurses returned from educational leave
of absence and were placed in areas requiring public health nursing staff. There
were forty-eight resignations, of which twenty-seven were for family reasons, four
to travel, ten to accept other positions, while eight nurses resigned to take further
education. In addition, there was one death. This year the Health Branch continued to have a high proportion of qualified public health nurses, with 88.7 per
cent of the nurses having either a diploma or university degree in public health
nursing. The nurses employed without qualifications as public health nurses plan to
obtain the required qualification following a short period of experience in the field.
Certain other activities are carried out by the public health nursing consultants
to encourage efficiency in nursing procedures and services by the nursing staff,
including the provision of literature, technical information, and equipment. The
Policy Manual has continued to be a useful tool for the public health staff, and the
public health nursing consultants have contributed many new sections and revised
K 48 PUBLIC HEALTH SERVICES REPORT, 1960
others this year. With the assistance of the Nursing Care Policy Committee, a home
nursing-care procedure manual was completed which can be carried by the public
health nurse in her nursing bag as she goes about her daily work. The Public Health
Nursing Records Committee met less frequently this year as the record system has
become fairly well stabilized and fewer changes are required. The public health
nursing consultant in Victoria is preparing a revision of the Records Manual, which
will be available early in 1961. The consultant in Vancouver continues to act as a
public health nursing adviser and maintains liaison with voluntary and official
agencies.
Due to the need for special emphasis on rehabilitation, the public health
nursing consultant in Vancouver was assigned the task of stimulating interest and
developing more emphasis on this phase of the public health programme. She is
working closely with rehabilitation specialists to help work up a programme which
can be built to suit the situation in this Province. Some progress has been made in
extending and improving loan cupboards in areas providing home nursing-care
service. In addition, a closer working relationship is being developed with the
Victorian Order of Nurses so that rehabilitation nursing will be extended in areas
served by both agencies.
Assistance was given the Provincial Civil Defence Co-ordinator in planning
and conducting courses of training in emergency health services for nurses in British
Columbia. This included participation in a one-week programme designated for
Directors of Nursing of hospitals throughout the Province. In addition, recommendations were made for the selection of nursing candidates for special courses
for nurses given at the Civil Defence College at Arnprior, Ont.
The public health nurse in the Occupational Health Service continued to provide a valuable service for the employees in the Victoria area. In addition, she
has assisted with plans for the extension of the service into the Vancouver area.
Arrangements have now been concluded so that an experienced public health nurse
will be available in the new year to inaugurate the service.
TRAINING PROGRAMMES
As public health nursing is becoming increasingly complex, it is important that
the public health nursing staff have a high degree of training. In addition to registration as a nurse, the public health nurse must qualify by securing a diploma or
degree in nursing, majoring in public health at a recognized university. As it has
not been possible to recruit a sufficient number of fully qualified public health
nurses, it has been necessary to continue with the public health nursing training
programme for selected candidates. A limited number of registered nurses are
taken on staff on the understanding that they will be completing the university
requirement at an early date. National Health Grant bursaries are made available
to the nurses who have demonstrated suitability for the public health nursing field,
following a satisfactory period of service on the staff. During the year eleven
nurses returned to local health service following completion of the public health
course at university and an additional eight are on educational leave of absence to
complete similar training. It is interesting to note that ninety-one nurses have
received National Health Grant bursaries since they were first inaugurated under
this plan in 1948, and that 48 per cent are still on staff. Nurses accepting financial
assistance are asked to serve for a period of two years after completion of the
programme. Over 80 per cent of the candidates served three years or over after
completing the university programme. As public health nursing supervision involves
preparation beyond that required for staff public health nurses, it is our plan to have
PUBLIC HEALTH NURSING
K 49
all supervisors and senior nurses complete courses designed to give special training
in public health nursing supervision and administration. Two public health nursing
supervisors returned following a year's programme in public health nursing administration and supervision at McGill University, while three public health nursing
supervisors are away this year, two at the University of Toronto and the third
enrolled in the Public Health School at Ann Arbor, Mich.
The provision of field experience for graduate nurse students is an important
contribution toward the training of nurses. During the year forty-three students
from the University of British Columbia were placed in health units for periods of
time ranging from two weeks to one month, while one student from McGill School
of Nursing was placed for public health nursing supervisory experience for a month.
Undergraduate nurses in all schools of nursing in British Columbia now observe
for periods of time ranging from four days to two weeks in local health services.
Students from the Vancouver General Hospital have a period of observation with
the Metropolitan Health Service. Eighty-five student-nurses had field observation
in Provincial health units adjacent to their schools of nursing, which included the
Saanich and South Vancouver Island Health Unit for Victoria schools of nursing,
Boundary and Simon Fraser Health Units for the Royal Columbian School of
Nursing in New Westminster, and the South Central Health Unit for the Royal
Inland School of Nursing at Kamloops. This year a new plan was put into effect,
whereby student-nurses from St. Paul's Hospital School of Nursing had field experience following their annual vacation in the health units of their residence. As a
result, fifteen nurses had a week's experience in health units which had not been
providing this kind of student experience before.
LOCAL PUBLIC HEALTH NURSING SERVICE
The public health nursing programme is developed on a local level to meet the
health needs of the community following an accepted standard of service. At the
end of the year there were 217 public health nurses serving full time and ten part
time (equal to five full time) in the Health Branch. The increase of twenty-six over
last year consisted mostly of casual appointments made under the provisions of
National Health Grants or the special funds for home nursing care. In addition,
other official agencies employed a total of 207 public health nurses to provide service in other parts of the Province. This included 159V_ with the Metropolitan
Health Committee serving the Greater Vancouver area, 121/- in the Victoria-Esquimalt Health Department, three in the Oak Bay Public Health Department, and eight
in the City of New Westminster, which forms part of the Simon Fraser Health Unit.
The Indian Health Services have twenty-four nurses who provide public health
nursing service on reservations not served by Provincial health units or the Metropolitan Health Committee. In addition to the above, a voluntary agency, the
Victoria Order of Nurses, supplements the public health nursing programme in the
larger cities and certain large rural municipalities through the provision of home
care nursing and other selected services. The Victorian Order of Nurses employed
sixty-one public health nurses in its various branches in British Columbia. At the
end of the year a total equivalent to 496 full-time public health nurses were employed in public health nursing positions throughout the Province. Public health
nurses in all services work closely with nurses in hospitals and with occupational
health nurses to provide continuity of nursing service in local districts.
The public health nursing programme throughout the Province is provided as a
generalized service designed to meet the health needs of all members of the family.
Methods vary in the conduct of the service, although every effort is made for all
K 50 PUBLIC HEALTH SERVICES REPORT, 1960
public health organizations to follow policies which are worked out on a Provincial
basis so that a similar standard is attained throughout British Columbia.
Certain health programmes are directed toward specific age-groups where special health needs are known to exist. The public health nursing service includes
health instruction for expectant parents through individual instruction and group
classes. A total of sixty-two centres throughout British Columbia provided this
type of programme. It is estimated that 12.2 per cent of mothers in relation to
babies born attended classes this year. All official agencies provide this type of
programme, and the Victorian Order of Nurses participates in the programme in
the Greater Vancouver and Victoria areas. At child health conferences and in
home visits, parents receive anticipatory guidance on the physical and emotional
development of the child in order to assist each child to reach its health potential.
Assistance is given parents in providing resources for the correction of defects and
medical care as indicated. Specific services such as immunization against preventable diseases, including smallpox, diphtheria, poliomyelitis, typhoid fever, tetanus, and whooping-cough, are provided at child health conferences, schools, and
special clinics. Regular child health conferences were held at 985 centres in the
Province last year. It is estimated that in the Provincial health unit areas 86 per
cent of all infants received public health nursing service either through attendance
at child health conferences or in home visits. A continuous health supervisory
programme is carried on in the schools to assist in the promotion of health among
the school-age children. This year the rheumatic fever prophylaxis programme was
extended to all rheumatic fever patients up to 18 years of age throughout the Province, and public health nurses provided nursing supervision in the home. Follow-up
on accidental poisonings is made by the public health nurses following receipt of
reports from Poison Control Centres. An increased emphasis is being placed on
mental-health problems, and a number of pilot studies are being conducted to determine the best results of follow-up of various community-sponsored mental-health
programmes. Public health nurses are active in the referral and follow-up of
selected patients. During the year the numbers of immunizations to adults increased, particularly for poliomyelitis. Local Kinsmen's Clubs assisted with organization and advertising in some instances, and as a result about 50,000 adults
completed the series this year.
During the year there was an acceleration in the establishment of organized
home nursing-care programmes in the Provincial health units. Local communities can arrange for this service with their health unit by approval of an additional
assessment of 10 cents per capita. Nursing care is then provided within the framework of the public health nursing service. The following new centres established
this programme during the year in the health units listed: Central Vancouver Island
Health Unit at Duncan, Ladysmith, Lake Cowichan, and Port Alberni; Saanich and
South Vancouver Island Health Unit at Sidney, Sooke, and Langford; North Fraser
Health Unit in Maple Ridge Municipality; South Central Health Unit at Kamloops;
Cariboo Health Unit at Williams Lake and Quesnel; Skeena Health Unit at Prince
Rupert; Selkirk Health Unit at Nelson; East Kootenay Health Unit at Kimberley;
West Kootenay Health Unit at Greenwood. In all, twenty-six centres in British
Columbia are now offering home nursing-care service. Early in the new year the
service will commence in the Cariboo Health Unit at Vanderhoof and Prince George,
in the West Kootenay Health Unit at Grand Forks and Castlegar, and in the Skeena
Health Unit at Terrace, while other areas are making plans for organizing this service. It should be noted that the home nursing-care service is merely the beginning
of a more extensive programme in home care. Certain communities such as
To the child health conference, the mother brings her older child as well as the new baby.
A home visit to the new mother is an important part of the maternal and
child health programme.
K 52 PUBLIC HEALTH SERVICES REPORT, 1960
Kelowna and Penticton in the South Okanagan Health Unit and Chilliwack in the
Upper Fraser Valley Health Unit have developed excellent homemaker service, so
that part-time housekeeping services are available in the home. This is an important adjunct to part-time home nursing service as professional care in the home cannot be effective if there is no one in the home to give the necessary care between the
visits of the public health nurse. It is anticipated that as more facilities become
available in each community, more persons can be cared for at home. During the
year public health nurses made 14,261 visits to care for patients in the organized
nursing-care programme.
The first complete statistical analysis was done this year by the Division of
Vital Statistics and the results published in Special Report No. 46, " Nursing Care
Programme Statistics, British Columbia, 1959." Some of the main points shown
up in this study include the fact that the average time of a public health nurse's visit
was twenty-nine minutes. This included sixteen minutes for treatment, ten minutes
for travel, and three minutes for other service. The types of nursing care fitted into
three categories: the largest was " injections," amounting to 69.6 per cent; " general care " amounted to 19.8 per cent; while the remaining 10 per cent included
treatments such as colostomy irrigation, douche, dressings, treatment to wounds,
exercises, etc. The time used by the public health nurse for general care averaged
forty-eight minutes, while injections averaged twenty-three minutes. It is interesting to note that 79 per cent of the patients are over 60 years of age, and that they
receive more visits per person than the younger age-groups. The largest number
of visits, or 38 per cent, was made to persons with heart disease and diseases of the
circulatory system, while the next largest number of visits, or 18 per cent, was made
to individuals suffering with anemia. The cost of a visit by a public health nurse
was $1.81, or approximately $2 if certain administrative charges are added. This
is considerably less than institutional care, and the over-all community costs in
terms of hospitalization utilization can be readily visualized if visiting nurse care
was unavailable. Although it can be shown that there is a financial saving in terms
of hospital usage in acute, chronic, or other type of institution, one of the major
values is the maintenance of the patient as a useful, happy member of society
restored to active life among his family and his friends. In areas where there is no
organized home nursing-care service, public health nurses have continued to provide limited home nursing care on a short-term and demonstration basis, as part of
the regular public health nursing programme, and 7,286 nursing-care visits were
rendered during the year. This is in addition to the 11,743 therapeutic injections
of streptomycin given to tuberculosis patients, which reduces their infection, promotes their " cure," and permits them to forego lengthy sanatorium treatment, thus
reducing tuberculosis treatment costs significantly.
PUBLIC HEALTH NURSING K 53
Statistical Summary Showing Volume of Public Health Nursing Services
during I9601
School service—
Assistance with examinations by public health physicians 21,568
Services by nurse to students 121,452
Teacher-nurse conferences (classrooms) 6,686
Consultations—staff members 60,074
School meetings attended 614
Home and office visits 37,006
Meetings with parents 5,574
Telephone consultations 31,564
Infant—
Child health conference attendance 69,293
Home visits 50,023
Phone consultations 12,776
Pre-school—
Child health conference attendance 96,252
Home visits 34,158
Phone consultations 15,743
Prenatal—
Expectant parents' classes—attendance 9,798
Expectant parents' exercise classes—attendance 7,209
Adult—Services rendered at home, and office and phone consultations 144,276
Tuberculosis—
Home and office service 12,537
Streptomycin injections 11,743
Venereal disease—Treatment of cases and other follow-up visits 2,295
Nursing care—■
General programme 7,286
Special programme 14,261
Prophylactic injections for communicable disease 3,532
Total homes visited 89,219
Immunizations: Series completed for protection against—
Pertussis 44,918
Diphtheria 76,080
Tetanus , 78,497
Poliomyelitis 105,564
Typhoid 65 8
Smallpox 67,043
Total number of individual doses 398,588
Tuberculin tests 13,857
1 This report concerns the services provided by the 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, New Westminster, and Oak Bay.
K 54 PUBLIC HEALTH SERVICES REPORT, 1960
REPORT OF THE DIVISION OF PUBLIC HEALTH
ENGINEERING
R. Bowering, Director
The Division of Public Health Engineering is concerned with the specialized
field in public health wherein engineering principles and techniques are employed
in the practice of public health. The major fields of work of the Division will be
discussed under separate headings.
WATER-SUPPLIES
Water-supply is one of the traditional fields of responsibility of public health
engineers. The Health Act requires that all plans of new waterworks systems and
alterations and extensions to existing systems be submitted to the Health Branch
for approval. The Division is responsible for reviewing these plans. Careful study
of these plans, together with inspections on the site in many cases, is carried out
before approval is given. During the year there were sixty-two approvals or provisional approvals given in connection with waterworks construction. This was
down from seventy-nine in 1959. The reason for this drop is probably the decline
in the house-construction industry.
In addition to approval of plans, waterworks systems in the Province are visited
from time to time for the purpose of checking on sanitary hazards and assisting generally in the improvement of waterworks systems.
Generally in British Columbia the water-supply sources are good, and expensive treatment of the water is not usually required. Most of the large water systems
in British Columbia obtain water from relatively uninhabited mountain watersheds.
Water from this type of terrain usually does not require sedimentation or filtration.
Chlorination is usually the treatment used for the purpose of bringing the water
within the standards for bacterial purity that are recognized throughout North
America. Over 80 per cent of the population of the Province uses water protected
by chlorination. One community in the Province, Fort Nelson, built a new water
system during the year.
By the end of the year 1960 there were seven communities fluoridating the
water, some using sodium silico fluoride and some using sodium 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. Fluoridation plants are visited from time to time for the purpose of checking on their
operations. In addition, a large number of regular water-supplies were tested again
for fluoride content. Generally speaking, the fluoride content of the water-supplies
of British Columbia is less than 0.3 p.p.m.
The local health units are responsible for the regular frequent sampling of the
water from public water-supply systems. The Division of Laboratories performs
the examination of the samples. The Division of Public Health Engineering offers
consultative advice on the interpretation of the samples to the health units.
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 the local health unit officials on various water-supply
problems.
PUBLIC HEALTH ENGINEERING K 55
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 the
local health authorities and engineers of the Division. In order to assist further
the efforts of the local water authorities to have better-trained people operating the
waterworks systems of the Province, a short course was held at the University of
British Columbia in September, 1960, attended by fifty-eight operators of small
water systems. This short school was organized in co-operation with the American
Water Works Association and the University of British Columbia. Engineers of
the Division took a prominent part in organizing the course.
SEWAGE DISPOSAL
The problem of sewerage and sewage disposal is one that comes within the
purview of the Division of Public Health Engineering. Using 1959 population
estimates, there were in the Province approximately 840,000 people served by common sewerage systems. This is just over 53 per cent of the total population of the
Province. This means that there are about 730,000 people who are not served by
common sewers. Of those not served by common sewers, the unorganized territory
and the Indian reserves account for about 300,000 people. This leaves about
400,000 living in municipalities who are not served by common sewers. Most of
these people, however, live in large district municipalities, a number of which,
although not thickly populated, will have to build extensive sewerage-works within
the next few years as they change in character from rural to urban communities.
There were, at the end of 1959, ninety-three communities in British Columbia
organized as cities, towns, and villages. Of these, thirty-three are cities, three are
towns, and fifty-seven are villages. Of the thirty-three cities, eighteen have populations over 5,000. All of these cities are sewered or partly sewered. The remaining cities, towns, and villages all have populations below 5,000. Eighteen of the
communities have populations between 2,000 and 5,000. Of these, thirteen are
sewered or partly sewered. There are fifty-seven of these communities below 2,000.
Of these, eighteen are partly sewered. Actually the figures for villages, towns, and
cities show that if an organized commmunity has a population in excess of 1,000
and a population density of five persons or more per acre of taxable land, then that
community is at least partly sewered.
The Division has the responsibility of reviewing plans for extensions, alterations, and construction of sewerage systems. During the year sixty-nine approvals
were given in connection with sewerage-works. This compares with sixty-four
in 1959.
Study of the plans for approval includes the study of profiles and plans of
appurtenances in order to see that a good standard of sewerage-work is constructed.
Also, the study includes the study of treatment-works, if any, and studies of the
receiving body of water in order to determine the degree of treatment required.
There were some important by-laws for sewerage construction passed in 1960.
Two of the notable ones include the largest district municipalities in the Greater
Vancouver area and the Greater Victoria area respectively—namely, Burnaby and
Saanich. Among other highlights this year were the construction by the City of
Penticton of a fine, new activated sludge treatment plant; the construction of a
sewage treatment plant to serve the Brighouse area of Richmond; the construction of a new sewerage system for Princeton; the construction of a new sewerage
system for Fort Nelson; and the beginning of construction of a new sewerage system
K 56 PUBLIC HEALTH SERVICES REPORT, 1960
to serve the City of Chilliwack and the surrounding areas of the District of Chilli-
whack. The extensive work being done by the Greater Vancouver Sewerage and
Drainage District should be mentioned. This includes the construction of the
sewage treatment plant near the Lions Gate Bridge to serve West Vancouver; the
work on the Highbury interceptor tunnel, which will eventually convey sewage from
the north side of Vancouver to the proposed Iona Island treatment plant; and the
outfall and interceptor in Port Moody.
There are now eleven installations of waste stabilization ponds in British
Columbia treating municipal sewage. They serve a combined population of about
28,000 people and provide a reasonably good sewage-treatment service at a relatively low cost. Generally, their use is restricted to smaller populations, although,
if land were available, even fairly large populations could be served by waste stabilization ponds.
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 wastes into surface-water. These discharges may have quite diverse effects on the receiving body of water because of
the extreme variations in the type and strength of the waste and the quality and
volume of the receiving water. The net result of such discharges, however, may
make the water less desirable and less useful.
