Open Collections

BC Sessional Papers

Ninth Report of the DEPARTMENT OF HEALTH AND WELFARE (HEALTH BRANCH) (Fifty-eighth Annual Report of Public… British Columbia. Legislative Assembly 1955

Item Metadata

Download

Media
bcsessional-1.0367835.pdf
Metadata
JSON: bcsessional-1.0367835.json
JSON-LD: bcsessional-1.0367835-ld.json
RDF/XML (Pretty): bcsessional-1.0367835-rdf.xml
RDF/JSON: bcsessional-1.0367835-rdf.json
Turtle: bcsessional-1.0367835-turtle.txt
N-Triples: bcsessional-1.0367835-rdf-ntriples.txt
Original Record: bcsessional-1.0367835-source.json
Full Text
bcsessional-1.0367835-fulltext.txt
Citation
bcsessional-1.0367835.ris

Full Text

 PROVINCE OF BRITISH COLUMBIA
Ninth Report of the
DEPARTMENT OF HEALTH
AND WELFARE
(HEALTH BRANCH)
(Fifty-eighth Annual Report of Public Health Services)
YEAR ENDED DECEMBER 31st
1954
VICTORIA, B.C
Printed by Don McDiarmid, Printer to the Queen's Most ExceUent Majesty
1955
  it   ;fc   « Office of the Minister of Health and Welfare,
Victoria, B.C., January 7th, 1955.
To His Honour Clarence Wallace, C.B.E.,
Lieutenant-Governor of the Province of British Columbia.
May it please Your Honour:
W&   The undersigned has the honour to present the Report of the Department of Health
and Welfare (Health Branch) for the year ended December 31st, 1954.
j| ERIC MARTIN,
Minister of Health and Welfare.
 Department of Health and Welfare (Health Branch),
Victoria, B.C., January 7th, 1955.
The Honourable Eric Martin,
Minister of Health and Welfare, Victoria, B.C.
Sir,—I have the honour to submit the Ninth Report of the Department of Health
and Welfare (Health Branch) for the year ended December 31st, 1954.
I have the honour to be, f§
• Sir'      f '
Your obedient servant,
G. F. AMYOT, M.D., D.P.H.,
Deputy Minister of Health.
 DEPARTMENT OF HEALTH AND WELFARE
(HEALTH BRANCH)
Hon. Eric Martin   -
Minister of Health and Welfare.
SENIOR PUBLIC HEALTH ADMINISTRATIVE STAFF
G. F. Amyot, M.D., D.P.H.
J. A. Taylor, B.A., M.D., D.P.H. -
G. R. F. Elliot, M.D., CM., D.P.H,
A. H. Cameron, B.A., M.P.H.      -
G. F. Kincade, M.D., CM.    -
C. E. Dolman, M.B., D.P.H., Ph.D., F.R.C.P.   -
W. S. Maddin, B.A., M.D., CM.   -      -      -
A. J. Nelson, M.B., Ch.B., D.P.H. -
J. H. Doughty, B.Com., M.A.
R. Bowering, B.Sc.(CE.), M.A.Sc.    -
T. H. Patterson, M.D., CM., D.P.H., M.P.H.   -
Miss M. Frith, R.N., B.A., B.A.Sc, M.P.H.
F. McCombie, L.D.S., R.C.S., D.D.P.H.     -
R. H. Goodacre, M.A., C.P.H.     -      -
Miss D. Noble, B.Sc.(H.Ec), C.P.H.   -      -      -
C. R. Stonehouse, CS.I.(C)       -
C. E. Bradbury       -------
Deputy Minister of Health and Pro-
vincial Health Officer.
Deputy Provincial Health Officer and
Director, Bureau of Local Health
Services.
Assistant Provincial Health Officer
and Director, Bureau of Special
Preventive and Treatment Services.
Director, Bureau of Administration.
Director, Division of Tuberculosis
Control.
Director, Division of Laboratories.
Director, Division of Venereal Disease Control.
Consultant in Epidemiology.
Director, Division of Vital Statistics.
Director, Division of Public Health
Engineering.
Director, Division of Environmental
Management.
Director, Division of Public Health
Nursing.
