PROVINCE OF BRITISH COLUMBIA
Seventy-second Annual Report of the
Public Health Services
of British Columbia
HEALTH BRANCH
Department of Health Services and Hospital Insurance
YEAR ENDED DECEMBER 31
1968
Printed by A. Sutton, Printer to the Queen's Most Excellent Majesty
in right of the Province of British Columbia.
1969
Office of the Minister of Health Services
and Hospital Insurance,
Victoria, British Columbia, January 10, 1969.
To Colonel the Honourable John R. Nicholson, P.C, O.B.E., Q.C., LL.D.,
Lieutenant-Governor of the Province of British Columbia.
May it please Your Honour:
The undersigned respectfully submits the Seventy-second Annual Report of the
Public Health Services of British Columbia for the year ended December 31, 1968.
RALPH R. LOFFMARK,
Minister of Health Services and Hospital Insurance.
Department of Health Services and Hospital Insurance
(Health Branch) ,
Victoria, British Columbia, January 3, 1969.
The Honourable Ralph R. Loffmark,
Minister of Health Services and Hospital Insurance,
Victoria, British Columbia.
Sir,—I have the honour to submit the Seventy-second Annual Report of the
Public Health Services of British Columbia for the year ended December 31, 1968.
J. A. TAYLOR, B.A., M.D., D.P.H.,
Deputy Minister of Health.
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DIVISION OF
PREVENTIVE DENTISTRY
Development of preventive dentistry
throughout the Province; consultative
service through regional dental consultants.
DIVISION OF EPIDEMIOLOGY
Evaluation and analysis ot information
on reportable diseases; promotion of
control methods; consultative service to
local health deoartments.
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The Health Branch is one of the three branches of the Department of Health
Services and Hospital Insurance, together with the branches of Mental Health Services and the British Columbia Hospital Insurance Service. Each is headed by a
Deputy Minister under the jurisdiction of the Minister of Health Services and Hospital Insurance.
In the Health Branch, the Deputy Minister of Health and the Directors of the
three bureaux form the planning and policy-making group. Under them the divisions provide consultative and special services to all public health agencies throughout the Province. The functions and responsibilities of these divisions are outlined
on the preceding page.
Direct services to the people in their communities, homes, schools, and places
of business are provided by personnel of local health departments. Greater Vancouver and Greater Victoria have their own metropolitan organizations, which,
though not under jurisdiction of the Health Branch, co-operate closely and receive
special services and financial assistance from the Provincial and Federal Governments. The remainder of the Province is covered by 18 health departments, known
as health units, which are under the jurisdiction of the Health Branch. Each unit is
complete in itself and serves one or more population centres and the rural areas
adjacent to it.
TABLE OF CONTENTS
Introduction-
Administration.
Page
. 9
. 12
Vital Statistics 16
Public Health Education 21
Financial Report 24
Special Health Services
26
Tuberculosis Control 29
Venereal Disease Control 34
Laboratories 37
Occupational Health 45
Rehabilitation 50
Extended Care 53
Local Health Services 54
Epidemiology 58
Public Health Nursing 61
Preventive Dentistry 69
Public Health Engineering 75
Public Health Inspection 78
Shellfish Programme 82
Emergency Health Service 83
Nutrition Service 85
Publications 87
Seventy-second Annual Report
of the Public Health Services of British Columbia
HEALTH BRANCH
Department of Health Services and Hospital Insurance
YEAR ENDED DECEMBER 31, 1968
The function of a health department is primarily to promote and maintain
ideal community health with the objective of ensuring for each individual optimum
conditions for maximum personal health. Organized health service at the municipal
level is desirable to co-ordinate community action toward that goal. At the Provincial level, administrative action should be developed to foster and support those
local health services at the municipal level; this involves establishing technical
divisions Provincially to serve in a consultative and advisory capacity to the staff
within the local areas. Provincial health services are designed, therefore, to contribute to local health service, and thereby enhance the quality of preventive medical
services which may be made available to the people of this Province.
Under the authority of the Health Act, each municipality within the Province
is required to establish a local board of health " to superintend and see to the
execution of any regulations made under the Act." Basically the ideal type of
full-time local health service has been found to be most efficiently administered
through a health unit, and under this same Act authority is provided for this wherein
two or more Municipal Councils may elect to unite their respective local boards of
health into a union board of health to operate health unit service. This is the
principal type of public health organization now in effect throughout the Province,
since all areas have taken this step to develop a uniform basic public health
administration. Uniformity between the various regions is further promoted by the
consultative and supervisory services available to all from the Health Branch. This
means, then, that there is a quality in uniformity of service to all citizens of the
Province whether they reside in a large urban area or in an unorganized part of the
Province. The geography and topography of the Province does mean, however,
that there are always likely to be some isolated, sparsely settled areas in which it is
not economically practical to maintain a full-time health service; in those areas,
basic services are provided on either a visiting programme or through the employment of part-time personnel.
THE PROVINCE AND ITS PEOPLE
More people, more marriages, a constant death rate, and a consistently decreasing birth rate are factors that must be recognized in assessing the health needs
within the Province as a whole. The population of the Province continues to
increase at a substantial rate, attaining a figure of 2,007,000 at the middle of the
year. This represents 10 per cent of the total population of Canada. Nearly
40 per cent of the people in British Columbia are under the age of 20 years, while
about 13 per cent are 60 years and over.
Among that population, preliminary figures would indicate marriages occurred
at a rate of 8.4 per 1,000 population, which is higher than any other rate since 1957.
N 10 PUBLIC HEALTH SERVICES REPORT, 1968
The over-all death rate was maintained at a low level, being 8.4 per 1,000
population, very slightly above the all-time record low of 8.3 established last year.
Heart disease, the disease entity making the largest contribution to the death rate,
maintained its rate at the low level of the preceding year. Some 304 deaths in
every 100,000 of the population resulted from heart disease. Mortality from cerebrovascular lesions (strokes) also showed a decline from the record low of a year
ago, at 94 per 100,000 population. For the fourth year in succession, cancer mortality has remained at about the same level, there having been 150 deaths resulting
from this cause in each 100,000 members of the population. Accident mortality
continues to exact a high toll of lives, having caused 71 deaths per 100,000 population, which means that the accident mortality rate is being maintained at a figure
well above previous averages. Motor-vehicle accidents continue to be the main
contributor, accounting for over 40 per cent of the accidental deaths. As a matter
of fact, the number of motor-vehicle accident deaths this year was well above that
ever before recorded, indicative of the trend that has been consistently observed
by other authorities.
During 1968, suicides were listed as a cause of death more frequently than
in any year since 1950—16.0 per 100,000 population. Both sexes were affected,
and greater use of barbiturates and firearms in committing suicide were significant
factors in the increase.
One of the indices of health care, the infant death rate per 1,000 live births,
reached the record low of 20.2. The attainment of such a rate is of some interest
since it ranks among the low rates of the world, but none the less it reflects a situation in which conscientious efforts should be directed toward lowering it still
further. A stillbirth rate of 12.3 per 1,000 live births was a record low, but still a
rate that is not particularly to be desired. The maternal mortality rate has remained
fairly consistent over the years, around 0.3 per 1,000 live births, which was the
rate obtained again for the present year.
The use of immunizing biologicals has greatly modified the communicable-
disease incidence throughout the Province to the degree that within recent years the
Province has been singularly free of preventable infections. Unfortunately 1968
was not such a year. A completely preventable condition, diphtheria, caused two
deaths among eight cases within a few months in an urban environment. Similar
occurrences in other Provinces are proof evident that this condition has not been
eliminated as a source of infection but can readily reappear when conditions permit.
Infectious hepatitis, a communicable infection prevalent throughout this
continent, continues to create a significant amount of illness among residents of
the Province. As the sources of infection are the body discharges from infected
persons, sewage naturally becomes an avenue of spread. For this reason, it is
advisable that each community focus its attention on adequate measures of sewage
disposal to circumvent an increase in the incidence of infectious hepatitis. British
Columbia is not in an enviable position in this regard in the revelation that 2,032
new cases were recorded during the year, a further increase over the incidence of
a year ago.
Despite a continuous educational warning, food poisoning continued to occur,
affecting 485 people who reported that they had become ill after eating. Subsequent
examination proved the offending food to be contaminated with bacteria or their
by-products. In the majority of instances these occurred following banquets at
which food had been prepared in quantity by volunteers lacking either the equipment
or proper knowledge of safe food-handling methods.
INTRODUCTION
N 11
Dysentery, from either bacterial or viral source, affected 500 members of the
public. In most cases the spread is traceable to the presence of health carriers in a
community. This creates problems in endeavouring to effect adequate control.
Streptococcal infection, which prior to the introduction of antibiotics was a
serious condition, is now a much less severe illness from the point of view of the
complications that may arise. Annually, however, there are a large number of
cases reported, somewhat less than a thousand during the past year. It must be
recognized, however, that the reported cases are only a rough index of the total
volume of incidence, the fact that not more are reported being yet further evidence
of the mildness of the infection.
The continuing encouraging advantages of preventive medicine are evident in
the completely changed emphasis that can now be directed toward paralytic poliomyelitis since another year has passed in which no cases were evidenced. It bespeaks
itself for the gains to society that can stem from a maintained immunization programme against a single disease entity.
The efforts directed toward venereal disease control have made certain inroads
on the incidence of syphilis, but gonorrhoea retains a significantly high incidence,
indicative of the need for prompt adequate reporting in endeavours to track down
contact sources and prevent consequent spread.
While tuberculosis does not present the grim picture it formerly displayed, there
is evidence that it remains an active infection among significant groups of the population as upwards of 50 cases a month are discovered through the energetic community
surveys. Treatment of the condition has altered to the degree that beds formerly
needed for patients of this condition are gradually becoming less necessary as
ambulatory treatment becomes the major therapeutic approach.
In general, from a disease-incidence viewpoint, the health of the Province,
while not ideal, was better than in previous years. However, it must be accorded
that morbidity and mortality statistics are not a complete index of the health status
since so many other factors have their influence. Health is but a means for attaining
optimum social well-being within the constraints of the physical, social, and biological environment in which man finds himself. Health is not just wellness, but
a broad concept that embraces the social, mental, and physical aspects of human life.
It includes the cognitive, affective, and action domains of human behaviour, and it
focuses on the individual, the family, and the community. Thus public health is
not just a discreet collection of functions, but a comprehensive entity involving the
total health of populations and their social cultural groupings. From that point of
view, health affects and is affected by a multitude of factors wherever people live.
In examining health problems and possible solutions, these factors are equally
important and demand simultaneous consideration.
N 12 PUBLIC HEALTH SERVICES REPORT, 1968
ADMINISTRATION
In the Health Branch, as in most other organizations, all senior and supervisory
staff are involved, in greater or lesser degree, in " administration " in the general
meaning of the term. The Bureau of Administration is responsible for co-ordinating
these activities and dealing with administrative matters in the specific sense. The
Bureau's responsibilities include personnel management, organization, training,
budget preparation, accommodations, health education, and vital statistics. The
Director of the Bureau of Administration serves with the Directors of the other two
Bureaux (Special Health Services and Local Health Services) on the Deputy Minister's central policy-making and planning group.
This report on "Administration " includes certain tables which have been found
to be useful as references and as a means of describing the services and activities.
Separate reports of the Division of Vital Statistics, the Division of Public Health
Education, and the Departmental Comptroller (Financial Report) appear in the
pages immediately following.
ORGANIZATION AND STAFF
Divisions, Offices, Clinics, Health Units
(Location and approximate numbers of persons employed at end of year.)
Health Branch headquarters (Victoria), Legislative Buildings, Victoria.... 45
Health Branch office (Vancouver), 828 West Tenth Avenue, Vancouver.. 39
Division of Vital Statistics—
Headquarters and Victoria office, Legislative Buildings, Victoria 65
Vancouver office, 828 West Tenth Avenue, Vancouver 21
Division of Tuberculosis Control—
Headquarters, 2647 Willow Street, Vanocuver 12
Willow Chest Centre, 2647 Willow Street, Vancouver 117
Pearson Hospital, 700 West 57th Avenue, Vancouver 318
Victoria and Island Chest Clinic, 1902 Fort Street, Victoria 11
New Westminster Chest Clinic, Sixth and Carnarvon, New Westminster 6
Travelling clinics, 2647 Willow Street, Vancouver 12
Survey programme, 2647 Willow Street, Vancouver 6
Division of Laboratories—
Headquarters and Vancouver Laboratory, 828 West Tenth Avenue,
Vancouver 86
Nelson Branch Laboratory, Kootenay Lake General Hospital 1
Victoria Branch Laboratory, Royal Jubilee Hospital1
84
86
482
87
Division of Venereal Disease Control—Headquarters and Vancouver clinic,
828 West Tenth Avenue, Vancouver 19
Local Public Health Services—
Health units—
East Kootenay, Cranbrook 26
Selkirk, Nelson 14
West Kootenay, Trail 19
North Okanagan, Vernon 25
South Okanagan, Kelowna 38
South Central, Kamloops 28
Upper Fraser Valley, Chilliwack 27
i Services are purchased from the Royal Jubilee Hospital, which uses its own staff to perform the tests.
ADMINISTRATION N 13
Local Public Health Services—Continued
Health units—Continued
Central Fraser Valley, Mission 25
Boundary, Cloverdale 51
Simon Fraser, Coquitlam 31
Coast-Garibaldi, Powell River 17
Saanich and South Vancouver Island, 780 Vernon Avenue,
Victoria 40
Central Vancouver Island, Nanaimo 48
Upper Island, Courtenay 23
Cariboo, Williams Lake 16
Skeena, Prince Rupert 24
Peace River, Dawson Creek 19
Northern Interior, Prince George 34
Nursing district—Telegraph Creek 1
506
Total 1,264
The total number, 1,264, is 29 more than the number on staff at the end of
1967. The increases occurred mainly in Pearson Hospital, the Division of Laboratories, and the health units.
There were also part-time employees in many of the places listed. The part-
time employees serving on a continuous basis totalled the equivalent of approximately 70 full-time employees.
The approximate numbers of employees by major categories at the end of the
year were as follows:—
Physicians in local health services 21
Physicians in institutional and other employment 19
Nurses in local health services 316
Nurses in institutions 96
Public health inspectors 59
Dentists in local health services 5
Bacteriologists 25
Laboratory technicians 30
Public health engineers 6
Statisticians 7
Others 680
Total 1,264
TRAINING
The Health Branch's professional training programme continued, using National Health Grants to defray part of the costs.
During 1968 nine employees completed training of one academic year's duration and nine others commenced such training, which usually leads to a diploma or
Master's degree in a public health specialty.
As usual the trainees were required to sign agreements to return to employment
with the Health Branch for specific periods following completion of their courses.
The details of this training are shown below, showing types of training, universities
or other training centres attended (in parentheses), and numbers trained:—
Completed training—
Diploma in Public Health Nursing (British Columbia) 6
Administration of Hospital Nursing Units (British Columbia) 1
Master of Public Health Nursing (Pittsburgh) 1
Master of Science in Nursing (California) 1
Total..
N 14 PUBLIC HEALTH SERVICES REPORT, 1968
Commenced training—
Diploma in Public Health Nursing (British Columbia) 5
Administration of Hospital Nursing Units (British Columbia) 1
Diploma in Public Health (Toronto) 1
Bachelor of Science in Nursing (Montreal, Halifax) 2
Total 9
In addition, some members of the Health Branch were given the opportunity
to attend short courses. Here again, National Health Grants helped to defray the
costs. The details were as follows:—
Short-term training—
Research Conference in Pulmonary Diseases (Veterans Administration—
Armed Forces, Cincinnati, Ohio) 1
Medical Health Officers' Refresher Course (School of Hygiene, University
of Toronto) 2
Workshop on Clinical Neuropsychology (Department of Psychology, University of Victoria) 4
Psychiatric Nursing Affiliation for Public Health Nurses (Riverview Hospital, Essondale, and The Woodlands School, New Westminster) 25
Nursing—Retarded Children (The Woodlands School, New Westminster).. 36
Seminars in Medical Control of Sickness Benefits, Cardiovascular Stress
Testing and Epidemiology of Occupational Diseases (Industrial Medical Association, San Francisco, Calif.)
Institute on Advanced Education in Dental Research (American College of
Dentistry, Cincinnati, Ohio, and Chicago, 111.)
Immunofluorescence (Department of National Health and Welfare, Laboratory of Hygiene, Ottawa)
The Therapist and the Hemiplegic Patient (Faculty of Medicine, University
of British Columbia, Vancouver)
Dental Research Training Programme (Dental Health Centre, United States
Public Health Service, San Francisco, Calif.)
Venereal Disease Contact Interviewing (Los Angeles, Calif.)
Conference on Pollution (Banff, Alta.)
Immunology and Virology (University of British Columbia, Vancouver)....
Gas Chromatography (Edmonton, Alta.).
Basic Freshwater Biology and Freshwater Pollution Ecology (Corvallis,
Oreg.).
Basic Principles of Water Waste Treatment Operation (Corvallis, Oreg.)
Occupational Health Nurse Course (New York University Medical School,
New York)
Eighth Revision of the International Statistical Classification of Diseases,
Injuries and Causes of Death (Dominion Bureau of Statistics, Ottawa)
Meeting of the American Speech and Hearing Association (Denver, Colo.)
In 1968 the Public Health Institute, the Health Branch's in-service training
course for its field staff in general, was combined with the annual meeting of the
Canadian Public Health Association at the University of British Columbia. The
institute was held on May 9, 1968.
ACCOMMODATION
Through a long-standing agreement with the Provincial Government, the Red
Cross Blood Transfusion Service has occupied the third floor of the Provincial
Health Building in Vancouver since it was built in 1955. During 1968 the Red
Cross Blood Transfusion Service undertook the construction of a new building
(on Oak Street between 31st and 32nd Avenues), which was nearing completion at
the year's end. Health Branch officials have made plans to use the vacated third
floor to provide much-needed space for the Public Health Chemistry Service of
the Division of Laboratories.
In Victoria the Health Branch's stockroom was moved in July from the Mc &
Mc Building to 818 Yates Street, the Taylor-Pearson Building, also in the central
area of the city.
ADMINISTRATION N 15
The Division of Public Health Engineering, which has a staff of eight, also
moved (in October) to the Taylor-Pearson Building from its former offices in the
basement of the West Wing of the Legislative Buildings. This move provided the
engineers with quarters more suitable to their needs and at the same time permitted
the Division of Vital Statistics to acquire much-needed space in the West Wing.
A very happy result is the fact that the Director of Vital Statistics will no longer
have to vacate his office whenever a civil marriage ceremony is performed. It has
now been possible to set aside a room for this purpose.
In the public health units throughout the Province, there was a continuation
of the programme to provide modern quarters. Three new community health
centres were built and one was enlarged. This brought to nearly 70 the number of
community health centres which have been built for the Provincial Health Services
during the past 20 years. The costs of construction have been derived from the
Provincial Government, the communities, certain voluntary agencies, and the
National Health Grants.
COUNCIL OF PRACTICAL NURSES
The Practical Nurses Act authorizes the appointment of a Council of 10
members representing the following: The Minister of Health Services and Hospital Insurance, the College of Physicians and Surgeons of British Columbia, the
Registered Nurses' Association of British Columbia, the Minister of Education,
the British Columbia Hospitals' Association, and the Licensed Practical Nurses'
Association. The Chairman of the Council is the Health Branch's Director of
Administration.
The Council's main responsibility is the licensing of practical nurses. This
process involves the careful assessment of all applications. The Council must also
maintain an interest in the training-schools and courses, which are the more direct
responsibility of the educational authorities.
During 1968 there were six formal meetings of the Council as a whole, bringing
to 25 the number held since the present Council was appointed in February of
1965. In addition, several committees held numerous meetings. As usual the
Committee on Credentials was particularly active.
A major project stemmed from the desire of the Department of Education's
representative to reassess the practical-nurse training programme. His interest
related to both the length of the course and the course content. Because Council
as a whole also has a real interest and responsibility in these matters, it employed
a professional consultant to conduct a survey during the four months April to July,
inclusive. At the year's end the consultant's report and recommendations were
being studied by Council.
Another major undertaking related to the desirability of making supplementary
training available to certain applicants whose qualifications, although generally
acceptable, were lacking in specific fields. Through the co-operation of the Department of Education, the vocational schools, and the Federal Department of Manpower and Immigration, Council was able to offer training opportunities. At the
time of writing this report, the response was not known.
In the licensing programme, the status was as follows at the end of 1968:—
Applications received 4,447
. Applications approved—
On the basis of formal training 2,176
On the basis of experience only—
Full licence 393
Partial licence 868
1,261
Total 3,437
Applications still to be received 234
N 16 PUBLIC HEALTH SERVICES REPORT, 1968
VITAL STATISTICS
The Division of Vital Statistics continued to administer the civil registration
system of the Province, and to provide a central biostatistical service to the Health
Branch, the Mental Health Services Branch, and other related agencies.
REGISTRATION SERVICES
Vital Statistics Act
This Act governs the registration of births, stillbirths, marriages, deaths, adoptions, and divorces, and the issuance of information and certificates based on the
registrations filed. Service is provided to the public through 109 district offices
and sub-offices throughout the Province.
The total volume of registrations under this Act continued to rise in 1968,
and was about 4 per cent higher than in 1967. Birth registrations, after a continuous decline from 1960 to 1966, levelled off in 1967 and rose slightly in 1968.
Substantial increases occurred in the registration of marriages and deaths.
The recent steady increase in volume of certificates issued was reversed in
1968, due to the combined effects of the nation-wide postal strike in July and the
increase in the cost of certificates from $1 to $2 made effective in April, 1968, in
accord with prevailing rates in other Provinces.
Marriage Act
The Division administers the Marriage Act in its entirety. The Act prescribes
the legal requirements for the issue of marriage licences and the solemnization of
marriage, and for registration of clergymen and Marriage Commissioners to solemnize marriage in this Province. The recent steady increase in the number of
marriages was maintained in 1968.
Change of Name Act
There was a considerable increase in the number of changes of name under
this Act, from about 600 in 1966 and 1967 to 725 in 1968.
Wills Act
This Act provides for notice of a testator's will (not the will itself) to be filed
voluntarily with this Division, and for certificates of such notices to be issued on
request. The increased use which is being made of this service is reflected in the
fact that the number of notices filed has increased by nearly 50 per cent in the
past three-year period. Approximately 16,850 notices were registered in 1968
and 9,960 certificates were issued.
Volume of Registrations and Certificates
Statistics based on the registrations of vital events which occurred in this
Province were compiled in the usual manner. Besides being presented in extensive
form in the Annual Report of Vital Statistics, these data are utilized in a number
of other reports prepared within the Branch.