Another aspect of stream pollution control is that, as the population of the
Province increases and as the industrialization of the Province increases, it will not
be possible to maintain the quality of the water in the streams to equal the quality
that existed before industrialization increased. The reason for this is that rivers
have to be used for the carrying-away of sewage effluent and industrial waste
effluent. In the case of industrial wastes, the cost of treatment has to be paid for
from the sale of the product. The aim in stream pollution control should be to so
control industrial and sewage effluents that their total effect on the quality of the
water in the river will not seriously harm beneficial down-stream uses, such as for
water-supply, agriculture, recreation, and fish-life.
Toward the end of the year a pulp-mill was placed in operation on the Columbia River. This was the first instance of a pulp-mill being established in British
Columbia on an Interior stream. Great care in planning was exercised by the
designers and owners to prevent undue pollution from this plant. Some difficulty
was experienced because of starting difficulties allowing fibre to enter the river,
but it is expected that this matter will be cleaned up when the plant comes under
full operation.
In addition to the Health Branch, other departments of Government have had
legislation for the 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 to take charge of the pollution problem in the Lower
Fraser River basin. It is possible that this Board may extend its control to other
areas of the Province in 1961.
THE POLLUTION-CONTROL BOARD
The Pollution-control Board, which was set up late in 1956 to control the
discharge of waste into the Lower Fraser basin, requires a considerable amount of
work by the Division of Public Health Engineering. The administration of the Act
is the responsibility of the Minister of Municipal Affairs. The Pollution-control
PUBLIC HEALTH ENGINEERING K 57
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 and executive engineer of the Pollution-control Board and is 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 only five permits for discharge of wastes were issued. This
compares with nine the year before. All permits have been made valid for only
five years, during which time it is believed that adequate studies of the capacity of
the river to receive pollution, together with studies of existing discharge to the river,
would be made.
A considerable survey of the area under the jurisdiction of the Pollution-control
Board was made during the year 1960. This report revealed that there were 221
individual outfalls into the area served by the Board. Some of these conveyed
industrial wastes and some domestic sewage. The outfalls that have been built since
the inception of the Pollution-control Board have been constructed with very restrictive conditions as to the quality of the water. The building of outfalls under permit
in the future will tend to stop any rapid increase in pollution. The further treatment of some of the effluent in existing outfalls will tend to lessen pollution in the
future. The programme of the Greater Vancouver Sewerage and Drainage District,
when fully carried out, will place considerably more than half of the presently discharged untreated sewage under treatment.
A large number of samples from Burrard Inlet and the Fraser River were
taken through the co-operation of local health units. This work will continue.
It is expected that the work of the Pollution-control Board will occupy a considerable amount of time of the Division of Public Health Engineering for 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 health units
that have one or more shucking plants within their area. Certificates of compliance
are issued to owners of shucking plants that comply with the regulations.
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 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 of the Province of British
Columbia. There is also good co-operation between the Health Branch and the
Provincial and Federal Fisheries Departments. With respect to paralytic shell-fish
poisoning, a continuing sampling programme was carried on. Unfortunately, the
number of samples gathered was not as great as was desirable. Some paid samplers
were employed to pick up samples in distant parts of the Province, but the number
of samples resulting was disappointing. It is possible that the fee that was paid
was too low. However, with this, it was determined that the toxicity that has
existed in the Gulf of Georgia area since 1957 is gradually dying out. It was pos-
5
K 58 PUBLIC HEALTH SERVICES REPORT, 1960
sible to reduce still further the area that remained closed for the taking of shell-fish
for commercial purposes. Also, it was possible to place only one species of clam
on the closed list. The area now closed for the taking of butter-clams is generally
the area north of Denman Island and Texada Island in the Gulf of Georgia and
south of a line drawn across Johnstone Strait at Blenkinsop Bay. This means that
the southern end of the Gulf of Georgia is all open now.
GENERAL
The Division of Public Health Engineering provides a consultative service to
other divisions of the Health Branch and to the local health units on any matters
dealing with engineering. This entails a considerable amount of work and travel.
During visits to the health units various problems requiring engineering for their
solution are examined in the field.
The position of Chairman of the British Columbia Examining Board for Sanitary Inspectors was again filled by the Director of the Division. Five persons
received certificates in sanitary inspection during the year.
The Director served also as a member of the Advisory Committee on Health,
which is a sub-committee of the Associate Committee of the National Building Code
of the National Research Council of Canada. Members of the Division gave lectures on civil defence for several civil defence courses during the year.
A considerable amount of the work of the Division depends upon co-operation
with the Division of Laboratories, which examines all specimens submitted for
examination. The Division wishes to record its appreciation to the Division of
Laboratories for its co-operation whenever requested. It is expected, that as
industrialization increases, the work of the Division in stream pollution control will
increase tremendously.
PREVENTIVE DENTISTRY
K 59
REPORT OF THE DIVISION OF PREVENTIVE DENTISTRY
F. McCombie, Director
The decreasing availability of dental practitioners to the people of British
Columbia is becoming more serious. The numbers of dentists each year commencing practice in this Province is not keeping pace with the rate at which the
population is increasing. Since 1952 the ratio of dentists to population in British
Columbia has worsened. By the standards of 1951, there is to-day a shortage of
100 dentists. If the present trend continues, this Province will be short of 300
dentists in the next ten years.
Not only is there an urgent need to train dentists in British Columbia, but it is
also imperative to decrease the need for dental treatment. One of the diseases of
the oral cavity—namely, dental caries—is to-day very largely preventable. The
severity and sequeke of other dental diseases (for example, pyorrhea, oral cancer)
and abnormalities (for example, crooked teeth) can be minimized to-day by early
and regular treatment.
PREVENTIVE DENTAL SERVICES
The metropolitan areas of Greater Vancouver and Greater Victoria provide
autonomous dental-health services. Grants-in-aid to these programmes are made
yearly by the Government of British Columbia, using both Provincial funds and
National Health Grants. Some of the clinical aspects of these programmes are
demonstrated in Table I below.
Table I.—Full-time Preventive Dental Treatment Services in British Columbia,
Shown by Local Health Agency, School-years 1954/55 to 1959/60
Grade I Pupils
■a
Sx)
*t
fl a
School-year
v. a
OH
I c 0
fl.'aU
c
•a.a
o
Z
^m
Sou
£2
3.<2
ZQ
Is
=1-
rtflO
£ o-g
Requirin
Treatme
when
Examine
c
bit!
sic
O 5 c
— G rt
rt 3 .
Bo fi
a w
Eh.SQ
(1)
(2)
(3)
1954/55
19
1,853
13,506
4,213
3,945
1,749
9,907
0)
1955/56......
15
1,815
13,423
3,878
4,710
3,202
11,790
1,566
1956/57
14
2,022
13,761
3,726
5,106
3,271
12,103
318
1957/58
9
2,213
13,715
3,204
5,587
3,208
11,999
481
1958/59...
8
2,538
14,091
3,617
5,952
3,508
13,077
178
1959/60—
Greater Vancouver Metropoli
tan Health Committee
5
2,753
12,077
3,575
5,307
2,823
11,705
146
Greater Victoria School Dis
trict
1
17
2,057
56
1,099
687
1,842
2
Totals
6
2,770
14,134
3,631
6,406
3,510
13,547
148
1 Information not available.
A comparison of the above table with that appearing in the 1959 Annual
Report shows that the programme of the Central Vancouver Island Health Unit is
not this year included therein. The clinical services to this area have, however,
continued and have, in fact, expanded but are now provided by resident general
dental practitioners and are included within those services reported in Table II
below.
L
K 60
PUBLIC HEALTH SERVICES REPORT, 1960
It will also be noted that the total number of pre-school children benefiting by
the above services continues to increase and now represents 42 per cent of the total.
It is also commendable to the educational activities of these services to note that
this past school-year no less than 45 per cent of the Grade I children examined in
the classrooms did not appear to be in need of dental treatment. Furthermore,
no less than 96 per cent of the total Grade I enrolment were either so classified or
subsequently received treatment by their own family dentists (25 per cent) or by
these school dental services (26 per cent).
The educational activities of these programmes include the counselling of the
maximum possible number of parents at the chairside with their child. Approximately 8,000 parents thereby received such advice and assistance. As a further
means of decreasing the incidence of dental caries, these services are currently
planning to include, within the preventive treatment they provide, the topical application of stannous fluoride when requested by the parent.
In the rural health units of this Province there operated during the past school-
year ninety-seven separately and locally sponsored community preventive dental
programmes. The continued expansion of these programmes is demonstrated by
the fact that last school-year they operated in sixty-seven of the seventy-three school
districts constituting the areas served by the seventeen rural health units of this
Province.
Table II.—Part-time Preventive Dental Treatment Services (Community Preventive
Dental Clinics) in British Columbia, School-years 1955/56 to 1959/60
School-year
IS
*>£ ■
Em!
3 U I
zx<
.so
3g
.a 5
S3
i-_-
£cU-o
s**
-O o'sl C3
Num
Scho
in W
Oper
2UO
.Q.2 3
3,8 3
ZQa,
— Sxi
ih
fc-aU
Owu
g.
Ih oj o
OQU
E <u it*-*
oiSO-g
1955/56.
1956/57..
1957/58..
1958/59..
1959/60.
14
16
17
17
17
37
59
1 45
74
53
80
59
93
67
97
74
96
114
126
134
1,753
1,871
2,277
2,760
2,797
7,888
8,497
11,214
12,948 |
13,403 |
3,260
4,115
4,999
5,981
6,079
6,444
7,641
8,793
10,212
10,130
Within these programmes 134 general dental practitioners provided their services on a part-time basis. These services were most warmly appreciated by the
parents, the local community organizations, and by all public health personnel. The
number of pre-school children benefiting by these programmes further increased and
was 28 per cent of the total, whilst Grade I pupils represented a further 60 per cent
of the total number of children receiving preventive treatment.
The preventive dental services of this Province, together with the efforts of the
general dental practitioners, have now established a pattern of behaviour whereby
the majority (approximately 60 per cent) of Grade I pupils of the entire Province
receive dental treatment. However, on entering school the average amount of dental
decay already experienced by these children has already affected at least six deciduous teeth and already more than one permanent tooth.
The costs of rehabilitating these children even at 6 years of age is to be deplored
since the majority of the treatment then needed could have been prevented. Not
only is the financial cost to be deplored, but also the expenditure of the dentists'
time, which is steadily decreasing in availability to the people of this Province.
PREVENTIVE DENTISTRY K 61
Therefore, during the past year the objectives of the community preventive
dental programmes of this Province were redefined in the following terms:—
(1) To educate families in the prevention of dental disease and abnormalities,
especially amongst children, commencing before birth, accented during
infancy, and vigorously continued during school years.
(2) To educate families to seek early and regular dental treatment for their
children, commencing at 2Vz years of age, either as private patients of
the practising dentists of the community or by being registered in the
community preventive dental programme when this can be arranged.
(3) To ensure that all Grade I pupils are regularly receiving dental care and
that all" stragglers " commence such treatment forthwith, either as private
patients or by being registered in the community preventive dental programme, when the programme includes Grade I pupils.
(4) To encourage the regular dental care of all school-children, particularly
pupils of Grades II and III as private patients, but only in exceptional
circumstances will pupils of Grades II and III be included in community
preventive dental programmes.
(5) To continue family education and that of all school pupils in the prevention of dental disease and the need for regular dental care.
(6) To establish and maintain the concept that the dental health of the
children is a family and a community responsibility.
To encourage parents to establish sound dental health practices for their
children at an early age, infant rosters are under preparation in the health unit
offices. As a child reaches 3 years of age, a " reminder " will be mailed to the
parents to advise them, if not already done, to take the child to their family dentist
for counselling, examination, and necessary treatment. This procedure is already
in effect in fourteen school districts.
In the community preventive dental programmes served by a resident general
dental practitioner, time previously allocated to the treatment of pupils of Grades
II and III will be required to be reallocated to pre-school children. Where there is
an acute shortage of available time by the local dentists, and this is rapidly becoming
a problem throughout the Province, several programmes previously confined to
" Grade I pupils only " are now operating as " pre-school only " programmes.
During the past years many of the smaller and more remote communities have
relied on this Division each year to arrange for them the services of a visiting dentist,
primarily for their community preventive dental programme. Latterly such visits
have in many instances been arranged in the form of a continuing schedule, thereby
providing continuous employment to the dentist over a period of some months.
During the past two years we have received from new dental graduates more applications for such assignments than vacancies existed. Therefore, commencing in
the summer of 1961, it is planned to establish in this Province a " dental public
health extern programme." It is planned each year to offer four such externships.
These externs will not only ensure the continuance of the much-needed services to
the smaller communities and thereby attain further clinical experience (especially
in children's dentistry), but they will also be given practical experience in the many
other dental public health activities of this Province. Throughout his nine to twelve
months' assignment each extern will serve under the direction of a regional dental
consultant of this Division and thereby serve as his clinical assistant.
To improve the quality and quantity of the services of such dentists, who utilize
a set of the transportable dental equipment of this Division when visiting the smaller
communities, a pilot transportable high-speed dental air-rotor unit has this past
K 62 PUBLIC HEALTH SERVICES REPORT, 1960
year been under trial. Such has been the success of this unit that four more are now
on order. When these are received each dental public health extern will be so
equipped.
RESEARCH
During the period 1958-60 dental-health surveys have been carried out
throughout the entire Province. Approximately 9,750 children have been examined, and these were randomly selected from virtually the total school population of
British Columbia, of more than 275,000. Standard statistical procedures were
utilized to attain this sample, and the results may be considered with a high degree
of confidence as representative of the total. One hundred and fifty-two dentists of
this Province participated in these surveys. Their co-operation has been warmly
appreciated.
Children of Greater Victoria were shown to have benefited by a significantly
greater amount of dental treatment than provided in any other region of the Province. They had also experienced rather less dental decay. The amount of dental
treatment received by children of the northern health units and those of the Koote-
nays was shown to be somewhat less than in other areas of the Province. The ratio
of dentists to population is best in the Greater Victoria area and least favourable in
the north and the Kootenays.
The better dental-health status of the children of Victoria is attributed not
only to the greater availability of dental practitioners, but also to their co-operation
in providing treatment to the children. The co-operation between the Board of
Trustees of this school district and the Victoria and District Dental Society, whereby
children may obtain dental treatment during school-hours, is also considered to be
a significant factor toward this result. Acknowledgment is also made to the dental-
health educational activities carried out over the past years by the teachers of this
school district and by the Director of School Dental Services, Dr. H. Clarke, and
his staff.
Nevertheless, the dental-health status of the children of this Province, as a
whole, needs improvement. By these surveys it has been shown that only 6 per
cent of all the children had no dental defects when examined and no less than 65
per cent suffered from some form of malocclusion (crooked teeth), with less than
1 per cent under treatment. More than 40 per cent showed evidence of poor oral
hygiene and greater than 10 per cent were suffering from some form of disease of
the gingivae (for example, gingivitis). At 5 years of age 85 per cent have already
experienced dental decay, with an average of six teeth already involved. At 15
years of age less than one-half of 1 per cent had no evidence of having experienced
dental decay, with an average of more than twelve of their twenty-eight permanent
teeth involved.
Results of the 1958-60 dental-health surveys of British Columbia are being
published in co-operation with the Division of Vital Statistics as Special Report
No. 52.
These surveys have demonstrated that the collection of such data is not only
possible but practicable, and that the evidence thereby resulting is of fundamental
importance. A methodology closely similar to that pioneered by this Province has
been adopted by the Canadian Dental Association and recommended for national
implementation.
In British Columbia the original methodology has been slightly amended in
view of experience gained in the past years and also to conform as closely as possible to that of the Canadian Dental Association. However, care has been taken
PREVENTIVE DENTISTRY K 63
to maintain at a minimum any loss of comparability between the results of future
surveys and of those providing the base-line data for the period 1958-60. The
revised methodology has also attempted to measure, as a subsection of all children
suffering from any type of malocclusion, those so severely affected as might be
expected to cause speech difficulty, loss of masticatory efficiency, or likely psychological disturbance. Plans now anticipate that surveys will again be conducted
throughout the Province during the years 1961 to 1965. The data from these future
surveys, when compared with that of the 1958-60 series, will reveal to what extent
the dental-health status of the children has been improved by the preventive dental
services of this Province.
A programme to encourage certain phases of preventive dentistry has been
undertaken with the British Columbia Dental Association and the practising dentists.
This past year, in co-operation with the Registry for Handicapped Children
and Adults, a survey of approximately 100 children born with a cleft palate and (or)
a cleft lip has been completed. These children were born in the period 1952 to
1956 and were randomly selected from all those in this category known to the
Registry. This survey should reveal the degree of success attained in the treatment
of these unfortunate children and whether or not any additional facilities for their
treatment would appear to be necessary. The results of this survey, it is anticipated,
will become available during 1961.
DENTAL PERSONNEL
As at June 1st, 1960, the ratio of dentists to the population in British Columbia was estimated at one dentist serving an average of greater than 2,500 persons.
Five years ago this ratio was approximately 1:2,300. At that time in this Province,
dentists resident in communities of less than 2,500 population served an average of
5,300 persons. To-day they attempt to serve no fewer than 9,300 people. Whilst
the people of Greater Victoria, Greater Vancouver, and New Westminster are
fortunate in having a ratio of dentists to population of 1:1,700, the people of the
remainder of the Province (55 per cent of the total population) are served by only
half as many dentists, at a ratio of 1:4,100. Making no assumptions regarding the
establishment of a Faculty of Dentistry at the University of British Columbia, the
past trends and the future estimated trends of the ratio of dentists to population in
British Columbia are demonstrated in the following table:—
Ratio of Dentists to Population in British Columbia, 1945-60,
and Estimated Ratio, 1965 and 1970
Ratio of Dentists Ratio of Dentists
Year (Jan. 1) to Population Year (Jan. 1) to Population
1945 1:2,326 1960 1:2,459
1950 1:2,203 1965 1:2,707!
1955 1:2,298 1970 1:2,937!
1 Estimated.
Since 1952 the increase in population of the Province has been consistently
greater, on a proportionate basis, than the increase in size of the dental profession.
If this trend continues, and there is no reason to believe it will not, then in the next
ten years it can be clearly shown that we may expect in this Province an approximate total of only 770 dentists instead of the 1,060 needed to serve the people to
a degree no greater than prevailing in 1951.
K 64 PUBLIC HEALTH SERVICES REPORT, 1960
GENERAL
With the most helpful co-operation of the Radiation Protection Division of
the Department of National Health and Welfare, a survey has been commenced of
the dental X-ray units of this Province. Whilst it is considered that the use of
dental X-rays is essential to the adequate diagnosis of many patients seeking dental
treatment, nevertheless the radiation to both patients and operators must be held
to a minimum. Therefore, to each dental office is offered a service to detect if any
excessive radiation exists from the X-ray unit. The dentist is advised of the techniques whereby radiation may be reduced to a minimum and also provided with a
two-week film monitoring service. It is pleasing to be able to report that at the
close of the year no such films had shown excessive radiation to be present.
During the past year, with the support of National Health Grants, the establishment of field dental officers of this Division was completed by the appointment
of a fifth regional dental consultant. Thereby, in the future, such services will be
available for the first time to all the rural health units of this Province. At the
close of the year two such dental officers were attending the University of Toronto
to attain postgraduate training in dental public health and will return to field duty
in the early summer of 1961.
By the activities of this Division it is hoped not only to improve the dental
health of the people of this Province, especially the children, but also to decrease
the unmet needs for dental treatment. It is not dental care that is expensive, but
dental neglect.