Director, Division of Preventive
Dentistry.
Director, Division of Public Health
Education.
Consultant, Public Health Nutrition.
Senior Sanitary Inspector.
Rehabilitation Co-ordinator.
E. R. Rickinson
Departmental Comptroller.
  TABLE OF CONTENTS
General—   Paoe
The Province and Its People _ :2L 11
The Health of the People  12
The Organization for Public Health Services  12
Other Major Developments and Activities  14
Report of the Bureau of Local Health Services  16
Health-unit Organization and Development  17
Administration  19
Community Health Centres  21
Home-care Programmes  22
Resident Physicians' Grants  26
School Health Services  26
The Health of the School-child  31
Table I.—Physical Status of Pupils Examined, Showing Percentage in
Each Group, 1947-48 to 1953-54  31
Table II.—Physical Status of Total Pupils Examined in the Schools for the
Years Ended June 30th, 1950-54  32
Table III.—Physical Status of Total Pupils Examined in Grades I, IV,
VII, and X for the Years Ended June 30th, 1953-54  32
Table IV.—Summary of Physical Status of Pupils Examined, According
to School Grades, 1953-54  32
Table V.—Physical Status by Individual Grades of Total Schools, 1953-54 33
Table VI.—Number Employed and X-rayed amongst School Personnel,
if                    1953-54 .  33
m Table VII.—Immunization Status of Total Pupils Enrolled, According to
If                    School Grade, 1953-54  33
Disease Morbidity and Statistics  35
Table VIII.—Notifiable Diseases in British Columbia, 1950-54 (Including Indians)  40
Table IX.—Notifiable Diseases in British Columbia by Health Units and
Specified Areas, 1954  41
Report of the Division of Public Health Nursing  42
Status of Service  42
OS     Public Health Nursing Consultant Service I  43
Public Health Nursing Training %  45
||     Local Public Health Nursing Service  46
General  48
Report of the Division of Environmental Management  50
A. Nutrition Services  50
Consultant Service to Local Public Health Personnel  51
Consultant Service to Hospitals and Institutions  52
Consultant Service to Other Government Departments  53
Other Activities  5 3
|§     B. Sanitary Inspection Services  54
Milk  54
:M            Food Premises  55
Locker Plants  56
Slaughter-houses  56
Meat Inspection  56
M             Industrial Camps  56
Summer Camps  57
fS            Schools  57
Plumbing  57
7
 L 8 BRITISH COLUMBIA
Report of the Division of Environmental Management—Continued
B. Sanitary Inspection Services—Continued
Rodent Survey	
General Sanitation	
C Civil Defence Health Services
Hospital Disaster Plans
Emergency Medical Supplies
Emergency Blood Service	
Study Forum	
Training	
Genera]	
D. Employees' Health Service	
Planning	
Service | 61
Records   62
Surveys and Other Activities   g
j?      Policy  62
E. Health-care Research Project  6!
Report of the Division of Preventive Dentistry 	
Prevention	
Dental Personnel 71
General I 73
Report of the Division of Public Health Engineering  74
Water-supplies i  74
Sewage-disposal  75
Stream Pollution	
Siell-fish j
Swimming and Bathing Places
Tourist Accommodation "
Frozen-food Locker Plants "
General	
Report of the Division of Vital Statistics	
Registration of Births, Deaths, and Marriages
Documentary Revision	
Microfilming of Documents	
Administration of the "Marriage Act"  ;^- "
Registration of Notices of Filing of a Will
Certification Services	
District Registrars' Offices !'
General Administration ~
Statistical Section . -
Cancer Registry "
Table I.—Number and Percentage of New Cancer Notifications by Site
and Sex, British Columbia, 1954 - 51
Table II.—Number and Percentage of Reported Live Cancer Cases by
Site and Sex, British Columbia, 1954
52
Table III.—Cancer Notifications by Sex and Age-group, British Columbia,
1954   '2
Table IV.—Live Cancer Cases Reported by Sex and Age-group, British
Columbia, 1954 ji '2
Population Characteristics of the People of British Columbia - J
Population in British Columbia by Age-group  1901-54   9
Birth and Stillbirth Rate  ____       |g 5| 8
Principal Causes of Mortality in British Columbia          - 5!