The volume of registration and certification undertaken during the year 1968,
together with the comparable data for 1967, is shown as follows:—
VITAL STATISTICS N 17
Registrations accepted under Vital Statistics Act—
1968
Type 1967 (Preliminary)
Birth registrations 33,423 33,800
Death registrations 16,244 16,800
Marriage registrations 15,882 17,000
Stillbirth registrations 411 400
Adoption orders 2,183 2,350
Divorce orders 2,781 2,350
Delayed registrations of birth 508 365
Registrations of wills notices accepted under Wills Act 15,241 16,850
Total registrations accepted 86,673 89,915
Legitimations of birth effected under Vital Statistics Act- 262 270
Alterations of given name effected under Vital Statistics
Act 160 166
Changes of name under Change of Name Act 604 725
Certificates issued—
Birth certificates 59,130 54,280
Death certificates 9,566 9,878
Marriage certificates 6,157 6,049
Baptismal certificates 27 16
Change of name certificates 755 888
Divorce certificates 282 283
Photographic copies of registrations 5,985 6,390
Wills certificates 9,437 9,931
Total certificates issued 91,339 87,715
Non-revenue searches for Government departments 13,712 12,858
Total revenue $203,793 $259,970
BIOSTATISTICAL SERVICES
The Division's Research Section of trained biostatisticians and clerical staff, in
collaboration with the Mechanical Tabulation Section, continued to function as the
statistical arm of the Health Branch. Following are notes on the progress of the
Section's main activities during the year.
Tuberculosis Control
During the year this Division co-operated with the Division of Tuberculosis
Control in a number of projects, including studies on the following:—
(1) Tuberculin sensitivity and atypical mycobacterial infections.
(2) Tuberculosis among Indian children.
(3) The risk of development of active tuberculosis from an inactive status.
Advice and assistance were given to a medical student at the University of
British Columbia in the preparation of his graduation thesis on the following subject:
" Treatment of Tuberculosis—Follow-up Survey of Patients with Active Pulmonary
Tuberculosis First Diagnosed in 1963."
As usual, service was provided to the Division of Tuberculosis Control in the
preparation of the annual report and special statistical tabulations.
Cancer Notification
Further steps were taken toward the establishment of a cancer register within
the organization of the Registry for Handicapped Children and Adults. Records of
2
N 18 PUBLIC HEALTH SERVICES REPORT, 1968
all live cases diagnosed since 1960 were transferred onto the newly designed cancer
register cards.
Careful study was given to devising the most effective method of channelling
information about cancer from all pathologists in the Province to the cancer register.
A resolution was passed by the pathology section of the British Columbia Medical
Association urging pathologists to co-operate in this project. A system of follow-up
by personal contact with the physician concerned has been adopted for dealing with
the problem of incomplete data on reported cases.
Toward the end of the year the design of the codes and punch-cards used in
this project was revised.
Cytology Screening Programme
The Division continued to undertake the processing of case reports of the
British Columbia Cancer Institute's cytology laboratory in connection with the
cytological screening programme for detection of cancer of the cervix uteri.
Assistance was given to the physicians in charge of this programme in the
preparation of a paper entiled " Cervical Cancer Detection in British Columbia,"
which was published in the Journal of Obstetrics and Gynecology of the British
Commonwealth, April, 1968.
A research officer of the Division presented a paper on " Statistical Methods
in a Screening Programme for Cancer " at the annual meeting of the Canadian
Public Health Association in May, 1968.
The Division prepared statistics for the laboratory's annual progress report
for 1967, and assisted in the design of special coding systems for a proposed
follow-up study of specified cases.
Mental Health
The Division again provided statistical services to the Mental Health Services
Branch in connection with the preparation of the Branch's annual report and other
projects. The latter included a special study conducted to ascertain the types of
patients, by diagnostic category, who may be classified as chronic.
Following the transfer of the administrative staff of the Mental Health Services
Branch to Victoria, and the establishment of a statistical unit within the Branch,
discussions were held regarding the future division of responsibilities between this
Division and the new unit. It was agreed that the Division of Vital Statistics will
continue to undertake the mechanical processing of statistical data relating to Mental
Health Services.
Dental Health
The Division provided statistical services in connection with the analysis of the
1968 Greater Vancouver Dental Health Survey, which was the first of a new series.
For this study, the methodology developed by the World Health Organization was
adopted in conjunction with standard Provincial methodology developed in past
surveys carried out in this Province.
The 1968 survey included a special study of the dental health of adults. For
every 20th child examined in the school survey, a visit was paid to the child's home
by the public health nurse, and a WHO field form was completed for every occupant
over 15 years of age.
Assistance was given in the analysis of the post-fluoridation survey of Prince
George and in the reporting of the results. A pre-fluoridation survey was conducted
in Quesnel, and the results were compared with those of the Prince George survey.
VITAL STATISTICS N 19
The comparison indicated a much more favourable condition respecting caries in
Prince George than in Quesnel.
Obstetrical Discharge Study
Three Lower Mainland hospitals co-operate in this continuing study of maternal
and child health, which involves the completion of a detailed questionnaire relating
to each obstetrical case discharged from the participating hospitals. With the
assistance of the Government's Data Processing Centre, 48,000 individual records
covering the period of study, 1963 to 1967, were analysed during the year.
Registry for Handicapped Children and Adults
The rate of new registrations of handicapped persons continued at a high level
during 1968. An exhibit regarding the work of the registry was presented by
Dr. J. R. Miller, genetic consultant to the registry, at the Second International Workshop in Teratology in Kyoto, April, 1968. At the same conference, Dr. Miller also
read a paper on " The Use of Registries in the Study of Congenital Defects."
Very favourable comment regarding the registry was made in the British publication " Developmental Medicine and Child Neurology," by a well-known authority in this field.
Two papers based on the operations of the Registry were published in the
British Journal of Preventive and Social Medicine during the year, and members of
the staff collaborated in the preparation of other papers which have not yet been
published.
B.C. Government Employees' Medical Services
Upon the adoption of the National medicare plan in July, 1968, Government
Employees' Medical Services was absorbed by the British Columbia Medical Plan,
under the general direction of the newly appointed Medical Services Commission.
One consequence of this change was that the responsibility for tabulation of statistics
for the B.C. Government Employees' Medical Services was taken over by the
Medical Plan's electronic data-processing unit, thus terminating the arrangement
whereby this Division assumed full responsibility for mechanical tabulation of
statistics required by the Medical Services and the preparation of an annual statistical
report.
Mid-1968 membership statistics were prepared for the Medical Services as in
previous years, and mechanical tabulations were completed for the final annual
report prepared by this Division on behalf of that organization.
Venereal Disease Statistics
Monthly statistics were, as usual, prepared for the Division of Venereal Disease
Control. Early in the year, at the request of the Director of that Division, the timetable for processing of these reports was telescoped to ensure issue within a week
following the month of reference.
Tabulations for the annual report for 1967 were prepared as usual, and annual
statistics relating to Greater Vancouver and Greater Victoria were again supplied
to the Department of National Health and Welfare, Ottawa.
G. F. Strong Rehabilitation Centre Statistics
This Division, as usual, produced annual machine tabulations of the centre's
1967 statistics, which provide data on adults and children admitted and discharged
N 20 PUBLIC HEALTH SERVICES REPORT, 1968
during the year. In addition, during the third quarter a special set of tabulations
and listings of accident and non-accident cases, classified by anatomical site involved, was produced for the medical director of the centre.
Public Health Nursing Statistics
Monthly and annual statistics for 1967 were prepared. Assistance was given
to the Director of Public Health Nursing in carrying out a time and cost study
relating to the nursing-care programme, and in analysing the results.
Other Projects
Papers were presented by two members of the Research Section at the conference of the Canadian Public Health Association in Vancouver during May, one
relating to the operation of the Cancer Cytology Screening Programme, and the
other to the use of record linkage in the ascertainment of congenital anomalies.
An analysis of hospital admission records relating to cases showing a diagnosis
of rheumatic fever was carried out on behalf of the Director of Epidemiology. The
purpose of this study was to assess the effectiveness of the rheumatic fever prophylaxis programme in reducing the need for hospitalization among persons infected
with rheumatic fever.
International Classification of Diseases
The eighth revision of the International Classification of Diseases was completed in 1967. In accord with decisions made at the Federal level, this Division
has arranged to commence using the eighth revision for coding purposes at the
beginning of 1969.
As the new revision includes a number of important changes, the Dominion
Bureau of Statistics arranged a training course for staff engaged in coding morbidity
and mortality statistics throughout Canada in November. This training course was
attended by the medical coder attached to this Division.
Annual Report of Vital Statistics
Revised population estimates for the Province by age and sex, covering the
period 1962 to 1965, were made available by the Dominion Bureau of Statistics,
based upon the results of the 1966 population census. The rates appearing in the
annual report of this Division were modified accordingly.
The British Columbia section of a draft standard geographic code prepared by
the Dominion Bureau of Statistics was reviewed at the request of the Bureau.
PUBLIC HEALTH EDUCATION N 21
PUBLIC HEALTH EDUCATION
The year has been replete with activity for the staff of the Division, encompassing a wide field of projects ranging from special programmes for venereal disease
control, home nursing, and eradication of head lice to pollution control. This has
been in addition to the basic programme of professional and administrative activities
summarized in this section of the Report.
The staff of the Division is the same as it was last year—the Director, a consultant in special educational techniques, a consultant in audio-visual services, and
a consultant in school health education.
This being a consultative services division, its activities are co-ordinated with
the Province-wide health units and other divisions of the Health Branch.
SERVICES PROVIDED TO LOCAL HEALTH UNITS
The consultant in special education techniques provided service to the various
health units throughout the Province. This included instructions in the preparation
of pamphlets, posters, material for overhead projectors, and other types of media
for education and information of the public. Special sessions on the utilization of
these techniques were carried out in the Central Vancouver Island, Skeena, Coast-
Garibaldi, Boundary, Cariboo, Northern Interior, South Central, and Central Fraser
Valley Health Units. In addition, this consultant was involved in the development
of a programme of home care specifically for the Simon Fraser Health Unit, in
which the need for this nursing service is acute. This resulted in the production of
pamphlets for public distribution, a pamphlet for dstribution to physicians, and a
directory of services for the hospitals in the Lower Fraser Valley area.
The lice, mentioned earlier, are in fact only a symptom of a very fundamental
problem in the Skeena Health Unit, and in this the consultant in educational techniques and the consultant in audio-visual services were involved in what developed
into an intensive educational activity directed toward preventive control. Because
of the urgency of the situation, a plan was developed whereby a series of slides would
be prepared by the staff of the Division and would cover not only the lice problem,
but also the elements of basic sanitation and nutrition in an extremely simple and
understandable way. The initial work of the two consultants in this particular health
unit was followed up by a visit of the consultant in educational techniques, in which
he gave advice and instruction to the teachers in the area and also the staff of the
health unit.
As reported elsewhere in this Report, a new poison control programme,
planned for the whole Province, has been established on a pilot basis. In this the
staff of this Division has been involved in assisting the Director of the Division of
Epidemiology. In consultation with him, a series of slides and cards has been
developed with the intention that these be used by the " orientation " teams that
are going to each hospital which intends to establish this service.
A number of health units have requested assistance in connection with official
openings of new health centres and the operation of prenatal classes. Such assistance
has involved the development of educational materials, displays, and assistance with
public information procedures.
CONSULTATIVE SERVICES TO OTHER DIVISIONS OF
THE HEALTH BRANCH
A great deal of work has been done by members of the staff with the public
health inspection service of the Branch. A major item involved the development
N 22 PUBLIC HEALTH SERVICES REPORT, 1968
of a manager's manual suitable for all types of restaurant. The main objective was
to set out the regulations under the Health Act in a way that operators and staff
could readily understand. A draft of this manual is currently in use by the British
Columbia Institute of Technology at Burnaby in all its food-handlers' training
courses.
The Division of Venereal Disease Control was assisted in its efforts to secure
more effective support from physicians. Following numerous discussions with
Division personnel, a particular plan of action was developed whereby eight messages on cards were designed and produced within the Health Branch. They were
prepared and distributed to physicians in the Vancouver area, to elicit their cooperation in reporting all cases of venereal disease, and, where possible, doing their
best to supply information in connection with " contacts." This programme has
not been under way for a sufficient length of time to evaluate its effectiveness; however, it is sincerely hoped that it will significantly improve the level of physicians'
reporting of venereal disease contacts.
A significant amount of work has also been undertaken by the staff of the
Division in connection with the Division of Public Health Engineering. Layouts
for various official permit forms were discussed and subsequently designed for use
by the Division of Public Health Engineering in connection with the new regulations
passed under the Health Act last year. In addition, technical advice was sought
from the engineers in connection with the production of the film entitled " British
Columbia's Natural Heritage," which deals with all forms of pollution—land, water,
and air. This film, which was one year in the process of discussion, script preparation, editing, and production, was a time-consuming project for the Division. In
addition to the Director of Local Health Services and staff of the Health Branch,
the Director of the Government's Photographic Branch and members of other departments gave their technical assistance.
CONSULTANT SERVICES IN SCHOOL HEALTH EDUCATION
There was a high level of activity in this aspect of health education throughout
the year. Consultant services were given to public health personnel and to teachers;
the consultant was involved in the preparation and teaching of courses in health
education to student teachers at the University of Victoria, and she gave consultant
and liaison services to the Department of Education's Curriculum Revision Committee for Elementary School Health Instruction; the major work of this Committee
in 1968 was in a programme of family life and sex education.
A number of requests from elementary schools were met by the provision of
consultation and advice in family life education, body mechanics, dental health, and
smoking. Requests were received from a number of schools throughout the Province for sets of the experimental teaching materials which had been the basis for
the study among teachers at Powell River last year.
In the secondary schools, requests for assistance involved aspects of the guidance programme, particularly in the areas of drug abuse, alcohol, and sex education.
Pending the setting-up by the Department of Education of a curriculum revision
committee for secondary school health instruction on guidance, materials were
distributed on loan, bibliographies prepared, and experimental methods suggested
for the teaching of certain controversial issues of concern to young people today.
While much of this was handled through correspondence, conferences were held in
five geographical areas of the Province; personnel of local health units were
invariably involved.
PUBLIC HEALTH EDUCATION N 23
Two teaching projects took place at the University of Victoria. One hundred
and twenty elementary teachers, in groups of 30, were given one two-hour session
on health teaching—the only health teaching, as such, in their course. During the
spring term a study of current health issues and teaching methods was conducted
with a group of 36 students in the first year of their physical education major.
Various speaking engagements were kept, in which the consultant represented
both the Health Branch and the Curriculum Division of the Department of
Education.
OTHER ACTIVITIES
In the film library the Division holds some 310 titles of films on health subjects,
involving a total of 820 prints. During the year a survey was made which established
that 60 per cent of the films in the library are utilized by schools. A review of all
films produced prior to 1960 was done to ascertain whether their content still met
today's standards. This was done during the summer months, and 90 films were
recommended to be deleted from the Health Branch film catalogue, which is
presently being revised.
The Division has continued to be very active in in-service education and
orientation, and during the year orientation schedules were established for a number
of visitors. The Annual Public Health Institute was combined this year with the
annual meeting of the Canadian Public Health Association, for which the British
Columbia division of the association was the 1968 host. The meeting was planned
for the campus of the University of British Columbia, and staff of the Division were
involved in the arrangements. It was at the Division's urging that this meeting be
transferred from the traditional hotel setting of a downtown metropolitan area out
to a university campus. The majority of out-of-Province registrants were satisfied
with the change, and the conference was an outstanding success.
The Division carried on its participation in the smoking and health programme,
in which the Federal and all Provincial health departments are involved. Two
publicity projects were undertaken, with the co-operation of the Department of the
Provincial Secretary; a special plate carrying an anti-smoking slogan was used in
the Government postage meters for several weeks, and a similar slogan will appear
on the next consignment of Government pencils. While it is true that the effect
of such publicity cannot be precisely evaluated, it is considered by some of the
world's leading health authorities to be a factor in motivating people to break the
smoking habit.
Other activities of the staff of the Division have continued in increased volume.
These include the operation of the central library, the film library, editing of the
annual report, preparation of material for the Minister's office, and the preparation
of news releases and similar informational items as necessary. In addition, the
Division has continued to provide news to the Canadian Journal of Public Health
on public health activities in British Columbia and to publish the monthly in-service
instructional newsletter " News and Views " for the staff of the Health Branch.
The volume of photographic work done remained high. Many sets of photographs or individual photographs, both in black and white and in slide form, were
produced for other divisions or for the local health services staff.
N 24
PUBLIC HEALTH SERVICES REPORT, 1968
FINANCIAL REPORT
For the Period April 1, 1967, to March 31, 1968
Expenditure incurred in operation of public health services for the fiscal year
1967/68 increased by 12.22 per cent or $1,387,482. This is largely due to salary
increases and adjustments for personnel within the divisions of Health Services.
The largest increase, as in previous years, is within the Local Health Services,
which is followed by the sections providing in-patient care; that is, Pearson Unit,
providing beds and care for tuberculosis, poliomyelitis, and extended-care patients,
and Willow Chest Centre, where beds and care are provided the tuberculosis patient.
These sections account for 67.9 per cent of the Health Services budget.
In the table below, the section " Cancer, arthritis, rehabilitation, and research "
shows a decrease of 2.5 per cent from the previous year's expenditure. The reason
for the decrease is that the costs of bed care carried within the Cancer Institute,
2656 Heather Street, Vancouver, were transferred from Health Services to Hospital
Insurance Service.
The balance of provided services—that is, General Administration and Consultative Services, Division of Laboratories, Division of Vital Statistics, and the
Division of Venereal Disease—have increased in expenditure to provide for salary
increases and to meet some increases in commodity prices for articles required in
the day-to-day operation of these Divisions.
Comparison Table of Public Health Services Gross Expenditure for the
Fiscal Years 1965/66 to 1967/68
Service
Gross Expenditure
Percentage of
Gross Expenditure1
Percentage
Increase or
Decrease
( —) over
Previous
Year
1965/66
1966/67
1967/68
1965/66
1966/67
1967/68
Patient-care
$2,992,005
4,086,237
1,967,175
578,014
568,837
392,311
150,908
$3,091,643
4,333,381
2,015,778
677,539
630,639
445,084
158,080
$3,894,939
4,756,869
1,965,855
767,027
701,064
491,641
162,231
27.9
38.1
18.3
5.4
5.3
3.7
1.4
27.2
38.2
17.7
6.0
5.6
3.9
1.4
30.6
37.3
15.4
6.0
5.5
3.9
1.3
26.0
9.8
Cancer, arthritis, rehabilita-
—2.5
General administration and
consultation services
13.2
11.2
Division of Vital Statistics
Division of Venereal Disease ..
10.5
2.6
Totals
$10,735,487
$11,352,144
$12,739,626
100.0
100.0
100.0
12.2
i Percentages may not add to 100 due to rounding.
FINANCIAL REPORT
N 25
The per diem rates for in-patient care during the fiscal year April 1, 1967, to
March 31, 1968, are as follows:—
Operating cost—
Willow Chest Centre..
Tuberculosis Hospitals
Pearson Tuberculosis Unit..
$733,527
519,871
Combined operating cost $1,253,398
Number of patient-days—■
Willow Chest Centre 26,219
Pearson Tuberculosis Unit 27,676
Total number of days' care..
Per capita cost per diem—
Willow Chest Centre
Pearson Tuberculosis Unit
Combined per capita cost per diem
Pearson Extended Care Unit
Operating cost
Number of patient-days
Per capita cost per diem
Poliomyelitis Pavilion (Pearson Unit)
Operating cost
Number of patient-days
Per capita cost per diem
53,895
$27.98
$18.78
$23.26
$1,235,719
57,687
$21.42
$390,727
12,349
$31.64
N 26 PUBLIC HEALTH SERVICES REPORT, 1968
SPECIAL HEALTH SERVICES
During 1968 the decision was made to shorten the title of the Bureau of Special
Preventive and Treatment Services to the Bureau of Special Health Services for
purposes of simplification. The new title does not reflect any change in the assigned
functions of the Bureau, which continue to encompass the Divisions of Tuberculosis
Control, Laboratories, Venereal Disease Control, Occupational Health, and Rehabilitation under a Bureau headquarters office. The detailed reports of the divisions
appear in the following pages together with reports of special programmes directly
under the Bureau office.
During the year the hoped-for development of both the rehabilitation and
speech-therapy programmes was hampered by recruitment difficulties. However,
good progress will be noted in the report by the Director, Division of Rehabilitation,
and the appointment of a speech-therapy consultant has made it possible to adopt
a more positive approach toward enlarging and developing the speech-therapy service in at least some of the health units. Recruitment of high-calibre staff continues
to be a serious problem nevertheless.
It had originally been planned that the Division of Laboratories would be
expanded into the third floor of the Provincial Health Building during the latter part
of the year and the renovations to the Venereal Disease Clinic and other areas would
be completed. The changes are now planned for 1969. The Division of Laboratories requires additional space to process effectively the volume of laboratory specimens flowing to it from all areas of the Province. Some temporary measures regarding space allocation have sustained essential services, with credit going to staff members maintaining a high standard of service.
The Division of Tuberculosis Control continues to provide tuberculosis services which are in keeping with the needs apparent in British Columbia. The trend
toward out-patient treatment rather than hospitalization of tuberculosis patients
continues, although only a small reduction in bed occupancy has occurred. Here
it is necessary to keep in mind the expansion of the population of the Province. In
the extended-care beds operated by the Division at Pearson Hospital, full occupancy
was experienced throughout the year.
The Division of Venereal Disease Control continued to operate an effective
programme, with syphilis remaining at a low controlled level and gonorrhoea being
brought steadily under control. The value of new treatment methods is very apparent, and continued progress and some diversification of activity are anticipated.
A considerable increase has been experienced in the activities of the Provincial
Employees' Health Services and the Radiation Protection Service of the Division of
Occupational Health. While a general increase was experienced in the demand for
the services of the former section, in the Radiation Inspection Service it was more
specific, with the placing in use of the first Provincial self-contained mobile field
laboratory, a combination vehicle which will be used for the survey or monitoring
of radiation sources throughout the Province and also for educational purposes.
VOLUNTARY HEALTH AGENCIES
Through the Bureau of Special Health Services the Provincial Government each
year maintains liaison with and makes grants to certain voluntary health agencies.
These agencies—British Columbia Cancer Treatment and Research Foundation,
British Columbia Medical Research Foundation, G. F. Strong Rehabilitation Centre,
SPECIAL HEALTH SERVICES N 27
Multiple Sclerosis Society of British Columbia, Canadian Arthritis and Rheumatism
Society, British Columbia Epilepsy Society, British Columbia Heart Foundation,
Canadian Cystic Fibrosis Foundation, and the Cerebral Palsy Association of British
Columbia—have continued to show great enthusiasm for the various tasks they have
undertaken and deserve great credit for the dedicated services they have performed
and for the leadership they have given in the development of then respective fields
of endeavour. Each agency submits an annual budget and audited financial statements to the Health Branch, and an effort is made to meet as many of their financial
needs as is possible within the policy of the grants programme and within the limitations of the total funds available.
LABORATORY ADVISORY SERVICES
The Council, set up several years ago, consists of representatives from the
Health Branch, the British Columbia Hospital Insurance Service, Vancouver General Hospital, the Faculty of Medicine at the University of British Columbia, and
the British Columbia Medical Association. The secretary is the Technical Supervisor of Clinical Laboratory Services for the Health Branch.
In 1968 the Council played an important role in advising British Columbia
Hospital Insurance Service on matters pertaining to diagnostic laboratory facilities.
Assessment of equipment, plans for laboratories in new hospital construction, and
development of regional services were subjects for discussion.