OCCUPATIONAL HEALTH DIVISION K 65
REPORT OF THE OCCUPATIONAL HEALTH DIVISION
J. L. M. Whitbread, Director
The Division of Occupational Health functions as a part of the Bureau of Local
Health Services and gives a consultative service in industrial health and emergency
health to the local health units and metropolitan health departments. Co-ordination
with other divisions of the Health Branch is required to obtain all consultative
opinions on particular problems. Other departments of Government request information and advice on industrial hazards that arise in their particular field. Efforts
have been made to expand the services of the Division to meet the additional
demands for advice and guidance in the various programmes described under the
appropriate headings below.
OCCUPATIONAL HEALTH
As a result of information obtained from a survey of industrial firms in British
Columbia, plans were formulated to meet the two principal requirements before
further developments in occupational health can take place.
First, the orientation and education of the public health staff in the field of
industrial health was begun. With the assistance obtained from National Health
Grants, fifty personnel from local health units and from the metropolitan health
departments attended the Third Annual Occupational Health Conference held in
Vancouver on February 26th and 27th. The issue of educational material to all
local health departments and industrial firms has been continued through the Division of Public Health Education. Four sanitary inspectors were sent on an industrial
health course early in 1960. The Director of the Division attended a refresher
course in industrial medicine at the School of Hygiene, University of Toronto, from
March 7th to March 11th, 1960.
Second, consideration has been given to the development of consultant laboratory facilities so that investigations can be made into the many occupational health
problems that have been revealed by the industrial survey and the many inquiries
received direct from the local health units, industry, and other departments of the
Provincial Government. Cause and effect can be determined and the solution to
the problem can be obtained in most instances. Steps will then be taken to rectify
the health hazard and the economic loss.
Some problems are solved by obtaining equipment for use by health unit staffs.
An example of this is the determination of the carbon monoxide content of air in
factories and garages. These industries have been surveyed in some health units
by using the M.S.A. carbon monoxide testers. The results of such surveys indicate
the need for better ventilation or improved maintenance in factory machinery.
An amendment to the Regulations for the Sanitary Control of Industrial Camps
permits the use of suitable trailers in construction camps, logging camps, and similar
industrial camps.
EMERGENCY HEALTH SERVICES
The role of the Emergency Health Services is to ensure that at the time of
disaster, whether this be a civil or a war disaster, the health facilities in British
Columbia are fully developed to care for the population in the many aspects of
national survival.
(1) Public health services must be expanded in time of disaster to cope with
conditions that will arise as a result of decreased nutrition, overcrowding,
K 66 PUBLIC HEALTH SERVICES REPORT, 1960
unusual contamination of water and food supplies, and the lack of existing
immunization agents.
(2) Hospitals must be developed or expanded to treat the many casualties
and the sick among the existing population and the evacuees from a disaster area.
(3) Medical units, called " casualty collecting units " and " advanced treatment centres," must be set up in all the larger communities throughout
British Columbia to be available for the care of casualties in any disaster
area.
(4) Assistance must be given to the Army Medical Services in order that they
may carry out their role in a national disaster.
(5) Consultative service for radiation problems must be available to Civil
Defence.
(6) Health supplies and equipment, stock-piled by the Department of National
Health and Welfare, must be distributed when the need arises.
In order to co-ordinate all agencies involved in Emergency Health Services, an
Advisory Committee has been meeting twice a year. During 1960 meetings took
place in May and December to discuss the many problems involving the Emergency
Health Services. This Committee consists of representatives from the various professional associations concerned with health, the St. John Ambulance Association,
the Canadian Red Cross Society, and other departments of Government involved
in Emergency Health Services, from the Department of National Health and Welfare
and from the Army Medical Services.
The Emergency Health Services plan was rewritten and issued in August,
1960, to include the various changes in procedure and policy since the first plan was
published in 1959. This plan is an operational plan, outlining the proposed operational requirements for Emergency Health Services in all communities throughout
British Columbia. A personnel plan must be developed by all zones and areas.
A supplies plan has been drafted by the Emergency Health Services supply officer,
appointed on August 28th, 1960, to ensure the distribution of Federal stock-piles
of medical stores and equipment. Local supplies for Emergency Health Services
should be surveyed in each community to enable the establishment of the various
health services facilities, even though Federal supplies may become available.
The Federal stock-pile of medical stores and equipment has been established
in the Army depot at Chilliwack under the control of the National Emergency
Health Services and the Army Medical Services. These health supplies and equipment, worth approximately $1,000,000, will be available when a national war
disaster is anticipated.
Hospital disaster supplies have become available to all hospitals who submit
plans to the Provincial Government, indicating that they are prepared for action in
case of (1) a disaster in their own hospital; (2) a local disaster in their community
or in some other community of British Columbia; or (3) a national emergency,
when expansion or evacuation of the hospital may be necessary, depending on its
location.
Many exercises have been held throughout the Province to stimulate the hospitals in the development of their disaster plans. These have been successful in
that many hospitals are prepared to handle any situation. The plans are reviewed
by the Provincial Hospital Disaster Planning Committee, with representatives from
the Provincial civil defence organization, British Columbia Hospital Insurance
Services, and the Health Branch. After review, the hospitals are informed of any
necessary amendments, and when the plans are approved, disaster equipment is
issued. Seven hospitals have received their disaster equipment during 1960.
OCCUPATIONAL HEALTH DIVISION K 67
Continuity of government is essential during survival operations of a war
emergency. Arrangements have been drafted for action by the Health Branch to
ensure that key personnel, equipment, and records will be available during and
after the fight for national survival.
Training of Emergency Health Services personnel has been carried out by the
Provincial civil defence organization in co-operation with the Provincial Emergency
Health Services and has proved very satisfactory during 1960. Forty-five nursing
administrators attended a course from January 18th to 21st and thirty-nine physicians attended a course from February 22nd to 24th. These courses were held in
Victoria. Eight physicians and three dentists from British Columbia attended the
two Federal physicians' and dentists' orientation courses at the Civil Defence College, Arnprior. The Federal course for nursing instructors was attended by ten
nurses from the larger hospitals and public health services in British Columbia.
Home-nursing and first-aid classes were given in many localities throughout the
Province during 1960. These courses were well attended, indicating that public
interest in preparedness is improving.
Training equipment for an advanced treatment centre was requested from the
Federal Emergency Health Services. Several areas intend to raise and train these
units. The need for demonstrations of the advanced treatment centre and the 200-
bed improvised hospital has been recognized, and arrangements have been made
for these exercises during 1961. All professional health associations and voluntary
organizations involved in Emergency Health Services give their support to the
training of personnel and the development of Emergency Health Services plans
throughout British Columbia.
RADIATION PROTECTION SERVICES
Satisfactory progress has been made in expanding the radiation protection
services during 1960. Discussions have been held with Medical Health Officers
at their semi-annual meetings, and visits have been made by the Radiological Technical Adviser to many areas. Through the efforts of the Medical Health Officers
and their staffs, the hazards of excessive radiation have been reduced.
A survey of fluoroscopic machines used in shoe-stores was carried out in
November, 1960. It was found that there were only six machines present in shoe-
stores in British Columbia, and three of these were only rarely used by the shoe-
store operators.
British Columbia associations of the health professions using X-ray sources
for diagnostic and treatment purposes have expressed their interest in co-operating
with the Division's efforts to reduce excessive radiation to the public. With the
assistance of the Director of the Division of Preventive Dentistry, discussions have
been held with the executive of the British Columbia Dental Association. In 1960
a survey was started, with the help of the regional dental consultants, of all X-ray
machines used by dentists in British Columbia. The Radiation Protection Division
of the Department of National Health and Welfare made available its monitoring
film services so that monitoring films can be used in the survey of dental X-ray
machines. This survey will be completed in 1961. Dental consultants discuss
with the local branches of the Dental Association methods of reducing radiation
exposure from their X-ray machines. The co-operation on the part of the dental
profession has been most satisfactory.
On September 24th the Director of the Division and the Radiological Technical Adviser attended a meeting of the British Columbia Chiropractors' Association and outlined the radiation protection services programme and discussed the
K 68 PUBLIC HEALTH SERVICES REPORT, 1960
methods that could be used to decrease unnecessary radiation from X-ray machines.
A similar meeting was held with the Vancouver and Fraser Valley Association of
Veterinarians on November 15th, 1960. This approach to the professional users
of X-ray machines has proved successful.
During the summer of 1960 the Radiological Technical Adviser visited northern and eastern health unit areas and surveyed not only hospital radiological departments, but also apparatus used by the various health professions. His visits were
well received and revealed many defects in radiation protection devices. Continuance of these surveys by the Radiological Technical Adviser will assist to a considerable extent in reducing radiation to the users of X-ray machines and to the
public. The future plans are to visit all radiation sources, whether X-ray machines
or radioisotopes, to familiarize operators with the most modern methods of radiation protection and to indicate to them the hazards which presently exist so that
steps may be taken to rectify them.
During the past year, reports from the Radiation Protection Division of the
Department of National Health and Welfare on the film badge service have been
received by the Division, and where excessive exposure is indicated, action has been
taken either directly or through the Medical Health Officers to stimulate action on
the part of business establishments to remove such hazards that may be present.
New regulations on health and safety have been passed by the Federal Government under the Atomic Energy Control Act to improve the control of radioisotopes. Under these regulations the Director of the Division has been appointed
the Provincial health authority for radiation, and it is planned to have inspectors
appointed under these regulations during 1961.
EMPLOYEES' HEALTH SERVICE
An increase in the activities of the Provincial Government Employees' Health
Service occurred during 1960. As a result of the availability of poliomyelitis vaccine, 550 employees received boosters to their previous poliomyelitis vaccination
series, 333 completed their course of immunization, and 169 new series of poliomyelitis vaccinations were completed. It is hoped to have every Government employee immunized against poliomyelitis by the end of 1961.
Steps toward the extension of the Employees' Health Service have been taken
to include Provincial Government employees in the Vancouver metropolitan area.
Equipment and personnel have been obtained, and suitable accommodation should
be available early in 1961. Requests from various departments, as well as the
Civil Service Commission, indicate the need for these services to improve the health
of the B.C. Government employees and so improve efficiency and decrease absenteeism.
During 1960, as in previous years, the Canadian Red Cross Society Blood
Donor Service held two clinics, one in June and one in December, the preliminary
organization being done by the occupational health nurse. Provincial Government
employees in Victoria gave 572 pints of blood at these clinics.
Information regarding the services supplied by the Occupational Health Unit
in the Douglas Building is outlined below:—
OCCUPATIONAL HEALTH DIVISION
K 69
1 Figures not available.
GENERAL
1958
1959
1960
Visits to clinic—
2,246
1,994
2,524
2,117
3,105
2,743
4,240
1,220
(*)
2,102
9
1
12
33
75
31
100
79
90
4,641
1,443
443
2,446
12
2
16
35
75
46
99
88
101
5,848
2,635
Tuberculosis—diagnostic or treatment (chiefly reading tuberculin tests)
288
2,742
Existing conditions shown—
13
4
13
44
94
55
136
104
117
During 1960 standards for licensing all motor-vehicle drivers were reviewed
and issued to all physicians by the B.C. Branch of the Canadian Medical Association. Physicians are therefore able to give better co-operation to Government
officials in the efforts to determine whether or not a person is capable of driving a
motor-vehicle. During 1960 approximately 5,000 reports of medical examinations
for drivers were received.
The Welfare Licensing Institutions Board met regularly every month and
reviewed applications for licensing. Several investigations were made with the
help of the Medical Health Officers into applications considered to be unsatisfactory.
K 70 PUBLIC HEALTH SERVICES REPORT, 1960
REPORT OF THE SANITARY INSPECTION SERVICE*
C. R. Stonehouse, Chief Sanitary Inspector
The Sanitary Inspection Service had the opportunity during the year to assist
health units in the evaluation of their sanitation programmes and found this to be a
satisfying and stimulating experience. As a result of joint discussions, goals and
objectives were established, methodologies were developed, and tools and techniques were further clarified. From the standpoint of both the Sanitary Inspection
Service and the health units concerned, the experience was reflected in a measure of
progress in the standards of service rendered, and this improvement was especially
notable in the fields of food-service operations, in industrial operations, housing
construction, and the many facets of community sanitation.
To meet the demand for service, the establishment of health unit sanitary
inspectors has reached forty fully qualified sanitary inspectors.
Five sanitary inspectors attended the Provincial civil defence radiation monitoring course at the University of British Columbia. It is anticipated that the training will be utilized to augment the health unit contribution to local civil defence
planning.
MILK-CONTROL
The study of the results of bacteriological tests on milk products and the coordination of the activities of the sanitary inspectors as milk inspectors for the
Department of Agriculture were slightly less time-consuming due to the continuing
improvement in milk quality.
Three vendors were convicted under the regulations of the Milk Industry Act.
Two of those convictions were for distributing pasteurized milk which exceeded the
limits of 1 coliform organism per millilitre, and the third was for the distribution of
raw milk which exceeded 30,000 colonies per cubic centimetre. Also, one raw-
milk vendor was convicted under a municipal milk by-law for selling raw milk from
a non-approved raw-milk dairy-farm.
A municipal milk by-law for the Village of Golden was reviewed prior to
approval by the Lieutenant-Governor in Council.
As in other years, the Sanitation Service processed a large number of requests
for information in respect to milk testing and distribution. With the kind assistance
of the Division of Laboratories, the Chief Veterinary Inspector, and Dairy Commissioner of the Department of Agriculture, the problems associated with the requests
were solved.
FOOD-CONTROL
Prevention of food-borne illness continues to be the keynote of food-premises
sanitation. Besides the required semi-annual inspection of each eating and drinking
place, food-handlers' courses in techniques and practices are given special attention
by the health unit personnel. In the Upper Fraser Valley the conventional short
course was held. In the Boundary Health Unit, as in the previous year, the classes
were extended to include members of voluntary organizations that cater to banquets.
Sanitary inspectors also assisted in lecturing at the Food Service Institute held at
Nanaimo for hospital cooks.
* This report concerns the services provided by sanitary inspectors under the jurisdiction of the Provincial
Health Branch and dees not include the services provided by the metropolitan health departments of Greater
Vancouver, Victcria-Esquimalt, and Oak Bay.
In the classroom, the sanitary inspector, using his light-meter, checks to see that students
are working under adequate levels of illumination.
As a step in determining the safety of domestic-water supplies, a sanitary inspector
takes a sample from a well.
K 72 PUBLIC HEALTH SERVICES REPORT, 1960
Food-handlers' classes, provided by local health units, began in a modest way.
Later they were co-sponsored by the local branch of the Restaurant Association,
and this was followed by the development of tourist clinics by the Government
Travel Bureau. Arising from these earlier steps, it is gratifying to observe the
commencement of an adult training programme by the Department of Education.
The first class in Food Sales and Services for Waitresses, by the Department of
Education, was held in Penticton under the auspices of the local School Boards and
co-ordinated by a representative of the local Restaurant Association. The second
class, at Trail, under the auspices of the School Board, was co-ordinated by the local
sanitary inspector.
In addition to routine duties and food-handling courses, special studies are
conducted on food premises. The Boundary Union Board of Health drafted a model
" food establishment by-law " for the consideration of the five participating Municipal Councils of the Union Board. The Peace River Health Unit completed a two-
year programme toward improvement of the eating-places on the British Columbia
portion of the Alaska Highway.
SLAUGHTER-HOUSES
Eighty-one slaughter-houses were licensed during the year under the Stock
Brands Act. Prior to 1950 the conduct of slaughter-houses was the source of
numerous complaints. Since the requirement invoked in 1950 that the applicant
for a licence or the applicant for a renewal of a licence had to have the written
approval of the Medical Health Officer, more than half of the present slaughter
establishments are new premises. In addition, many establishments now provide
their own meat inspection service under the Meat Inspection Act. In the Cariboo
the meat inspection is now provided at Prince George and Quesnel. Five establishments in the Fraser Valley inaugurated meat inspection during the year.
INDUSTRIAL CAMPS
The Regulations for the Sanitary Control of Industrial Camps stimulate the
maintenance of an improved standard of housing for the logging, fishing, oil, and
construction industries of the Province. The standards of housing which prevail
have lessened the need for an annual inspection of each operation.
More than the usual quota of inquiries for copies of regulations and more than
the usual quota of complaints were received. However, upon investigation, the
complaints were of a minor nature and were readily and easily corrected by the
camp operator.
For the past ten years the use of trailers as camp accommodation has continued
to increase annually. The construction and interior features provided in trailers have
shown considerable improvement through the efforts of employer, employee, and
manufacturer. During the year the Regulations for the Sanitary Control of
Industrial Camps were amended to modify the requirements for this type of
accommodation.
SUMMER CAMPS
Summer camps are licensed under the Welfare Institutions Licensing Act.
A requisite to obtaining a licence is satisfactory compliance with the sanitary
standards for such camps.
In the 1960 evaluation of reports of seventy-three camps, 76 per cent were
classified as good, 20 per cent as fair, and 4 per cent as poor or unsatisfactory.
SANITARY INSPECTION SERVICE K 73
Itinerant Scout camps are not included in the evaluation of camp accommodations on permanent sites. In all other respects, however, the health guidance is
made available to Scout organizations.
TOURIST ACCOMMODATION
During the year several referrals by the Travel Bureau requested specific
reports on tourist accommodation.
As many municipalities and unorganized territories are without by-laws or
regulations respecting trailer courts and tenting spaces, the sanitary inspector is
consulted to advise on the necessary layout and sanitary facilities.
SUBURBAN DEVELOPMENT AND SUBDIVISION APPROVALS
The extensive residential and commercial development beyond the boundaries
of cities and villages has added to the sanitation work load of the health unit. The
Medical Health Officer is routinely requested to advise on the suitability of the land
for drainage, and on private water and private sewage disposal potential.
GARBAGE DISPOSAL
Information on refuse disposal in the unorganized portion of the Province was
gathered by health units. This information was tabulated for the interdepartmental
committee appointed by the Minister of Municipal Affairs to study the problems.
The reports of 339 individual areas included a population of 151,000. Examples
were noted of successful operation of collection and disposal systems on a weekly
collection basis, with a nominal charge by co-operative bodies established as improvement districts under the Water Act. In the lesser populated communities
without collections are many examples of community associations, Boards of Trade,
Farmers' Institutes, and other local organizations maintaining disposal-sites in a
satisfactory manner. No examples of arrangements under the Local Services Act
were reported. It is anticipated that the results of the survey, now in the hands of
health units, will stimulate many communities to minimize the local problems by
their own efforts, as has been demonstrated by the reports on successful operations.
Three applications for approval of Crown land for garbage disposal purposes
were reviewed and approved.
GENERAL
In the industrial hygiene programme, carbon monoxide testing services are
now available to garages and industrial plants through the health units. Six units
availed themselves of the testing equipment in 1960 for survey purposes.
There were three convictions under the Sanitary Regulations, involving such
nuisances as illegal dumping of garbage, illegal dumping of animal entrails, and
illegal dumping of septic-tank sludge.
Sanitation by-laws for the City of Prince George, the Village of Dawson Creek,
and the Village of Comox and a by-law respecting keeping of birds and fur-bearing
animals in Richmond were approved by the Deputy Minister of Health under the
authority of section 634 of the Municipal Act.
K 74 PUBLIC HEALTH SERVICES REPORT, 1960
REPORT OF THE NUTRITION SERVICE
Joan Groves, Consultant
The present-day knowledge of nutrition has resulted in the realization that
proper nutrition makes an important contribution to the physical health and well-
being of the individual.