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 9
Page
Report of the Division of Public Health Education  95
Local Health Educators  95
In-service Training  95
fMaterials   96
Publications and Publicity  97
Staff  98
Report of the Health Branch Office, Vancouver Area  99
Buildings -  99
|j§   Personnel  99
Faculty of Medicine, University of British Columbia  100
Voluntary Health Agencies  100
General  101
National Health Grants  102
Acknowledgment  108
Report of Division of Laboratories  109
Table I.—Statistical Report of Examinations Done during the Year 1954, Main
Laboratory  110
Table II.—Statistical Report of Examinations Done during the Year 1954,
Branch Laboratories  111
Ifi   Tests for Diagnosis and Control of Venereal Diseases   111
Tests Relating to Control of Tuberculosis  112
Salmonella-Shigella Infections  112
Other Types of Tests ^.  113
Branch Laboratories  115
General Comments  116
Report of the Division of Venereal Disease Control  117
Introduction  117
Treatment  117
Epidemiology .  117
Social Service !  118
Education : |  118
General  119
Report of the Division of Tuberculosis Control—  120
Deaths from Tuberculosis by Place of Death, 1945-54  120
Admissions to Tuberculosis Institutions, 1945-53  120
New Cases of Tuberculosis by Year of Notification, 1947-54  121
Sanatorium Accommodation  122
Age Distribution in Sanatorium  122
National Health Grants  123
Recalcitrant Patients  124
Control of Tuberculosis  125
Report of the Rehabilitation Co-ordinator  126
Rehabilitation  126
Report of the Accounting Division  127
  Ninth Report of the Department of Health and Welfare
(HEALTH BRANCH)
Fifty-eighth Annual Report of Public Health Services
YEAR ENDED DECEMBER 31st, 1954
G. F. Amyot, Deputy Minister of Health and Provincial Health Officer
During 1954 the events and trends in public health in British Columbia were, for the
most part, encouraging. It was possible to effect certain improvements in the organization
and administration of the service. There was no dramatic outbreak of disease to disturb
the course of events.
The General section, immediately following, describes in summary form the major
developments which took place throughout the year and the situation at the year's end.
The later sections describe in greater detail the programmes and activities of the various
services which constitute the Health Branch.
The Deputy Minister of Health is grateful to all those persons and agencies who
helped to maintain and improve the service. Other departments of Government, professional groups, voluntary agencies, private citizens, and employees of the Health Branch
all contributed to make this a year of progress. To them the Deputy Minister extends his
sincere thanks. The Deputy Minister also wishes to direct special attention to the
assistance given by the Department of National Health and Welfare. Throughout this
Annual Report, there is repeated reference to the National health grants and the part
that they have played in improving public health services in British Columbia. Although
it is not possible to describe all the benefits that have resulted from this far-reaching
Federal programme, the Deputy Minister wishes to express his gratitude to the Federal
authorities, not only for the financial aid, but also for their co-operation in helping to
administer the programme.
GENERAL
|| A. H. Cameron, Director, Bureau of Administration
THE PROVINCE AND ITS PEOPLE
The area of British Columbia is approximately 366,000 square miles. The population, according to the mid-year estimate, is 1,266,000, an increase of 36,000 over the
1953 population. Over the Province as a whole, this gives a population density of 3.5
persons per square mile, which is the second lowest among the Provinces of Canada.
However, the greatest concentration is in the southern and particularly the south-western
sections, with almost one-half of the total population of the Province living in the metropolitan areas of Greater Vancouver and Victoria-Esquimalt. With more than 72 per cent
of the people residing in urban areas (metropolitan areas and communities with populations of more than 1,000), British Columbia ranks with Ontario among the Provinces of
Canada in having the highest proportion of urban residents. Approximately 15 per cent
of British Columbia's population is 60 years of age and over. The Canada-wide figure
for the same group is only 11 per cent.