Assessment of new equipment required to perform many of the recently developed tests considered essential to good patient-care has become more difficult. To
illustrate the growing demand, equipment totalling $250,000 was purchased by
laboratories in British Columbia in 1967, whereas this amount was spent in the
first six months of 1968. A fairly comprehensive consultation service with biomedical engineers and biochemists was used to assist in making recommendations
to the British Columbia Hospital Insurance Service.
A sub-committee of the Laboratory Advisory Council worked with architects
and hospital personnel advising on space and arrangement for laboratories in new
hospitals.
The work load in each of the eight regional laboratories increased, and additional professional personnel was required. The original concept of the Laboratory
Advisory Council was to have pathologists with varying specialties resident in the
regional hospitals. This worked well in some areas, such as the Lower Fraser Valley, where seven pathologists worked from the Royal Columbian Hospital in New
Westminster, and in the Kamloops area, where a third pathologist was appointed
to be resident in the Royal Inland Hospital. However, in the Okanagan region
three hospitals of similar size posed a different problem, and a third pathologist was
appointed to be resident in Penticton but to work closely with the two pathologists
in the regional hospital in Kelowna. The position of a second pathologist approved
for the West Kootenay area has not been filled, and approval in principle was given
for a pathologist for the East Kootenay area, pending the completion of the new
hospital in Cranbrook. A meeting of the regional pathologists and members of the
Laboratory Advisory Council was held for the first time, and progress reports indicated that the regional system has provided adequate diagnostic services.
The Technical Supervisor of Clinical Laboratory Services chaired a panel in
" Problems of Technologists in smaller Hospitals " at the National Convention of
the Canadian Society of Laboratory Technologists. The presentation of that subject attracted much favourable comment and directed attention to the regional hospital laboratory programme developed in British Columbia.
N 28 PUBLIC HEALTH SERVICES REPORT, 1968
Training facilities for medical laboratory technologists at the British Columbia
Institute of Technology were adequate, but the classes were limited due to the restricted number of spaces available for the year of practical training in approved
laboratories. This has resulted in a shortage of registered technologists, particularly
in the suburban areas.
The complexities of new techniques in laboratory procedures necessitated postgraduate training for registered technologists. Courses were given in such subjects
as blood banks, hematology, and microbiology. As a result, the 11th annual postgraduate course in medical technology, held at Kamloops, attracted an attendance
of 127 laboratory technologists.
SPEECH-THERAPY SERVICE
The ability to communicate through oral language is basic to learning and to
the growth and maintenance of the individual as an independent and fully functioning member of society. Disorders of speech, language, and hearing can disrupt these
processes at any point in the input/output system, and may occur at any age. Their
presence necessitates a comprehensive programme of assessment and management.
It is on these basic premises that attempts have been made to develop speech and
hearing services as part of a total community health programme.
Establishment of a service to the speech and hearing handicapped population
through local health units gives an opportunity for work to be carried out on both
preventive and direct service levels, and enables the speech and hearing clinician
to become a member of the health team.
Preventive service is offered through the identification of communication problems in the pre-school child, with follow-up counselling and guidance to parents in
the management of the problem; in specific cases, direct therapy with the child may
be instituted. The early referral of these children, occurring frequently through a
public health nurse contact, can prevent the development of a more complex problem, involving not only the child, but the total family unit, at a later age. This type
of service has been developed on a regular basis in the Simon Fraser, Boundary, and
South Okanagan Health Units during the past year.
Services to all other age-groups have been offered on a limited consultative
basis. Therapists were active in five health units (Boundary, Simon Fraser, South
Okanagan, Upper Island, and Central Vancouver Island) during the present year,
five of these being employed on a part-time basis. A full-time therapist was available to the South Okanagan Health Unit, and a therapy programme for all age levels
plus consultative services to medical and educational organizations continued to be
developed and maintained. A consultant speech pathologist joined the Bureau in
September of this year, which, it is anticipated, will lend an impetus to the whole
programme.
TUBERCULOSIS CONTROL
TUBERCULOSIS CONTROL
N 29
The Division is charged with the responsibility of correlating and directing all
phases of tuberculosis treatment and prevention in British Columbia. In carrying
out this work, the Division operates two sanatoria in Vancouver—namely, Pearson
Hospital and Willow Chest Centre—and maintains three stationary chest clinics
(Victoria, Vancouver, and New Westminster) and four travelling chest clinics which
visit all parts of the Province. It also provides a Province-wide mass chest X-ray
and tuberculin testing programme and supervises the distribution of free anti-tuberculosis drugs throughout the Province. It operates a Provincial case register which
produces reports and carries out studies whereby various phases of the work are
modified from time to time. It acts in a consultant capacity to both official and
voluntary agencies in all aspects of tuberculosis control and works very closely with
the local health authorities; the latter are primarily responsible for the tuberculosis
problem in their areas, but they rely on the Division for facilities and direction in
carrying out their tuberculosis programmes. The Division also provides hospital
facilities for post-poliomyelitis and extended-care cases at Pearson Hospital.
The Division of Vital Statistics assists in the tuberculosis programme in processing and analysing all the information supplied by the Division of Tuberculosis
Control, while the Division of Laboratories plays a very important part in the programme, operating a special tuberculosis laboratory, not only for routine bacteriology, but also for sensitivity studies and the identification of atypical mycobacteria.
TUBERCULOSIS SANATORIUM FACILITIES
There has been no further reduction in sanatorium beds within the Division
during the past year, with 173 beds available for tuberculosis cases at Willow Chest
Centre and Pearson Hospital. The following table shows the change in the sanatorium population in recent years:—
Date
Total
Sanatorium
Population
Patients
50 Years and
Over
Percentage
of 50 Years
of Age
and Over
244
163
145
134
128
100
84
77
52.5
61.3
November, 1967.
57.9
November, 1968
57.4
The reduction in the sanatorium population has been very gradual during the
past four years, there being only 29 fewer patients in 1968 as compared to 1964.
This is at its lowest number during the fall, and these figures increase about 10 per
cent during the winter. Many patients who are able to look after themselves outside of institution during the good weather are forced to return for care during the
inclement seasons.
Sanatorium patients today come from the older age-groups, and at the present
time 57.4 per cent are 50 years of age and over, one patient being 107 years of age.
There is a much more rapid turnover in sanatorium patients at the present time,
because once treatment is initiated and the disease is brought under control, a
large proportion of the patients under treatment are discharged. While there are
only 134 patients on treatment in sanatorium, there are approximately 1,000
patients for tuberculosis on an ambulant basis, many of them while working.
N 30 PUBLIC HEALTH SERVICES REPORT, 1968
TUBERCULOSIS CLINIC SERVICES
The operation of the travelling tuberculosis clinics remained essentially unchanged during the year. Fifty-four centres on the Mainland and 10 on Vancouver
Island are visited, and these services cover the whole Province.
The steady increase in the population of the Province is reflected in the volume
of work to be done in the various centres where the travelling clinics operated.
While there are about 20,000 known cases of tuberculosis outside of sanatorium,
the supervision and follow-up of whom is the responsibility of the stationary and
travelling clinics, the majority of cases seen at each clinic visit is made up of non-
tuberculous diagnoses who require regular follow-up by X-ray because they represent a high-risk group. After having been interviewed by the clinic physician on
one or two occasions, they do not need to be seen each time they go to the clinic.
This type of case can be followed adequately by annual chest X-rays taken at the
local hospital, and every effort is made to keep clinic appointment lists clear of
this type of case as far as possible.
Clinic schedules are constantly under review, having in mind the frequency of
clinic visits to any centre each year. Where this is practical, the clinic visits have
been reduced from four times a year to twice a year, providing it does not result
in any decrease in the efficiency of the clinic service.
A preliminary review of the volume of work done during the current year
indicates that some change has occurred, notably in the number of referred films
to be read. In previous years this has shown a moderate increase, but the figures
presently available indicate that this will be down for the current year. Referred
films come mainly from centres that do not have a resident radiologist, and as the
number of such centres is gradually decreasing, the number of referred films that
are received also decreases. The number of cases seen at clinic visits in the various
centres remains fairly stable.
Miniature X-ray equipment previously used for routine admission films in
hospitals and which has been removed to health unit quarters in five centres is working well. This equipment is used principally to follow up the known positive tuberculin reactors and certain other cases where a miniature film is considered adequate.
All new health unit construction now includes adequate space for the work of the
travelling clinics, and this system works out very well. The cost of this accommodation is borne by the British Columbia Tuberculosis-Christmas Seal Society. In a
few smaller centres the travelling clinics still work in the local hospital, and although
the hospital authorities are most co-operative, it is frequently very inconvenient to
both the clinic staff and the hospital staff to have to use the same area of the hospital.
Most of the hospitals are quite busy, and wherever possible the travelling clinic
operates on Saturday, when normal hospital activities are reduced to an emergency
basis. For several years, clinics have been held in some areas where facilities are
not available for developing the X-ray films that are taken. In such instances it is
necessary to take the films and develop them elsewhere. Although there is some
advantage in the patient and clinic physician having a discussion, this is not always
satisfactory since there is a distinct advantage in consultative clinician services if
the film is available for discussion between the patient's physician and the clinic
consultant. Consideration is being given to abandoning such clinics and making
arrangements to have the films taken at a local hospital.
Clinic attendance remains much the same, and is usually very good, averaging
about 80 per cent of appointments, but being much lower where there is a high
percentage of patients of Indian extraction. Follow-up of these patients presents
TUBERCULOSIS CONTROL N 31
a real problem in trying to achieve adequate treatment in these cases, and staff
members are fully aware of this situation.
The relationship between the travelling clinics staff and health unit staff continues to be extremely good, and this obviously makes the work of the clinics more
effective and more satisfactory.
MOBILE SURVEYS
During the year combined tuberculin and X-ray community surveys were
carried out in the South Okanagan, Peace River, and Cariboo Districts. Since these
areas were last surveyed in 1962, there has been a marked increase in the population, partly due to immigrants into the Province. The response to the surveys was
excellent, and the medical findings indicated they were well worth while. The
response of native Indians in these areas was particularly gratifying; three active
cases of tuberculosis were found among them.
At the end of the year a similar survey was carried out in Ladner, Tsawwassen,
and White Rock districts in the Boundary Health Unit.
One of the highlights of the 1968 programme was an " X-ray only " survey
carried out in downtown Vancouver (skid row), where 3,825 persons were X-rayed
in 10 days and seven new active cases of tuberculosis were found. This is one new
active case for each 546 X-rays. Six new inactive cases were discovered, and
another two patients were placed on chemoprophylaxis. This makes one person
with significant tuberculosis disease for each 233 X-rays. Because of these findings
it was decided to repeat this survey yearly until the findings fall more in line with
those of the rest of the Province.
Besides this special survey in Vancouver, the usual surveys in the British
Columbia Penitentiary, other penal institutions, Riverview Hospital, the Pacific
National Exhibition, and the Surrey Farm Fair were carried out.
From time to time, certain research projects are carried out in our mobile
surveys, and two such projects were done this year. The first was a pilot study in
co-operation with the Cancer Institute. Males between the ages of 45 and 60 years
who are heavy smokers have the highest incidence of lung cancer. Members of
this group who attended our surveys were requested to submit sputum specimens
for cytology examination, and the findings were correlated with the X-ray pictures.
The study indicated that such screening for early cancer of the lung was feasible.
A second project was carried out in co-operation with the United States Public
Health Services. Five thousand school-children in the Cariboo District were tested
with two types of tuberculin. These results will be studied along with similar results
from other areas of North America in order to determine the effect of atypical acid-
fast infections on the tuberculin reaction.
Recently published well-controlled studies have proven that prophylactic INH
can reduce, almost to the vanishing point, the amount of active tuberculosis that
develops in high-risk groups. So far this year 37 persons have been placed on
chemoprophylaxis. The identification of high-risk groups for prophylaxis is becoming an important objective of mass surveys, and may eventually replace the
number of new active cases discovered as an indication of the effectiveness of such
surveys.
In the first nine months of 1968, 108,922 persons in all were screened by our
mobile surveys, 61,472 persons were X-rayed, and 89,417 were tuberculin-tested.
Forty-eight new cases of tuberculosis were found, of which 21 were active. This
gives a rate of one new active case for every 2,927 X-rays.
Mass surveys continue to play an important part in tuberculosis control in
British Columbia, and no major change is indicated in the near future as we continue to revisit communities throughout the Province at about eight-year intervals.
N 32 PUBLIC HEALTH SERVICES REPORT, 1968
TUBERCULOSIS AND MENTAL HEALTH
Tuberculosis has long been a problem associated with the institutional care of
the mentally ill. For many years a tuberculosis service has been provided at the
Provincial Mental Hospital, Riverview, as an extension of the service of the New
Westminster stationary clinic, and it provides for treatment and prevention in
tuberculosis for both patients and staff. About 15 years ago the North Lawn Building was built as a sanatorium on the ground of the Riverview Hospital and at one
time housed 200 active tuberculosis patients. At the present time there are only 12
tuberculosis patients in residence in this institution, and the vacant accommodation
has been turned over for other purposes. However, there are 255 inactive cases of
tuberculosis amongst the patients who are continually under supervision by the
members of the tuberculosis staff at the Provincial Mental Hospital.
During the course of the past year 10,796 chest X-rays were taken on patients
and staff, of which 1,657 were taken on patients by the mass X-ray unit which visits
this institution annually. A total of 2,675 tuberculin tests was done, 2,174 being on
patients and 501 on staff. B.C.G. vaccination for protection against tuberculosis
was carried out on 98 members of the staff. There were 12 active cases of tuberculosis admitted to North Lawn and 11 discharges, and three tuberculosis deaths
occurred.
TUBERCULOSIS AMONG INDIANS
In the latter part of 1966 the Provincial Government agreed to relieve the
Federal authorities of the necessity of maintaining tuberculosis treatment facilities
and to accept registered Indians in Provincial sanatoria. This was based on an
agreement with the Department of National Health and Welfare that patients of
Indian status would be provided with hospital care at standard per diem rates.
During the next 18 months the patients in the Indian tuberculosis hospitals at Nanaimo, Miller Bay, and Coqualeetza were transferred to Willow Chest Centre and
Pearson Hospital, and since that time all newly diagnosed cases of tuberculosis have
been admitted directly. With the transfer of the patients from Coqualeetza Hospital
in the spring of 1968, the facilities of the Indian tuberculosis hospital were released
for other purposes.
A large percentage of these patients has already been treated and discharged
to continue treatment and follow-up under the supervision of the Provincial tuberculosis clinics and local health services. At the present time, only 22 Indian patients
remain in sanatoria and an additional 10 Indian children are being treated for tuberculosis at Sunny Hill Hospital in Vancouver. Fourteen of the adult patients are
female, and these represent 41 per cent of the total female population in sanatoria.
While the tuberculous Indian patients who have been treated in Provincial
sanatoria will continue under the care and supervision of the divisional clinics, it
has not as yet been possible to extend the Provincial case-finding and follow-up
services to the rest of the Indian population, and these are still provided by the
Medical Services Directorate of the Federal Government. It would be ideal if the
Provincial services could be extended to all the native population. While there is a
very close working relationship between the Division and the Medical Services Directorate and services are exchanged freely, the present situation does lead to duplication of effort, while at the same time certain deficiencies do occur in the border-line
areas of responsibility.
NURSING EDUCATION
Education at all levels, both lay and professional, has always been considered
an important aspect of tuberculosis control, and an affiliation course in tuberculosis
TUBERCULOSIS CONTROL
N 33
for student nurses was made a prerequisite for registration as nurses in British
Columbia in 1945 by the British Columbia Registered Nurses' Association. At that
time a nursing education department was set up within the Division to carry out this
programme, and the student nurses were required to spend six weeks affiliated with
the Division of. Tuberculosis Control, taking a course which involved a week of lectures followed by experience in medical, surgical, and clinical areas and visits to the
public health agencies. Over 400 student nurses attended this course yearly.
With the decrease in the number of sanatorium beds, less ward experience
was available, and the course was reduced to a one week's lecture series in 1958.
Throughout the years various other courses of instruction in the care and control
of tuberculosis have been arranged for student nurses in both the hospital and university course. The Division has continued to meet the requirements of many groups
of nurses and para-medical personnel wishing to be well informed, and has interpreted changing trends to them. Over 500 students participated in this programme
of learning during 1968. With changing methods of student-nurse teaching and
revision of the curriculum, it became impossible for the nursing schools to send these
students to the Division of Tuberculosis Control, even for one week, so that the
student nurses' affiliation course within the Division of Tuberculosis Control was
terminated in July, 1968. Schools of nursing will accept responsibility for teaching
their student nurses about tuberculosis in their basic programme, but the Division
will continue to advise on the content of the courses and will provide lecturers from
the medical and nursing staff who will visit the schools to keep them up to date on
the latest methods of treatment and control. The Division of Tuberculosis Control
will also continue to provide educational courses for medical and para-medical personnel, both at the student and postgraduate level.
N 34
PUBLIC HEALTH SERVICES REPORT, 1968
VENEREAL DISEASE CONTROL
The number of cases of infectious syphilis has reached a lower plateau, and any
further reduction would occur more by chance than programme improvement. The
number of cases of gonorrhoea continues to decline as the programming progressively
effects those segments of the population involved in the spread of this disease. The
sustained increase in non-gonococcal urethritis is becoming a major problem.
Family planning assistance is a social need of promiscuous women who do not want
children and will not care for them.
Reported Infectious Syphilis and Gonorrhoea, British Columbia,
1946, 1951, 1956, 1961, 1964-68
Year
Infectious Syphilis
Gonorrhoea
Number
Ratei
Number
Rate*
1946
1951
1956
834
36
11
64
304
165
71
72
68
83.0
3.1
0.8
3.9
17.5
9.2
3.8
3.7
3.4
4,618
3,336
3,425
3,670
5,821
6,005
5,415
4,706
4,1992
460.4
286.4
244.9
1961
225.3
1964 . .
344.9
1965 ....
1966 ,
1967 ...
1968
335.7
290.8
241.7
209.22
i Rate per 100,000 population.
2 Preliminary.
INFECTIOUS SYPHILIS
Infectious syphilis is no longer an endemic disease in British Columbia. It is
constantly being introduced by people who, having contacted the infection elsewhere, are either entering or returning to this Province. Thus the infection is
acquired by a small segment of the population travelling abroad, by non-paired
homosexual males who are single and travel freely to cities along the Pacific Coast,
and by seamen coming from ports on the Pacific rim.
The control measures are very effective. All laboratories report the positive
results of blood tests, and physicians co-operate in reporting this infection. Persons
who have lesions and seek medical assistance quickly become known to the Division.
Antibiotics are effective in treatment. The persons whom it is necessary to treat are
the case, the sexual contacts to the case, and those persons who have been sexually
exposed to the contacts. By treating them all as quickly as possible on an epidemiological basis, each individual epidemic is rapidly brought under control.
LATENT AND LATE SYPHILIS
Not all persons have skin lesions caused by syphilis, and the infection can then
only be detected by blood tests. The various laboratories—the Provincial Laboratory at Vancouver and branch laboratories at Nelson and Victoria, together with
those of the Provincial Mental Hospital, Shaughnessy Hospital, and the Red Cross
Society—process about 700 screening blood tests a day for latent syphilis.
VENEREAL DISEASE CONTROL N 35
This is necessary to prevent spread of infection from mother to baby, to patients
receiving blood transfusions, and to discover unknown cases as 10 per cent may
develop irreversible damage.
The Provincial Laboratory has introduced a new confirmatory test for syphilis
—the fluorescent treponemal antibody-absorption test, or F.T.A.-Abs. test. This
test can be done on the specimen submitted for the V.D.R.L. screening test, and
confirms whether or not the person has antibodies to treponemal organisms, of
which the only one occurring in Canada is syphilis. All patients with both tests
positive are advised by their physician to have adequate treatment for syphilis if this
has not already been obtained, in order to prevent the development of late lesions.
The increase in laboratory diagnosis of old infections has caused an increase
in the number of cases of latent syphilis being reported.
GONORRHOEA
The introduction of effective oral treatment for gonorrhoea allowed the contacts to be easily treated by nurses without having to make arrangements with a
clinic or physician. When the infected man will name his sexual contacts, it is
possible to introduce the immediate treatment of these contacts, a procedure called
" speed zone epidemiology."
The second approach is to identify the females in each location who are
promiscuous, and whenever gonorrhoea occurs in that area these females are treated
every three months. Also male contacts are identified and treated. It has been
possible to control epidemics in any location, but the introduction of the disease by
transient females is a problem. This situation is a particular problem in the Peace
River area.
Twenty-one per cent of the females entering the Vancouver City gaol in 1966
were infected with gonorrhoea. By treating all known promiscuous females entering in 1967, this figure was reduced to 12 per cent. By placing known promiscuous
females on quarterly interval treatment, this figure has been further reduced in
1968 to 3 per cent.
A survey of case reporting by physicians revealed that 30 male cases (36 per
cent of the total) were being reported each month. The remaining 60 cases, while
adequately treated by their physicians, were not reported, with the unfortunate
result that the female source of infection was not investigated but continued freely
to spread the infection to new contacts. A public health nurse is visiting the physicians in Vancouver to determine how to obtain better contact reporting. If an
improvement in this situation occurs, a further reduction in the incidence of gonorrhoea may be obtained.
As would be expected, the peak incidence occurs in August. One of the
reasons for this is a summer influx of people. Because some groups hesitate to
associate with the " establishment," medical students and part-time physicians supplying service to certain volunteer organizations have been given necessary drug
supplies for the treatment of gonorrhoea.
NON-GONOCOCCAL URETHRITIS
Gonorrhoea in its simple form produces a urethral discharge, and pain on
micturition, in the male. When these symptoms occur and the gonococcus is not
present, the infection is referred to as non-gonococcal urethritis. Recent studies
have shown that a mycoplasma organism can be cultured from 65 per cent of these
patients, and a conjunctivitis inclusion virus from 11 per cent. Both of these
N 36
PUBLIC HEALTH SERVICES REPORT, 1968
organisms are susceptible to tetracycline therapy. The number of patients attending
the Vancouver clinic for this disease has trebled, and now there are about 800
patients a year attending. The cost of treating this disease has become excessive,
and attempts are planned to determine if the incidence can be reduced.
FAMILY PLANNING
Although family planning is not an integral part of the programme of the
Division, promiscuous women are at risk of becoming pregnant. These women do
not usually raise these children, but turn them over to the welfare agency for adoption or ward care. In many instances these women are desperate for assistance in
the prevention of unwanted pregnancy. In an endeavour to determine the community need for family planning, pilot projects for assistance to these women are
being operated in Vancouver and in Prince George.
GENERAL
Diagnostic and treatment clinics are maintained throughout the Province, at
Prince Rupert, Dawson Creek, Prince George, Kamloops, New Westminster, Victoria, and two in Vancouver. In addition, clinics are maintained at the Vancouver
City Gaol, Willingdon School for Girls, and Oakalla Prison Farm.
There is concern about a rising incidence of infection in Washington State and
Alberta. To maintain the Division's achievement of successful reduction of an
epidemic will therefore require sustained efforts.
LABORATORIES N 37
LABORATORIES
In its 38th year, the Division of Laboratories collaborated in three major public
health projects—the Skaha Lake limnological study, the Lower Mainland air quality
and meteorological study, and the arbovirus study. Although there were decreases
in work load in some of the laboratory's functions, these were more than offset by the
increasing demand in environmental pollution. To cope with this, plans were prepared for the expansion and extension of laboratory accommodation.