The practical application of this knowledge is an important aspect of health
teaching and lies in the encouragement of good eating habits and a wise choice
of food.
The Nutrition Service makes its contribution to the health programme by the
provision of consultant service to public health personnel, to those involved with
group feeding, and to other key people concerned with nutrition education.
CONSULTANT SERVICE TO PUBLIC HEALTH PERSONNEL
Consultant service has been given to the public health personnel to keep them
up to date on the latest nutrition information and to assist with projects and problems. This has been done by visits to the health units, the provision of reference
material, departmental circulars, and correspondence. Food-habit studies and
rat-feeding demonstrations have been encouraged as a means of directing school-
children's attention to the meals they are eating. Rats, which are used to demonstrate the value of good eating habits, are supplied through the courtesy of the
Animal Nutrition Laboratory of the University of British Columbia.
CONSULTANT SERVICE TO HOSPITALS AND INSTITUTIONS
In co-operation with the Hospital Insurance Service, visits have been made
to ten hospitals in the Province to give assistance with problems of food service.
Assistance was given in menu planning, purchasing, cost-control, food preparation,
and work planning. A considerable number of inquiries have been answered by
correspondence and advice has been given on hospital plans.
A five-day food-service institute was held in October at the health unit in
Nanaimo. Twenty-six cooks from hospitals not employing staff dieticians attended.
These cooks came from Vancouver Island centres, Coastal communities, and a few
Interior centres. National Health Grants enabled this project to be undertaken,
being used to defray incidental expenses for travelling and accommodation of the
guest speakers and of those attending.
Other institutions throughout the Province have availed themselves of the
services of the nutrition consultant—namely, the Provincial Home, Kamloops;
Tranquille School; the G. F. Strong Rehabilitation Centre; the Dominion-Provincial
Training School, Nanaimo; the Allco Infirmary; and The Woodlands School.
SERVICE TO OTHER DEPARTMENTS AND AGENCIES
A talk was given on emergency feeding at a civil defence course for welfare
directors. Discussions on low-cost menu planning were carried out with a Red
Cross Home Emergency Service group.
Numerous inquiries regarding nutrition and group feeding have been received
and dealt with from private individuals, from the Food and Drug Directorate, the
Provincial Department of Agriculture, and the Oak Bay public health service.
NUTRITION SERVICE
OTHER ACTIVITIES
K 75
Membership continues with the British Columbia Nutrition Co-ordinating
Committee (formerly the Vancouver Nutrition Group). This Committee has recently
revised the low-cost food allowance list. The aim of this group is co-operation with
others working in the field of nutrition.
K 76 PUBLIC HEALTH SERVICES REPORT, 1960
REPORT OF THE DIVISION OF VITAL STATISTICS
J. H. Doughty, Director
The Division of Vital Statistics provides a centralized bio-statistical service,
fulfilling the statistical requirements of all other divisions of the Health Branch, the
Mental Health Branch, and a number of large voluntary health agencies. It is
charged with the responsibility of collecting, compiling, and analysing statistical data
stemming from the many health services of these official and voluntary agencies,
including statistics required for programme evaluation and administrative control.
In addition, it operates the Province-wide vital statistics registration system and
administers in entirety the Vital Statistics Act, the Marriage Act, and the Change of
Name Act.
In order to carry out its extensive statistical duties, the Division is equipped
with modern mechanical tabulation machinery and employs trained bio-statisticians
and statistical clerks. Its registration services are provided through the central office
in Victoria and through approximately ninety district offices situated at convenient
locations throughout the Province.
One of the gratifying developments of recent years has been the increased
awareness on the part of professional and administrative personnel in the medical
and public health fields of the value of statistical information, and an increased disposition to utilize analytical statistics in planning and administering health programmes. This has resulted in a steadily expanding work load for the Division of
Vital Statistics and an increasing involvement in the programmes of other divisions
and agencies. This trend was again manifested in 1960, when several new statistical
projects were undertaken by the Division and more extensive use was made of data
derived from previously established statistical systems.
In the field of vital statistics registration it is also gratifying to report that almost
1,000 Doukhobor couples have availed themselves of the privilege of registering
marriages which had been performed according to Doukhobor custom, as authorized
by the 1959 amendment to the Marriage Act. These marriages were all registered
after the parties concerned had appeared before Magistrate William Evans, who had
been appointed as the Special Marriage Commissioner to inquire into such applications and to make recommendations respecting registration. The Division is most
appreciative of the help and co-operation of Magistrate Evans in achieving this
notable registration success.
It was with regret that the resignation was received of Mr. G. C. Page, who had
served with the Division for over twenty-five years, and for the last twelve years had
held the position of supervisor. Mr. Page was responsible for many improvements
in the vital statistics registration system in this Province, and his departure to assume
a more advanced position in the business world was a distinct loss to the Health
Branch. Mr. P. W. Weston, who has also had extensive experience in the Division,
was promoted from his former position as Inspector of Vital Statistics to fill the
vacancy created by Mr. Page's resignation. Mr. H. H. Gardner, formerly head
of the Registration Section of the Division, was appointed as Inspector of Vital
Statistics.
TUBERCULOSIS STATISTICS
New Procedures in Tuberculosis Statistics
The major change in the method of recording and filing the medical history
and treatment information respecting tuberculosis patients, which was planned
VITAL STATISTICS K 77
during 1959, was effected in 1960, and the associated changes in the handling of the
statistical data were accomplished with a minimum of difficulty. One of the features
of the new system was the development of regional active-case registers, and this
required close co-operation between the Division of Vital Statistics and the Division
of Tuberculosis Control respecting both forms and procedures. The implementation
of the new system also involved a general review of some of the more important
medical-record forms in use, and the Division of Vital Statistics participated actively
in this work.
The introduction of the new system also made possible a major improvement
in the mechanical tabulation procedures respecting tuberculous cases. Previously
separate index punch-cards and statistical punch-cards were prepared for all new
cases reported, but during 1960 a single combined index and statistical card was
devised. All cases reported from the first of the year were processed onto this new
card, and the complete file of known cases was converted from the two-card system
to the single-card system. This involved some 25,000 punch-cards respecting known
tuberculous cases and approximately the same number of cards covering cases with
non-tuberculous chest conditions.
As part of the conversion project, an extensive review was made of the entire
case load of both tuberculous and non-tuberculous patients. Special attention was
directed to locating cases which had been unreported for some time, or which had
moved to an unknown address. With the co-operation of the Vancouver Metropolitan Health Committee, every case shown as being resident in Metropolitan
Vancouver was checked and verified.
The change to the single-card system has resulted in a considerable simplification in the processing of information respecting new cases and of follow-up information respecting known cases, and has led to an over-all economy in the punching,
verifying, and tabulating of tuberculosis case records and a substantial saving in
punch-card storage space.
Tuberculin Testing Statistics
The Division received the records from all tuberculin testing surveys carried
out and provided analyses of the populations surveyed and of the tuberculin testing
results for the Division of Tuberculosis Control. Approximately 24,000 tuberculin
testing records were processed onto punch-cards for this phase of the tuberculosis
case-finding programme.
Tuberculosis Out-patient Anti-microbial Therapy
In June the Division of Vital Statistics was consulted regarding the possibility
of punching data on patients involved in the anti-microbial programme of the Division of Tuberculosis Control. It was agreed that this could be done, and a code and
a statistical summary sheet were drawn up and approved. Information on certain
patients was punched and tabulated during the year, and the resultant statistics are
at present under study in the Division of Tuberculosis Control. It is anticipated that
further cross-tabulations will be required. It is intended that this research project
will be continued in 1961.
Other Tuberculosis Statistics
The Division continued to process the admission and discharge records of all
patients entering and leaving tuberculosis institutions in the Province. It addition,
statistical analyses of all B.C.G. vaccinations carried out were undertaken. Alpha-
K 78 PUBLIC HEALTH SERVICES REPORT, 1960
betical and numerical indexes of all known cases were prepared for the Division of
Tuberculosis Control. Monthly, quarterly, and annual statistical reports were prepared covering new cases reported, the known case load, and the treatment of
patients in sanatoria.
Use of Statistics in the Tuberculosis-control Programme
The processing of statistics for the Division of Tuberculosis Control was one
of the first projects undertaken by the Division in the field of health statistics.
Over the years these statistics have played an important role in the tuberculosis-
control programme, and in many instances have resulted in important changes in
this programme. For example, statistical analyses showed that there was a considerable number of newly reported cases being found in the age-group over 30 years.
In order to reach and examine this group more completely, the community and
industrial case-finding surveys were intensified. Other statistics showed that certain
school districts had a greater number of tuberculosis cases being reported than had
others, and this appeared to indicate that a reservoir of tuberculosis cases existed
in these areas. Consequently, special emphasis was laid on surveying the high-
incidence and high-prevalence areas. The operation " Doorstep," which was carried
out two years ago in Health Unit No. 1 of the Vancouver Metropolitan Health
Committee area, was undertaken in the light of the high prevalence found to exist
in that area.
Five years ago a statistical study was set up covering cases treated surgically
within the Division of Tuberculosis Control. Data from the first three years of this
project have now been tabulated and have been studied by the medical staff in the
Division of Tuberculosis Control. These data have resulted in certain important
changes being made in the surgical management of tuberculosis cases.
The study involved the statistical recording of the pre-operative data, the data
respecting the operation itself, and the data concerning the post-operative effects
respecting all cases undergoing surgery. Along with this there was a special method
of examining the surgically removed lung tissue. A photographic record of the lung
tissue was made, and this was correlated with the X-ray of the patient. The statistical recording of these pathological data revealed a need for improvements in the
medical terminology in use, and after consultation between the Division of Tuberculosis Control and the Department of Pathology of the Vancouver General Hospital,
these improvements were effected.
The statistical evaluation of the surgical cases also indicated that certain aspects
of the X-ray required very careful study in order that the pre-operative diagnosis
might be improved.
The accumulated statistics of this study of surgical cases also led to a change
in the medical opinion respecting which tuberculosis lesions are suitable for resection
and which should be treated by other methods. In consequence, there has been a
definite reduction in the number of cases being brought to surgery.
Furthermore, the type of operation has been changed as a result of these
studies. For example, segmental resections were shown to have five times the
incidence of complications as had lobectomies. Hence, when faced with a choice
of saving a segment or removing a lobe, the surgeons now prefer to remove the lobe
because they feel that in the long run the patient will receive much greater benefit
by the avoidance of complications.
This statistical study has demonstrated the important results that can accrue
from the planned statistical recording and the statistical evaluation of medical and
r
VITAL STATISTICS
K 19
public health programmes. It is reported here as being illustrative of the use to
which statistics are put in the public health programme.
INFANT MORTALITY STATISTICS
For a number of years the Division has been carrying out a special study
relating to infant mortality. This has involved the matching of the infant's death
registration with the corresponding birth registration and physician's notice of birth
and the correlation and analysis of the facts relating to the infant both at birth and
at death. It has also involved the detailed analysis of all births occurring in the
Province in order to make possible the compilation of specific mortality rates.
During 1959 an extensive analysis of six years' data from this project was undertaken, and early in 1960 three special reports dealing with various aspects of infant
mortality were prepared.
The study included over 194,000 births and over 4,400 associated infant
deaths. It provides an extensive collection of statistical data which should contribute to a better understanding of the factors associated with the mortality experience of infants under 1 year of age. Some of the data compiled are already being
used for teaching purposes in medical schools in Canada. Among other things, the
data revealed certain differentials in infant mortality between regions of the Province and even between certain groups within the same region. These differences
are being further studied with a view to pin-pointing the specific causes of the excess
mortality. In some instances, data specific for particular hospitals have been made
available to the hospitals concerned on a confidential basis in order that the hospitals might critically compare their own infant mortality experience with the total
Provincial picture.
VENEREAL DISEASE STATISTICS
The statistics of the Division of Venereal Disease Control have also been produced by the Division of Vital Statistics for many years, and they have had an
important bearing on policies and programmes of that Division. Two major series
of statistics are processed, one relating to the incidence of new venereal disease
cases reported in the Province, the other relating to the epidemiological activities
of the Division of Venereal Disease Control in case-finding and contact investigations. From these two series, monthly, quarterly, semi-annual, and annual statistical reports are prepared. These reports include a number of specially computed
indices which indicate the degree of success being attained by the Division of
Venereal Disease Control in case-finding, contact-tracing, and medical examination
of contacts.
Immediately upon receipt of these reports in the Division of Venereal Disease
Control, certain key data, including the contact indices, are transferred to a series
of continuous charts which are maintained for administrative purposes. These
charts are used as a monitor on the several phases of the venereal disease control
programme, and on the current status of the venereal disease problem in the
Province.
During the year special arrangements were made for the statistical study of
venereal infection amongst homosexuals. Also, during the year the Procedure
Manual for Venereal Disease Statistics was thoroughly revised and improved.
A number of special requests for statistical information respecting venereal disease
were dealt with. One of these requests involved the preparation of an extensive
body of information to be used in connection with a study being conducted by the
K 80 PUBLIC HEALTH SERVICES REPORT, 1960
Community Chest and Councils of Greater Vancouver relating to the problem of
Indian girls in an urban setting.
EPIDEMIOLOGICAL STATISTICS
The Division continued to handle the notifiable-disease reporting system and
to compile the weekly and monthly notifiable-disease reports. Special records were
maintained on the incidence of poliomyelitis during the period of the outbreak,
and close contact was maintained with the Director of Epidemiology in planning a
detailed analysis of the 1959 and 1960 cases.
The Division also operates a registry of all cases of cancer diagnosed in the
Province. A special statistical report on cancer morbidity and mortality is prepared annually by the Division.
PUBLIC HEALTH NURSING STATISTICS
During the year a special report was issued setting forth an analysis of the
home care programmes operating in the Province in 1959. Statistics from this
report were of assistance in planning the additional home care services for which
funds were provided during the year. Slight modifications to the home care reporting form were instituted in 1960 on the basis of the previous year's experience,
and provision was made for several additional items of information. These changes
will increase the value of the resultant statistics.
Data from the annual time study of public health nursing activities was processed mechanically, and an analysis of the results provided to the Director of
Public Health Nursing. The Director was also provided with routine analyses of
public health nursing activities as derived from the nurses' daily reports.
DENTAL-HEALTH STATISTICS
Another in the series of community dental-health surveys based on statistical
samples of school-children was completed during the year, and the results were
published in three special reports of the Division. Two of these reports analysed
the results of the 1960 survey, which covered the Okanagan and northern regions
of the Province and the municipalities of Victoria, Esquimalt, Saanich, and Oak
Bay. The other report presented a summary of the results of the 1958-60 surveys,
which together covered samples of all but a small proportion of the Province's
school-children. These statistical reports are the source of valuable information,
hitherto unavailable, which is used extensively in planning the programme of preventive dentistry. The statistics provide an indication of the general level of dental
health amongst school-children in the Province, as well as information concerning
the variations in dental health by age and by geographic region. They also provide
information which is essential to the evaluation of public health dental programmes.
The two other projects were carried out jointly by the Division of Vital Statistics and the Division of Preventive Dentistry. One of these related to an assessment
of the extent of the cleft palate and hare-lip problem, and the other to an assessment
of the effectiveness of the topical application of a solution of stannous fluoride to
children's teeth. The first of these studies was completed during the year, and an
analysis of the results was begun. The second stage of the Victoria stannous fluoride
study—namely, the re-examination of the survey group—was commenced toward
the end of the year. Similar studies were initiated in two other areas of the
Province.
VITAL STATISTICS
K 81
REGISTRY OF HANDICAPPED CHILDREN AND ADULTS
Effective April 1st, 1960, the former Handicapped Children's Registry was
expanded to become the Registry for Handicapped Children and Adults. This
change was made as a result of planning which had been in progress in the Health
Branch for several years. In the eight years of operation of the Handicapped Children's Registry, its value in furthering the care of handicapped children had been
clearly demonstrated, and it was felt that similar advantages would accrue to many
handicapped adults if the age-limit of the Registry could be removed.
The expansion of the Registry to cover handicapped persons of all ages presents a number of problems and raises a number of questions respecting the definition of a registrable handicap, the type of information to be recorded respecting
handicapped adults, and the disposition of cases registered. For these reasons, the
general registration of handicapped adults is not yet being invited, but rather certain specific groups of handicapped persons are being registered on a pilot-study
basis. With the experience gained in this initial phase, the Registry will be in a
better position to deal expeditiously with the general registration of handicapped
adults. In general, the expanded Registry will follow the same policies and procedures which have proven to be satisfactory and effective in the Handicapped
Children's Registry.
During the year a statistical report of the Handicapped Children's Registry
for 1959 was prepared by this Division. The statistical data which have been
accumulating through the years of operation of the Registry are now assuming
significant proportions, and it is possible to compute certain minimum incidence
and prevalence rates for certain disabilities and congenital malformations. In the
Registry report, some of these rates are compared with similar rates which have
been published elsewhere.
The report gives some indication of uses that have been made of the statistics
gathered by the Registry to date. ' For example, it was possible to show after a
very few years of operation that the problem of the retarded child was quite a major
one in this Province. Registry statistics also revealed that most of these children
remained within their own communities, and that there was a large group of them
who were of school age but who were not receiving any form of education or
training. The newly formed British Columbia Association for Retarded Children
received this information and used it as a basis for action. This led to the establishment of a large number of day-schools for retarded children in many communities throughout the entire Province.
The Registry statistics also pointed up the number of children who suffered
from deafness or were hard of hearing in British Columbia, and also revealed that
these children were not being registered or their defects brought to attention at an
early enough age. This resulted in more emphasis on early detection and registration of these cases, and subsequently the size of the group registered brought
about the development of a programme for hearing which may avoid the necessity
of many of these children having to go to a special school. A great many of them,
it is anticipated, will be educated in the normal school system.
These are but two of many examples which might be cited of the effective use
of the statistics of the Registry. However, in addition to serving as a statistics-
collecting agency, the Registry performs valuable service in providing liaison between the various treatment centres and private voluntary organizations engaged
in the care of handicapped children. Furthermore, while not offering a direct
medical service to the handicapped child, the Registry has been instrumental in
bringing a large number of handicapped children to the most appropriate medical
care.
K 82 PUBLIC HEALTH SERVICES REPORT, 1960
MENTAL-HEALTH STATISTICS
The Division of Vital Statistics provides a full statistical service to the Mental
Health Branch of the Department of Health Services and Hospital Insurance. This
includes the processing of admission and separation reports for patients treated in
institutions of the Mental Health Services, as well as the processing of the statistical
records of adult patients treated at the Mental Health Centre in Burnaby.
During the year many meetings were held with the Geriatric Division of the
Mental Health Services with a view to setting up statistical records and procedures
for that Division. The planning is now in its final stages, and it is anticipated that
the routine statistical processing will commence in 1961.
A number of special assignments relating to mental-health statistics were carried out during the year both for the Mental Health Services and for the Department of Psychiatry at the University of British Columbia.
OBSTETRICAL DISCHARGE STATISTICS
The processing of the obstetrical discharge records for the Vancouver General
Hospital and Grace Hospital was continued during the year, and a large number
of statistical tables was prepared for the benefit of these institutions. This project
is part of a wider study of maternal mortality, maternal morbidity, and foetal wastage in British Columbia which is being sponsored by the Department of Obstetrics
of the University of British Columbia.