11
 L 12 BRITISH COLUMBIA
THE HEALTH OF THE PEOPLE
Although health has, or should have, much broader implications, than the mer
absence of disease and infirmity, it is usual to report on the health status of any group 0f
people by reporting in terms of death rates, causes of death, and sickness experience
According to the Director of Vital Statistics, British Columbia's crude death rate for
1954 was 9.6 deaths per 1,000 population. This was the lowest rate experienced since
1939, and, in view of the increased proportion of older people in the population to-day
it represents a considerable improvement. Heart-disease, cancer, intracranial lesions of
vascular origin, and accidents were again the four leading causes of death, as they have
been for some time.
The Director of Local Health Services reports a decrease in the total incidence oi
notifiable disease. The decrease in respect to the volume of poliomyelitis was particularly
gratifying. On the other hand, infectious hepatitis was on the increase and enteric infections of the shigella-salmonella group continued their upward trend. The minor communicable infections, such as chicken-pox, measles, mumps, pertussis, and rubella,
accounted for approximately two-thirds of the total notifiable disease. With reference
to school-children, the Director of Local Health Services states that this group is in good
physical condition clinically but stresses the need for increasing the proportion of children
immunized against the major communicable diseases such as diphtheria and smallpox,
Because of the advent of antimicrobials and the advances in chest surgery, the
Director of Tuberculosis Control states that it is now possible to cure tuberculosis. The
death rate from this disease has declined markedly since 1946, when streptomycin was
introduced. In 1954 it was 9.3 per 100,000, as contrasted to 57.4 per 100,000 for 19ft
(These rates include the Indian population.) Although there has not been such a sharp
decline in the morbidity rate, it is gratifying to note that fewer cases have been found, in
spite of increasing efforts to locate them. |
The Director of Venereal Disease Control states that the total number of venereal-
disease cases reported in 1954 was lower than in previous years. However, non-specific
urethritis remains a problem requiring special attention.
THE ORGANIZATION FOR PUBLIC HEALTH SERVICES
In British Columbia the two large metropolitan areas, Greater Vancouver and
Victoria-Esquimalt, operate their own city health departments. Although these do not
come under the direct jurisdiction of the Provincial Health Branch, they receive substantial
financial assistance from it and co-operate closely with it. Throughout the remainder oi
the Province, public health service is provided by health units. (A health unit is defined
as a modern local health department staffed by full-time public-health-trained personnel
serving one or more population centres and the rural areas adjacent to them.)
Original plans, made some years ago, called for the formation of seventeen such
health units. It is most encouraging to be able to report that sixteen of these are now
completely organized and in operation. Only the Gibsons-Howe Sound area has not
attained health-unit status, although even here full-time public health nursing and sanitary
inspection services are in operation. It is also encouraging to note that only one of the
sixteen units was without a full-time medical director at the end of the year. On the other
hand, the shortage of public health nurses continued to be a most discouraging problem
Only by employing some nurses who lacked postgraduate training in public health was
it possible to maintain service to the public.
The metropolitan health services (Greater Vancouver and Victoria-Esquimalt) and
the Provincial health services together reach practically every citizen of the Pro*
Excluding Indians, for whom services are provided by Federal authorities, the percent**
of the Province's population receiving public health service at the end of 1954 from'
sources named were as follows:—
I
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 13
Source of Service Per Cent
City health departments of Greater Vancouver and Victoria-
Esquimalt   47.1
Provincial health units  49.3
Non-health-unit  areas   (public  health nursing  and  sanitary
inspection districts)      1.9
Total  98.3
The staffs of the health units—that is, the "teams" of public health physicians,
nurses, sanitary inspectors, and related workers—provide direct to the public a generalized
service. Supporting these " teams " and serving the public through them are certain
Provincial specialized services which, for economic or other reasons, cannot be established
and maintained locally. Important among these specialized programmes are the services
rendered by the Divisions of Tuberculosis Control, Venereal Disease Control, and Laboratories, which comprise the Bureau of Special Preventive and Treatment Services.
At the year's end the Division of Tuberculosis Control was providing 788 treatment-
beds in its four institutions—Willow Chest Centre and Pearson Tuberculosis Hospital, in
Vancouver; the Vancouver Island Chest Centre, in Victoria; and Tranquille Sanatorium,
near Kamloops. In the Division as a whole there were approximately 730 employees.