In Table I the number of tests and the work load in Dominion Bureau of
Statistics units performed at the main laboratories are compared with the figures for
1967. The work load decreased by 7 per cent, from 1,065,000 units in 1967 to
990,500 units in 1968. Excluded from these figures are the tests performed and
work load in connection with the programmes for shellfish surveillance, air-quality
control, and virology. The main decreases in work load were in throat and nose
swabs for diphtheria, enteric bacteriology, water bacteriology, and syphilis serology;
by contrast, the main increases were in antistreptolysin tests and chemical analyses
of water and waste water. The number of tests and the work load in units performed at the branch laboratories in Nelson and Victoria in 1968 are reported in
Table II. Each Dominion Bureau of Statistics (D.B.S.) unit is equivalent to 10
minutes of work. The routine work load of the Division in 1968 comprised the
following:— d.b.s. units
Main laboratories 990,527
Nelson branch laboratory 32,368
Victoria branch laboratory 148,500
Total ._- 1,171,395
BACTERIOLOGY SERVICE
Tests for the Diagnosis and Control of Venereal Diseases
The demand for tests for syphilis decreased by about 10 per cent, from
155,000 in 1967 to 140,000 in 1968. Major changes in the programme for the
laboratory diagnosis and control of syphilis were introduced to take advantage
of the increased specificity of immuno-fluorescence tests. In April, 19*68, the
indirect fluorescent treponemal antibody-absorption (F.TA.-Abs.) test was taken
into use for sera and spinal fluids reactive in the V.D.R.L. screening test. Because
it is a time-consuming and demanding laboratory procedure, the F.T.A.-Abs. test
was accorded a unit value of 10. The Kolmer complement-fixation test for sera
and spinal fluids was discontinued.
The number of sera sent to the Laboratory of Hygiene, Ottawa, and the Public
Health Laboratory, Ontario Department of Health, for the Treponema pallidum
immobilization (T.P.I.) test was only 120 in 1968, compared with an annual average of 270 in previous years. Positive results were obtained in 51 tests (42 per
cent). During 1968, 281 exudates from 217 patients were examined for T. pallidum
by dark-field microscopy; in 24 patients (11 per cent) examinations were positive.
The work load related to the diagnosis and control of gonorrhoea decreased by
about 4 per cent. Of the 42,400 smears examined microscopically for the gono-
coccus, 4,600 (11 per cent) were positive; of the 5,880 cultures examined, 1,450
(25 per cent) yielded gonococci.
N 38 PUBLIC HEALTH SERVICES REPORT, 1968
Other Serological Procedures
The number of specimens examined for antistreptolysin increased by 20 per
cent, from 7,000 in 1967 to 8,400 in 1968. The demand for serological tests for
the diagnosis of typhoid, undulant, and glandular fevers decreased by more than 30
per cent, from 16,500 in 1967 to 12,300 in 1968.
One hundred and eighty-three serological tests for bacterial, fungal, or parasitic
diseases were performed at reference laboratories on sera from 143 patients. Forty
positive results were obtained—toxoplasmosis (21), lymphogranuloma venereum
(5), leptospirosis (3), trichinosis (3), histoplasmosis (2), visceral larva migrans
(2), echinococcosis (2), ascariasis (1), and filariasis (1).
Isolation and Identification of Pathogenic Enteric Bacteria
The number of specimens submitted for culture for Salmonella and Shigella
and for enteropathogenic Escherichia coli (E.E.C.) decreased by 7 per cent,
from 18,900 in 1967 to 17,600 in 1968. The enteric pathogens isolated from 777
persons comprised 296 Salmonella;, 370 Shigella;, and 136 E.E.C. The 296
Salmonella; belonged to 38 different types. One type of Salmonella, S. horsham,
was isolated for the first time in Canada; five types—S. Chester, S. havana, S. kott-
bus, S. minnesota, and S. oslo—were isolated for the first time in British Columbia.
The most common types isolated from human sources were S. typhimurium and S.
typhimurium var. Copenhagen (98), 5. new port (43), and S. saint paul (36). Seven
cases of typhoid fever were confirmed bacteriologically. During 1968 Salmonella;
were isolated from 16 of 73 (22 per cent) specimens collected from non-human
sources; one specimen yielded Salmonella; of two different types. S. tennessee was
isolated from fish meal, S. typhimurium from a finch, S. infantis from chicken liver,
5. heidelberg from a table, and Salmonella; of five different types from turtle tanks.
The 340 Shigella strains isolated in 1968 comprised Sh. sonnei (300), Sh.
flexneri (38), and Sh. boydii (2). The most common E.E.C. isolated in 1968 were
026:B6 (23), 0127:B8 (22), 055:B5 (18), and 0119:B14 (17).
Food Poisoning
Eighty-six samples of human food collected during the investigation of suspected food-poisoning incidents were examined bacteriologically. The following
organisms were recovered: Staphylococcus aureus (from one sample of turkey
dressing and from one sample of potato salad) and Salmonella infantis (from one
sample of chicken liver).
Other Examinations
Diphtheria
In the 12 years 1956 to 1967, only 12 cases of diphtheria with four fatalities
and four carriers of Cory neb acterium diphtheria were detected bacteriologically.
Between March and July, 1968, six diphtheria incidents occurred in Vancouver.
There were two deaths—an unimmunized 10-year-old boy and a 49-year-old
woman. C. diphtheria' gravis was isolated from a skin lesion of a 63-year-old man.
The largest outbreak of diphtheria occurred in a school and involved four mild
mitis type infections; 17 carriers of the mitis type were discovered among the 500
school contacts. The cases, fatalities, and carriers of diphtheria from 1956 to 1968
are summarized in Table III.
LABORATORIES N 39
Blood Cultures
Of the 146 blood cultures submitted for examination, 17 yielded organisms.
The bacteria isolated were coagulase-positive Staphylococcus aureus (4), coagulase-
negative Staphylococcus albus (4), diphtheroids (2), Salmonella typhi (2), Alka-
ligenes faicalis (1), Escherichia coli (1), Neisseria catarrhalis (1), Streptococcus
facalis (1), and Str. viridans (1).
Whooping-cough
In 1968 the prenasal and postnasal swab method was introduced for the isolation of Bordetella pertussis, in place of the unproductive cough-plate technique.
B. pertussis was isolated once from the 10 specimens submitted.
Fungal Infections
The demand for mycological investigations was 5,300 in 1967 but decreased
to 5,200 in 1968. About 30 per cent of the specimens examined yielded positive
results. The following dermatophytes were identified: Trichophyton rubrum
(222), Microsporum canis (107), T. mentagrophytes (56), Epidermophyton floc-
cosum (35), T. tonsurans (4), T. verrucosum (3), and T. violaceum (1).
In addition, Candida albicans (839) and Candida spp. (247) were isolated.
Malassezia furfur was identified microscopically on 31 occasions.
Parasitic Infections
The number of specimens submitted for examination for intestinal parasites
decreased slightly, from 6,600 in 1967 to 6,500 in 1968. The following protozoan
parasites were identified in stool specimens: Entamoeba coli (167), Giardia lamblia
(141), Endolimax nana (54), Entamoeba histolytica (53), lodamosba biitschlii
(22), Chilomastix mesnili (17), and Enteromonas hominis (4). The following
helminthic eggs were identified in stool specimens: Trichuris trichiura (55), Entero-
bius vermicularis (20), Clonorchis sinensis (17), Ascaris lumbricoides (15), hookworm (13), Tamia (11), Hymenolepsis nana (5), Diphyllobothrium latum (1),
and Schistosoma mansoni (1). Mature worms, Ascaris lumbricoides (6), Tainia
spp. (6), Diphyllobothrium latum (3), and Enterobius vermicularis (1), were also
identified. Eggs of Enterobius vermicularis were found in 369 (19 per cent) of
1,928 anal swabs.
Tests Relating to the Diagnosis and Control of Tuberculosis
The number of specimens submitted for culture for Mycobacterium tuberculosis
increased by 4 per cent. In 1967, 25,700 specimens were examined by culture and
12,000 by microscopy; in 1968, 26,500 specimens were examined by culture and
12,900 by microscopy. Inoculation of animals for identification of Mycobacteria
doubled from 200 in 1967 to 390 in 1968.
Tests for antimicrobial sensitivity were performed on 1,105 cultures in 1968,
compared with 1,255 cultures in 1967. Two hundred and twenty-seven mycobacterial cultures required additional study to determine whether they were atypical
cultures compared with 273 cultures in 1967.
Quality Control
The quality of performance of medical microbiology is known to vary from
laboratory to laboratory. To achieve a consistently high standard of laboratory
performance throughout British Coulmbia, it is desirable that " unknown " speci-
N 40 PUBLIC HEALTH SERVICES REPORT, 1968
mens including cultures be distributed at intervals to all participating laboratories
and that each laboratory report its findings, after examining the " unknown " specimen, to the quality control laboratory. The laboratories of many hospitals in
British Columbia voluntarily participated in this new programme. Unknowns were
distributed on three occasions; a total of 83 was dispatched.
PUBLIC HEALTH CHEMISTRY SERVICE
The programme undertaken by the Public Health Chemistry Service in 1968
included water bacteriology, shellfish bacteriology, chemical analysis of water and
waste water, and air pollution.
Water Bacteriology
The number of water samples examined by the coliform test decreased by
5 per cent, from 17,700 in 1967 to 16,900 in 1968. The number of completed
coliform tests was 2,278, a decrease of 2 per cent. The Faecal coliform test was
done on 255 samples.
During the summer the laboratory tests required for the limnological study of
Skaha Lake were carried out by laboratory personnel in Vancouver and Penticton.
Shellfish Bacteriology
The shellfish surveillance programme, begun in March, 1965, continued in
1968. Tests were carried out on 664 samples—sea waters (422), shucked oysters
(146), and shellstock (96). The standard plate count was done on 140 shucked
samples.
The special sea-water survey of Ladysmith Harbour which started in March,
1967, was extended to December, 1968.
Chemistry of Water and Waste Water
The work load for chemical analyses of water and waste water increased by
15 per cent, from 57,500 units in 1967 to 66,300 units in 1968. This increase was
mainly due to additional requests from the health units and from the Pollution
Control Branch for water-pollution surveys. A total of 140 samples was submitted
from Skaha Lake for determination of nitrate, phosphate, silica, turbidity, alkalinity,
and conductance.
Air Pollution
Air-sampling was continued in Prince George, Port Alberni, and Nelson. The
study in the Sparwood-Natal-Michel area was discontinued at the end of October,
and studies were begun in Marysville and Castlegar.
During 1968, 179 dust-fall samples were submitted for determination of
soluble solids, insoluble solids, total particulates, and tar. Analyses for suspended
particulate matter were performed on 537 high-volume filter samples, and sodium
was measured in 165 of the filters. A total of 17,600 determinations was made on
110 soiling-index tapes providing the smoke concentration on a 2-hourly basis at
11 stations. Analyses for oxides of sulphur were performed on 152 lead peroxide
candles, and 10 tapes were analysed for hydrogen sulphide, a total of 3,600
determinations.
The Public Health Chemistry Service completed a study of atmospheric sodium
in Port Alberni. A new modification of the test for sodium in suspended particulate
matter was found to be a good index of kraft-mill pollution.
LABORATORIES N 41
A study of the relationship of meteorological conditions to air quality in the
Lower Mainland of British Columbia was started with financial support of a National
Health Research Grant. Fixed sampling-stations were selected, and a mobile air-
quality laboratory was equipped for monitoring gaseous and particulate air contaminants. The experimental results will be used to assess proposed air-quality
standards and regulations to determine the pollutant contribution of motor-vehicles,
and to study on a continuing basis the health effects of air contaminants.
VIROLOGY SERVICE
The Virology Service undertook virus isolation and serological identification
of enteroviruses and respiratory viruses. Serological identification is achieved by
demonstrating a fourfold rise in specific antibodies between acute phase and convalescent phase sera. Viruses were isolated on 52 occasions: Coxsackie B5 (10),
Influenza B (10), Coxsackie Bl (5), Echo 4 (4), Echo 14 (4), Coxsackie B2 (2),
Polio 2 (two vaccine strains), Adenovirus (2), Mumps (2), Echo 3 (1), Echo 5 (1),
Echo 22 (1), Echo 30 (1), Herpesvirus (1), Influenza A (1), and unidentified
viruses (5). The diverse syndromes associated with infection by these viruses
included encephalitis and meningitis, pericarditis and myocarditis, pneumonia,
febrile rashes, and gastro-enteritis.
Using animals, embryonated eggs, and tissue cultures, 2,500 specimens from
976 patients were examined in 1968, compared with 1,940 specimens from 729
patients in 1967, an increased work load of nearly 30 per cent. The following
laboratory supplies were required: 115 litres of media, 380 families of suckling
mice, 635 embryonated eggs, and nearly 34,000 tubes of tissue culture.
A widespread outbreak of influenza occurred in British Columbia during the
first quarter of 1968. Influenza virus Type A was isolated from one patient and
serological identification of the same viral agent was made in 10 patients, while influenza virus Type B was isolated from 10 patients and serological identification of the
same viral agent was made in 42 patients. In the previous British Columbia epidemic of influenza in 1966, influenza virus Type A was isolated from 9 patients and
serological identification of this viral agent was made in 18 patients, while Type B
virus was not isolated and serological identification of this agent was made in only
five patients.
In 1967 about 100 sera were examined by the hsemagglutination-inhibition test
for rubella antibodies. So valuable did this procedure prove that in 1968 more than
530 tests were performed.
With the assistance of a National Health Grant, the arbovirus project was
established to determine the prevalence of arbovirus infections of man by serological
survey; the natural reservoirs and vectors were also investigated. Some 1,268
human sera were collected by arrangement with the Medical Health Officers of the
East Kootenay, Selkirk, and West Kootenay Health Units. Hsemagglutinin-inhib-
iting antibodies for western equine encephalomyelitis virus were found in 21 test
sera, for California encephalitis virus in 21, and for Powassan virus in 25. Complement-fixing antibodies for western equine encephalomyelitis virus were discovered
in no sera, for California encephalitis virus in two, for Colorado tick fever virus in
two, and for Powassan virus in one. Neutralizing antibodies for western equine
encephalomyelitis virus were detected in 16 of 21 sera positive by hjemagglutination-
inhibition or complement-fixation, for California encephalitis virus in 3 of 23 sera,
for Colorado tick fever virus in neither of two sera, and for Powassan virus in none
of 26 sera. These findings suggest that human infection due to these four arboviruses may occur in British Columbia.
N 42
PUBLIC HEALTH SERVICES REPORT, 1968
BRANCH LABORATORIES
The Kootenay Lake General Hospital continued to provide accommodation for
the Nelson branch laboratory. The work load decreased by about 15 per cent, from
38,100 units in 1967 to 32,400 units in 1968, still a heavy work load for one technologist with part-time assistance from a laboratory maid. The technician-in-charge
visited the main laboratory for in-service training and attended the annual meeting
of the Canadian Public Health Association. The Director inspected the branch
laboratory in August. During the annual vacation of the technician-in-charge, specimens received from West Kootenay, East Kootenay, and Selkirk Health Unit areas
were shipped by air to the main laboratory.
The Royal Jubilee Hospital laboratory continued to provide, on contract, public
health laboratory services for the Greater Victoria Metropolitan Board of Health.
The work load decreased by 9 per cent, from 164,200 units in 1967 to 148,500 units
in 1968.
Table I.—Statistical Report of Examinations and Work Load in 1967 and 1968,
Main Laboratory
Uniti
Value
1968
Tests
Performed
Work-load
Units
1967
Tests
Performed
Work-load
Units
Bacteriology Service
Enteric Laboratory—
Cultures—
Salmonella-Shigella
Pathogenic E. coli...
Food-poisoning examination.....
Miscellaneous Laboratory—
Animal virulence (diphtheria)..
Cultures—
C. diphtheria:..
Haemolytic staph.-strep..
Miscellaneous
Fungi.
N. gonorrhoea?.
Smears for—
N. gonorrhoea;.
Vincent's
Miscellaneous
Serology Laboratory—
Agglut.—Widal, Paul-Bunnell, Brucella .
Anti-streptolysin test
Blood—
V.D.R.L. (qual.)
V.D.R.L. (quant.) .
Complement-fixation
F.T.A.-Abs
C.S.F.—
Complement-fixation
V.D.R.L
Dark field—T. pallidum...
Tuberculosis Laboratory—
Animal inoculation
Anti-microbial sensitivity..
Atypical mycobacteria.
Cultures for M. tuberculosis..
Smears for M. tuberculosis.-...
Intestinal parasites —
Chemistry Service
Water bacteriology—
Plate count .....
Coliform test...
Water chemistry—
Routine analysis.
Partial analysis
BOD
Totals
7
10
15
5
5
5
5
5
2
2
2
2
5
1
2
2
10
2
2
3
10
25
25
6
2
3
50
14,389
3,028
86
39
3,425
8,209
3,783
5,231
5,876
42,449
45
3,307
12,299
8,397
140,158
1,835
3,079
1,589
1,080
1,344
281
393
1,105
227
26,451
12,905
6,528
1,814
16,874
139
4,795
310
100,723
30,280
1,290
234
17,125
41,045
18,915
26,155
29,380
84,898
90
6,614
24,598
41,985
140,158
3,670
6,158
15,890
2,160
2,688
843
3,930
27,625
5,675
158,706
25,810
19,584
3,628
84,370
6,950
34,550
24,800
15,165
3,489
86
9,326
12,250
4,311
5,269
6,420
43,338
50
3,716
16,521
6,998
155,471
2,476
9,687
2,014
322
204
1,255
273
25,660
12,042
6,578
1,628
17,730
284
3,772
240
106,155
34,890
1,290
24
46,630
61,250
21,555
26,345
32,100
86,676
100
7,432
33,042
34,990
155,471
4,952
19,374
4,028
966
2,040
31,375
6,825
153,960
24,084
19,734
3,256
88,650
14,200
24,085
19,200
331,470
990.527
366,579
1,064.679
i One D.B.S. unit = 10 minutes of work.
LABORATORIES
N 43
Table II.—Statistical Report of Examinations and Work Load during the Year 1968,
Branch Laboratories
1 One D.B.S. unit=10 minutes of work.
Unitl
Value
Nelson
Victoria
Tests
Performed
Work-load
Units
Tests
Performed
Work-load
Units
Enteric Laboratory—
Cultures—
Salmonella-Shigella...
7
10
15
6
5
5
5
5
5
2
2
2
2
1
2
2
10
6
2
3
2
5
247
1,729
2,630
880
5
18,410
8,800
75
Miscellaneous Laboratory—
Cultures—
C. diphtheria;.
130
2,158
388
650
10,790
1,940
1,002
7,345
22
1,567
1,539
1,491
24
418
948
11,761
94
635
7
2,193
1,789
1,459
1,683
4,062
5,010
36,725
Miscellaneous
no
7,835
7,695
Smears for—
N. gonorrhoea;
701
1,402
2,982
48
836
Serology Laboratory—
Agglut.—Widal, Paul-Bunnell, Brucella
Blood—
V.D.R.L. (qual.)
V.D.R.L. (quant.)
452
3,812
23
904
3,812
46
1,896
11,761
188
1,270
Tuberculosis Laboratory—
70
13,158
Smears for M. tuberculosis
52
72
104
216
3,578
4,377
Water Laboratory—
3,336
2,155
10,775
20,310
Totals
10,190
32,368
41,554
148,500
GENERAL COMMENTS
The study group established in 1967 reviewed existing laboratory procedures
and recommended improvements in the handling and processing of laboratory specimens and reports. Requisition forms were redesigned as combined requisition and
report forms, and a photocopying machine was installed to curtail the volume of
typing and to permit rapid and accurate reporting of laboratory results.
In August the Director presented a paper on listeriosis at the 23 rd annual
meeting of. the International Northwest Conference on Diseases in Nature Communicable to Man, held at the Rocky Mountain Laboratory, Hamilton, Mont.
A senior bacteriologist attended a two-week course on immunofluorescent
techniques at the Laboratory of Hygiene, Ottawa.
N 44 PUBLIC HEALTH SERVICES REPORT, 1968
Table III.—Diphtheria Cases, Fatalities, and Carriers, 1956-68
Year
Mild
Cases
Fatal
Cases
Total
Types
Gravis
Intermedins
Mitis
1956
1957
2
2
1
1
32
1
63
1
2
1
2
4
2
7
1
1
3
1
1
24
(!)
(ij
(i)
1
1
1
(!)
(1)
(1)
1
1
1
1
6
1958
1959
(!)
1960
1961
C1)
1962
(!)
1963
1964
1965 _
1966
1967
1968
16
22
Totals-
16
6
20
40
1 Not typed.
2 Includes 1 eye exudate.
s Includes 1 skin infection.
OCCUPATIONAL HEALTH N 45
OCCUPATIONAL HEALTH
The Division of Occupational Health is concerned mainly with employee
health services and radiation protection. Detailed reports of these programmes
will be found below. Miscellaneous activities of the Division include air pollution,
pesticide hazards, and occupational health programmes in industry.
PROVINCIAL EMPLOYEES' HEALTH SERVICE
This service has been developing in depth as a result of greater involvement
by the Division's nurses and Director in the operations of Government departments.
For example, the nurses are increasing their departmental visiting in order to interview employees and discuss potential problems with the supervisors; at the same
time, staff of the occupational health service are becoming more familiar with the
working conditions and the stresses that employees face in the multitude of jobs
performed by Civil Servants.
The Director has been attending Personnel Officers' meetings and has attempted to bring about a more uniform approach to such problems as supervision and
control of sickness absenteeism and the handling of disability retirements. To
further facilitate this, a committee has been established by the Chief Personnel
Officer of the Civil Service Commission to review and recommend desirable changes
in the present Sick Leave Regulations. (The Director of the Occupational Health
Division is a member of this group). A screening committee was established two
years ago, consisting of the Chief Selection Officer, Chief Classification Officer, and
Administration Officer of the Civil Service Commission, and the Director of this
Division as chairman. It meets regularly to discuss long-term employees who have
health problems and can no longer continue in their present type of work. These
problems can often be difficult to solve, and the committee relies heavily on the
sympathetic co-operation of all Government departments for help in placing these
employees.
The following are the types and numbers of services that are rendered to
employees in the Victoria, Vancouver, and Essondale areas. In Victoria a total
of 4,241 visits was made by employees to the Occupational Health Service unit,
slightly more male than female, and about one-third of them reported with nonoccupational conditions. Fifty-five employees were seen because of job problems,
and the nurse interviewed 372 others either because they were new staff or they
had a personal health problem. The main types of conditions seen at the unit were
upper respiratory infections, lacerations, and skin troubles. The Director, who
attends about once a month, interviewed thirty-eight employees and physically
examined another nine. The nurse makes a practice each week of visiting several
Government departments to meet new employees and explain the Occupational
Health Service; also, it presents an opportunity to meet the supervisors. Under
" treatments " the largest single activity was the administration of immunizations,
and a total of 2,406 was given in 1968.