A number of other hospitals in the Province have indicated an interest in
instituting the special obstetrical discharge report which is used as the basis for
the statistics of this study, and it is anticipated that at least two of the larger hospitals will adopt the record during 1961. The use of the standardized detailed
obstetrical record offers advantages to the individual participating hospital in the
management of its obstetrics department in addition to the value of the statistical
information which accrues from it.
EPILEPSY CENTRE STATISTICS
The first statistics were compiled for the Epilepsy Centre in Vancouver from
the statistical summary sheets and punch-cards that were set up the previous year.
The new system appeared to function very satisfactorily and to provide to the
Medical Director the statistical information he requires.
CYTOLOGY STATISTICS
The statistical processing of the records of the Cytology Laboratory was continued during 1960, and close liaison was maintained with the staff of the Cytology
Laboratory in the preparation and analysis of the statistical data required. A detailed manual covering the statistical procedures which have been set up for the
handling of the cytology statistics was prepared and printed during the year. The
volume of cytology records processed has risen from 35,000 in 1958 to more than
63,000 in 1960, and it appears that further increases may be expected as the programme continues to expand.
G. F. STRONG REHABILITATION CENTRE STATISTICS
The Division continued to provide statistical service to the G. F. Strong Rehabilitation Centre. This included the mechanical processing of the statistical
records of the Centre and the preparation of an extensive set of tables respecting
patients under care and treatments given.
VITAL STATISTICS K 83
In conjunction with the Registry of Handicapped Children and Adults, the
G. F. Strong Rehabilitation Centre is conducting a vocational survey of its patients
who were discharged in the year 1958/59, and the Division is assisting in the statistical aspects of this survey.
POISON CONTROL CENTRE STATISTICS
The mechanical processing of the records of the Poison Control Centre was
continued by the Division during the year. A series of statistics relating to the
reports submitted during 1959 was produced for epidemiological study. These
statistics classify the accidental poisonings according to health unit of occurrence,
substance swallowed, age, fatal outcome, and various other categories. These data
were discussed at the annual meeting of the British Columbia Poison Control
Council.
B.C. GOVERNMENT EMPLOYEES MEDICAL SERVICES
Under a reciprocal agreement with the B.C. Government Employees Medical
Services, the Division processes the claims records of the plan and provides certain
administrative statistics for the directors in return for the privilege of utilizing the
morbidity statistics which are produced.
An annual report is issued each year in the Division's Special Report series
containing data relating to the utilization of medical services and the morbidity
experience of enrollees in the plan. The report contains information respecting the
distribution by age and sex of the persons covered under the plan, illness rates by
age and sex for the major categories of illness, the proportion of illness, cost and
service in each illness category, costs according to type of service and according to
medical specialty, costs and volume of service according to the status of the subscriber, the volume and cost of operations performed, and many other classifications
of data.
OTHER STATISTICAL ASSIGNMENTS
The Division continued to meet a large number of requests for statistical information from the public and from medical researchers. It continued to co-operate
with the Biology Branch of Atomic Energy of Canada Limited in an important pilot
study relating to the automatic linkage of vital records for studies in demographic
genetics.
Members of the Division served on the Public Health Nurses' Record Committee, the Committee on Sanitation Records, and on record committees of the
Vancouver Metropolitan Health Committee.
The Division also participated in the study of pedestrian traffic accidents
among children which is being undertaken by the Department of Paediatrics of the
University of British Columbia.
REGISTRATION SERVICES
The Division of Vital Statistics also has major responsibilities in the registration field. These duties stem from its administration of the Vital Statistics Act,
the Marriage Act, the Change of Name Act, and certain sections of the Wills Act.
These Acts set forth a wide range of responsibilities, including the registration of
all births, deaths, stillbirths, and marriages that occur in the Province, the registration of all adoptions and divorces ordered by the Supreme Court of British Columbia, the maintenance of a voluntary registry of wills notices, the issuance of burial
permits, the licensing of ministers and clergymen for the solemnization of marriage,
K 84 PUBLIC HEALTH SERVICES REPORT, 1960
the issuance of marriage licences, the appointment of Civil Marriage Commissioners, the granting of legal changes of name, and the issuance of certificates and certified copies relating to any of the registrations on file.
There was an increase of 2 per cent in the volume of registrations filed during
the year over that of the preceding year. In addition, there was a 7-per-cent
increase in the volume of certificates issued and a 6-per-cent increase in the revenue
received by the central office. Preliminary counts of the more important registration services rendered by the Division in 1960 are as follows:—
Registrations accepted—
Birth registrations 40,700
Death registrations 14,890
Marriage registrations 11,260
Stillbirth registrations 460
Adoption orders 1,530
Divorce orders 1,550
Delayed registrations of birth 460
Wills notices 7,122
Legal changes of name 468
Legitimations of birth 141
Alterations of given name 256
Certificates issued—
Birth certificates 57,400
Death certificates 7,522
Marriage certificates 5,694
Baptismal certificates 41
Change of name certificates 644
Divorce certificates 250
Photographic copies of registrations 13,206
Revenue searches 40,211
Non-revenue searches 49,462
Revenue received by central office $72,997
Vital statistics registration facilities are available to the public through ninety
district offices which serve the seventy-three vital statistics registration districts of
the Province. Thus a district office is to be found in most of the cities, towns, and
larger villages throughout British Columbia. In each office there is an appointee
known as the District Registrar or Deputy District Registrar of Births, Deaths, and
Marriages. He is responsible for collecting registrations of all births, deaths, stillbirths, and marriages which occur in his jurisdiction. The Indian Superintendents
of the nineteen Indian Agencies of the Province act as District Registrars for the
Indian population within their respective Agencies.
The offices of fifty District Registrars and Deputy District Registrars and seven
Indian Agencies were visited by the Inspector of Vital Statistics as part of the routine inspectional and training programme. The standard of work performed by
the District Registrars throughout the Province was found to be very satisfactory.
PUBLIC HEALTH EDUCATION K 85
REPORT OF THE DIVISION OF PUBLIC HEALTH
EDUCATION
R. H. Goodacre, Director
The level and extent of service provided by this Division are related directly
to the degree to which health education is incorporated into general programme
planning and evaluation. Thus many of the developments occurring during 1960
are discussed elsewhere in this Report by those in whose programmes members of
this Division participated.
PERSONNEL
Organizational plans outlined in the 1956 Annual Report have progressed
as predicted. The introduction and improvement of efficient systems and procedures and the employment of adequate clerical and technical personnel have
resulted in the development of an audio-visual aids and pamphlet service which is
now becoming capable of meeting the many demands made on these facilities.
The Division continued to benefit by the availability of a reference librarian from
the staff of the Provincial Library who, in addition to guiding the cataloguing of
Health Branch holdings throughout the Province, also served valuably in duties
related to library research.
AUDIO-VISUAL AIDS AND WRITTEN MATERIALS
For many years the Health Branch has relied largely on the Department of
National Health and Welfare for the availability of free educational literature and
posters. However, there are indications that the current arrangement between the
Federal and Provincial health services may not continue to the same extent enjoyed
during the past. Another Federal Government agency, the Department of Agriculture, has ceased to issue free publications through its consumer section, and it
would appear that, in future, copies of this Department's publications held by the
Health Branch will have to be purchased from the Department of Public Printing
and Stationery in Ottawa.
Due to the increasing multiplicity of sources and large-quantity requirements,
it is no longer possible for the Health Branch to store all publications required by
local health services. Nevertheless, facilities are still available for the issuing of
over 250 different posters and pamphlets. This number excludes an additional 150
items available from such free sources as voluntary health agencies, from which local
health departments now order direct. Administratively, it is interesting to note that
whereas in 1950 fewer than 250,000 pieces were distributed from this office, ten
years later, in 1960, the total was over 1,000,000.
As can be expected, film and filmstrip use has increased significantly during the
same ten-year period. In 1950 the library consisted of 108 films and seventy-two
filmstrips, with bookings in the neighbourhood of 500. In 1960 the library consisted of 440 films and 224 filmstrips, for which confirmed bookings totalled approximately 2,500. Of the film holdings, the largest single block (19 per cent) consisted
of those used in sixty-two classes for expectant parents, a service to which, it has
been reported, 1.4 per cent of the public health nurses' time was devoted.
In the multiplicity of educational aids available to local health services, the
Division strives to avoid duplication, which is eliminated, or reduced to a negligible
factor, by a co-ordinated review of the objectives of the programme in which the
aids are being used.
K 86 PUBLIC HEALTH SERVICES REPORT, 1960
With increasing attention being devoted to home care and community rehabilitation during the year, the services of this Division were called upon to develop a
series of three pamphlets. Previously a bibliography of readily available reference
material for staff guidance had been completed.
Following the redefinition of Departmental policy with respect to the provision
of dental-health services, which included emphasis on early dental care for 3-year-
old children, a comprehensive plan of dental-health education was developed together with the regional dental consultant for the Fraser Valley health units and the
Director of the Boundary Health Unit. While prepared specifically for the Boundary
Health Unit, this plan is also being effected in other areas of the Province. Included
is the use of dental-health teaching kits, developed a year ago for teachers of Grades
I, II, and III. These have been well received by teachers and, indeed, are now being
purchased locally by some School Boards. It is quite apparent that the " kit"
approach to health teaching in the schools is fundamentally sound, and it has been
suggested that similar kits be prepared for other aspects of health teaching, as, for
example, with respect to eyesight, in which the content can be related to care of the
eyes, vision screening, etc. The development of this type of kit will undoubtedly be
possible with the acquisition of a teacher to the staff of this Division.
Considerable time was devoted during the year to the preparation of television
scripts scheduled for nation-wide presentation over the Canadian Broadcasting Corporation network in the early months of 1961. This Division was represented on a
committee established for the Canadian Broadcasting Corporation to develop a total
of ten such broadcasts. Other members of the committee consisted of the health
educator with the Vancouver Metropolitan Health Committee and the programme
director (a trained public health educator) of the British Columbia Tuberculosis
Society, who was responsible for promoting the preparation of the series.
From time to time, on such occasions as the official opening of new health
centres or health unit offices, local health unit personnel arrange public health
displays, in which health services available to the public are depicted, together with
other media having educational value. The Division acts in an advisory capacity on
these occasions and supplies suitable material. Prominent items have been photographs and colour slides showing health unit activities, and the collection has been
augmented during the year by new photographs and transparencies taken by a member of the Division. A continuous slide projector, purchased through National
Health Grant funds, has been put to good use in these displays.
IN-SERVICE TRAINING
One of the main responsibilities of this Division is the co-ordination of in-
service training designed primarily for staff of local health services. The primary
function is the Annual Public Health Institute, which is a four-day training course
for members of local health departments throughout the Province. The institute for
1960 was held in Victoria and was addressed by the main guest speaker, Dr. Halbert
L. Dunn, Chief of the United States Public Health Service National Office of Vital
Statistics. In addition to Dr. Dunn's series of four lectures, the four-day intensive
agenda included lectures and discussions on rehabilitation, the health requirements
of teen-agers, health requirements of the aged, and similar topics designed to keep
staff informed on current trends and advances in public health. The Health Branch
had recently acquired its own public address system, and this was installed and
operated by members of the Division. The new equipment resulted in a much higher
level of audience hearing efficiency than had been obtained in the past with rented
equipment.
PUBLIC HEALTH EDUCATION
K 87
Members of the Division were involved in other forms of training, including
a course for waterworks operators, discussed under the report of the Division of
Public Health Engineering, and a one-day workshop for health teachers, organized
jointly by the Vancouver Metropolitan Health Committee, voluntary health agencies,
and the Provincial Health Branch, with representatives from local health departments in the Fraser Valley.
Instructional and informative manuals received continuing attention, notably
the Policy Manual, prepared for the guidance of local health services; the Nursing
Care Manual; the Nurses' Guide for Expectant Parents Classes; and poison-control
information material for Poison Control Centres located in general hospitals
throughout the Province.
STAFF ORIENTATION
The Division continues to be responsible for planning the personnel orientation
schedules for newly appointed staff members of the medical and dental professions.
Three health unit directors and two regional dental consultants visited Victoria and
Vancouver for this purpose. They were familiarized with the work of the various
bureaux and divisions, and with the functioning of the Mental Health and Hospital
Insurance branches of the Department, during their stay. Similar services were
performed for the following guests from other nations, who were visiting British
Columbia to study departmental policies and procedures in government: Mr. N.
Soudi (Jordan), Mr. Kon-Sook Han (South Korea), Mr. H. De Four (West
Indies), and Mr. O. Gurusinghe, Mr. R. W. M. A. Kapukotuwe, and Mr. K. D. H.
Dharmawardane (from Ceylon, visiting Canada under auspices of the Colombo
Plan).
K 88 PUBLIC HEALTH SERVICES REPORT, 1960
REPORT OF THE DIVISION OF TUBERCULOSIS CONTROL
G. F. Kincade, Director
This is the twenty-sixth annual report of the Division of Tuberculosis Control
in British Columbia. With the great changes that have taken place in the tuberculosis programme in recent years, it is of interest to reflect on the present situation
and consider the changing problems.
While the first organized campaign against tuberculosis was initiated with the
admission of patients for treatment to Tranquille Sanatorium in 1908, it was not
until 1935 that the Division of Tuberculosis Control was created. This served to
bring about a correlation of all the activities which had developed up to that time
and were then being carried out by the sanatoria, the travelling clinics, and the local
health services.
At that time the emphasis was on treatment of tuberculous cases, because this
was the overriding problem, with people suffering and dying from tuberculosis in
large numbers, not to mention the economic hardship and privation that was created
as a result of widespread disease. The public health field service was in its infancy,
but has since expanded to become a major force in the tuberculosis-control programme. While the treatment programme was successful in the saving of lives and
in the reduction of deaths due to tuberculosis, the progress from the beginning of
the century until the advent of anti-microbial therapy was very slow. However, this
has changed since the new drugs came into use, and this success in treatment is
reflected in closure of sanatorium beds and reduction of numbers of persons under
sanatorium treatment.
Since the development of drugs for tuberculosis, treatment, which was formerly
the major part of the programme, has now become secondary in importance to the
field programme. Moreover, in the latter sphere of activity the emphasis is also
changing. In the past the chief effort in the field programme was to identify the
known cases of tuberculosis and the contacts of these cases so that they could be
kept under surveillance. The point is now approaching where it becomes possible
to contemplate the identification of all persons in the population who have been
infected as a result of contact with tuberculosis and can be identified by a positive
tuberculin reaction. It is not many years since it was accepted that practically all
persons in the population would be infected with the tubercle bacillus by the time
they reached adult life. Present studies indicate that, as a result of the control programme over the years, this incidence of infection has been markedly reduced, so
that at the present time possibly less than one-third of the population is infected.
This brings within reasonable bounds the task of identifying those who have been
infected and of keeping this group under observation as possible sources of new cases.
There has been a marked reduction of tuberculous infection in the younger
age-groups, and the great hope of tuberculosis-control is that we can prevent infection in this group by preventing their contact with known cases who may be infectious or might break down.
The problem, then, to-day is to carry on the treatment programme while at
the same time continuing an energetic programme in the field to find new cases of
tuberculosis as they develop, and to identify those people in the population who
may be infected and might eventually break down with the disease. There are
approximately 23,000 known cases of tuberculosis in British Columbia and an
estimated 300,000 persons who have been infected. About 1 per cent of the known
inactive cases break down each year and must be treated again. For that reason,
TUBERCULOSIS CONTROL K 89
this group must be followed closely. Amongst those who have been infected, only
a small percentage will develop disease, but it is this group that will produce the
future tuberculosis cases.
TREATMENT
It is well known that the major achievement in tuberculosis-control has been
in the successful treatment of those suffering from the disease. This success has
been reflected in a marked reduction in the number of patients under sanatorium
care. During the past eight years there has been a 65-per-cent reduction, from
838 patients under treatment at the end of 1952 to 294 patients under treatment
at the end of 1960. This trend became apparent at the beginning of the present
decade and showed a rapid acceleration, which has now begun to level off. The
decline was rapid from 1953 to 1955, inclusive, with a reduction of seventy-four
patients per year under treatment during this period. It further accelerated to
ninety-one per year during the next three years, from 1956 to 1958, inclusive.
However, during 1959 and 1960 this rate has decreased, and the numbers have
only been reduced by nineteen per year during this period. This has represented
about a 15-per-cent reduction in the number of patients each year from 1953 to
1957, with a 10-per-cent reduction per annum over the past two years.
The bed capacity was reduced another 8 beds in 1960 and now stands at 344
beds, 90 of these being at Willow Chest Centre and 254 being at Pearson Hospital.
At the end of the year there were 64 empty beds in the Division. Most of the
empty beds appear at Pearson Tuberculosis Hospital, and, as a result of the progressive-care plan for patients, these represent unstaffed beds when they are not
in use.
A similar reduction in tuberculosis patients is also apparent in the Indian
Health Services and in the Vancouver Preventorium.
We now have over one year's experience with the operation of the progressive-
care plan in the Tuberculosis Division. This is essentially a self-help scheme in
which the patients take as much responsibility for their own care as is possible,
depending on their physical and mental state. This is part of the physical rehabilitation process to prepare patients so that on discharge they will be able to look
after themselves in their home environment and thus lessen the stresses of the
transition period when the patients are moving from sanatorium to their normal
environment. Patients in sanatorium are now segregated into three types—those
on intensive care, standard care, and minimum care.
The provision of minimum-care facilities at Pearson Hospital has proven
very beneficial. After a year's trial these wards seem to have worked out satisfactorily, and it is felt that the main objective, which is the patient's recognition and
acceptance of responsibility for his or her own care, particularly in the taking of
their own drugs, has been achieved. In addition to this, the patients have received
as good care as formerly, and have been able to have more freedom within the
hospital on their own wards and with regard to leave away from the hospital than
the patients on the intensive-care wards. The patients have taken very kindly to
use of the washing-machine and drier, to being able to prepare snacks for themselves, and also to the added recreational facilities at their disposal, with nothing
but beneficial results.
It is becoming obvious that once patients are transferred to the minimum-care
unit, they feel they are well on their way to recovery and discharge from hospital,
and the pressures to leave hospital are increased. The trend is to discharge patients
from hospital more quickly when they demonstrate that they are able to look after
themselves adequately and conscientiously take their medicines. This, of course,
K 90
PUBLIC HEALTH SERVICES REPORT, 1960
leads to the largest number of empty beds in the institution being located in the
minimum-care unit, and there has been a situation during the year of 20-odd beds
being empty in the institution at times but not available on the intensive-care units.
A tendency is gradually developing of transferring maximum-benefit cases to
the minimum-care unit, and certainly this does the patient no harm, but over the
course of time will result in a core of patients accumulating there who have little
chance of being discharged, and their numbers will probably increase gradually
for the next year or so.
It does give one a great deal of pleasure to report that the plan is working
satisfactorily, that the patients seem to be doing well while they are sharing some
responsibility for their own care and to be able to report a very substantial saving
in the cost of running the institutions. To make the most efficient use of the ward
personnel, a constant review of the staffing requirements has been carried out by
the superintendents of nursing, and rearrangements of duties amongst the various
types of ward personnel is constantly taking place. This has resulted in the provision of a high calibre of care with a minimum of staff and has made possible some
staff reductions.
Age Distribution in Sanatoria
Date
Total
Sanatorium
Population
50 Years of
Age and
Over
Per Cent 50
Years of Age
and Over
November, 1952
November, 1955
November. 1957 .