These staff members served not only the institutions mentioned above, but also Divisional
headquarters and the clinics, both stationary and travelling, which are operated in strategic
parts of the Province. Because renovations at Tranquille Sanatorium had made extra
beds available, it was possible to close Jericho Beach Hospital, in Vancouver, at the end
of October. This was desirable, and even necessary, because the building, a temporary
structure built by the armed forces during World War II, had become very difficult to
maintain and operate economically.
Throughout the year the Division of Venereal Disease Control continued to use the
old and inadequate building on Laurel Street, Vancouver, as its headquarters and principal
clinic and treatment centre. (It is anticipated that the new Provincial Health Building,
now nearing completion, will provide more modern quarters long before the next Annual
Report is written.) Other clinics were operated at the following locations: Victoria,
New Westminster, Vancouver (City Gaol, Juvenile Detention Home, Girls' Industrial
School, and the Metropolitan Health Committee's Health Unit No. 1), Oakalla Prison
Farm, Prince Rupert Gaol, and Prince George City Gaol. Two changes in the administrative organization are examples of co-operative planning. The Victoria Clinic, which
was formerly a self-contained subsection of the Division of Venereal Disease Control,
has now been placed under the immediate administrative management of the Division of
Tuberculosis Control's Vancouver Island Chest Centre. The New Westminster Clinic
has become closely integrated with the Simon Fraser Health Unit, whose staff have
assumed responsibility for case-holding and treatment of venereal-disease patients. The
staff of the Division consisted of approximately thirty full-time employees and several
part-time employees. Drugs, free of charge to the patient, were again made available
to all private physicians for the treatment of venereal disease. In order that the drugs
can be dispensed locally to private physicians, supplies are placed in health units
throughout the Province.
The year's end once again found the Division of Laboratories operating its headquarters and main laboratory in the old wooden houses on Hornby Street, Vancouver.
This Division has suffered more acutely than any other part of the public health service
from lack of proper accommodations over a period of many years. It is gratifying to
report, therefore, that the Division of Laboratories will move to modern, properly designed
quarters reasonably early in 1955 when the new Provincial Health Building is completed.
Branch laboratories were operated throughout 1954 at Victoria and Nelson.   However,
 L 14 BRITISH COLUMBIA
the one-person branch laboratory at Prince George, which had been in operation forf011r
years, was closed after the end of March. For the Division as a whole, the Director of
Laboratories reports that there was little change in the work-load. A decline in total
number of tests performed was offset by increases in many of the more time-consumfe
types of tests. The staff of the Division numbered approximately forty-seven. AH but
a very few of these work in the main laboratory in Vancouver.
Other specialized services are provided by the Divisions of Public Health Nursing
Public Health Engineering, Preventive Dentistry, Environmental Management, Vital
Statistics, and Public Health Education. All of these provide consultative service to the
staffs of the health units, and some of them, the Division of Public Health Nursing
particularly, have large responsibilities in recruitment and placement of personnel. The
Divisions of Public Health Engineering and Vital Statistics also have responsibilities in
providing service direct to the public. There were no major changes in the organization
of these six Divisions during 1954.
TTiere were, however, three important changes contemplated or actually effected in
the central consultative services of the Health Branch. The first of these was the appointment of a Consultant in Epidemiology. Dr. A. John Nelson, former Director of the
Division of Venereal Disease Control, assumed this position in April, 1954, and has
already done much to meet a long-felt need in communicable-disease control. During
the first year the entire salary and travel expenses of the Consultant will be paid from
National health grant funds, which will also meet part of the costs during the following
two years. |
The second was the appointment of a Provincial Co-ordinator of Rehabilitation in
September. This development was the result of an agreement between the Province and
the Federal Department of Labour, which share in paying the salary and expenses of the
Co-ordinator. The new appointee is Mr. C. E. Bradbury, former Rehabilitation Officer
in the Division of Tuberculosis Control.   His first report appears later in this volume.