In Vancouver, which is a difficult area geographically bceause the offices are
so scattered, the nurse has to spend a lot of time travelling. In spite of this, a total
of 3,359 services was rendered. Here again about one-third were seen for nonoccupational conditions. There were 2,130 immunizations administered, and the
nurse interviewed over 600 employees for a variety of reasons. At the Essondale
office (which includes Riverview and Valleyview hospitals, The Woodlands School,
and the Colony Farm), the pattern of service differs from the other two areas, as
N 46 PUBLIC HEALTH SERVICES REPORT, 1968
many initial treatments are given in the wards; in Riverview, for example, there
are eight first-aid stations. Seven hundred and eighty-five conferences were held
with supervisors concerning such subjects as illness absence, environmental problems, and health education. As far as the latter is concerned, programmes have
been set up for new staff coming to work on the wards or in the kitchens. The
occupational health nurse gives assistance to the education centre at Riverview
and is presently giving weekly lectures on health and safety. Over 670 staff members have had counselling during the year, and 673 have had immunizations. The
Director of Occupational Health has interviewed or examined 158 staff members.
The pattern of service in the different areas varies somewhat due to such
factors as number of employees involved, their geographical locations, the particular
departments served, and the type of work they do; for example, the Mental Health
Branch employs shift workers, the Ferry Authority employs extra staff on weekends, etc. As mentioned in previous reports, immunizations administered on a
routine basis include poliomyelitis, smallpox, and influenza vaccines, and tetanus
toxoid.
COMMITTEE ACTIVITIES
Air Pollution Advisory Committee
The Director of the Occupational Health Division is chairman of the Health
Branch Air Pollution Advisory Committee, which is composed of members from
the Divisions of Laboratories, Public Health Engineering, and Local Health Services.
The Department of Health Care and Epidemiology and the Department of Chemical
Engineering at the University of British Columbia and the Meteorological Branch
of the Department of Transport act as consultants to this Committee.
The most significant activity of the above Committee was the preparation of
draft air-pollution standards.
Members of the Advisory Committee have held discussions on several occasions
with Lower Mainland municipal representatives who are exploring the possibility of
setting up a regional air-pollution control agency.
For purposes of obtaining information on conducting an air-pollution control
programme, some members of the Advisory Committee visited the Puget Sound Air
Pollution Control Agency in Washington State during July. This agency controls
air pollution in three counties in the State of Washington where the majority of
industries are located. Information was garnered which can be incorporated into
a basic approach toward amelioration and prevention of air contamination within
the Province.
More details on the activities of the Committee will be found in the reports of
the Divisions of Laboratories and Public Health Engineering.
Pesticides
The Director of the Division continued to serve as a member of the Advisory
Committee on Agricultural Pesticides and Veterinary Drugs, a body appointed by
and reporting to the Minister of Agriculture. The main task of the Committee has
been in the preparation of regulations governing the sale and distribution of medicated feeds and veterinary drugs under " open shop " conditions.
Advisory Committee on Radiation Protection
The Director of Occupational Health has recently been appointed a member
of this Advisory Committee on Radiation Protection, established by the Department of National Health and Welfare in Ottawa.
OCCUPATIONAL HEALTH
N 47
RADIATION PROTECTION SECTION
The increased use of radioisotopes in the field of research and medicine in the
past year and the announcement of the construction of TRIUMF (Tri-University
Meson Facility), a project proposed by the staff of the three Coast universities
in British Columbia, is demanding an expanded programme of consultations and
inspections. The year 1968 also saw this Section paying special attention to various
radium supplies presently in the Province with the discovery that several of the
sources were leaking and causing considerable contamination.
The increased use of the testing-grounds off Nanoose Bay by nuclear-powered
submarines required a revamping of the Section's surveillance programme as the
public health aspects of radiation accidents fall within the jurisdiction of the Provincial Health Branch. This has led to the creation of the first mobile field radiation
laboratory in Canada, which is a self-contained tractor-trailer unit complete with its
own power and water supply and equipped with instruments capable of measuring
radioactivity in air, water, and solids. With additional equipment loaned by the
Department of Nuclear Medicine, Vancouver General Hospital, it has been possible
to determine energy ranges of the various samples obtained and thus identify the
nuclides responsible.
The laboratory has recently been used to survey a water supply that originates
in the base rock of a uranium mining claim near Trail. The preliminary report
indicates that air and sediments in the water contain radioactivity in the uranium
Canada's first mobile field radiation laboratory, manned by personnel of the Radiation
Protection Section of the Division of Occupational Health.
r
N 48
PUBLIC HEALTH SERVICES REPORT, 1968
Interior of the trailer unit, showing instruments and equipment used for measuring
radioactivity in air, water, or solids.
series in excess of 40 times background levels. In collaboration with the Radiation
Protection Division of the Department of National Health and Welfare, investigations will be carried out on produce grown in this area, and estimates may be made
of the radioactive body burdens of individuals who have been drinking the contaminated water for a long period of time. It has been planned to use the mobile
facility as a field training unit for industrial users of radioisotopes.
The Division is continuing its effort to find a solution to the radioactive-waste
disposal problem, which will become more acute as time goes on, more particularly
after the start-up of the meson facility at the University of British Columbia. It is
expected there will be large quantities of long-lived radioactive wastes to be disposed of either by shipment to Atomic Energy Limited in Ottawa, which is very
costly, or by burial in a suitable Provincial disposal ground.
In view of the continued expansion in the use of radioactive isotopes and the
increase in the number of hospitals now being constructed, this Section has had to
increase inspections and consultations with the various professionals concerned.
The following is a summary of the surveys and consultations conducted by the radiation inspectors: Surveys, 472; on-site consultations, 204; telephone consultations,
1,015. In view of the number of leaking radium sources which have been detected
during the year, it has been proposed to continue with the programme, using the
liquid scintillation counter for such tasks. In conjunction with leak testing, a survey
or radium storage facilities will be carried out in order to bring them up to the
OCCUPATIONAL HEALTH
N 49
required standards as defined in the licence and in the Radium Safety Code. The
X-ray survey programme inspected 96 dentists and 42 chiropractors (the latter
figure indicating a complete survey of all chiropractors in the Greater Vancouver
area).
The technical adviser (radiology) acts as secretary of the Radiological
Advisory Council. The Equipment and Planning Committee of this Council met on
nine occasions during 1968 and reviewed 89 applications for financial grants for
X-ray equipment at the request of the British Columbia Hospital Insurance Service.
The total value of grants approved was $872,036.
A study was conducted by the Radiation Protection Section on coloured television sets. A total of 256 television sets, representing nine different manufacturers,
was surveyed, and there were only two instances where detectable amounts of
X-rays were found, and these were only detected when the units were partially
dismantled.
All members of the Radiation Protection Section place strong emphasis on
education and have, on several occasions this year, spoken at seminars and conferences on the various aspects of radiation protection and public health hazards.
The Radiological Advisory Council is continuing its close interest and co-operation
in X-ray technician courses which have been conducted at the British Columbia
Institute of Technology. The interest and attendance at these courses continue to
grow because of the quality and calibre of the lectures presented.
N 50 PUBLIC HEALTH SERVICES REPORT, 1968
REHABILITATION
Steady growth of the Division's activities continues. The format of the present
programme was developed in 1961 as a result of a series of rehabilitation survey
projects which were undertaken at that time by the Health Branch with the cooperation of the Department of Social Welfare. From these surveys a programme
was developed which subsequently was put into effect in three communities in British
Columbia on a developmental and experimental basis. It was through this developmental work that the concept of a local rehabilitation committee was formed and has
now become the mechanism through which referrals for rehabilitation in communities in the Province are made. This aspect of the programme has now developed to
the point where, at the present time, there are 29 local rehabilitation committees
actively at work, located in 16 health unit areas.
So that the work could be better co-ordinated on a local basis, the first regional
rehabilitation consultant was appointed in the Vancouver Island region in 1964, and
since then five others have been appointed. All regions of the Province are now
covered, with the exception of the extreme north-west portion. In the past year two
additional rehabilitation consultants have been added to the staff of the Division.
One is serving in the Vancouver Island region and the other, before the end of the
year, assumed responsibility for continuing development in the East and West Kootenay region.
As the staff of the Division has grown and the services extended to take care of
the demand which has been now placed upon it, the case load has grown considerably; from 179 cases in 1961, it has risen to 1,068 by the end of 1968.
The demand for services of the Division continues to grow, and on occasion it
is difficult to accede to all the requests made for service, partly because of the extreme
difficulty in locating and recruiting suitable personnel in the sensitive and demanding
position of rehabilitation consultant. Over the past year and a half while consistent
efforts have been made to locate additional field personnel, it has taken that period
of time to recruit two regional rehabilitation consultants. One vacancy still exists,
and the process of active recruitment to fill that vacancy continues.
VOCATIONAL TRAINING OF THE DISABLED
The Division is responsible for administration of the provisions of the Federal-
Provincial Agreement for the Vocational Rehabilitation of Disabled Persons. Schedule 3 of the Agreement provides for vocational training for the handicapped. Seven
deaf students have been assisted in attending Gallaudet College in Washington, D.C.,
which is the only college in North America for the deaf. Of those who have attended
Gallaudet in the past two years, two have graduated and are now employed in professional positions. The Division also continues to assist 10 blind students at universities and 18 disabled students at the regional college level, as well as 12 students
in the British Columbia Institute of Technology. In addition to these, there were
260 disabled persons admitted into other types of vocational training during the year,
and it can also be reported that during the year 126 graduated from training.
This aspect of the programme is a most valuable one. In most cases it is the
means by which the disabled are prepared to overcome the effects of a handicap
imposed by their disability so that they may again be economically self-sufficient.
REHABILITATION N 51
FINANCIAL ASSISTANCE TO AGENCIES
In previous years, mention has been made of the assistance which has been
provided through the Division to rehabilitation agencies such as the Vancouver
Training Workshop for the Handicapped and the Goodwill Enterprises of Victoria.
It is worthy of note that during 1968 the benefits of assistance toward the payment
of professional salaries has also been afforded to the Western Institute for the Deaf.
This organization has grown rapidly into an effective agency serving the community
of the deaf in a variety of positive ways.
The liaison which has been established over the past few years with the Goodwill Enterprises of Victoria has been particularly gratifying, and at the present time
the professional staff of that agency, for which the Division pays 80 per cent of the
salaries, comprises the Local Rehabilitation Committee in Victoria and is serving
the Greater Victoria area. It is also noteworthy that the Vancouver Training
Workshop for the Handicapped, through assistance which was provided by the
Government of British Columbia and a private donor, has been able to expand and
has recently purchased a salvage operation, at a cost of approximtely $250,000,
with potential for becoming an industrial rehabilitation centre. This will enable
it to greatly expand its services to the handicapped of the Lower Mainland area.
Eighty per cent of the salaries for the professional personnel of this agency also
are paid through the Division of Rehabilitation. These two agencies have been most
valuable in providing certain aspects of vocational rehabilitation services for the
handicapped in their various regions. It is believed that, in so far as the Goodwill
Enterprises of Victoria is concerned, the combination of official and voluntary
service which has been developed in the field of rehabilitation in the Vancouver
Island region may well be one of the most sophisticated combinations of government and voluntary agency co-operation in Canada.
The demands on these agencies and the Division are increasing rapidly as the
services become better known and better established.
OTHER SERVICES
Thalidomide Deformities
The Division has continued to assist children with thalidomide deformities. Of
those children who suffer from these deformities, four are still under attention by
the Division. In the current fiscal year two of these children were provided with
special services and the most modern type of prostheses at the Montreal Rehabilitation Institute. Originally there were 10 children born in this Province who were
known to have thalidomide deformities; four of them have d:ed, and two have not
required assistance for any services.
Renal Dialysis
For those suffering from chronic renal (kidney) failure, assistance in the
programme of peritoneal dialysis, which was begun through St. Paul's Hospital in
1965, has continued, although the number of individuals who are on the peritoneal
dialysis programme has decreased. Some patients on hemodialysis are being
assisted with the costs of their out-patient treatment.
Earlier this year, funds were made available by the Government to set up a
comprehensive programme in which dialysis could be carried out in the patient's
home. Three hospitals—the Vancouver General, St. Paul's in Vancouver, and the
Royal Jubilee in Victoria—are participating, and a special training unit is being
N 52 PUBLIC HEALTH SERVICES REPORT, 1968
set up at the Vancouver General Hospital. Selected staff from the three hospitals
are receiving training and instruction, and they, in turn, will provide the necessary
instruction and supervision to patients. Renal dialysis is not a simple procedure,
and a patient's period of instruction will run between six weeks and three months.
Because dialysis in the home differs so markedly from that in a hospital setting,
the choice of equipment has been painstaking. Some dialysers and other items have
been purchased, and in December the first patients were being trained on the actual
equipment they will use in their own home.
NEW SERVICES
In the past the major effort in rehabilitation has been toward assisting people
to become financially independent through such services as medical help, social and
vocational assessment, counselling, social casework, vocational training, and job
placement. It has always been the aim of the Health Branch to develop a programme which would be diversified and extended to include those who might be
restored to self-care and personal, if not financial, independence. These aims are
gradually being put into effect as personnel and funds become available. In the
coming years it is expected that the benefits of this programme will be extended
downward to include certain children below the age of 16 years who require
assistance with such items as prostheses, appliances, braces, etc. It is also hoped
that some of the benefits may be extended to those of the medically indigent who
have otherwise no coverage for items which would assist them to self-independence
and, as progress is made, toward the older age-group as well.
CASE LOAD OF THE DIVISION OF REHABILITATION,
JANUARY 1 TO DECEMBER 31, 1968
Accepted cases active at January 1, 1968 682
New cases referred to local rehabilitation committees.... 686
Cases referred from other sources 471
Cases reopened 51
Total referrals considered for rehabilitation service, January 1 to
December 31, 1968 1,208
Total 1,890
Analysis of Closed Cases
Cases closed, January 1 to December 31,1968—
Employment placements made—
Canada Manpower 34
Division of Rehabilitation 9
Other placements 113
156
Resumed former activities .... 66
Job placement not feasible (restoration services completed).. 158
Deceased 9
389
Cases assessed and rejected as not capable of rehabilitation 439
Cases currently under assessment or receiving rehabilitation services 1,062
Total 1,890
EXTENDED CARE N 53
EXTENDED CARE
The extended-care programme at Pearson Hospital for poliomyelitis and
extended-care cases represents the largest proportion of the work in that institution
in the matter of beds and services. Of a total of 101,201 patient-days, only about
one-quarter of this was accounted for by the tuberculosis cases. Admissions and
discharges to the Poliomyelitis Pavilion were not significantly changed, and there
were 37 admissions and 39 discharges to a bed complement of 40.
The type of work performed in the Poliomyelitis Pavilion continues much the
same as in the previous year. There were almost as many patients in this area who
do not have chronic poliomyelitis but whose needs are, in most cases, similar, and
this continues to be an active-treatment ward.
In the extended-care section, however, there were only one-half the number
of admissions as in the previous year, and this was due to the fact that fewer new
beds were opened during the year. The number of discharges was down, which
seems to be the trend and would indicate that the turnover in the future will be
limited and slow. The total patient-days' treatment in the extended-care section was
up 10,000 over the previous year and accounted for 61,219 of the total patient-days;
there were 48 admissions, 24 discharges, and 23 deaths.
For most of the year there were 170 beds for extended-care patients, and these
beds are always fully occupied. As time goes on, a greater and greater number of
quadriplegics and paraplegics are being cared for, and with the policy of admitting
those who can benefit from the facilities of the institution, it is found that the nursing
care for these patients is becoming very heavy. Unfortunately it is difficult to recruit
experienced staff adequately trained in the nursing and handling skills for grossly
handicapped patients, such as are in the majority in this hospital. This places an
added burden on the senior nursing staff in the instruction and orientation of new
employees. Forty hours of basic instruction are needed for all levels of nursing
staff, and this is apart from the continuing education of staff members.
The physiotherapy department gave a total of 46,024 treatments. This represents the maximum possible with present staff and equipment. Plans have been
approved for enlarging this department, while new equipment on order will aid in
more effective care for certain types of patients. Every effort is made to have all
patients in the extended-care wards utilize the facilities, and, during the day, occupational and physiotherapy departments are working to provide all the care required.
A large variety of entertainment is provided for these patients, even including
a sports day for paraplegics. There are also indoor sports, live talent shows, movies,
bingo, and special parties for such occasions as Christmas, St. Valentine's Day, and
Hallowe'en.
Electric wheelchairs have been donated by the Women's Auxiliary and others
have been purchased privately by the patients. These have proven a great help to
the patients and, as a result, they have been able to be up and about and take part
in many additional activities.
N 54
PUBLIC HEALTH SERVICES REPORT, 1968
LOCAL HEALTH SERVICES
The majority of personnel in the central office of the Health Branch at Victoria
are specialists in some field of public health. However, if they are to provide knowledgeable support and consultation to local health unit staff in the field, they must be
informed on the activities of their colleagues and of the Bureau as a whole, to include
programme and service developments in the 18 health units bracketing the entire
Province. This report summarizes the work of these specialists within the Divisions
of Public Health Nursing, Preventive Dentistry, Epidemiology, Public Health Engineering, Sanitation Services, and Nutrition Services, and the shellfish programme.
Each local health unit produces its own individual annual report, and these can be
referred to if more detailed information is required concerning any specific area of
the Province.
ADMINISTRATIVE CONSIDERATIONS
The various PERSONNEL changes that have occurred during the year are
considered in the divisional reports which follow, and only Medical Health Officers
need be commented upon here. Two resignations were received and one appointment was made at the level of health unit director, and another, at the level of assistant director (trainee), toward the year's end. This has resulted in current vacancies
in four health unit director positions. Such a situation will not be regarded with
complacency, particularly when three of these vacancies are in the three northernmost health unit areas having headquarters in Prince Rupert, Prince George, and
Dawson Creek. Among central office staff, one additional engineering position was
filled and an appointment made to add one nursing consultant to the staff.
With respect to the TRAINING of physicians, one health unit director proceeded to the School of Hygiene, University of Toronto, to obtain the Diploma in
Public Health, while another completed six months' training toward the certification
in public health at the University of British Columbia; two directors attended a
refresher course at the University of Toronto of one week's duration and four directors attended a two-day course on immunology and virology at the University of
British Columbia.
The programme of HEALTH CENTRE CONSTRUCTION or extension continues unabated, with new centres in Cranbrook, Nakusp, and Hazelton either corn-
British Columbia's newest and largest community health centre, opened at Kamloops
in September.
LOCAL HEALTH SERVICES
N 55
twmJ^T £T n1dU1nng *e year and an extension for the heal* centre
in Williams Lake in the final planning stages. In keeping with the philosophy of
locating community mental health clinic teams in the public health centres on a
tS^l^aS1S, Ugc°Ut the Pr°vince' plannin2 is Presently unde' way to extend
ffie health centres in Surrey and Coquitlam, and it is hoped that these will be com-
Kh S the Present fiscal year- Extensions are planned on a similar basis for
health centres in Haney Terrace, Campbell River, and Nelson. Initial planning is
under way for new health centres to be constructed in Squamish, Fort St John
Agassiz, Delta, and possibly Chetwynd. '
An initial draft revision of the HEALTH ACT has been completed and stand
been p°re?aVeAdUTY OF RECEIVING WATERS "* ** AIR TOIlStSnSL
Close co-operation continues with the Department of Education as progress is
made toward the REVISION OF THE HEALTH EDUCATION CURRICULUM
m schools and of TEACHER-TRAINING IN HEALTH in the Faculties of Education at the three universities. At this time the revision of the elementary health
curriculum nears completion and plans are being formulated for in-service training
of the community resource personnel who will be involved, primarily teachers
«. |he implementation of the British Columbia Medical Insurance Plan suggests
that the Medical Health Officer will continue to develop an mere Jin?fa£gfa
healer ST&'SBKX'SSK.'ffi ITkTS KM pufc
DrrA^LaSHDealthtSeres; Dr-" * ^T^^'AiSiSssSPSt
MenialvSg&SS* """" * ***> "* **' * G" ™«' De^ Mini^ «f
N 56
PUBLIC HEALTH SERVICES REPORT, 1968
COMMUNITY HEALTH CARE PROGRAMMES at all levels. His concern
must extend to the provision of a broad spectrum of facilities offering care within
the community—from the hospital, through extended and intermediate, to home
care and the boarding home. Despite the fact that much of this care is concerned
with the individual, and to some extent with treatment, the motivation and raison
d'etre of the Medical Health Officer continues to be " prevention within the community." It is perhaps this word " prevention " that offers such potential scope to
his activities and might, to advantage, be considered further for a moment.
PREVENTION can be considered as primary or secondary depending upon
whether the disease is prevented altogether (as in vaccination against smallpox) or,
the disease process having already started, the action taken in secondary prevention
stops it from progressing further.
Examples of each activity are available, be it in terms of service to the family
or to the individual. PRIMARY prevention will include health supervision in
infancy and childhood where the health unit staff exercise their role in prenatal
classes; at the postnatal level in newborn baby visits, child health conferences, and
various screening programmes; with the pre-school child in kindergarten and nursery school; and in the 3-year-old dental programme and for the school-age child as
consultant to the teacher. It should be noted that such prevention involves both
child and adult, and in terms not only of physical disease, but also and increasingly
in mental illness. Much of the work in environmental sanitation also involves " primary prevention," as does communicable-disease control (including venereal disease
The main office of Skeena Health Unit at Prince Rupert.
LOCAL HEALTH SERVICES
N 57
and tuberculosis control programmes), rheumatic fever prophylaxis, the poison-
control programme, and activity in family planning and in health education.
The early diagnosis and treatment of disease in the child or adult involves
SECONDARY prevention where public health staff are generally not directly involved in treatment, but where they are offered opportunities to assist other agencies
and the community to develop and make available the necessary resources. The
identification of the child or adult with a problem and subsequent referral for early
diagnosis and follow-up is, however, a key role. Since health unit staff, under their
Medical Health Officer, are organized into a highly effective network of health units
throughout the Province with immediate support and consultative advice available
from experts in central office, they are able to perform these varying roles to the
best advantage of the patient/resident.
In the years ahead, the continued availability and effectiveness of this machinery and these personnel cannot do other than have a very significant effect upon the
ultimate cost to the taxpayer of services offered under medical care insurance. The
less disease that is prevented, the later the disease process is identified and treated—
the greater the cost in dollars and perhaps in that other sum which we are too often
inclined to overlook—the sum total of human happiness.
N 58
PUBLIC HEALTH SERVICES REPORT, 1968
EPIDEMIOLOGY
COMMUNICABLE DISEASE
Again this year no serious outbreaks of communicable disease were reported.
However, two conditions have given cause for some concern. In only one of the
last 10 years has more than a single case of diphtheria been reported, but in 1968
eight cases with two deaths occurred within a few months in the Greater Vancouver
area. Similar outbreaks have also taken place in other Provinces in recent years.
This is good evidence that diphtheria has not been eliminated but is only suppressed.
For this reason, public health staff throughout the Province are making every effort
to keep the immunization level of all young people as high as possible so that
diphtheria cannot again become a major health problem.
The number of cases of infectious hepatitis reported has also continued to
increase, as it has over the whole of North America, signifying the appearance of
a new group of susceptible persons. A total of 2,032 cases was recorded this year,
up 368 cases from 1967.