838
615
448
332
331
294
276
251
217
189
161
169
32.9
40.8
48.4
November, 1958. •
November, 1959... _
56.9
48.6
57.4
For some time now it has been apparent that tuberculosis is a greater problem
in the older person than it is in the younger person. A generation ago this was
quite the opposite, and tuberculosis was considered to be a disease of late adolescence and early adult life, particularly in females. This change is reflected in the
sanatorium population, and from the above table it will be seen that an increasing
percentage of the patients in sanatorium are 50 years of age and over, and while
there has been a reduction of 65 per cent in the total sanatorium population, there
has been a reduction of only 39.8 per cent in the sanatorium population 50 years
of age and over. In fact, during the year 1960 there was a further increase in the
number of persons 50 years of age and over in sanatorium. There are more than
four times as many males as females 50 years of age and over in sanatorium. In
the total sanatorium population, 76.2 per cent are males, making a ratio of about
3 to 1. To a large extent the accumulation of older persons in sanatorium is the
result of the success of the newer forms of treatment. In earlier days these patients
would have died, but with the newer drugs they have been kept alive but have not
recovered sufficiently to leave sanatorium.
COMMITTALS TO SANATORIUM
It has previously been reported that until the end of 1959 there had been
forty-five recalcitrant tuberculous patients committed to sanatorium. During 1960,
committal orders were issued on four additional patients. Two were committed
at the beginning of the year and both have now been discharged; one successfully
completed treatment, including chest surgery, and the other improved to the extent
TUBERCULOSIS CONTROL K 91
that he could be released. The third and fourth cases were only admitted during
the last month of the year, and before the end of the year one of them had died.
The other is still in hospital. At the end of 1949 there were five patients under
committal in hospital, three in the Division of Tuberculosis Control and two in
Essondale. Of these five, one was released from Essondale, one has been released
on probation, one has been transferred from Essondale to Pearson Tuberculosis
Hospital, another remains in hospital, and the fifth one died. An additional case
allowed out on probation in 1958 returned voluntarily for further treatment in
sanatorium and still remains.
At the end of 1960 there were four committal patients remaining in the hospitals of the Division of Tuberculosis Control.
CLINIC SERVICES
The responsibility for the follow-up and supervision of all the known cases
of tuberculosis in the Province outside of sanatoria rests with the clinic services of
the Division, the staff of local health services, and the family physician. This is
provided by three stationary clinics, located in Vancouver, Victoria, and New
Westminster, and by four travelling clinics, which hold clinics regularly in sixty-
four centres throughout the Province. Working closely with the public health
services in the field, it is possible to keep in close contact with these patients and
to provide good supervision. A consultive service is also provided to the medical
profession for the investigation of chronic chest disease, and in this way an appreciable amount of tuberculosis is discovered.
At the end of 1960 there were approximately 23,000 known cases of tuberculosis in the Province, of which 4,900 were Indian. Of these, an estimated 20,000
were classified as inactive and 1,400 were on treatment with tuberculosis antimicrobials as out-patients. Due to the relapsing nature of tuberculosis, long-term
follow-up of these cases is necessary. In spite of the improvement in relapse rates
that has occurred since the advent of anti-microbial therapy, we still find that
approximately 1 per cent of the inactive cases reactivate each year, and this has
proven to be one of the major sources of cases coming under treatment. During the
past year approximately 102 cases reactivated.
STATIONARY CLINICS
Being located in the heavily populated areas, these clinics are responsible for
the supervision of the great majority of tuberculous cases outside of sanatorium, and
this is their chief work. However, they also carry on survey programmes for case-
finding with miniature X-rays and tuberculin testing. Over the year there has been
no great change in the volume of work carried on in these clinics, but there has been
increasing use of the tuberculin test as a method of screening younger persons
attending the clinics.
TRAVELLING CLINICS
The operation of the travelling diagnostic clinics for the past year has continued
without any major change in policy. The change effected in the fall of 1958 when
the Interior Travelling Clinic moved to Vancouver following the closing of Tranquille and the moving of the Kootenay Travelling Clinic records to Vancouver in
1959 brought about the centralization of travelling records in one office in Vancouver. This has been most satisfactory. In the previous report it was pointed out
that the centralization of staff—that is, the travelling clinic tuberculosis officers—
was of value because of the availability of staff to " cover off " during the absence of
K 92 PUBLIC HEALTH SERVICES REPORT, 1960
one member. During the past year this was found to be particularly valuable when
one of the doctors was off for a period of five months. The other members of the
staff were able to cover the film-reading work without the necessity of having to call
on someone else from within the Division.
Following the combined tuberculin and X-ray surveys done in the Okanagan
area, it has been found that there is an increase in demand for clinic time spent in
the area where the surveys have been done. For example, the Penticton-Oliver area
used to require four and a half to five days, whereas in the last clinic a total of eight
working-days was necessary to cover this area. Likewise, the duration of the
Kelowna clinic has gone up from two or occasionally three days to four days. It is
probable that all this increase will not be permanent, but a considerable number of
the extra cases seen as a result of the survey will become regular attenders at the
travelling clinics, and some increase in the time necessary to be devoted to these
areas will result. This reflects itself in the number of days that the travelling clinic
technician must spend out of Vancouver. Taking his total number of days out of
Vancouver to cover the Okanagan, Cariboo, and Peace River, in 1960 this amounted
to 109 clinic working-days. In the itinerary for 1961, this is estimated to be 135
days. Including travelling-time, the technician of the Interior Travelling Clinic will
be out of Vancouver for 210 days in 1961.
It is planned to operate the travelling clinics during the coming year in the same
manner in which they have been operated in 1960. The increased demand for services in areas that have had combined tuberculin and X-ray surveys, however, brings
up the problem which has previously been raised; that is, the one of frequency of
visits. At the moment it is impossible for the Interior Travelling Clinic X-ray
technician to spend any more time travelling than at present. If this demand should
increase as a result of continued surveys, it would be necessary to make some adjustment. Previously considered, and a distinct possibility, is changing the frequency
of clinic visits from a basis of visits every three months to visits every four months.
Even at the present time it is not possible to cover all the clinics on a three-monthly
basis, and some centres are seen every six months, whereas other centres of equal
size are seen every three months. A shift to a basis of four months might make it
possible to cover all of the major centres on a four-month basis rather than seeing
some at six-month intervals and others at three. The Coast Travelling Clinic currently operates on this basis for its far north trip, and it appears to work quite well.
Further consideration to such a change will be necessary during the coming year.
A review of the statistics for the year's work shows no significant trends. The
usual year-to-year variations (up or down) in the number of films read, under the
categories clinic film, referred film, miniature hospital admission and out-patient
films, and large hospital admission films, are noted. Only one consistent change is
noted: hospital admission and out-patient miniature films read by the Interior Travelling Clinic are down (14,348 in 1958, 11,885 in 1959, 8,920 in 1960). The
numbers are also lower this year in the Island and Coast Clinics, but up in the
Kootenay Clinic. No obvious reason for this is apparent. The Division's policy
of recommending no more than one routine film annually and advising against
routine chest X-rays in persons under 18 years of age, unless they are tuberculin
positive, may play some part.
TUBERCULOSIS SURVEYS
Previous reports have indicated that special emphasis has been placed on intensifying the programme of case-finding throughout the Province. Experience has
shown that while there has been a marked reduction in the death rate from tubercu-
TUBERCULOSIS CONTROL K 93
losis, the incidence of new cases has been declining much more slowly. This indicates that there are still unknown cases of tuberculosis in the population, and if the
programme of tuberculosis-control is to progress, these cases will have to be brought
to light.
The initial step two years ago was the formation of a tuberculosis-survey team,
to be responsible for the planning and operation of this project. While X-ray surveys have been carried out for the past fifteen years, this tempo was rather slow,
and this service could not have been extended to all of the population in the foreseeable future unless the coverage was increased. Moreover, it became apparent
that the time had come for the introduction of tuberculin testing into the survey programme along with the X-rays, the aim being that all persons in the Province should
be eventually tuberculin-tested.
The tuberculosis-survey team is composed of experienced and well-trained
persons, each capable of providing a special service for the various phases of the
programme. In this type of work many varying abilities are necessary for such
things as the organization of local groups to assist in the programme, education and
publicity, tuberculin testing, the taking of X-rays, and, of course, medical experience
in tuberculosis. With the present staff this team is geared to do 1,000 tuberculin
tests in school-children and 3,000 tuberculin tests and X-rays in adults weekly in
community surveys.
This programme has achieved a considerable degree of success, which has
come about as a result of a combined effort by the Division of Tuberculosis Control
and the British Columbia Tuberculosis Society. All staff and equipment have been
pooled, so that an intensive effort may be undertaken in each community survey.
In view of the fact that the local interest in any programme can only be sustained
for a limited time, through promotion and education, each survey must be completed quickly.
The Society has greatly increased its financial participation in this programme
to supply both personnel and equipment, so that at the present time this participation represents the major activity of the Society. This organization is entirely
responsible for the organizing and promotional effort to get the people out for
examination. This, of course, is basic to any successful survey. In this they have
achieved outstanding results through the use of local volunteers, as has been shown
by about a 90-per-cent community participation in several centres in the Interior
of the Province. In each centre visited the team strives for complete coverage of
the populace, and, for that reason, facilities are made available in each block of
the communities surveyed, with volunteers making a door-to-door canvas. This
has made for much detailed planning and scheduling of equipment, but the participation of the people has made the additional effort most worth while. Previous
surveys have shown that amongst those not participating there is a high rate of
tuberculosis. Complete surveys are essential if we would achieve maximum success.
During the past year large-scale surveys have been held in centres widely
scattered throughout the Province. These centres are as follows, and the number
of persons examined in each survey is in parentheses: Victoria (17,688), Hope
(1,957), Penticton (13,315), Kamloops (14,442), Prince George (15,102), and
Greater Vancouver (44,143). At the end of the year a tuberculosis survey was
just commencing in New Westminster. This will continue for three months into
1961.
TUBERCULIN TESTING
The increasing use of the tuberculin test in the tuberculosis programme was
forecast in previous reports. The acceptance of this test by the public has been
K 94 PUBLIC HEALTH SERVICES REPORT, 1960
most encouraging, and the volume of tests done during the year has increased very
markedly. The purpose of this programme is to make it possible to identify all
persons who have been in contact with the disease and have been infected. This
group will then be given special attention for periodic check-up by chest X-rays in
the future. Rather than X-raying all the population periodically, we will eventually
be able to confine the use of chest X-rays for case-finding purposes to those who
are known positive tuberculin reactors. With the decreasing percentage of the
population now infected, this brings within the realm of possibility the continuation
of supervision of these people on a selective basis, much as we now do the known
cases of tuberculosis. As an example of how this would work, it can be reported
that in 1959 a combined X-ray and tuberculin survey was carried out in the Oliver
district. The positive tuberculin reactors were recorded and were told that they
should have another chest X-ray one year hence. In 1960, when the mobile units
were proceeding to the Okanagan area for community surveys, a short visit was
made to the Oliver district. A notice was sent to all known tuberculin reactors
informing them that the X-ray unit would be in their area on a certain date. The
response to this notice was very satisfactory, and about 75 per cent of those notified
turned out for examination. It is planned to use this method next year to examine
the positive tuberculin reactors found in Penticton, Kamloops, and Prince George
during the 1960 surveys.
School tuberculin testing has increased considerably. Tuberculin testing in
schools is carried out in conjunction with community surveys when they are held,
but special school tuberculin testing is also done. During the past year a complete
survey of the schools in the Upper Fraser Valley Health Unit was done, including
Hope, Chilliwack, and Abbotsford, and, in all, over 12,000 tuberculin tests were
given. In the Kootenay region the travelling clinic nurse has carried out tuberculin-
testing surveys in the schools of Creston, Nelson, and Kimberley. On Vancouver
Island over 8,500 tuberculin tests have been done in schools in Victoria and
environs, with an additional 7,000 children having been done in the Central Vancouver Island Health Unit. A programme for the testing of all students in Grades
I and VI in the Vancouver schools was begun this fall and almost completed by
the end of the year. This will include over 22,000 students.
The response in industry to tuberculin testing has been most gratifying. It is
only about a year ago that the employers refused to take the responsibility of having tuberculin tests done on their employees. This position has quite reversed,
and so many requests for the tuberculin test have been received from industry that
this has become an accepted part of the tuberculosis examination. All industries
now being done are having tuberculin tests. All the large department stores and
many big industries have made tuberculin testing part of their employment examination.
TUBERCULOSIS AND MENTAL ILLNESS
An important aspect of the work of tuberculosis-control is that carried out in
the Provincial Mental Hospitals. Tuberculosis poses a great threat and could
become a major problem in the mental hospital setting. This Division is happy
to be associated with the Mental Health Branch in an energetic programme to
control tuberculosis amongst the mentally ill.
Three members of the staff of the Division of Tuberculosis Control are assigned
to Essondale to direct and assist in an extensive programme carried on at Essondale
—namely, a physician-specialist, a public health nurse, and a clerk. This is made
possible through National Health Grants. A similar programme is carried out at
Colquitz by the Vancouver Island Chest Centre.
The Pearson Tuberculosis Hospital in Vancouver, location of the self-help unit
of the Division of Tuberculosis Control.
The Willow Chest Centre in Vancouver is the major surgery unit
of the Division of Tuberculosis Control.
K 96 PUBLIC HEALTH SERVICES REPORT, 1960
The programme at Essondale is similar to that of a stationary tuberculosis
clinic and includes the supervision of the treatment of the known cases of tuberculosis, together with periodic examinations by tuberculin testing and X-rays of
all patients and all members of the staff. A programme of vaccination against
tuberculosis through the use of B.C.G is also carried out on patients and staff who
are negative tuberculin reactors.
The North Lawn Building at Essondale is a tuberculosis sanatorium for the
mentally ill and usually houses about 200 tuberculous patients. All the modern
forms of therapy for tuberculosis are used and it is gratifying to note that the results
of treatment are good and many patients achieve an inactive status. Several
patients from this hospital improved to the extent where is was possible to transfer
them to Willow Chest Centre for lung surgery, which was completed successfully.
Through the close relationship that exists it has been possible to work effectively
with Essondale for the transfer of mental patients from Willow Chest Centre and
Pearson Tuberculosis Hospital for short periods of time for treatment of mental
illnesses and to return them to the Provincial sanatoria without undue delay when
the acute phase of their mental illness has passed.
In the programme of staff and patient supervision at Essondale, over 15,000
X-rays were taken and about 4,000 tuberculin tests were performed. This supervision extends to Woodlands, Valleyview, and Colony Farm, as well as to Essondale
itself. In addition, the geriatric hospitals at Vernon (Dellview) and Terrace
(Skeenaview) are examined annually by the travelling clinics of the Division of
Tuberculosis Control. It is gratifying to report that this rather extensive coverage
of the mentally ill has kept the tuberculosis problem well in hand. New cases
developing are spotted quickly and segregated rapidly so as to prevent the spread
of disease, which could be so widespread in this type of environment if special
precautions were not taken.
PENAL INSTITUTIONS
Considerable attention is given to tuberculosis in the penal institutions of
British Columbia. As these are mostly adjacent to New Westminster, the Director
of the New Westminster Clinic of the Division of Tuberculosis Control is chiefly
responsible for carrying out this programme.
For many years routine chest X-rays have been taken on prisoners committed
to Oakalla Prison Farm, and this has been one of our most productive sources,
yielding our highest case-finding rate in tuberculosis in our routine survey programmes. In the present year over 7,000 chest X-rays were taken at Oakalla
Prison Farm. Through this programme it has also been possible to relocate many
of our unco-operative and recalcitrant patients and bring them under treatment and
follow-up again. Prisoners having tuberculosis and needing treatment are brought
to the Provincial sanatoria for the period of their active treatment, although many
continue their treatment following return to prison after their disease has been
brought under control. Many of these patients undergo chest surgery for their
tuberculosis while in sanatorium.
The tuberculosis problem at the British Columbia Penitentiary is quite different
than that at Oakalla because tuberculous patients are not transferred to the British
Columbia Penitentiary from Oakalla unless their tuberculosis is considered inactive.
At the present time there are nineteen inactive cases in the British Columbia Penitentiary under surveillance. Periodically X-ray surveys are carried out at the
Penitentiary.
TUBERCULOSIS CONTROL K 97
During the past year a tuberculin testing survey with X-raying of positive reactors was carried out at the Haney Correctional Institution for both inmates and staff.
This group, too, has been screened in passing through Oakalla so that the tuberculosis problem here is not serious. However, annual tuberculosis surveys will be
carried out in the Haney Correctional Institution.
At the end of the year a miniature X-ray machine was installed in Prince
George Gaol and is just beginning operation. While the volume will be smaller than
at Oakalla, we feel that the screening of the patients there will be very effective in
follow-up.
The various prison authorities are keenly aware of the tuberculosis problem in
penal institutions and have given the utmost co-operation in carrying out procedures
for its control.
NURSING EDUCATION
A continuous programme of nursing education is carried on in the Division of
Tuberculosis Control. This course provides a programme not only for student-
nurses, but also for in-service training and for postgraduate nurses. During the
year a week's programme of classroom teaching is conducted every five weeks for
student-nurses from the training-schools on the Lower Mainland. Similar courses
are carried out two or three times a year in Victoria for the student-nurses at St.
Joseph's Hospital and the Royal Jubilee Hospital, as well as in Kamloops for the
student-nurses in the Royal Inland Hospital. This lecture programme is provided
by a full-time nursing instructor, who is assisted by many members of the staff of
the Division. During the past year 489 student-nurses received this training. For
postgraduate students both the wards and clinics of the Division are used by the
School of Nursing at the University of British Columbia. Three clinical supervision
students spent a total of five months obtaining experience in these facilities. Three
public health nurses had a one-week programme of orientation in tuberculosis-
control in British Columbia, and sixteen third-year university nursing students also
had one-day lectures. In conjunction with the Vancouver Vocational Institute
School of Practical Nursing, thirty-six students were given a four-week course of
planned instruction and experience on the wards. Besides this, many others, such
as staff nurses, social workers, and auxiliary staff, audited the lectures given to
student-nurses.
MORBIDITY AND MORTALITY
During 1960 there were fifty-nine deaths in British Columbia from tuberculosis,
five more than in 1959. This represents a death rate of 3.7 per 100,000 population,
which was an increase from 3.4 per 100,000 in the previous year. This compares
with seventy deaths from tuberculosis in 1958, with a rate of 4.5 per 100,000.
This is only the second occasion since 1946 when the steady decline in the death
rate has been interrupted, the last being 1955. On both occasions the increase was
not particularly significant in indicating any changing trends in the favourable results
of the treatment programme.
Of the fifty-nine deaths from tuberculosis in 1960, only five were in the native
Indian population, as compared with seven deaths in this group in 1959. For
Indians this given a death rate of 12.6 per 100,000, as compared with a rate of 3.4
for non-Indians.
There were no deaths in persons under 25 years of age, while in persons 50
years of age and over there were forty-four deaths, and this latter group accounts for
almost 75 per cent of all deaths from tuberculosis. This again confirms the fact that
the tuberculosis problem has shifted from the younger person to the older age-groups.
K 98 PUBLIC HEALTH SERVICES REPORT, 1960
There was a decreased incidence of new cases of tuberculosis in 1960, the
final figure showing 1,173 new cases discovered in the total population, as compared
with 1,200 the previous year. The incidence of new active cases was also lower, with
631 of the cases found being in that category. Of these, 511 were non-Indians and
120 were Indians. This comparesw ith 719 in 1959, of which 138 were Indian. In
addition, amongst the known cases of tuberculosis there were 102 cases previously
classified as inactive which reactivated during the year, eighty-eight being non-Indian
and fourteen Indian.