The third major change is the proposed appointment of a Technical Supervisor of
Clinical Laboratory Services. Although the salary will be derived from the National
health grants, the British Columbia Civil Service Commission has been asked to conduct
a recruiting competition in accordance with the Commission's usual procedures. It is
hoped that an appointment will be made early in the new year. The Technical Supervisor will take an important part in effecting the proper use of the Laboratory and
Radiological Services Grant to strengthen and develop clinical laboratories, particularly
those in rural hospitals throughout the Province. I
AM of the foregoing describes briefly the organization for public health services as
provided by the official agencies—the Provincial Health Branch and the two metropolitan
health departments. Supplementing these official agencies, British Columbia's voluntary
health agencies continued to provide much-needed services. Although the Provincial
Government has not yet considered it desirable or necessary to enter these specialized
fields on an operational basis, it provides considerable financial support through the
Health Branch. Because the headquarters of most of the voluntary agencies are in Vancouver, the Assistant Provincial Health Officer has the responsibility of effecting proper
liaison and co-ordination. This close tie between the official health agency and the
voluntary groups has done much to prevent misdirection of energies and duplications
or omissions in services.
OTHER MAJOR DEVELOPMENTS AND ACTIVITIES
During 1954 there was encouraging progress in the construction of much-needed
accommodation for laboratories, offices, clinics, and treatment services. At the end of
the year the general structure of the Provincial Health Building on Tenth Avenue near
Willow Street in Vancouver had taken form, although it was anticipated that it wo*
take several months' more work to make the building ready for occupancy.
 DEPARTMENT OF HEALTH ANtfWELFARE, 1954 L 15
Construction of the Poliomyelitis Pavilion was undertaken on the grounds of the
Pearson Hospital, of which it will form an administrative sub-unit. Although last year's
Report expressed the hope that the new pavilion would be ready to receive patients by
the summer of 1954, it is now known that the building will not be ready for occupancy
before February, 1955. Designed for the care of convalescent poliomyelitis cases, it
will relieve the general hospitals—particularly the Vancouver General Hospital and the
Royal Jubilee Hospital in Victoria—so that those institutions may be better able to care
for acute cases.
The Federal Hospital Construction Grant is being used to assist in the construction
of both the Provincial Health Building and the Poliomyelitis Pavilion.
New community health centres were completed at Oliver, Nanaimo, New Westminster, and Vancouver, and construction was undertaken at Ladner and Revelstoke.
Plans were being made for similar developments in Keremeos, Rossland, Penticton, and
Cloverdale, and for further construction in Vancouver, fi In each case the Federal and
Provincial Governments have assisted the local community in the cost of construction.
The National Hospital Construction Grant has provided the Federal contribution, and
service clubs and voluntary agencies have given material assistance with the local
contribution in some cases.
At Smithers and Nakusp the public health nurses were provided with much-improved
office and clinic accommodation by the Provincial Government which made space available in the Court-house in those centres. An improvement was also effected for the
public health nurse at New Denver, where a building was renovated to provide a small
business office and a larger separate clinic.
At Nelson more spacious accommodations were made available on a rental basis
for use as clinics and offices. When these quarters were being altered and renovated to
suit them for their new role, health-unit staff members themselves assisted materially by
building the necessary cupboards, counters, and similar interior fittings.
In the field of personnel administration an important change was made in April,
1954, when Mr. P. M. Nerland, former personnel assistant in the Division of Tuberculosis
Control, was appointed as personnel officer for the Bureau of Special Preventive and
Treatment Services. This change extended the personnel officer's responsibilities to the
Divisions of Venereal Disease Control and Laboratories as well as the Division of
Tuberculosis Control. Since the headquarters and main operational centres of all three
Divisions are located in Vancouver, it is sound to have their personnel administration
under the control of one official. Information in respect to numbers of positions, employees on staff, and related matters of establishment control has been placed on a firm
basis.
In February, 1954, an Employees' Health Service for Provincial Civil Servants in
the Victoria area was placed in operation with the appointment of Mrs. Evlyn Dalman
as industrial nurse. The Health Branch had earlier participated in planning with the
Civil Service Commission and the Department of Public Works, both of which have an
interest in the Service. During this first year of operations the salary and expenses of
the industrial nurse have been derived entirely from the National health grants, which
will continue to share the cost for the next three years. The programme is supervised
by the Health Branch's Director of Environmental Management. His report, which
appears later in this volume, provides details of the new service.