Food poisoning was again a problem, with 485 people reporting that they had
become ill from food which on examination proved to be contaminated with disease-
producing bacteria or their toxic products. Most of these poisonings followed the
consumption of food prepared by people who lacked the equipment or knowledge
to handle food in large quantities. Such outbreaks can probably never be com-
The newly introduced poison-control information programme, in use at the emergency
department of Royal Jubilee Hospital, Victoria.
EPIDEMIOLOGY N 59
pletely prevented but can be reduced by constant education by the public health
inspectors.
Over 500 cases of dysentery, caused by either a bacterial or a viral infection,
were reported. Many people continue to excrete the organisms causing this disease
long after they are well and moving about freely again. The presence of these
healthy carriers in a community makes the control of this condition extremely
difficult.
There were no cases of paralytic poliomyelitis reported this year. Only one
such case has occurred in the Province in the past six years, which is gratifying.
Too, it offers epidemiological support for the policy adopted in 1956 of providing
a continuous poliomyelitis immunization service.
Just over a thousand cases of streptococcal infection were reported, contrasted
with over 2,400 cases in 1967. The after effects of this disease are now far less
severe than they were a generation ago. In addition, the ready availability of antibiotics makes infections of this type far less of a problem than in the past.
A few cases of typhoid fever continue to occur every year. This year the four
new cases reported were felt to be due to elderly chronic carriers unwittingly spreading their disease, although the source of only two of these cases was found.
Seventeen cases of meningococcal (spinal) meningitis were reported, which is
little different from other years. Although strains of meningococci that are resistant
to many antibiotics have appeared in some parts of the world, there is no evidence
that this has yet taken place here.
Whooping-cough continues to be a problem in infants. One hundred and
forty cases were reported this year but no deaths. Every effort is being made to
persuade parents to have their children protected as early in life as possible, since
the most serious effects of this disease are felt in babies under 1 year of age. There
were many confirmed cases of influenza Type B in the Interior of the Province this
year, which resulted in considerable absenteeism but few instances of serious illness.
The vaccine available is felt to be about 60 to 70 per cent effective and is recommended for people suffering from chronic illnesses and for those over 70 years
of age.
RHEUMATIC FEVER PROPHYLAXIS
The rheumatic fever prophylaxis programme continued its slow and steady
growth. At the close of the year there were 1,482 children taking daily prophylaxis.
This growth reflects not only the increasing number of young people in the Province,
but also the increasing acceptance of the value of prophylaxis by practising physicians. A review of this programme has been started to determine if some of those
now receiving prophylaxis could be dropped without possible future harm to
themselves.
POISON-CONTROL PROGRAMME
A basic set of 1,500 poison-control information cards, developed with the
co-operation of the Faculty of Pharmacy, University of British Columbia, under a
National Health Grant, was completed during the summer. These cards, along
with other material useful in treating cases of accidental poisoning, are being offered
to all acute hospitals of 50 beds or over that wish to operate a poison-treatment
centre. It is hoped that by the middle of next year some 40 such centres will have
been established.
The Department of Paediatrics, Faculty of Medicine, University of British
Columbia, has agreed to augment the information supplied to local treatment
centres by developing a Provincial reference centre at a psediatric hospital in
N 60
PUBLIC HEALTH SERVICES REPORT, 1968
Vancouver. In complicated cases, this centre will provide information by telephone
to physicians calling from anywhere in the Province.
MOTOR-VEHICLE ACCIDENTS PREVENTION
The Health Branch has continued to provide a consultative service to the
Motor-vehicle Branch in connection with its continuing programme of restricting
or suspending the driving privilege of those people judged unfit to drive a motor-
vehicle for medical reasons. A start has been made on the revision of the manual
" Guide to Physicians in Determining Fitness to Drive a Motor-vehicle " to bring
this publication into agreement with current practice. The Health Branch is also
collaborating with the Traffic and Safety Committee of the British Columbia Medical
Association in drawing up proposed standards for the equipment that should be
carried in ambulances and the first-aid training that should be required of ambulance drivers and attendants.
Reported Communicable Diseases in British Columbia, 1964—68
(Including Indians)
(Rate per 100,000 population.)
Reported Disease
Number
of
Cases
1964
Rate
1965
Number
of
Cases
Rate
1966
Number
of
Cases
Rate
1967
Number
of
Cases
Rate
1968
Number
of
Cases
Rate
Botulism—.
B rucellosis
Diarrhoea of the newborn
(E. coli)...
Diphtheria
Dysentery—
Amoebic
Bacillary
Unspecified
Food poisoning—
Staphylococcal intoxication
Salmonella infection
Unspecified
Hepatitis, infectious
Leprosy
Meningitis, viral or aseptic—
Due to coxsackie virus
Other and unspecified
Meningococcal infection
Pemphigus neonatorum
Pertussis _.
Poliomyelitis, paralytic
Scarlet fever.
Streptococcal throat
Tetanus
Trichinosis
Typhoid fever
Paratyphoid fever
Totals
52
4
131
310
1
200
28
1,062
37
11
5
181
1
330
652
1
0.1
3.0
0.2
7.5
17.8
0.1
11.5
1.6
61.1
2.1
0.6
0.3
10.4
0.1
19.0
37.5
0.1
0.3
0.3
32
3
114
225
1
348
74
1,237
3
53
15
1
231
848
824
3,018
173.6 | 4,027
0.3
0.1
1.8
0.2
6.4
12.6
0.1
19.4
4.1
69.1
0.2
3.0
0.8
0.1
12.9
47.4
46.0
0.2
0.4
225.1
31
203
367
12
342
4
844
311
988
796
1.7
10.8
19.6
0.6
18.2
0.2
45.0
1.7
0.6
16.6
52.7
42.5
0.2
0.1
3,944
210.5
2
138
489
9
256
24
1,664
1
9
31
12
264
695
1,782
3
1
10
5,413
0.1
0.1
0.8
0.1
0.1
7.1
25.1
0.5
13.1
1.2
85.4
0.1
0.5
1.6
0.6
13.5
35.6
91.5
0.2
0.1
0.5
0.2
19
4
276
165
9
165
311
2,032
1
42
17
3
136
300
720
0.1
0.9
0.4
0.2
13.8
8.2
0.4
8.2
15.5
101.3
0.1
2.1
0.8
0.1
6.8
35.9
0.1
0.1
278.0
4,215
210.0
PUBLIC HEALTH NURSING N 61
PUBLIC HEALTH NURSING*
The Division of Public Health Nursing functions as part of the Bureau of Local
Health Services and has administrative as well as consultative functions. To assure
a high quality of service to meet the changing health needs in our society, the
Division is concerned with professional competence of the public health nurses.
Therefore, attention is directed to the recruitment, training, and the professional
development of public health nurses. Improved efficiency is encouraged through
evaluation studies, consultation, and guidance, and by the provision of new technical
information in the various health programmes involving public health nursing staff.
The staff consists of a director and four consultants, who are concerned with
the professional efficiency of 342 field nurses (316 full time and 26 part-time)
employed in local health service, as well as six part-time public health physiotherapists.
The Division works closely with other health agencies, such as the Greater
Vancouver Metropolitan Health Service, the Medical Services Directorate of the
Department of National Health and Welfare, the Victorian Order of Nurses, and the
Red Cross nursing service, to co-ordinate the use of facilities and resources.
ADMINISTRATION AND CONSULTATION
The Public Health Nursing Division assists local health units in assessing the
need for public health nursing services and helps evaluate the programmes being
conducted so that the best use is made of available nursing time. This is accomplished by statistical analysis of health needs considered in relation to population
changes, socio-economic conditions, as well as through study of the needs of each
area as indicated at the time of routine visits to all districts. As was the situation
one year ago, the larger urban health units and certain other communities have continued to have greater population increases than elsewhere in the Province. To take
care of this, it was possible to add eight full-time public health nursing positions at
Vernon, Kelowna, Prince George, Comox, Surrey, Delta, and Nanaimo, while the
part-time position at Squamish was increased to full time. Four half-time public
health nursing positions were added at Fort St. James, Chetwynd, Campbell River,
and on the Queen Charlotte Islands. Part-time nurse positions for the home
nursing programme were added at Prince George, Delta, Nanaimo, and Qualicum.
During the year two health units completed a pilot study which proved that
it was feasible to allocate certain non-professional activities such as routine vision
and hearing screening to an aide, thus freeing the public health nurse for professional
duties. It is hoped that it will be possible to extend the duties of all health unit aides
to take over more activities so that other areas of the Province will benefit. Other
studies involving all health units included the case-load analysis, a study of the
amount of service provided by the health units to the medical care plan, and the
home nursing programme.
Public health nursing consultants have been active in planning with public
health physiotherapists and speech therapists so that their special contributions can
be integrated into the local programme. Local health staff have the benefit of
utilizing manuals which are prepared in part by the public health nursing consultants.
* Except where otherwise stated, this report concerns the services of public health nurses under the jurisdiction of the Provincial Health Branch and does not include services provided in Greater Vancouver, Victoria,
Esquimau, Oak Bay, and New Westminster.
N 62
PUBLIC HEALTH SERVICES REPORT, 1968
These provide technical information and standardized procedures which help in the
development of local programmes. This year the " Guide for Expectant Parents
Classes " was revised and supplied to health units; it has also been much in demand
from outside the Province. A manual for public health nursing supervisors was also
prepared and issued.
STAFF DEVELOPMENT
To supply the need for qualified public health nurses for staff, senior and
supervisory positions, it is necessary to have a staff-development programme to
arrange appropriate opportunities for training, experience, and education so that
suitable candidates will be available for vacancies. As part of the programme of
recruiting qualified public health nurses for service in the rural parts of the Province,
23 nurses were engaged. These will be given postgraduate training in public health
nursing. These nurses will gain valuable field experience before enrolling in the
required public health nursing university course next year, and on their return will
make an excellent contribution to the service. At present 13 public health nursing
trainees who were on staff last year are becoming qualified for permanent public
health nursing positions. Similarly, as there is a need for well-prepared public
health nursing seniors and supervisors, it is necessary to encourage suitable staff
nurses to transfer to positions of increased responsibility and to continue their professional education so that they may be prepared for supervisory positions when
they become available. During the year two supervisors returned from advanced
training and two more are attending university for advanced courses in public health
nursing supervision and administration.
Special educational opportunities were made available for 25 public health
nurses to complete an eight-week psychiatric nursing course at Education Centre,
Riverview, and in addition 36 public health nurses completed a one week's workshop on retardation, especially planned for public health nurses at The Woodlands
School.
To assist with public health education of nurses, 51 public health nursing
students from the University of British Columbia had four weeks' field experience;
in addition to this group, a new plan for concurrent field experience was initiated
this fall for 10 additional nursing students from the university. Ten public health
nursing students from the University of Alberta also had four weeks' field teaching.
One nursing student under the auspices of the Pan American Health Organization
was placed for a month's special field experience in the East Kootenay Health
Unit. Also 191 undergraduate nurses had a week's field teaching. Assistance is
also provided to the University of British Columbia School of Nursing through
conferences and special lectures to public health nursing students.
PUBLIC HEALTH NURSING SERVICE IN THE HEALTH UNITS
Public health nursing activities in local health service fall into two general
categories, the first involving the promotion of community health services, and the
second direct professional nursing service which is provided on a family-centred
basis to individuals at home, at work, at school, and in certain institutions or health
centres. Public health nursing services are available to all age-groups and not limited to any special segment of society.
Each public health nurse serves a designated district where she is responsible
for the public health nursing service within the framework of the policies of the
local health unit and the Health Branch. She is usually assisted in her work by
PUBLIC HEALTH NURSING N 63
volunteers who give many hours of free service and health unit aides who provide
limited non-professional service. The following general programmes and services
summarize the main accomplishments and activities of the public health nurses
throughout the service this year.
EXPECTANT PARENTS participated in special classes held by public health
nurses at 70 centres to help them to cope with the special problems of the anticipated new child and the extended family. Many potential problems are prevented
through discussion about pregnancy and normal infant development. During the
year 3,274 mothers and 1,098 fathers attended 21,220 classes, which was an increase
of 61 per cent over last year, in spite of a lowered birth rate and a reduction in the
length of the course. In addition, public health nurses made 3,999 pre-natal and
18,371 postnatal home visits.
INFANT AND PRE-SCHOOL CHILDREN received special attention as
this is the period in the child's life when good health habits can be established and
corrections made to physical or emotional defects so that permanent damage may
be avoided. Special activities therefore included routine screening for defects such
as hearing, vision, speech, mental retardation, etc. This is usually done at the time
of home visits or at a child health conference, 989 of which were held throughout
the health units. Special vision-screening clinics were held in some health units,
and this year, with the introduction of the VASC audiometer for hearing-screening
of pre-school children, many special clinics were held for this purpose. Public health
nurses made a total of 33,835 visits concerning the health of infants and 33,569
visits concerning physical and emotional health problems of pre-school children.
The enrolment at child health conferences was up 6 per cent, with 14,910 new infants
and 8,139 new pre-school children enrolled. A total attendance of 57,585 infants
and 84,749 pre-school children remained high. Routine public health nursing service was provided in 234 kindergartens, with an attendance of 14,670 pre-school
children. Consultative assistance was offered to operators of day-care centres.
MENTAL HEALTH continues to take a considerable amount of the public
health nurse's time as she is concerned about both primary and secondary prevention. Primary prevention is accomplished in the public health nurse's daily work
at such places as child health conferences, schools, and homes, when she identifies
potential emotional problems, gives health counselling and guidance, and refers individuals for diagnosis and treatment to the appropriate mental health clinic. In secondary prevention the public health nurse's activities have continued to increase as
more mental health treatment is done in local communities and the public health
nurse provides home supervision. This year public health nurses made 17,793
mental health visits in connection with secondary prevention, which is 3 per cent
over last year. Although a majority of the visits have been for children, 44 per
cent are for adults, and the number of adult visits is 11 per cent higher than last year.
HOME CARE as part of a health unit service was first introduced on a pilot-
study basis in 1947 in the South Okanagan Health Unit at Kelowna. The service
is now available from 65 health centres to 113 districts for about 80 per cent of the
population in health units. It includes liaison with hospitals and other health and
welfare agencies so that continuity of care may be extended to the home. Besides
providing the bedside nursing service, public health nurses encourage the establishment of needed auxiliary services such as homemakers, physiotherapists, medical-
supply loan cupboards, and meals on wheels. The home care service thus enables
patients to be discharged home earlier so that the facilities may be used for more
patients. The number of home visits was up 4.2 per cent for a total of 71,053
during the year.
N 64 PUBLIC HEALTH SERVICES REPORT, 1968
Since the service was first introduced just over 20 years ago, it has been carefully evaluated and studied, and this year a two-month study was conducted to compare this year's activities with the results of the last five-year study done from 1959
to 1963. It is interesting to note that the number of visits has just about doubled
since 1963, and that the 60-and-over age-group still accounts for the greatest percentage of the patients (74.1) and visits (76.7). The home care service is averaging 250 new admissions each month. Also it is encouraging to note that the percentage of new admissions which are hospital discharges is now 49.8 per cent in
contrast to around 25 per cent in 1963.
CONSULTANT PUBLIC HEALTH PHYSIOTHERAPISTS are employed
on a part-time basis in eight health units, where they are involved in the home care
programme. Their particular work is in assessing and supervising the progress of
selected home-care patients for rehabilitation, and by providing an in-service training programme on rehabilitation nursing to the nursing staff. In addition, the consultant physiotherapists have been involved in assisting some operators of personal-
care institutions and private nursing homes to develop rehabilitation nursing and
recreational programmes for patients in these institutions. They also provide consultative help to schools, particularly in relation to children in special classes and
children in schools for the retarded. There are six physiotherapists; one has occupational training also, and she was appointed for the Fraser Valley health units.
Three of these part-time positions are now vacant.
GERIATRICS has continued to be an important part of the public health
nurse's work. The majority of patients on the home care programme are over 65
years of age, and more services have been added to assist this age-group to maintain
health. Public health nurses made 59,525 visits on behalf of older people in relation to nursing care, mental health, and other services, and, in addition, 1,337 visits
were made to 124 personal-care institutions to assist operators in meeting the health
needs of elderly patients. Special geriatric clinics for counselling and general health
supervision are held in many districts at centres where older persons congregate,
such as recreation centres and senior citizens' housing.
FAMILY HEALTH service was provided as the public health nurses made a
total of 165,564 visits to homes in addition to the 161,729 professional services
rendered on the telephone. In addition to the specialized services discussed elsewhere, public health nurses made 39,077 visits to adults for general health supervision, which represents an increase of 7.2 per cent over last year. The visits generally result in the person seeking diagnosis or medical care and treatment, and many
include nutrition and general health teaching.
DISEASE CONTROL is a traditional area of concern to the public health
nurse, and routine services continued to be given to prevent and control disease.
Included in these measures is the supervision of tuberculosis patients and contacts
in the community, to whom 10,212 visits were made. Tuberculin tests amounted
to 21,950, while other tests for communicable disease amounted to 2,943. Public
health nurses gave 4,430 services in connection with the control of venereal disease,
and regularly supervised 1,077 children on rheumatic fever prophylaxis. In addition, 9,855 services were provided in disease control, which included such items as
epidemiological investigations, injections for infectious hepatitis and rubella; the
latter represented a 45-per-cent increase over last year.
IMMUNIZATIONS form an important part of the communicable-disease
control programme, providing protection to those who take advantage of the service.
This is available to all age-groups, at child health conferences, schools, and special
clinics. During the year a total of 445,690 immunizations was done, which included
PUBLIC HEALTH NURSING N 65
93,784 protected against smallpox and 174,324 against poliomyelitis, while 23,456
were protected by the combined antigens for diphtheria, poliomyelitis, and tetanus.
On 84 INDIAN RESERVES, general public health nursing service was provided; this was done on a per capita assessment basis by arrangement with the
Medical Services Directorate, Department of National Health and Welfare. In this
way, 11,380 Indians living on these reserves receive the same service as the non-
Indian population in the health unit area concerned. In addition, 2,474 Indians
from the designated reserves now live off the reserve as part of the general community. During the year the Cariboo Health Unit took over service to the Canim
Lake Indian reserve.
SCHOOL HEALTH SERVICES were an important part of the work of the
public health nurse. This year there were 22,190 more pupils than last year, for a
total of 306,466 children in the schools, which represents a 7.7-per-cent increase
within the Provincial health units. This is 2.8 per cent higher than the Province as
a whole. To make the best use of nursing time in serving increasing numbers of
children, the emphasis continues to be on selecting children with special problems
and directing services toward them. Selection is accomplished in a variety of ways,
including teacher referral, self-referral, review of the individual and family history,
teacher-nurse conferences, school liaison committees, and routine screening. The
public health nurse is particularly interested in assisting the family and teacher in
understanding the child with special problems so that he can remain in the general
school system as long as possible.
Guidance is given to teachers for retarded or emotionally disturbed children.
During the year the public health nurses provided health service to 55 schools with
970 retarded children and 35 classrooms with 991 children who had problems such
as learning disabilities and emotional disturbances. During the year, conferences
were held with teachers concerning the health of individual pupils in 8,106 classrooms; direct services for pupils was up 18 per cent, for a total of 301,582 individual services, while public health nurses made 4,269 home visits for general health
and in addition 8,796 visits concerning emotional problems of students. In addition, public health nurses provided teachers with up-to-date information to assist
them in teaching such subjects as family living, child care, menstrual hygiene, venereal disease, smoking, communicable diseases, etc. They held 59,012 conferences
with school staff, and 1,973 school staff meetings were attended in an official
capacity.
The following tables and explanatory remarks refer to school health services
for the whole Province; with the exception as noted in Table IV and V, they include
the services provided by the metropolitan health departments of Greater Victoria
and Greater Vancouver.
N 66
PUBLIC HEALTH SERVICES REPORT, 1968
Table I.—Enrolment by Grades in Public Schools in British Columbia,
June, 1968
Grade
Greater
Vancouver
Greater
Victoria
Remainder
of Province
Total
6,546
12,689
12,849
12,450
1,109
11,865
11,695
11,394
11,203
1.939
1,408
11,352
11,022
10,311
9,395
8,699
492
2,308
3,399
3,555
3,596
331
3,543
3,292
3,376
3,222
329
491
3,228
3,109
2,781
2,616
2,237
46
7,157
27,649
26,327
26,124
2,209
24,613
23,776
23,360
22,633
2,263
3,391
22,714
20,648
18,042
15,265
11,907
1,372
16,011
Grade I
43,737
Grade II
42,731
Grade III
42,170
3,649
Grade IV
40,021
Grade V
38,763
Grade VI
38,130
Grade VII
37,058
4,531
5,290
Grade VIII
37,294
Grade IX
34,779
Grade X
21,134
Grade XI
27,276
Grade XII
22,843
Grade XIII.....
1,910
Totals
146,418
280
41,459
139
279,449
612
467,326
1,031
These figures are for public schools only. When figures for private schools
are added from Table II, the complete enrolment, including schools for retarded
children, is 505,150. Kindergarten enrolment in public schools is now more than
one-third of the Grade I enrolment, and when private schools are taken into consideration, the percentage rises to over 50 per cent. The emphasis in the school
health programme continues to be on prevention and early detection of defects,
and public health nurses are aided in this approach by the attendance of an increasing number of 5-year-old children who have the advantage of school health services,
including vision and hearing tests, at an early age. The enrolment in public schools
for retarded children has risen by 37 per cent from last year. This increase of 280
pupils more than offsets the decrease of 49 pupils in privately operated schools.
Table II.—Enrolment in Private Schools in British Columbia, June, 1968
Greater
Vancouver
Greater
Victoria
Remainder
of Province
Total
10,167
5,657
102
2,962
517
11,435
5.595
24,564
11.769
358 460
15,926
3,479
17,388
36,793
In private grade schools the enrolment has decreased by 211 from last year
and in schools for retarded children by 49. The kindergarten enrolment has
increased by 1,579.
Table HI.—Number of Pupils with Basic Immunization Prior to Entering Grade I,
September, 1967
Greater
Vancouver
Greater
Victoria
Remainder
of Province
Total pupils enrolled
Smallpox
Diphtheria, pertussis, and tetanus
Poliomyelitis
13,248
9,354 (70.6%)
10,079 (76.1%)
10,770 (81.3%)
3,535
2,600 (73.6%)
2,819 (79.7%)
2,919 (82.6%)
29,221
20,319 (69.5%)
22,069 (75.5%)
25,293 (79.7%)
PUBLIC HEALTH NURSING N 67
In previous years, health units have reported the number of pupils with complete immunization at the time of school entry. Because this figure eliminated many
who had basic immunization and required only a reinforcing injection, it did not
fully reflect the success of the infant and pre-school immunization service. This
year the report shows the number of children who had basic protection against the
four specified diseases prior to entering school. One problem facing health units
in their efforts to maintain a high immunization status is the task of locating newcomers to the district and obtaining previous health records, particularly in construction areas where there is a rapid turnover of population. Services to preschool children are receiving increasing attention each year, and it is hoped that
percentages will be higher next year, especially for smallpox.
Table IV.—Referral of Pupils to School Health Services
Item
Greater Vancouver
Greater Victoria
Remainder
of Province
|
(1) 3,493
(1) 3,368
26,235
22,945
Totals ...
6,861
49,180
i Figures not available.