ACKNOWLEDGMENTS
The fight against tuberculosis has always been waged on a broad front, and its
success is due to the participation of many individuals and groups. To all these
persons the Division records its appreciation. Thousands of volunteer workers have
contributed during the year to the success of the community surveys as canvassers,
clerks, and assistants in many capacities. Without them the surveys could not have
been maintained on the present basis.
Many agencies, both official and voluntary, played a big part in the tuberculosis-
control programme. Within the Health Branch various divisions are involved. The
local health services are an integral part of the programme and meet the problem
on a day-to-day basis at the grass-roots level. The Division of Vital Statistics
compiles and processes all the data collected by this Division and produces volumes
of information by which the tuberculosis programme is guided. The Division of
Laboratories does a large volume of bacteriology on tuberculous cases and provides
a most essential service. The closest co-operation exists and the working arrangements could not be more cordial.
The Indian and Northern Health Services of the Federal Government provide
a tuberculosis programme for the Indians of the Province, and with this service we
have a common aim in overcoming the tuberculosis problem. Here, again, our relationships are most cordial and a most effective working arrangement exists. The
tuberculosis programme carried on by the Indian Health Services has met with
great success in the reduction of deaths and in the incidence of new cases.
Amongst the voluntary agencies, special mention should be made of the Canadian Red Cross Society, which supplies us with all the blood, without which our
chest surgery would not be possible. The Vancouver Preventorium (Princess Margaret Children's Village) provides the only facilities we have for the treatment of
children with tuberculosis and is, therefore, an integral part of the tuberculosis
control treatment facilities. The work of the British Columbia Tuberculosis Society
has already been mentioned in connection with the community tuberculosis surveys,
but its efforts cover other phases of the programme, particularly in the field of
education. In this field they make a major contribution.
To all members of the Health Branch and in particular to the staff of the Division of Tuberculosis Control is recorded appreciation for their initiative, unstinting
efforts, and loyal support for the furtherance of the objectives of this Division.
VENEREAL DISEASE CONTROL K 99
REPORT OF THE DIVISION OF VENEREAL
DISEASE CONTROL
A. A. Larsen, Director
The total number of cases of venereal disease reported in 1960 showed only
minor changes from the numbers notified over the past four years. There were
3,573 cases of gonorrhoea reported this year, compared with an average of 3,507
cases per annum over the period 1956-59. Since 1956 there has been a significant
increase in the number of newly acquired cases of syphilis reported. In 1960 sixty-
three people were diagnosed as having primary or secondary syphilis, compared
with an average of thirty-four cases per annum over the four-year period 1956-59.
However, in 1960, 194 cases of latent syphilis were reported, compared with an
average of 212 cases per annum for the preceding four years.
Several factors seem to be related to the continued high incidence of gonorrhoea. An increasing number of cases are being reported from some of the northern
health units, coincident with the presence there of more construction-workers.
Many patients are no longer deterred from promiscuity by painful or long drawn-out
treatment and are frequently reinfected several times in one year. We are especially
concerned about the high rate of gonorrhoea in native Indian women and the frequency with which white males are reported as contacts. It is felt, too, that the
trend toward better reporting of venereal disease is continuing, and that this is helping to keep up the total number of cases.
Most of the cases of heterosexually transmitted early syphilis originated from
exposure to prostitutes in Vancouver, and every effort continues to be made to
locate and treat these source contacts. Many cases of infectious syphilis reported
this year were, however, contracted through homosexual practice. This has presented a very difficult control problem since most homosexual men are very promiscuous and may refuse to reveal the names of their sexual contacts. It is felt, too,
that there were a number of such patients who falsely gave the names of females as
contacts so as not to reveal their sexual deviation. Every homosexual known to the
staff of the Division has been warned of the danger and advised to have frequent
blood tests. Several articles have been published in the Canadian Medical Journal,
and no opportunity has been lost in acquainting private physicians with this problem.
As yet there is no evidence that penicillin has lost any of its effectiveness in
the treatment of either gonorrhoea or syphilis. However, an increasing number of
patients are being found to be sensitive to this drug and have to be treated with
some alternate medication which is less effective and more expensive.
ADMINISTRATION
Dr. Charles Hunt, Senior Consultant and Acting-Director of the Division, has
transferred to another position in the Government service, and Dr. Ainsley S. Atkins
has been appointed as Senior Consultant. Miss H. E. Cawston, Superintendent of
Nurses, resigned from the service, and her place was taken by Mrs. M. McVeigh,
who was formerly Assistant Superintendent of Nurses at the Pearson Tuberculosis
Hospital. Again this summer, with the help of a National Health Grant, the Division
employed a senior medical student. He supplied holiday relief for the clinical and
epidemiological staff and completed a study begun the year before on the effect
of topical cortisone in the treatment of non-gonorrhceal urethritis. Another senior
student, working under the direction of Dr. D. Ford, Associate Professor, Faculty
K 100 PUBLIC HEALTH SERVICES REPORT, 1960
of Medicine, University of British Columbia, spent the summer months in the Division studying the incidence of the " T " forms of pleuro-pneumonia-like organisms
in clinic patients with non-gonorrhoeal urethritis.
PUBLIC CLINICS
Patient attendance for diagnostic and treatment purposes has increased only
slightly at the various clinics operated by the Division. However, the number of
blood tests taken for United States immigration purposes has increased sharply.
In 1959, 2,612 such tests were done. In 1960 the figure was approximately 3,750.
The Division has operated a part-time public clinic in one of the Vancouver
City health unit offices near the area where many patients are exposed. In recent
years this clinic has shown a marked decrease in attendance, and it was felt that it
had outlived its usefulness. This clinic, therefore, has been closed on a trial basis.
It was felt that few of the patients going there could not attend the main Vancouver clinic, and that a more efficient and economical operation would result from
consolidation.
EPIDEMIOLOGY
The trend toward younger and younger people being named as contacts to
venereal diseases, which caused considerable concern a few years ago, seems to
have come to at least a temporary halt. This year considerably fewer boys and girls
in their teens were reported.
The Metropolitan Health Committee has continued its policy of seconding one
of its public health nurses for full-time work in this Division. One of the duties of
this nurse is to interview all the young people who are named to the Division as
venereal disease cases or contacts, and who are still attending school, with a view
to uncovering the underlying social and emotional problems that caused them to act
as they did. Only nine such cases were seen in 1960.
In October a meeting was called by the Medical Officer of Health for the City
of Vancouver which was attended by representatives from the Division, Vancouver
City Police, City Prosecutor's Office, City Licence Inspector's Department, the
Liquor Control Board, and the British Columbia Hotel Association to review the
problem of prostitution and facilitation as they relate to the spread of venereal disease. While there is no evidence to suggest that organized prostitution is contributing
significantly to the incidence of venereal disease, many individuals, through indifference or avarice, are still facilitating contact between infected and healthy persons.
Recent information indicates that certain establishments in Vancouver are serving
as regular places of meeting and sexual exposure between homosexuals, and active
steps are being taken by the authorities concerned to control this situation.
EDUCATION
The educational programme for physicians, medical students, public health
nurses, and student-nurses has been continued. The senior nursing students from
the Vancouver General Hospital have rotated through the Vancouver clinic on a
three-day programme, and lectures have been given at St. Paul's Hospital, the
Royal Columbian Hospital in New Westminster, and at the Vancouver Vocational
Institute. A number of public health nursing students from the University of British
Columbia were given an intensive one week's course covering all phases of venereal
disease control, and lectures were given to students in medicine at the University.
The clinic has continued to employ nine newly graduated doctors on a part-
time basis to conduct public venereal disease clinics. Appointments as clinic
VENEREAL DISEASE CONTROL K 101
physicians are limited to one year so that the maximum number of physicians can
be accommodated. This policy is now beginning to show definite results. It is our
feeling that more private practitioners are willing to care for patients with venereal
disease, that better care is being given to these patients, and that the Division is
receiving more co-operation in tracing contacts than ever before.
A new film, " Innocent Party," dealing with the problem of venereal disease in
teen-age groups has been purchased and is available for distribution.
232503
K 102
PUBLIC HEALTH SERVICES REPORT, 1960
REPORT OF THE DIVISION OF LABORATORIES
E. J. Bowmer, Director
During 1960 there were some resignations among senior members of the staff.
On the resignation of Mr. A. R. Shearer, B.A., Assistant Director since 1956,
Miss V. G. Hudson, B.A., who has served with distinction in this Division for
twenty-nine years, was promoted to fill the vacancy. This resulted in the successive
promotion of two bacteriologists to take charge of the Enteric and the Milk and
Water Laboratories.
Table I.—Statistical Report of Examinations and Work Load in 1959
and 1960, Main Laboratory
Unit1
Value
1960
1959
Tests
Performed
Work-load
Units
Tests
Performed
Work-load
Units
Enteric Laboratory—
Cultures—
7
10
100 =
1502
4
2
3
1
2
5
15 =
6
5
5
10
5
5
5
2
2
2
2=
5=
1
2
2
2
2
2
2
3
4
2
10
25
25
6
2
3
17,114
2,364
82
37
12
4,993
4,513
3,190
430
1,463
12,361
55
2
6,854
6,584
2,993
2,197
9,270
28,045
132
2,701
13,616
1,509
128,824
1,526
8,138
1,887
24
145
148
397
25
127
655
1,032
223
24,635
12,588
4,252
119,798
23,640
8,200
1,051
1,800
19,972
9,026
9,570
430
2,926
61,805
825
12
34,270
32,920
13,951
2,001
66
97,657
20,010
Chemistry Laboratory—
Water-
Complete analysis -
6,244
B.O.D
Milk and Water Laboratory—
Milk and milk products—
26
5,274
4,827
3,489
437
1,509
10,888
59
1,600
21,096
9,654
10,467
437
Water—
3,018
Coliiorm— -
54,440
295
Miscellaneous Laboratory—
Cultures—
C diphtheria?. „
Hemolytic staph.-strep
8,390
6,767
357
2,857
1,844
8,666
27,084
169
2,440
16,943
1,117
134,639
1,652
8,723
1,923
33
187
201
417
63
41,950
33,835
3,570
Miscellaneous— -
Fungi
AT. gonorrhoea;..
Direct smear—
14,965
10,985
46,350
56,090
264
5,402
27,232
7,545
128,824
3,052
16,276
3,774
48
290
296
1,191
100
254
6,550
25,800
5,560
147,810
25,176
12,756
14,285
9,220
43,330
54,168
338
Miscellaneous
Serology Laboratory—■
Agglut. tests—Widal, Paul-Bunnell, Brucella
4,880
30,209
2,234
Blood—
V.D.R.L. (qual.)
134,639
V.D.R.L. (quant.)
3,304
17,446
C.S.F.—
3,846
66
Cell count — _
374
402
1,251
Viruses—
252
Tuberculosis Laboratory—
713
7,130
Cultures—M. tuberculosis
Direct smears—M. tuberculosis—
26,169
16,347
3,930
157,014
32,694
11,790
Totals _ - -
305,143
872,835
314,158
833,145
1 One D.B.S. unit=10 minutes of work.
- Unit va
lues altered or
l January 1st,
1960.
LABORATORIES
K 103
The total work load, calculated in Dominion Bureau of Statistics units (one
unit is equivalent to ten minutes of work by laboratory personnel), for 1960 showed
an increase of over 5 per cent compared with 1959, although the actual number of
tests performed was slightly less in 1960 than in 1959. This is a trend that has
been noted during the past few years; it is due mainly to the increasing demand
for " high-unit value " tests. The major increases were in enteric bacteriology,
chemical analysis, parasitology, mycology, and special tuberculosis bacteriology.
The major decreases were in sanitary bacteriology, serology, and routine tuberculosis bacteriology.
At the request of the Deputy Minister, a survey on laboratory utilization was
started in co-operation with the Director of Epidemiology. The object of the study
was to review the work load of each section in the Division and to determine whether
physicians and health unit officials were utilizing the Division's laboratory facilities
economically and efficiently. As a result of the survey on milk samples submitted
to the Division, the work load in this programme was curtailed.
Table II.
-Statistical Report of Examinations and Work Load during
the Year 1960, Branch Laboratories
Unit1
Value
Nelson
Victoria
Tests
Performed
Work-load
Units
Tests
Performed
Work-load
Units
Enteric Laboratory—
Cultures—
7
10
4
2
3
1
2
5
15
6
5
5
5
5
5
2
2
2
2
5
1
2
2
2
2
2
3
10
6
2
3
383
2,681
1,056
267
782
782
592
207
2,249
2,249
5
5
556
556
20
211
379
512
8
651
376
4
14,995
243
1,008
326
393
394
18
19
2,060
2,060
434
7,392
2,670
3,128
1,564
1,776
207
Milk and Water Laboratory—
Milk and milk products—
709
529
333
182
1,678
2,836
1,058
999
182
Water—
4,498
11,245
75
Coliform
8,390
Miscellaneous Laboratory—
428
428
385
30
Cultures-
2,140
2,140
1,925
2,780
2,780
100
1,055
512
12
46
1,282
3,833
40
1,895
1,024
16
1,302
752
20
Direct smear—
N. gonorrhoea? -
Vincent's spirillum— , ,
256
6
23
641
3,833
20
Serology Laboratory—
Agglut. tests—Widal, Paul-Bunnell, Brucella
Blood—
V.D.R.L. (qual.) --
14,995
486
2,016
652
V.D.R.L. (quant.)
C.S.F.—
1
Cell count - _
786
2
54
Tuberculosis Laboratory—-
190
12,360
4,120
1,302
Direct smears—M. tuberculosis
108
80
216
240
Totals
-
10,023
28,534
33,417
82,058
1 One D.B.S. unit=rl0 minutes of work.
K 104 PUBLIC HEALTH SERVICES REPORT, 1960
In Table I the total number of tests and the work load in units during 1960
are compared with the figures for 1959. The work loads undertaken at the Division's two branch laboratories, in the Royal Jubilee Hospital, Victoria, B.C., and
in the Kootenay Lake General Hospital, Nelson, B.C., in 1960 are reported in
Table II.
TESTS FOR THE DIAGNOSIS AND CONTROL OF
VENEREAL DISEASES
The demand for standard tests for syphilis (S.T.S.) decreased in 1960 by
nearly 5 per cent. The tenth evaluation survey of S.T.S. in which this Division
participated was started by the National Laboratory of Hygiene. During 1960,
397 exudates from 198 individuals were examined for Treponema pallidum by the
darkfield technique. Nineteen (10 per cent) of these patients were found positive,
compared with twenty-eight (13 per cent) of the 216 patients examined in 1959.
A total of 319 sera was submitted to the National Laboratory of Hygiene and
the Ontario Division of Laboratories for the conduct of the Treponema pallidum
immobilization (T.P.I.) test, which is the most valuable confirmatory test for
syphilis. The results were positive in 100 patients (34 per cent). The comparative study of the S.T.S., the T.P.I, test, and the Reiter Protein Complement-Fixation
(R.P.C.F.) test, commenced in 1959 in collaboration with the National Laboratory
of Hygiene and the Provincial Division of Venereal Disease Control, was completed.
The Chief of Clinical Laboratories of the Laboratory of Hygiene analysed the
results, which indicated that the R.P.C.F. test is a valuable screening test in the
diagnosis of syphilis.
Demands for direct microscopy and culture in the diagnosis and control of
gonorrhoea increased by about 5 per cent. No satisfactory method of transporting
specimens for culture has yet been developed for use by out-of-town physicians.
The cultural techniques are thus available only to the V.D. clinics in the Greater
Vancouver area. Out of 28,000 smears examined, 3,840 were positive (14 per
cent). Out of 9,270 cultures investigated, 1,540 were positive (17 per cent).
Other Serological Procedures
The demand for antistreptolysin O titre estimation for the diagnosis or exclusion of acute rheumatism and other diseases associated with beta-haemolytic streptococcal infection increased by 45 per cent, from 1,035 in 1959 to 1,509 in 1960.
Of the sera examined in 1960, 703 (47 per cent) showed raised serum antibody
titres.
In 1960 the conduct of all serological procedures was transferred to the
Serology Section, resulting in increased efficiency in the operation of the Division.
TESTS RELATING TO THE DIAGNOSIS AND CONTROL
OF TUBERCULOSIS
The number of microscopic examinations of smears for Mycobacterium tuberculosis was further reduced in 1960. In 1959, 16,350 such smears were examined,
while in 1960 the number decreased to 12,600, of which 282 were positive (2 per
cent). The routine laboratory work load in connection with the diagnosis and
control of tuberculosis is summarized in Table III. The demand for cultural examination decreased by 5 per cent. The special studies on M. tuberculosis continued.
Anti-microbial sensitivity tests were performed on over 1,000 strains to assist the
Division of Tuberculosis Control in determining the appropriate chemotherapy for
patients with tuberculosis. Over 200 strains of anonymous mycobacteria were
LABORATORIES
K 105
investigated by a battery of laboratory tests to distinguish the potentially pathogenic
non-photochromogens from the predominantly non-pathogenic skotochromogens.
A small number of strains of M. tuberculosis from patients who were refractory to
treatment with the usual anti-microbial agents were tested for their sensitivity to a
new anti-microbial agent, TH 1314, which was undergoing clinical trial in the Division of Tuberculosis Control.
The Division of Laboratories occupies three floors of the Provincial Health Building in
Vancouver. At left is Miss V. G. Hudson, appointed Assistant Director of the Division
in 1960.
Table III.—Routine Tuberculosis Bacteriology
I960 1959
Number of direct smears examined microscopically.__. 12,588 16,347
Number of positive smears 282 368
Number of specimens cultured 24,635 26,169
Number of positive cultures 1,562 1,661
Number of guinea-pigs inoculated 655 713
Number of positive guinea-pigs 32 41
ISOLATION AND IDENTIFICATION OF SALMONELLA, SHIGELLA,
AND OTHER ENTERIC BACTERIA
The considerable increase in the demand for stool culture in the diagnosis
and control of diarrhoeal diseases suggests that their incidence in the community
is on the increase, and that physicians and health unit officials are becoming more
aware of the value of laboratory confirmation. The first six months of 1960 was
K 106
PUBLIC HEALTH SERVICES REPORT, 1960
remarkable in that about 40 per cent more stool specimens were received than in
the comparable period of 1959. Stool culture is one of the "high-unit value"
tests requiring skilled bacteriologists and the expenditure of much media. Work
loads and positive results for the four-year period 1957 to 1960, inclusive, are
shown in Table IV.
Table IV.—Stool Culture for Salmonella;, Shigella;, and Pathogenic
Escherichia coli
Salmonella-Shigella
Pathogenic E. coli
Year
Total
Number of
Specimens
New Positives
Total
Number of
Specimens
New-
Salmonella
Shigella
Total
Positives
1957...
1958 ,
1959 _ -
1960
11,130
14,574
13,951
17,114
243
344
458
472
174
552
388
1,161
417
896
846
1,633
1
100 7
1,139 143
2.001 207
2,364 199
1
The numbers of new cases of infection from which salmonellae, shigella;, and
pathogenic Escherichia coli were isolated showed a marked increase in 1960.
Several fascinating epidemio-bacteriological studies were made. Salmonella heidel-
berg was the commonest salmonella isolated, with S. typhi-murium second. Between February and May a new salmonella serotype with the antigenic formula
4,12:b-l,6 was isolated from twenty-two persons widely scattered in the Fraser
Valley, Lower Mainland, and Vancouver Island. As this organism was also isolated
in seven other Canadian Provinces, the name proposed for it was Salmonella canada.