Health-unit personnel and senior officials of the Health Branch were again fortunate
in being able to add to their professional knowledge by attendance at the Public Health
Institute. At the 1954 meeting, which was held in Vancouver from April 20th to April
23rd, the chief speaker was Miss Ruth Gilbert, Assistant Professor of Nursing Education,
Teachers College, Columbia University. Miss Gilbert's six lectures on mental hygiene
were of deep interest and value to all members of the staff.
 L 16; BRITISH COLUMBIA
REPORT OF THE BUREAU OF LOCAL HEALTH SERVICES
J. A. Taylor, Director
Any health department functions primarily to promote and maintain ideal maxim
community health, thus ensuring optimum conditions for ideal maximum individual heato
This can only be accomplished adequately and efficiently through properly orffimizJ
health services at the municipal level, staffed with sufficient numbers of trained personnel
to co-ordinate community action toward that goal. Health services at the provincial
level foster and support those local health services at the municipal level, and the various
divisions ProvincMly serve in a consultative and advisory capacity to the staff within
the local areas. Provincial health service is designed, therefore, to contribute to local
health service, and all programmes are planned Provincially to flow through local health
services to the people who are to be served.
As the year ends, it is possible to record the progress and, conversely, the lack of
progress toward meeting community health needs throughout the Province. On the asset
side can be recorded such items as:—
A gradually increasing growth of home-nursing programmes.
The development of more adequate prenatal clinics.
An improvement in the consultative pediatric clinics throughout the whole
of the Province.
An increase in the cancer diagnostic and consultative clinics in the Province.
An improvement in the services of the child guidance clinics.
An increase in the number of community dental clinics.
An increase in the number of diagnostic X-rays of hospital in-patients.
A fortuitous decrease in the incidence of poliomyelitis.
The development of a consultative epidemiological service to assist in the investigation of disease outbreaks.
A complete revision of the programme of School Health Services.
A research study of hospital admissions as a basis of inquiry into morbidity
causes.
The development of a Provincial Government Employees' Health Service,
which also serves as an industrial health-programme pilot study.
The development of a sanitary inspector training programme to provide additional trained staff for recurring vacancies.
The promotion of an annual meeting of representatives of Union Boards of
Health.
The construction of additional community health centres.
On the other hand, certain hindrances and lack of progress can be seen in:—
A serious shortage of public health nurses, creating vacancies in nursing districts in health units, and preventing opening of new nursing districts in
growing communities.
The resignation of the Assistant Director of the Division of Public Health
Nursing.
A difficulty in recruiting sufficient dentists to develop the complete programme
of Regional Dental Consultants.
The resignation of the public health physician in the Skeena Health Unit, an
the lack of success to date in recruiting a replacement
A marked increase in the incidence of infectious hepatitis in many commiHUu •
A gradually increasing annual incidence of enteric infections of the salmofle
and shigella type.
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 17
At this time it is also possible to enumerate some of the points requiring study and
investigation if the health needs of the people of the Province are to be entirely fulfilled.
Amongst these points are:—
A thorough evaluation of present public health practices, particularly in the
jII        field of public health nursing, to ensure that effective use is being made
of existing staff and, where possible, to redistribute the load on that staff
so that they may adequately handle other tasks.
The continuation of studies into disease morbidity to determine bedside nursing-
care needs throughout the Province.
Refinements in the programme of maternal and child hygiene.
A further study toward a more complete programme of industrial hygiene.
An approach toward a more favourable recruitment of public health nurses.
The planning of a programme of vaccination for poliomyelitis as a possible
control of that disease.
A study of methods of control of infectious hepatitis, possibly through the distribution of gamma globulin as a prophylactic and therapeutic measure.
An attempt toward decreasing the incidence of enteric infections.
f|r A study of opinions on tuberculosis infectivity to co-ordinate the ideas of field
personnel with the specialists in tuberculosis.
The organization of postgraduate refresher training for staff members serving
continuously over periods of years.