The number of referrals to the school health service in the Victoria area has
decreased by about 1,000, and the number referred in areas served by the Health
Branch has increased by over 13,000, making a referral rate in both areas of
approximately 17 per cent of all pupils.
Table V.—Pupils Referred by Public Health Nurses for Further Care
Person or Clinic to Which Referrals Made
Greater Vancouver
Greater Victoria
Remainder
of Province
Private physician for other than vision defects
Investigator of vision defects
(!)
C1)
C1)
(!)
m
2,157
1,681
51
113
11,733
15,029
781
1,393
1,541
Mental health clinic
Totals.
| 4,225
[
30,477
1 Figures not available.
The percentage of pupils refen
about 10 per cent again this year,
remaining essentially the same as last
follow-up of pupils who have physica
"ed by public health nurses for further care is
with the numbers referred in each category
year. This figure is a good indication of active
1 or emotional problems.
N 68 PUBLIC HEALTH SERVICES REPORT, 1968
Statistical Summary of Selected Activities of Public Health Nurses, 1968
School service—
Direct by nurse 301,582
Teacher-nurse conferences 8,106
Home visits 51,586
Conference with staff 59,012
Meetings 1,973
Expectant parents—
Class attendance by mothers 17,121
Class attendance by fathers 4,099
Prenatal home visits 3,999
Postnatal visits 18,705
Child health-
Infants—
Conference attendance 57,585
Home visits 33,835
Preschool—
Conference attendance 84,749
Home visits 33,569
Nursing-care visits 71,053
Visits to personal-care institutions 1,337
Adult health supervision visits 39,077
Mental health visits 17,793
Disease control—
Tuberculosis visits 10,212
Venereal disease visits 4,430
Communicable disease visits 9,855
Rheumatic fever patients 1,077
Immunizations—
Smallpox 93,784
Poliomyelitis 174,324
Basic series 23,456
Other 154,126
Total doses 444,690
Tests—
Tuberculin 21,950
Other 2,934
Total visits to homes 165,564
Professional services by telephone 161,729
PREVENTIVE MEDICINE
N 69
PREVENTIVE DENTISTRY
PATTERNS OF DENTAL DISEASE
During the past decade there have been modest but significant trends which
indicate improvement in the dental health status of the children of British Columbia.
In 1955 this Province, the first of any in Canada, devised a methodology
whereby the dental health status of a random sample representative of the total
child population of the Province could be measured and compared with similar
groups in future years. The methodology was field-tested in 1956 and 1957, and
modified where necessary. During the period 1958-60 seven surveys were carried
out throughout the Province. A total of 9,295 children was dentally examined;
they included a representative sample of over 97 per cent of the children attending
public schools. A second series of surveys was carried out during the years 1961
to 1967, in which 9,489 children participated. Within this group was a 96-per-cent
representation of the public-school enrolment.
Comparisons between the two series of surveys show that in this period of
time the prevalence of dental decay in the permanent teeth of all age-groups (7 to
15 years), and in all regions except one, decreased. The over-all reduction was
8 per cent. The percentage of children of all ages with caries-free permanent teeth
increased from 10.6 to 13.5 per cent.
Improvement in the attainment of dental treatment was demonstrated by the
percentage of children of all ages with no obvious need of treatment of carious teeth,
which increased significantly from 16.8 to 22.8 per cent. The percentages of children of all ages having prematurely lost one or more deciduous teeth and of those
having lost one or more permanent teeth both declined. There was a fourfold
increase in the percentage of children noted as having been fitted with a device to
retain adequate space for the eruption of permanent teeth after the early extraction
of deciduous teeth.
However, while an improvement has been made, the present dental health
status of the children of this Province provides no grounds for complacency but
demonstrates the immediate need for the implementation of all means of prevention
of dental diseases and especially dental caries. During the 1961—67 surveys more
than 92 per cent of all children examined were obviously in need of dental treatment.
Of the 13-year-olds, more than one-third had already lost one or more of their permanent teeth. Close to one-half of all children examined were scored as having
"poor oral hygiene." In addition, 15-year-olds, on an average, had more than 11
of their 28 permanent teeth already attacked by dental decay. Of these 11 teeth,
one had already been lost and four had open untreated carious cavities. By comparison, in Brantford, Ont., which has had fluoridated water since 1945, the average
17-year-old has less than five teeth showing any sign of dental decay.
At the close of 1968 in British Columbia there were 16 communities with a
fluoridated water supply. A further four communities, in which referenda have
been passed by the required majority, were in various stages of installation of the
necessary equipment. More than six million Canadians benefit by fluoridation.
Those persons represent 43 per cent of those served by piped drinking-water. In
Manitoba the percentage is more than 90; in Nova Scotia, 77 per cent; Ontario,
70 per cent; Saskatchewan, 53 per cent; and Alberta, 48 per cent. In British
Columbia less than 8 per cent of the population having a piped water supply receive
fluoridated water.
N 70 PUBLIC HEALTH SERVICES REPORT, 1968
In December, 1968, fluoridation referenda were held in the water district of
Courtenay-Comox, five rural municipalities, and throughout the Greater Vancouver
Water District. In Courtenay-Comox and Alert Bay more than three-fifths of the
votes were in favour, and in two other communities the majority of votes were in
favour but the mandatory 60-per-cent majority was not attained. In the Greater
Vancouver Water District 56 per cent of the votes cast were in favour, and thereby
the 875,000 persons resident will not as yet benefit from this important public
health measure.
PERSONNEL
During the past year one regional dental consultant resigned to join the Faculty
of Dentistry, Univeristy of British Columbia. His replacement, fortunately, has
already received graduate training in dental public health. A second consultant
resigned to enter private practice but has remained on a part-time basis until a suitably qualified and experienced successor can be attracted to this vacancy.
Again we were most appreciative to the Dental Health Division, United States
Public Health Service, for the privilege of having one of our dental consultants
tutored by its senior staff over a five-week period. This advanced training included
attendance at its field research centre at San Francisco and observation of a clinical
trial at New Orleans where the self-administration of a known cariostatic (decay
preventing) agent was being field-tested. This experience will be of inestimable
value to this Division when carrying out further field research studies.
The Director of this Division was privileged to be invited to attend a three-week
institute in advanced dental research, with special emphasis on epidemiology and
biometrics, sponsored by the American College of Dentists. Several internationally
recognized authorities in these and allied fields led discussions with this group, which
numbered 15. All participants had previously carried out field dental research projects within their respective university, health department, or pharmaceutical manufacturing organization. A conference on the clinical testing of cariostatic agents
followed the institute and was arranged by the Council on Dental Therapeutics of
the American Dental Association. There were some 70 participants, including those
foremost in this field in North America and others from England and Continental
Europe. It is planned that from this conference there will evolve guidelines for the
future conduct of such trials so that greater reliability and international comparability
of results will be attained. Since this Division has already given some leadership in
Canada in the carrying-out of this type of field research, the information derived
from this conference will be of great value in the conduct of current and future trials.
In addition to dental caries, there are at this time two other major dental public
health problems—malocclusion (crooked teeth) and periodontal (gum) disease. In
British Columbia, Province-wide surveys have shown that three out of every ten
school-children have severe malocclusion. A dental handicap of this severity may
cause speech difficulties, interference with the proper mastication of food, or personality or emotional problems. The treatment of such cases is, of course, lengthy and
costly. After the age of 35 years more teeth are lost because of periodontal disease
than from dental caries. In this Province three out of every ten 15-year-olds show
evidence of periodontal disease (inflamed gums), which, if unresolved, will lead to
periodontosis (pyorrhoea) and loss of teeth in early adulthood.
SERVICES AND PROGRAMMES
Since 1963 the Greater Victoria School Dental Service has carried out an entirely preventive programme, directing all its efforts to the counselling of parents,
PREVENTIVE MEDICINE N 71
education of children, and motivation for necessary treatment to be carried out by
the family dentists. They achieved an enviable record in the 1961-67 Province-wide
survey. Children of the Greater Victoria School District had a lower dental-caries
attack rate than was recorded in any other region of the Province, and the percentage
of children who had all dental caries adequately treated was higher in Greater Victoria than in any other region.
Greater Vancouver Metropolitan Dental Division has these past years given
ever-increasing attention to dental health counselling and education in the health
units and in the schools. This past year, for the first time, it employed a dental
hygienist to give additional services in this area of activity.
During the school-year 1967/68, in both the metropolitan areas, routine
educational dental examinations revealed that 51 per cent of all Grade I pupils
were not in obvious need of dental treatment, and follow-up of those needing
treatment showed that a further 38 per cent of the total received treatment from
their family dentist or, in Vancouver, at the school dental clinics. Records for the
school-year 1953/54 (the first year that comparable records are available) show
that at that time only 29 per cent of Grade I pupils in these areas were not in
obvious need of treatment at the time of examination.
In 16 of the 18 rural health units of this Province, in 31 communities with
resident dentists, 3-year-old birthday-card programmes were in operation during
the 1967/68 school year. By these programmes, more than 5,500 3-year-olds
visited their family dentist. The previous year there were 24 such programmes,
in which some 3,500 children so benefited. Participation rates within these programmes continue to improve. In many communities more than two-thirds of the
3-year-olds who are known to the health unit, and who have received a birthday
card, subsequently visit their family dentist, while in one community monthly participation rates have now reached 80 per cent. A high level of utilization of this
service is invariably achieved when a member of the health unit staff carries out a
tactful and persuasive telephone follow-up with non-participating families. Children
who profited by these programmes received, at no direct charge to the parents, a
complete dental examination including X-rays if necessary. Most children, in
addition, benefited by having applied to their teeth a decay-preventing fluoride
solution. Parents were advised as to how and when their children's teeth should
be brushed and as to how dental decay may be significantly reduced by a sound
dietary regimen, especially in relation to sweet foods and confections. Any further
treatment required by these children was carried out at the family's expense.
The South Okanagan Union Board of Health has, since the summer of 1964,
employed one and latterly two dental hygienists. School dental health programmes
are operated in seven school districts within the areas of the North and South
Okanagan Health Units. Dental examinations and classroom dental health demonstrations are carried out in Grades I, III, V, and VII. Each year some 15,000
children are examined and counselled. All children are given a card to be presented
to their family dentist and later collected by the health unit staff. Families for whom
such cards are not returned to the health unit are contacted by telephone, and
endeavours are made to persuade them to have their child attend the dentist. Before
the close of the school-year a Dental Award Day is held, when children whose cards
have been returned receive a small prize. At this time in many communities between
70 and 80 per cent of all children have either been to their dentist or on examination
are found to be either caries-free or having had all necessary treatment completed.
In 1964, in the first Okanagan community to benefit by a dental hygienist programme, 38 per cent of the Grade I pupils were classified as dentally neglected;
that is, having previously received no dental treatment whatsoever. In 1967 the
N 72 PUBLIC HEALTH SERVICES REPORT, 1968
percentage of Grade I children in this category in this community had been almost
halved to 22 per cent.
Six dental public health externs, being fully qualified young graduate dentists,
during the school-year 1967/68 visited 44 communities, each without a resident
dentist. Visits included travel to such remote areas as the Queen Charlotte Islands,
the western Chilcotin country, and the north-west coast of Vancouver Island, and
such communities as Field, Bralorne, Sointula, Chetwynd, and Stewart. Five
further communities were visited by individual dentists for periods of two or three
weeks or on a monthly basis. The newly designed transportable equipment issued
on free loan to each extern greatly facilitated treatment and was much appreciated
both by the patients and the dentists. Nine sets of this equipment are now available.
In each community visited there was previously organized a dental programme
for the younger children, for which the costs are shared equally by a local agency,
usually the Board of School Trustees, and the Health Branch. Parents register their
children within the programme for a nominal fee and pay no further costs for the
treatment provided. This past school-year, 1967/68, by these programmes, approximately 3,000 children (aged 3 years to pupils of Grade III) received complete
restorative and preventive dental treatment. In these communities the dentists
also provided older children and adults with dental treatment on a fee-for-service
basis.
The Oral Cancer Committee of the British Columbia Dental Association has
been most active this past year in encouraging the dental profession to give increased
attention to the EARLY DETECTION OF CANCER within the oral cavity. Clinical demonstrations of the oral smear and biopsy techniques were presented in Vancouver at the annual meeting of the association and at many local dental society
meetings. The booklet " Oral Cancer Diagnostic Services " was rewritten to include
a section describing appropriate biopsy techniques and distributed to all members
of the dental profession in this Province. This was a co-operative project among
the British Columbia Cancer Institute, the Faculty of Dentistry of the University of
British Columbia, the dental association of this Province, and this Division. These
four organizations also assisted the Canadian Broadcasting Corporation in the preparation of a 30-minute television film designed to bring these services to the attention
of the public.
In British Columbia there is at present one dentist for every 2,416 persons.
This ratio has worsened each year for the past five years. During the past decade
the population of British Columbia has increased by 31.4 per cent and the number
of dentists has increased by 27.9 per cent. Notwithstanding that this Province has
more dentists per person of population than any other Province in Canada, the
uneven distribution of practitioners results in an acute shortage of dental services
in many rural areas; for example, in the Greater Vancouver region the ratio of
dentists to population is approximately 1:1,800, while for the Cariboo, northern,
and north-western areas of this Province a ratio of 1:4,750 pertains. The Faculty
of Denistry of the University of British Columbia graduated its first class of six
students in the spring of this past year. Final- and third-year classes each have
seven students, while in second year there are now 20 students.
In addition, 20 students were selected for the first two-year course for dental
hygienists. At the beginning of 1968 there were 39 dental hygienists licensed to
practise in British Columbia.
RESEARCH
The results of the study carried out in the Fraser Valley to observe the effects
of supervised tooth-brushing using an acidulated fluoride phosphate solution have
PREVENTIVE MEDICINE N 73
now been evaluated. At the commencement of the study there were 1,271 children,
mostly 12 and 13 years of age. These students carried out a total of nine brushings
during the two school-years. They were examined annually during the study and
again one year later. Half the children brushed with the test solution and half with
distilled water to which only the inactive flavouring agent had been added. At the
end of the two-year period, 494 subjects in the experimental group had approximately 25 per cent fewer newly decayed tooth surfaces than the control group
comprising 525 subjects. This difference was sustained during the following year
of observation. At the conclusion of the study, the control subjects, on an average,
had three more tooth surfaces which had decayed during the three-year period
than the subjects who had brushed their teeth nine times with the test solution.
The public health significance of these findings must, however, await their confirmation by other similar studies.
Examinations have been completed for a total of 252 children in the Lower
Mainland area who were known to have received a tetracycline drug during infancy.
Of these subjects, 23 per cent demonstrated resulting discoloration of the permanent teeth. The records of these 59 children and of the 193 whose teeth suffered no
discoloration are being carefully compared to endeavour to ascertain if one particular
tetracycline drug is responsible or if there is a " threshold " dosage beyond which
discoloration occurs.
In the Kootenay region the dental consultant contributed in a community
weekly newspaper a column entitled " Dental Data." After six months, questionnaires were distributed to the homes by Grades I and II pupils. Forty-six per cent
of the questionnaires were returned. Of the regular readers of the paper, 88 per
cent stated that they had read the dental column and 50 per cent that they read
the column regularly. Of the total respondents, 61 per cent indicated that they had
learned " something " from the column, 29 per cent " quite a bit," 5 per cent " a
great deal," and 5 per cent " not much."
In Prince George, with the co-operation of the local dentists, the dental consultant organized a survey of 962 children aged 6 to 14 years. All were lifetime
residents of this community, which in 1955 commenced fluoridation of its water
supply. Dental surveys had previously been carried out in 1956 and 1962, and
results of these surveys were compared with those of this year. In the 12-year
period 1956—68 the over-all reduction of permanent teeth attacked by decay was
61.1 per cent. For the 12—14-year-old group the loss of permanent teeth decreased
by 86 per cent. Not one child was observed with disfiguring fluorosis (mottling).
In the Greater Victoria schools a study was carried out during the 1967/68
school-year to evaluate the motivational effects of classroom diagnostic examinations
toward having children attend their family dentists. This study comprised some
1,600 Grades I to V pupils. The first group received a diagnostic examination and
at that time minimal dental health education. Those children who were obviously
in need of dental treatment received a card notifying the parents to this effect. The
second group received a diagnostic examination with maximal dental health education, and those in need of treatment received a card similar to that received by the
first group. The third group received the same maximal dental health education,
and all pupils received a card recommending regular dental examinations and
treatment as necessary by the family dentist. The fourth group received minimal
dental health education, and all pupils a card similar to that used with the third
group. The latter two groups were examined clinically to determine those in need
of treatment, but parents were not informed of the results of these examinations.
In terms of motivation for those in need of treatment to attend their family dentist,
there was little difference in response of these subjects in the first two groups and
N 74 PUBLIC HEALTH SERVICES REPORT, 1968
between such subjects in the latter two groups. However, there were nearly twice
as many subjects in group one and two in need of treatment who attended their
family dentist compared to such subjects in the latter two groups. Therefore, within
the circumstances of this study, it appeared that a diagnostic examination with the
parents of children in need of treatment being so notified, in fact, motivated the
parents to have their children attend their family dentist for treatment.
During the year it became necessary to modify the chewing-gum study being
carried out in the Trail area. While a gum had been prepared in a research laboratory which contained dicalcium phosphate dihydrate agglomerated with sugar and
free fluoride in a precise quantity, difficulties arose when preparing such a gum in
commercial quantities. Now being studied are three groups—one chewing a dicalcium phosphate sugar gum, a second group chewing a sugarless gum, and a third
group who received no gum. The gum was first issued in February of this year.
Toothbrushes and a non-therapeutic dentifrice were provided and will continue to
be provided to all three groups. Dental re-examinations were carried out in May
and June, 1968, and in 1969 and 1970 will be repeated.
The World Health Organization has recently developed a global methodology
for dental epidemiological surveys, and some entirely new concepts for the recording
of dental diseases and abnormalities have been included. This methodology was
demonstrated in Canada in 1967 at the annual meeting of the Canadian Public
Health Association. It is planned that it will be the basis of Canadian national
dental health indices. To provide such data from British Columbia, when the regular dental health survey was carried out in Greater Vancouver early in 1968, all
2,077 subjects (aged 5 to 19 years) were also examined according to the WHO
methodology.
In addition, a study is being carried out in the Fraser Valley to determine if a
correlation can be determined between the crude WHO indices and the precise
treatment needs of the subjects examined.
In the Okanagan, with the co-operation of a psychologist of the Mental Health
Services, there is being developed a research project to test " high fear," " low fear,"
and " combined " approaches to parents who had not previously been motivated to
place their child under care for urgently needed dental treatment.
GENERAL
Since 1956 a continuing programme of Province-wide surveys has kept under
constant surveillance the dental health status of the British Columbia children. In
Greater Vancouver, in 1956, 1962, and 1968, such surveys have been carried out.
The percentage of children of all ages (7 to 15 years) with no untreated carious
lesions in 1956 was 15.4, in 1962 it was 31.0, and in 1968 it was 49.2. For each
age-group the number of permanent teeth attacked by dental decay was lower in
1962 than in 1956, and again lower in 1968 than recorded by the 1962 survey. For
13-year-olds in 1956 the average number of permanent teeth having experienced
decay was 10.2, reduced to 8.5 in 1962, and further reduced to 6.9 in this year's
survey. However, in Prince George, which commenced fluoridation in 1955, comparable data for this age-group showed a reduction from 11.2 to 4.5; that is, a reduction of 60.1 per cent over the same period of time.
When all other communities of British Columbia benefit by this important
public health measure, and when all school districts benefit by dental health programmes conducted by dental hygienists, then there will be a truly significant improvement in the dental-caries status of the children and, in later years, of the adults
of this Province. Preparation must be made at this time to pioneer dental public
health programmes for the control of malocclusion and periodontal disease.
PUBLIC HEALTH ENGINEERING N 75
PUBLIC HEALTH ENGINEERING
Outstanding in a year notable for an increased tempo of activity, three developments in particular were given high priority in the work of the Division. These were
implementation of an announced policy requiring that sewage be treated prior to
discharge into surface waters, the preparation of water- and air-quality standards,
and the provisional approval of the first tertiary treatment plant for a British Columbia municipality. These events all pointed toward a milestone in the struggle against
pollution of the environment. It has been evident from the many discussions with
municipal officials and public alike that the people of this Province support the efforts
of the Department and are anxious to do what they can to restore and preserve their
environment. Even though a good deal of progress has been made this year to
make people aware of the problems, there is need for continued explicit explanation
of the public measures that may be undertaken to conserve our natural environment
for the future.
APPROVAL OF PLANS AND SPECIFICATIONS for all public water and
sewerage works constructed in British Columbia is the primary divisional function.
A second function is that of CONSULTANT SERVICE TO FIELD STAFF on
subjects such as water supplies and treatment, sewage and solid-waste disposal, public swimming-pool approvals, subdivision approvals, industrial ventilation, and air-
pollution problems.
A Ministerial certificate of approval must be issued prior to construction of
any public water or sewerage works. This year the number of these certificates issued
totalled 139 for waterworks and 133 for sewerage-works; this is for the first nine
months of the year only. In some instances, provisional approval is sought before
proceeding with money by-laws. One of these was the tertiary treatment plant—the
first in the Province—previously mentioned. It is expected that this proposed plant
will greatly reduce the amount of nutrient material presently being discharged from
one of the Okanagan Valley municipalities into Okanagan Lake.
A considerable amount of time was devoted to discussions, speeches, and lectures relating to the policy statement concerning sewage-treatment requirements.
The statement was issued in late September and applied to all areas of the Province.
Health approvals for sewer-main construction to serve unoccupied areas were withheld in cases where inadequate sewage-treatment facilities were provided. Only
when the municipalities submitted satisfactory evidence that a programme was under
way to finance and construct a minimum of primary treatment facilities was granting
of approvals resumed. Allowances were made to enable sewer construction in areas
of existing land pollution. This policy advanced the construction date on a number
of treatment plants. All pollution-control permit applications received for the information of the Health Branch were considered by both the local health unit staff
and engineers of the Division. In cases where the public health was concerned, comments went to the Pollution Control Branch.
As mentioned elsewhere in this volume, STANDARDS FOR WATER
QUALITY were prepared and reviewed. They will be used as a guide to the field
staff and to those involved in the supply of potable water and in the treatment of
waste water.
New regulations introduced last year continued to require our interpretation
and support. The PUBLIC SWIMMING-POOL REGULATIONS required more
attention than the others, and a one-day school was offered at 10 different centres
throughout the Province. Three staff engineers presented lectures on subjects such
N 76
PUBLIC HEALTH SERVICES REPORT, 1968
as regulations, pool design, public health objectives, pool chemistry, recirculation
systems, filtration, and operating problems. More than 300 persons attended these
short courses.
Another aspect of environmental control is SOLID-WASTE DISPOSAL.
This has definite public health significance, and some valuable assistance was provided to municipalities and regional districts which experienced garbage-disposal
problems. This subject requires more attention.