In view of the high incidence of S. heidelberg infection, over 200 reports on new
cases were analysed and found to reveal many interesting features. A case of
typhoid fever was traced to ingestion of storm-water in a drain contaminated by a
known chronic typhoid carrier. A classical outbreak of salmonella food poisoning
was investigated: sixty-nine persons were found to be excreting S. heidelberg and,
of these, thirty-six were also excreting S. thompson. Bacteriological investigation
revealed the presence of both salmonellae in the suspected food—turkey dressing and
vegetable salad.
The most common salmonellae isolated during 1960 are compared with those
isolated in 1959:—
Organism 1960
1. Salmonella heidelberg 144
2. Salmonella typhi-murium 108
3. Salmonella thompson 106
4. Salmonella paratyphi B 27
5. Salmonella canada 22
6. Salmonella tennessee 12
7. Salmonella newport 11
8. Other salmonellae 42
1959
179
139
5
20
36
71
Totals 472
458
Shigella sonnei was isolated from 1,095 new cases, while Shigella flexneri was
was only isolated from sixty-six new cases. Laboratory examinations for pathogenic
E. coli increased by nearly 20 per cent.
LABORATORIES K 107
SANITARY BACTERIOLOGY
Examination of Dairy Products
Late in 1960 the American Public Health Association published the eleventh
edition of Standard Methods for the Examination of Dairy Products. A review of
current laboratory methods and procedures was started, to ensure that the new
standard methods were being observed.
The survey on laboratory utilization in the Milk Laboratory indicated that some
health authorities were sampling in excess of the requirements of the Milk Industry
Act and regulations. Curtailment of this excessive sampling resulted in a decrease
in work load of about 5 per cent. A total of 468 milk shipments, each containing
about five samples, was received by this Division; of these, nine (2 per cent) arrived
at temperatures over 10° C, and were therefore unsuitable for examination.
Water Bacteriology
The American Public Health Association published the eleventh edition of
Standard Methods for the Examination of Water and Wastewater late in 1960.
A review of current laboratory methods and procedures was started to ensure that
the new standard methods were being observed. A survey of laboratory utilization
in water bacteriology was commenced. The demand for bacteriological examination of water increased by about 15 per cent in 1960 compared with 1959.
Many water samples were shipped by mail and 84 out of 12,361 (0.7 per cent)
were more than four days in transit and therefore considered unsuitable for bacteriological examination.
Bacterial Food Poisoning
In 1960 there were fifty-five demands for bacteriological culture of food substances suspected of causing food poisoning, compared with fifty-nine in 1959. Only
five samples yielded pathogenic organisms: Streptococcus viridans was isolated from
oysters which were consumed by thirty people; Streptococcus pyogenes was cultured
from prawns eaten by two persons; coagulase-positive Staphylococcus aureus was
isolated from custard slice eaten by one person and from chicken eaten by another
individual; and Salmonella heidelberg and Salmonella thompson were recovered
from turkey dressing and vegetable salad when over fifty persons developed acute
gastro-enteritis following a wedding breakfast.
OTHER TYPES OF TESTS
Diphtheria
This was the second successive year in which Corynebacterium diphtheria; was
not isolated. Only two animal virulence tests were performed on suspicious cultures.
Parasitic Infections
The demand for examinations for intestinal parasites showed a slight increase
on previous years. The following parasitic protozoa were identified in faeces specimens : Giardia lamblia (116), Entamasba coli (116), Endolimax nana (31), Enta-
mazba histolytica (11), and Iodamceba butschlii (2). The following helminthic
eggs were identified: Trichuris trichiura (19), hookworm (21), Clonorchis sinensis
(12), Enterobius vermicularis (14), Ascaris lumbricoides (11), and Diphyllo-
K 108 PUBLIC HEALTH SERVICES REPORT, 1960
bothrium latum (1). The following adult worms were also identified: Ascaris
lumbricoides (2), Enterobius vermicularis (1), and Taenia saginata (1). In addition, in 360 specimens out of 1,700 submitted on National Institute of Health swabs
or scotch tape, eggs of Enterobius vermicularis were identified.
A small outbreak of trichinosis occurred in Vancouver, North Vancouver, and
West Vancouver. Seven individuals, all of whom had eaten undercooked pork
obtained from one butcher, developed suggestive symptoms. The diagnosis was
confirmed by muscle biopsy, by skin test, or by serological tests, or by a combination
of methods. Skin test antigen was provided and serological tests were performed
by the consultant parasitologist to the Department of National Health and Welfare.
Fungus Infections
The demand for mycological investigations remained at the same high rate as
in 1959. The following dermatophytes were isolated and identified: Trichophyton
rubrum (105), Microsporon cants (97), Trichophyton mentagrophytes (22), Epi-
dermophyton floccosum (12), Trichophyton discoides (9), Trichophyton tonsurans
(4), Trichophyton megnini (3), and Trichophyton violaceum (1). This is the first
report of Trichophyton megnini in these laboratories. The patients were recent immigrants from Holland. The patient infected with T. violaceum was a recent immigrant from Greece. On 215 occasions Candida albicans was isolated and other
Candida species were recovered 184 times.
Of the 2,200 specimens received for mycological examination, 30 per cent
yielded positive results.
Miscellaneous Tests
The smaller clinical laboratories with no facilities for bacteriology submitted
over 200 blood cultures for examination; of these, nine proved positive. The organisms isolated were coagulase-negative Staphylococcus albus (3), coagulase-positive
Staphylococcus aureus (2), Aerobacter aerogenes (2), Salmonella typhi (1), Salmonella paratyphi 5(1), and paracolon-like organism (1).
Virus Investigations
A total of twenty-five viral and rickettsial complement-fixation tests, involving
seven patients, was performed. The positive findings included one case of mumps
and one case of Q fever.
During 1960 specimens from 127 patients were submitted to the Virus Laboratories of the National Laboratory of Hygiene for virus isolation and identification.
These included specimens collected at six autopsies. The following entero-viral
agents were identified: Poliovirus Type I (33), Polio virus Type III (9), Coxsackie
A9 (1), and Coxsackie B5 (19). Thus a total of 62 viral agents was isolated from
127 patients, an isolation rate of nearly 50 per cent.
In spite of their heavy commitment in the laboratory study of the live attenuated polio vaccine programme, the National Laboratory of Hygiene continued to
provide this service for the Province of British Columbia.
Chemical Analyses
In spite of staff changes the work load in the Chemistry Section showed a
substantial increase. The tests performed were the chemical analysis of old and new
public water-supplies and the estimation of biochemical oxygen demand (B.O.D.)
of sewage and other effluents.
LABORATORIES K 109
BRANCH LABORATORIES
Recommendations were made for the purchase from the Kootenay Lake General Hospital of technical and non-technical assistance for the laboratory technician
in the Nelson Branch Laboratory. The Director of the Division made one visit to
the laboratory to inspect and advise on laboratory facilities. During his visit he
attended the medical staff meeting and discussed with the physicians the services
available. The work load at Nelson laboratory decreased by nearly 20 per cent
compared with the 1959 work load.
The Director visited the Royal Jubilee Hospital Branch Laboratory twice and
discussed problems with the staff. There was a substantial increase of over 20 per
cent in the work load at the Victoria Branch Laboratory in 1960 compared
with 1959.
GENERAL COMMENTS
Four courses on serological techniques, each lasting one week, were conducted
for trainee technicians attending technician training-schools in the Greater Vancouver area. Eight members of the staff participated in instruction at the University
of British Columbia in the Faculty of Medicine and in the Departments of Bacteriology and Nursing. The Division presented a display of its activities and of the
new aluminum mailing containers introduced in 1960 at the annual meeting of the
British Columbia Division of the Canadian Medical Association. In August the
Director presented a paper at the annual meeting of the International Northwest
Conference on Diseases in Nature Communicable to Man. In November the Director attended the sixteenth annual meeting of the Technical Advisory Committee on
Public Health Laboratory Services to the Deputy Minister of National Health, and
presented a paper at the annual meeting of the Laboratory Section of the Canadian
Public Health Association in Ottawa.
In spite of many changes in the senior staff, the quantity and quality of laboratory work were maintained. The staff are to be congratulated on their rapid
readjustment to the resulting administrative changes during 1960.
K 110 PUBLIC HEALTH SERVICES REPORT, 1960
REGISTRY AND REHABILITATION SERVICES
C. L. Hunt, Director
The Registry for Handicapped Children made steady progress during the year
1960. It has added more than 200 new registrations per month, and its case load
at this time is approximately 16,500.
During the year a survey was conducted on deaf and hard-of-hearing children
over the age of 16, the results of which have not as yet been summarized. It also
collaborated with the Division of Preventive Dentistry in a survey of cases with cleft
palate and hare-lip.
This Registry has now been in existence for over nine years and has provided
valuable information regarding the problems of handicapped children in this Province. Besides providing a measure of the nature and extent of the problems, it has
also shown the areas in which those problems were mostly concentrated, and has
revealed what facilities were available, or should be made available, for dealing
with them.
Since the co-operation of doctors in private practice was sought in acquiring
information about their patients, the Registry developed a consultative service in
the field of rehabilitation to help the physicians in handling their more difficult
problems. Thus the Registry and Rehabilitation Services have become interrelated.
The Children's Registry concerned itself with persons under 21 years of age.
It was realized, however, that many of those originally registered, though having
passed beyond the age-limit, still required some type of rehabilitation service as
adults. Moreover, since a general programme of adult rehabilitation is being developed, it was felt that the services of the Registry should be extended to include
handicapped adults, thus automatically taking care of those previously registered
as children.
In April of 1960 the Registry was given permission to eliminate its age-limit
of 21 years, and has become the " Registry for Handicapped Children and Adults."
Registration on a general scale for the adult group has not as yet been requested.
However, approximately 200 adult cases have so far been notified, and these are
being registered. They consist of cases admitted to the G. F. Strong Rehabilitation
Centre, cases over 21 years of age who have contracted poliomyelitis during 1960,
and some miscellaneous cases that have been registered by the local health services.
Plans are going ahead for registering other adult cases, such as those on social
assistance who are receiving medical care and persons receiving treatment from the
Canadian Arthritis and Rheumatism Society (British Colmbia Division).
The adult section of the Registry is gradually surveying the cases known to it
who were registered as children and who are now over 21 years of age. These cases
are being reviewed and up-to-date information is being requested from the local
health services.
The Registry, with the assistance of local health services personnel, has also
undertaken to do a follow-up study of a vocational nature on cases that have been
discharged from the G. F. Strong Rehabilitation Centre during the years 1958 and
1959. The questionnaire has been worked out in collaboration with the G. F. Strong
Rehabilitation Centre and is being handled by the local health services.
Staff members of the Registry continue to participate in the activities of various
voluntary agencies concerned with handicapped children and adults by serving on
committees and on directing boards of these agencies.
REGISTRY AND REHABILITATION SERVICE Kill
During the year the Director of the service spent three months in Britain and
Denmark to observe the methods used there in the field of rehabilitation and chronic
care. On his return a report was submitted and has been distributed to various
interested agencies.
The Registry and Rehabilitation Services, besides registering handicapped persons of all ages, has taken an active part in advising and arranging for the rehabilitation of those considered likely to benefit from this service. Such an arrangement
has necessitated the co-ordination of many facilities within the community capable
of offering assistance. These include medical rehabilitation services, psychological
education, vocational assessment and training, social welfare, and the assistance
of the National Employment Service, besides the assistance of many community
organizations.
CASEWORK OF THE REHABILITATION SERVICE
An important aspect of the Rehabilitation Service is the individual casework
service offered to disabled persons. Referrals come from a variety of sources, including social service agencies, private and public hospitals, private physicians, voluntary
agencies, etc. The aim of the programme is to restore the disabled person to the
greatest possible degree of independence. The ultimate goal is to assist the referred
person to industrial competence and financial independence, a result obtained in
nearly two-thirds of the referrals.
After referral, information about the patient's medical, social, and vocational
background is studied in order that appropriate further action consistent with the
patient's needs may be planned on a logical co-ordinated basis. The Service then
arranges for the requisite services and closely follows the patient's progress until a
conclusive result is obtained.
Case Load of the Rehabilitation Service, January 1st, 1960, to
December 31st, 1960
Cases active at January 1st, 1960 121
Cases deferred at January 1st, 1960 4
Cases accepted, January 1st, 1960, to December 31st, 1960 64
Total 189
Cases closed, January 1st, 1960, to December 31st, 1960 72
Cases active at December 31st, 1960 117
Cases deferred at December 31st, 1960 4
Case load at December 31st, 1960 121
Seventy-two case closures were reported during the year, of which forty-five
have been re-established in gainful employment. One case, as a result of services
provided, was able to enter the University of British Columbia, and the balance of
twenty-six cases were closed without the desired result of industrial independence
having been achieved, but an improvement in physical and social competence usually was noted.
K 112 PUBLIC HEALTH SERVICES REPORT, 1960
Source of Support at Referral
Social Allowance 31 Vi
Private resources 28
Unemployment insurance benefits 12Vi
Total 72
None of the seventy-two cases was self-supporting at the time of acceptance
for service, but at closure the economic status of the group had changed markedly,
as shown in the following table:—
Source of Support at Closure
Wages 45
Disabled Persons' Allowance 5
Social Allowance 9
Private resources 13 *
Total 72
1 One person who is attending university is closed as rehabilitated, but source of support is private.
Age-grouping of Seventy-two Closed Cases
Under 20 years 8
21-30 years 31
31-40 „ 11
41-50 „ 16
51-60 „ 6
Over 60 years
Total 72
Annual Earnings of Cases Closed in Employment
$500.00-$ 1,000.00 1
1,001.00- 2,000.00 7
2,001.00- 3,000.00 19
Over $3,001.00 8
Self-employed 3
Not reported 7
Total 45
VOCATIONAL REHABILITATION
Rarely is the disabled person encountered who does not envision a useful and
productive life, disability notwithstanding. However, it is a fact that disabled
persons frequently have not had either the physical ability or the opportunity to
develop academic and vocational skills. Others find it necessary to develop new
vocational skills. To the majority, rehabilitation is synonymous with productive
work and gainful employment. It is for this reason that vocational rehabilitation
measures are so vital to the rehabilitation process. Vocational training is an important area of vocational rehabilitation. Special facilities for vocational assessment
REGISTRY AND REHABILITATION SERVICE K 113
have not been extensively developed, but many of the disabled are eligible for
admission to normal vocational training-schools.
During the past year nearly 50 per cent of those cases closed in employment
had received vocational training through the provisions of Schedule R of the Canadian Vocational Training Co-ordination Act. The annual amount of Social Allowance required to support the group prior to acceptance for rehabilitation services
was almost $26,000, and for many of this group the cost of support had been an
annually recurring expenditure. The total cost of providing vocational training,
including fees and maintenance allowance, was almost $15,000, a non-recurring
expenditure. The annual income of this group from salaries and wages is about
$90,000. Thus, not only was it less expensive to provide vocational training than
to maintain the group on Social Allowance, but the need for Social Allowance disappeared and a substantial economic gain was achieved by the group.
LIAISON WITH THE NATIONAL EMPLOYMENT SERVICE
Another important facet in the area of vocational rehabilitation is suitable
placement of disabled persons in gainful employment after initial rehabilitation
measures have been concluded. Early in 1959 an experimental programme of job
placement of disabled persons referred to the Rehabilitation Service was begun with
the assistance of the National Employment Service. The National Employment
Service seconded a senior special placement officer to the Rehabilitation Service to
provide advice and assistance in the job placement of disabled persons, and to act
as liaison officer between the Rehabilitation Service and the regional and local offices
of the National Employment Service. At the end of the experimental period, the
programme was evaluated and was found to be sufficiently effective for it to be
continued.
At January 1st, 1960, twenty-four cases had been continued on the placement
case load, and during the period to December 31st, 1960, forty-nine new cases were
added. A total of forty-one job placements were made during the year, involving
thirty-seven persons, four of whom were placed twice.
REHABILITATION SURVEY PROJECTS
A pilot study is being undertaken in the Nanaimo area to determine if some
individuals presently in receipt of welfare allowances due mainly to medical reasons
might benefit from rehabilitation services and become self-supporting. This study
was a co-operative undertaking on the part of the Health Branch and the Department
of Social Welfare, using funds from the National Health Grants.
In view of the experimental nature of the study, all procedures are being documented and evaluated in order to determine which might be applied in other areas
of the Province.
EDUCATION
In the realm of education, many talks have been given to medical and community groups describing modern concepts of rehabilitation techniques, the purpose
to be served, and the aims to be achieved, as well as the part that the community can
play in the over-all programme. The interest displayed has been universally gratifying in this relatively new service.
K 114
PUBLIC HEALTH SERVICES REPORT, 1960
REPORT OF THE ACCOUNTING DIVISION
For Period April 1st, 1959, to March 31st, 1960
J. McDiarmid, Departmental Comptroller
As the title shows, this report of the Accounting Division relates to the fiscal
year ended March 31st, 1960, rather than the calendar year ended December 31st,
1960, the period covered by the other sections in this volume.
The functions of the Accounting Division are to control expenditures, process
accounts and payrolls for payment, account for revenue, forecast expenditures, and
prepare the Departmental estimates of revenue and expenditure in their final form.
In addition, the Division is responsible for the inspection and control of expenditures
for Departmental cars.
The table shown at the end of the report gives the breakdown of costs by main
services, expressed in dollars and as a percentage of the total, comparing the three
years 1957/58 to 1959/60, inclusive.
There was a slight increase in the gross expenditure over the previous fiscal
year 1958/59. It is interesting to note that the cost of in-patient care continues to
decrease, which is largely due to a reduction in patient-days within the tuberculosis
institutions. Another important observation is the continued increase in expenditure
for local health services, which provides preventive and other services at the community level.
Quarterly inspections of Government motor-vehicles continued to be made
throughout the Province by the mechanical inspection staff. No serious accidents
occurred throughout the Health Branch, and at no time has an accident occurred due
to a mechanical failure. All accidents were referred to the Safety Committee for
review. Safe driving methods were continually stressed by the mechanical inspectors.
Service
Gross Cost
Percentage of Gross Cost
1957/58
1958/59
1959/60
1957/58
1958/59
1959/60
$3,078,650
1,999,027
838,423
348,299
355,990
374,199
263,623
274,957
99,588
$2,555,389
2,144,454
857,766
526,197
391,397
369,552
342,055
275,523
97,731
$2,342,565
2,417,767
899,090
309,430
413,249
405,688
376,785
312,200
99,145
40.3
26.2
11.0
4.6
4.6
4.9
3.5
3.6
1.3
33.8
28.4
11.3
7.0
5.2
4.9
4.5
3.6
1.3
30.9
31.9
Cancer, arthritis control, rehabilitation, etc—
Research, training, etc. . •,
Poliomyelitis
General administration and consultative ser-
11.9
4.1
5.5
5.3
5.0
4.1
1.3
Totals
$7,632,756 | $7,560,064
$7,575,919
100.0
100.0
100.0
Printed by A. Sutton, Printer to the Queen's Most Excellent Majesty
in right of the Province of British Columbia.
1961
660-1160-8468
BC Sessional Papers
Sixty-fourth Annual Report of the Public Health Services of British Columbia HEALTH BRANCH DEPARTMENT… British Columbia. Legislative Assembly 1961
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