One of the major roles of the Division is to offer CONSULTATIVE ENGINEERING SERVICE TO MUNICIPALITIES on subjects relating to environmental control. The engineers, during their field visits, inspected water and sewerage
works with the purpose of reviewing the operation of the works to ensure safety
to public health. This year 323 official visits were recorded. In addition to speaking to municipal delegations on matters of public health, members of the staff were
active in various other types of speaking engagements, including the Swimming
Pool Contractors' Association, the Institute of Adult Education in Victoria, the
Professional Engineers Continued Training Programme (Municipal Engineering
Division), the Public Works Convention, the Plumbing and Mechanical Contractors'
Association, and the British Columbia Recreation Association. The Division staff
again shared responsibility with the University of British Columbia for organizing
and teaching at the British Columbia Water and Wastes School.
WARNING
UKStfE m MTHINC
mm POLLUTED
:xs
™»*
;.*.* •'■*
Pollution control has become of increasing concern to British Columbia's Government. Pictured are, left, the Honourable R. G. Williston, Minister of Lands, Forests, and
Water Resources, and, right, the Honourable Ralph R. Loffmark, Minister of Health
Services and Hospital Insurance; between them is Dr. J. A. Taylor, Deputy Minister
of Health.
PUBLIC HEALTH ENGINEERING N 77
A major contribution by this Division was made to the National Advisory
Committee on Public Health Engineering when it prepared a report on " A Comparison of Canadian Standards for Private Sewage Disposal Systems." A comparison, in tabular form, showed that even with slight variations in the requirements across Canada, a common basis of approach could be adopted as a Canadian
standard.
IN-SERVICE TRAINING PROGRAMMES are considered important in
these days of rapid change and development. Staff members were able to take
advantage of a number of short courses offered at Corvallis, Oreg., and Cincinnati,
Ohio. The courses included " Elements of Solid Waste Management," " Sanitary
Land Fill—Principles of Design and Operation," " Basic Fresh Water Biology,"
" Fresh Water Pollution Ecology," and " Basic Principles of Waste Water Treatment Operation." The conferences that were attended included the Pollution Conference in Banff, the British Columbia Public Works Association Convention in
Williams Lake, and the Western Canada Water and Sewage Conference in Calgary.
AIR-POLLUTION PROGRAMME
During the year AIR-QUALITY SURVEY PROGRAMMES were conducted
by the Health Branch as the result of continuing requests from the field for technical
assistance in determining local levels of air pollution. The air-monitoring programmes in Port Alberni, Prince George, and Nelson were continued throughout
the year. The Sparwood-Natal-Michel study was terminated late in the year after
the programme provided satisfactory evidence of the degree of pollution existing in
the tri-community area. Air-quality survey programmes were investigated and
instituted in the Lower Mainland area, in Marysville, and in Castlegar.
In August the Minister directed the Air Pollution Advisory Committee of the
Health Branch to draft STANDARDS FOR AIR QUALITY in British Columbia.
During the year the Division of Public Health Engineering offered technical
advice to industrial organizations on controlling the release of contaminants to the
atmosphere from their plants. Many industries were visited, including forest products, gypsum plants, and the cement industry.
During the year 179 dust-fall canisters were collected. In addition, 537 24-
hour filter samples were obtained to determine the suspended particulate in the
atmosphere. One hundred and twenty-two smoke tapes and 152 lead peroxide
candles were collected to determine the total smoke and total sulphation in the
atmosphere; this was done in the various localities in the Province. The field work
was done by public health inspectors of the health units, and testing was carried out
by the Provincial Health Laboratory. The work continues.
N 78
PUBLIC HEALTH SERVICES REPORT, 1968
PUBLIC HEALTH INSPECTION
An introduction of new regulations under the Health Act has done much to
ensure the safety of the environment. As a result of the new regulations, the public
health inspectors' activities have shown a marked increase. The Consultant in
Public Health Inspection has not only answered numerous inquiries concerning the
regulations, but has attended a number of meetings with health unit staff and community organizations to assist in the interpretation of the regulations.
Since the passing of the SEWAGE-DISPOSAL REGULATIONS, the Department of Lands, Forests, and Water Resources has co-operated by referring Crown
subdivisions to the Medical Health Officers for comment. These referrals have
recently been extended to include waterfront leases and residential inland home-sites
of 5 acres or less.
Because of the more stringent health regulations, a substantially greater number
of SUBDIVISIONS have been referred to the Medical Health Officers for an opinion
as to the suitability of the soil for septic-tank installation. Consequently more
subdivisions have been serviced with both water and sewage systems.
The CAMP-SITE REGULATIONS have had the effect of not only updating
existing camps, but have resulted in the development of some first-class privately
operated tent and trailer parks throughout the Province.
The Consultant in Public Health Inspection has worked with various groups
representing the MOBILE-HOME AND CAMP-SITE OPERATORS, including
The public health inspector works closely with local fire and building authorities in
the inspection of sub-standard housing. This dilapidated shack is on the outskirts of one of
British Columbia's coastal cities.
PUBLIC HEALTH INSPECTION N 79
the British Columbia Motels and Resorts Association. Co-operation with the Department of Travel Industry has resulted in travel counsellors contacting the public
health inspectors prior to the listing of tent and trailer parks in the British Columbia
Tourist Directory.
SURVEYS
A sanitary survey of cannery housing at Port Edward and Namu was completed in July of this year by the staff of the Skeena Health Unit. Members of the
Miller Bay Hospital staff provided valuable assistance. There is a need to upgrade
the native housing situation in the area to prevent overcrowding and to provide
adequate sanitary facilities. Action to achieve this has been initiated. The senior
public health inspector of the Skeena Health Unit has been active in a survey of
substandard housing in the downtown area of Prince Rupert. In this he worked
in co-operation with the city fire chief and building inspector. One hundred and
fifty-two units were inspected, of which 20 were subsequently brought up to standard; 89 were closed or destroyed.
TRAINING COURSES FOR FOOD-HANDLERS
The Consultant in Public Health Inspection represents the Health Branch
on the Food Trades and Accommodation Industries Advisory Committee, which
advises the Department of Education on various TRAINING PROGRAMMES
FOR FOOD SERVICE WORKERS. Health unit staff have participated in the
spring crash training programmes for waitresses sponsored by the School Boards
in many areas of the Province. A close liasion is maintained with the Co-ordinator,
Accommodation and Food Services, Department of Education, who is responsible
for the training programme.
An outbreak of FOOD POISONING affected 300 persons attending a banquet
at a Trail restaurant in January, 1968. At that time the imminence of the Olympic
ski meet was expected to tax the food-handling facilities of the Trail-Rossland area
to the utmost. With these facts in mind, the health unit director decided that there
was an urgent need for a crash food-handlers' training programme. The special
efforts of the public health inspectors in " selling " this programme to food-handlers
contributed immeasurably to the success of the course. A total of 215 persons
attended the classes.
PERSONNEL
The number of public health inspectors employed by the Health Branch totalled
59, plus four trainees. These four have now successfully completed the last of the
one-year in-service correspondence course given by the Canadian Public Health
Association for the Certificate in Public Health Inspection, and, in line with Health
Branch policy, have been transferred to other health units to gain further experience
as fully qualified public health inspectors.
A two-year course at the British Columbia Institute of Techology has replaced
the one-year correspondence training course for public health inspectors. Four
students completing the first year were hired during the summer months and
seconded to Provincial health units to gain field experience and to assist health unit
staff. A close liaison is maintained with those responsible for the training course
at the Institute, and representatives of the Health Branch have been asked to
give lectures on a variety of subjects, including food-handling and public health
administration.
N 80 PUBLIC HEALTH SERVICES REPORT, 1968
Statistical Summary of Public Health Inspectors' Activities, 1966 and 1968,
for 17 Provincial Health Units1
„ , . 1966 1968
Food premises (Preliminary)
Eating and drinking 2,657 4,808
Food-processing plants 440 397
Food-stores 1,263 1,111
Slaughter-houses 166 153
Shellfish plants 351 167
Other food premises 242 184
Industrial camps 365 325
Institutions—
Hospitals 119 79
Boarding homes 351 308
Kindergartens 258 61
Summer camps 201 289
Other institutions 94 120
Housing 1,702 2,079
Tourist accommodation 609 1,912
Barber-shop and beauty-parlours 730 667
Farms—
Fur-farms 182 59
Live stock 105 180
Piggeries 188
Poultry-farms 168
Pollution control—
Bacteriological 2,754 2,401
Chemical 865 1,040
Disease investigation 400 423
Industrial health visits 1,027 424
- Consultation 23,198 27,103
Site inspections—
Subdivisions 1,706 3,755
Other 2,628 8,453
Waste disposal—
Garbage dumps 912 1,004
Industrial waste 298 712
Private garbage 608 964
Recreation—
Fairs 52
Parks and beaches 775
Restrooms 556
Other recreation 73 124
Sewage—
Municipal outfalls and plants 1,102 1,056
Private sewage disposal 2,515 11,380
Plumbing 372 277
Samples 420 161
Surveys—
Sanitary 419 380
Other 406 748
PUBLIC HEALTH INSPECTION
N 81
Statistical Summary of Public Health Inspectors' Activities, 1966 and 1968,
for 17 Provincial Health Units1—Continued
Schools
Public water supplies-
Inspection
Sample
Private water supplies—
Inspection
Sample
Swimming-pools—
Inspection
Sample
Complaints investigated—
Sewage
Garbage and refuse...
Other
Telephone calls
Meetings
Educational activities
1966
1,229
1968
(Preliminary)
431
1,943
6,609
1,453
6,044
2,164
3,736
2,159
2,675
813
739
1,920
1,199
2,708
2,165
2,046
38,066
1,735
906
3,855
2,295
2,637
54,333
2,492
1,145
i Does not include Saanich and South Vancouver Island Health Unit.
The following items in the foregoing table are of special interest:—
The number of subdivision inspections increased from 1,706 in 1966 to 3,755
in 1968. The huge increase in this phase of the public health inspectors' activities
represents not only a careful review of plans, but a detailed survey of the property
to scrutinize soil conditions, water-table, lot sizes, etc.
Site inspections to determine suitability of lots for septic-tank disposal increased from 2,628 in 1966 to 8,453 in 1968. Most of this increase can be
attributed to the introduction of Regulations Governing Sewage Disposal, and is
indicative of a sound preventive health programme to reduce further pollution. The
introduction of sewage-disposal permits by the Medical Health Officer accounts
for the great increase in the number of private sewage-disposal visits, amounting
to 2,515 in 1966 as opposed to 11,380 in 1968.
The introduction of Swimming-pool Regulations has meant closer supervision
of swimming-pool operations. This is evidenced by 813 inspections in 1966 as
compared to 1,920 in 1968.
Because of the significance of the tourist industry in British Columbia, public
health inspectors increased the number of restaurant inspections from 2,657 in
1966 to 4,808 in 1968. Other tourist accommodation, including mobile-home
parks and camp-sites, accounted for 609 inspections in 1966 as compared with
1,912 in 1968.
Not shown in the table are inspection visits to air-sampling stations, mentioned in the report of the Division of Public Health Engineering. At each station
this involved a significant portion of the time of the public health inspector in that
locality.
L
N 82 PUBLIC HEALTH SERVICES REPORT, 1968
SHELLFISH PROGRAMME
The relationship between marine environment and shellfish production has
been given considerable attention over the past five years, firstly, in relation to
the problem of TOXICITY IN CLAMS which may result in paralytic shellfish
poisoning to the consumer, and, secondly, to the BACTERIOLOGICAL EXAMINATION OF OYSTERS and oyster-growing waters so that international standards can be met under British Columbia climatic conditions.
In the matter of toxicity it has been determined by a pilot study by the
Canada Department of Fisheries that under controlled conditions the conventional
canning process will reduce the toxicity of the raw product to an acceptable level,
which could lead to a recovery and development of the butter clam resource from
the northern waters of the Province presently closed to the taking of butter clams.
Secondly, the extensive sampling of clams for toxicity strongly indicates that an
increase in toxicity occurs in the summer months. For this reason, sampling will
be conducted in the period April 1 to October 30, 1969. Of the 780 samples
collected for bio-assay examination during 1968, 22 per cent failed to meet the
international standard.
The comprehensive three-year bacteriological sampling programme of oyster-
growing waters and shellstock was completed on June 30th. Examination of the
shucked product from shucking and packing plants on a routine monthly basis
continues. Results of examinations during the three-year period were concurrently
given to the lease-holders and plant operators to help in their evaluation of harvesting measures and plant procedures. These actions served to promote the industry
and to resolve the recurring problem of the export product failing to meet the
United States Food and Drug Administration requirements. Two new practices
have been initiated within the industry: firstly, a preliminary heat-treatment processing arrangement for the product destined for cannery and heat packing use;
secondly, through a joint Provincial and Federal fisheries subsidy, a 50 bushels-
per-day commercial oyster depuration plant will be in operation in 1969, the first
such commercial oyster operation on the continent.
The practice of the forest industry whereby logs stored in the vicinity of
shellfish-growing waters are treated to control the ambrosia beetle was again approached. A further refinement resulted in the use of a less toxic material—
namely, methyl trithion, an organo-phosphate—to replace benzine hexachloride of
the hydrocarbon group.
The participation of the Health Branch in the monitoring of shellfish-growing
waters and the inspection and certification of shucking plants started in 1926 to
control potential disease of bacterial origin. In the intervening years, significant
advances in fish technology, engineering services, plant inspections and licensing,
laboratory facilities, research resources, marketing advantages, and other amenities
and assistance have been made available to the fishing industry by the Canada
Department of Fisheries. It is suggested that enforcement of bacterial standards
and plant licensing could readily become the continuing responsibility of the
Federal department on the Pacific Coast as well as the Atlantic, thereby enabling
the Health Branch to discontinue its activity in the promotion of this resource, and
at the same time facilitating international negotiations.
EMERGENCY HEALTH SERVICE
N 83
EMERGENCY HEALTH SERVICE
The British Columbia Emergency Health Service Plan was completely rewritten
and brought up to date this year. It has been incorporated in the Health Branch
Policy Manual, which is available in all offices of local health services throughout
British Columbia; it has also been distributed to all other agencies of government
which would be affected by it. Bound printed copies will shortly be available for
additional distribution.
The Health Branch has assembled documents considered essential for the
proper operation of an emergency public health service. With the co-operation of
the Provincial Civil Defence Organization, microfilming of the more important of
these has been completed, and they are now stored in the regional emergency government headquarters in Nanaimo.
The Director of the Emergency Health Service this year was again chairman
of the British Columbia Medical Association's Disaster Planning Committee. Other
members are the Medical Health Officer of the City of Vancouver, the Superintendent of the Pacific Region, Medical Services Directorate, Department of National
Health and Welfare; and representatives from all the Lower Mainland medical
societies. A disaster plan for the Greater Vancouver metropolitan area has been
developed and is now in the process of being implemented. This particular project
proved to be far more complex than was first anticipated, and has occupied a great
deal of time.
Arrangements have been made with the security section of the Canada Armed
Forces to install and maintain intrusion alarms in all the pre-positioned sites where
narcotics and control drugs will be stored. A number of these alarms have already
been installed, and more will be in place shortly.
The Health Supplies Officer, who had been with the Provincial Emergency
Health Service since its inception, retired on July 31st. A new position of Pharmaceutical Consultant was created, and this appointment has now been filled.
The Emergency Health Service is responsible for the pre-positioning of emergency medical
units throughout the Province.
N 84 PUBLIC HEALTH SERVICES REPORT, 1968
Three well-attended one-day public health disaster institutes were held in 1968;
these took place at Prince George, Kamloops, and Vernon. The institutes were
designed to acquaint the public health field staff with their duties and responsibilities
in the event of a major natural or wartime disaster. The institutes were also attended
by representatives from the many other community agencies which would be working
with the public health staff in the event of disaster.
An advanced treatment centre designed for training purposes was set up in a
typical rural high school to allow us to determine the suitability of such accommodation and to learn what the potential problems might be in the event that this accommodation was ever needed. At the same time the advanced treatment centre was
demonstrated to those people in the community who would be involved in its
operation; approximately 60 people attended.
The components of the emergency hospital (training) were demonstrated in
Campbell River at the time of the official opening of a new wing of the Campbell
River Hospital, where our local operational unit is stored.
The Director lectured at four Provincial Civil Defence training courses, and
also to the student nurses at St. Joseph's Hospital School of Nursing in Victoria, on
the organization and operation of the Provincial Emergency Health Service, and on
the health hazards of radiation.
Pre-positioning of emergency medical units throughout the Province has continued, and in this generous help has been received from the Provincial Civil
Defence Organization. Units were distributed to Campbell River, Duncan, Mission,
100 Mile House, and Revelstoke. In other pre-positioning activities, two casualty
collecting units have been based at the Vancouver International Airport, and two
at the Abbotsford International Airport, which is used as a satellite airport when
the Vancouver Terminal is closed on account of fog. Arrangements have been
made to place one casualty collecting unit at eight other airports in British Columbia
operated by the Department of Transport. A unit has also been placed at Boston
Bar, midway in the Fraser Canyon. One hundred blood-donor packs have been
placed in 13 strategically placed hospitals throughout the Province. A reserve of
five packs is kept in the main medical stores depot in Kamloops.
Training of persons involved in the Emergency Health Service continued; a
total of nine persons attended courses conducted at the Canadian Emergency Measures College at Arnprior, Ont., from British Columbia. These were composed of
Health Branch, hospital, and pharmaceutical personnel.
NUTRITION SERVICE
N 85
NUTRITION SERVICE
The consultation and service provided by the public health nutritionist has
concentrated attention on the following nutritionally vulnerable groups of people:—
(1) Low-income and fixed-income families.
(2) Native Indians and first-generation New Canadians.
(3) Northern communities.
(4) Teen-agers and senior citizens.
(5) Health-handicapped persons requiring special diets.
For the second year now, a series of food-buying slides has been developed as
an aducational tool for consumer groups, particularly those with LOW INCOMES.
Public health nurses and home economists have used them with prenatal classes, premarital classes, SENIOR CITIZENS' groups, training programmes for visiting home-
makers, and consumer guidance classes for TEEN-AGERS. These slides and dialogues were developed with the assistance of the nutritionist of the Pacific Region of
the Medical Services Directorate, Department of National Health and Welfare, and
have been most successfully used by INDIAN homemakers' groups. A number of
welfare recipients are also benefiting from these materials.
Vancouver City nutritionists organized a series of six half-hour television programmes entitled " Beat the Food Budget " and viewed on CHAN-TV. There has
been a widespread viewing audience, judging by the requests for low-cost recipes
from over 4,000 viewers. In conjunction with the television shows, organized discussion groups that followed each programme were held in seven low-cost housing
developments in Vancouver. Similar LOW INCOME discussion groups are being
organized in Victoria and other viewing centres in the Province for the next television
series.
One of a series of slides made to assist consumers (especially low-income groups) in
food-buying. Prices on the various food items indicate cost per serving.
N 86
PUBLIC HEALTH SERVICES REPORT, 1968
NORTHERN COMMUNITIES are handicapped by high food costs, as indicated by the second Provincial Food Cost Survey. Results from this survey, in which
store foods were costed in 47 cities and towns, indicate a difference of approximately
20 per cent for monthly food bills between the centres with the highest and lowest
food costs.
School-teachers and community health workers in a few NORTHERN COMMUNITIES have received consumer and home-management information to be used
by LOW-INCOME FAMILIES and INDIAN communities.
A survey of the nutritional status and dietary intakes of TEEN-AGERS was
conducted jointly by the School of Home Economics of the University of British
Columbia, the Upper Fraser Valley Health Unit, and the Health Branch Nutrition
Consultant. In this survey, data were collected from Grade IX students through
clinical examinations, biochemical analysis, anthropometric measurements, dental
examinations, and dietary records. Also two similar surveys were jointly conducted
by the Medical Services Directorate and the School of Home Economics of the University of British Columbia to assess the nutritional status of INDIANS. These
surveys are the first of a number of comprehensive studies to provide baseline data
regarding nutritional status of residents of British Columbia. Such information is
of fundamental importance to the establishment of criteria for future public health
nutrition programmes.
ANIMAL FEEDING DEMONSTRATIONS were highlights of nutrition
education programmes in 90 elementary schools. An evaluation of these programmes is providing information that will influence future trends in elementary-
school nutrition education.
Community DIET COUNSELLING services are very scarce. Effective diet
counselling is vital for persons with disorders such as diabetes, cardiovascular
disease, ulcers, gall bladder disorders, allergies, and metabolic disorders such as
phenylketonuria. The number of overweight and obese individuals is growing,
and the rising volume of requests for guidance from these people is of special
concern.
In 1969 continued effort will be made to provide, to expand, and to co-ordinate
nutrition services in British Columbia in order to bridge the gap between existing
scientific knowledge of nutrition and the public's knowledge and use of food.
PUBLICATIONS, 1968 N 87
PUBLICATIONS, 1968
" Portable Equipment for ' Sit-Down-Lie-Down' Dentistry," J. Canad. Dent.
Assn., 34:90, February, 1968, by A. S. Gray.
" An Evaluation of a Grade One Dental Health Program," Canad. J. of Pub.
Health, 59:166, April, 1968, by A. S. Gray.
" Dental Birthday Cards for Three Year Old Children," J. Canad. Dent. Assn.,
34:201, April, 1968, by A. S. Gray.
" Optimum Fluoride Levels for Community Water Supplies," J. Canad. Dent.
Assn., 34:250, May, 1968, by H. J. Hann.
" The Basic Philosophy of the British Columbia Dental Health Program," Canad.
J. of Pub. Health, 59:337, September, 1968, by H. J. Hann.
" Three Year Study of Self-Administration of a Fluoride-phosphate Solution," J.
Pub. Health Dentistry (fall issue, 1968), by J. M. Conchie, F. McCombie,
and L. W. Hole.
" Size of Tuberculin Reactions in Various Age Groups," Amer. Rev. Resp. Dis.,
Vol. 98, No. 2, August, 1968, by S. Grzybowski, G. F. Kincade, C. C. McLean, and J. Rowe.
" Lung Cancer Mortality According to Birthplace," Canad. Med. Assn. J., Vol. 99,
No. 10, September, 1968, by P. Coz, S. Grzybowski, and J. F. Rowe.
" The Combined Use of a Central Registry and Vital Records for Incidence Studies
of Congenital Defects," Brit. J. Prev. Soc. Med., Vol. 22, No. 22, April, 1968,
by D. H. G. Renwick.
" Serological Survey of Human Arbovirus Infections in Southeastern British Columbia," Canad. Med. Assn. J., Vol. 99, No. 12, September, 1968, by G. D.
Kettyls, V. M. Verrall, J. M. H Hopper, P. Kokan, and N. Schmitt.
" Retailing of Barbecued Chickens—A Survey in British Columbia," Canad. J.
Pub. Health, October, 1968, by R. G. Scott.
" Influenza in British Columbia, 1966-1968," Canad. Med. Ass. J., Vol. 99, No. 22,
December 7, 1968, by G. D. Kettyls, V. M. Verrall, M. R. Smart, J. M. H.
Hopper, and N. Schmitt.
" Salmonella: Ubiquitous Pathogens of Animals and Man " (editorial), Canad. J.
Pub. Health, October, 1968, by E. J. Bowmer.
Printed by A. Sutton, Printer to the Queen's Most Excellent Majesty
in right of the Province of British Columbia.
1969
730-1268^16
BC Sessional Papers
Seventy-second Annual Report of the Public Health Services of British Columbia HEALTH BRANCH DEPARTMENT… British Columbia. Legislative Assembly 1969
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