HEALTH-UNIT ORGANIZATION AND DEVELOPMENT
The Bureau of Local Health Services has had as its major function to encourage
and stimulate the development of adequate health units throughout the Province to raise
the standard of health services in the Interior parts of the Province to the level of those
available in the larger metropolitan areas. Originally, seventeen such health units were
planned, sixteen o^ which have now come into being. Only the Gibsons-Howe Sound
area is not completely organized. Even in this area some progress has been made, with
the addition of a full-time sanitary inspector this year to augment the services provided
by the two public health nurses. It has not yet been decided whether this area would
be better served through union with the North Shore Union Board of Health or through
organization of an entirely separate unit with its own public health physician as Medical
Director. The growth of the area, as further development of the Pacific Great Eastern
Railway progresses, will be a factor in determining the decision. In the meantime the
people in this area are fairly adequately served by the aforementioned staff, supported by
private physicians acting as part-time Medical Health Officers in the populated centres
within the area.
It was also possible during this year to recruit a young physician interested in public
health to become full-time Director of the Peace River Health Unit, thereby restoring
to that unit its full complement of staff for the first time in two years. This physician
will probably undertake postgraduate study in public health within a year.
The physician employed as Medical Director of the Skeena Health Unit expected to
depart on postgraduate study in public health during September, but suddenly reversed
his decision in favour of returning to the private practice of medicine. While another
qualified public health doctor had been located to replace the departing candidate, last-
minute changes in his immigration plans from England rendered this impossible. This
unit has, therefore, been operating without the services of a Medical Health Officer and
School Medical Inspector since September, and all attempts to recruit a replacement
have been fruitless.
It is of some value to contemplate the development that has taken place in local
health services over the past five years, since National health grants came into being, as it
 L 18 f BRITISH COLUMBIA
serves to illustrate the impact that these health grants have had in accelerating the growth
of local health services. The major growth has occurred outside the metropolitan health
areas, which already had fairly extensive health-department coverage prior to 1948, The
Aajor need at that time was for the development of full-time local health units for the rest
of the Province as a method of offering equal health services to all citizens, irrespective of
their place of residence. It is interesting, therefore, to compare the local health services
situation, excluding metropolitan areas, in 1947, prior to National health grants, with that
in 1953 after National health grants had been in operation for five years:—
111 1947   '       1954
Number of health units     6 16
Number of health-unit directors     5 15
Number of public health nurses  98 141
Number of sanitary inspectors     6 31
Number of dental officers  5
Number of health educators g       1
Number of health-unit clerks     6 35
The costs of development within local health services have shown significantly pro-
portionate increases, but comparison does show the very fortunate situation that local
areas occupy, from the point of view of the amount requested from them toward financing
of the total programme. It is readily seen that the greater proportion of the increase in
local health services has originated from the contributions provided by National health
grants, with a proportionate increase by the Province and a lesser amount by local
governments.
Expenditures for Local Health Services, Exclusive of
Metropolitan Areas
1947 1954
Provincial  S $331,922.00 $598,789.00
Local     121,078.00 163,199.00
Federal  240,588.00
Totals  $453,000.00 $1,002,576.00
Estimated per capita  1.00 1.561
Inclusion of Dental Costs
Provincial  $331,922.00 $598,789.00
Local      121,078.00 212,624.00
Federal  328,473.00
Totals   $453,000.00 $1,139,886.00
Estimated per capita  1.00 1.781
1 Based on population of 640,670.
In 1947 the per capita cost for local health services was approximately $1, but*
changing economic trend has increased this to the degree that the per capita cost, outside
metropolitan areas, has risen to $1.56. § |
Local health services within the metropolitan areas of Greater Vancouver and
Victoria-Esquimalt continue to make substantial progress during the year. While ties6
services operate somewhat independently of the direct supervision of the Health Brancn,
they, nevertheless, maintain a very excellent co-operation, and participate in the annual
Public Health Institute and the bi-annual Health Officers' meetings. Financial assistance
toward their operation has been continued on the same basis throughout the year as id
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 19
previous years, any increases in costs being absorbed by the municipalities themselves.
A table briefly indicates the present situation as far as these financial contributions are
concerned, indicating the amounts involved in assistance toward metropolitan health
services:—
Metropolitan Health Services, Inclusive of Dental Costs
Provincial      $175,504.00
Federal        152,440.00
Local     1,173,116.00
Total    $1,501,060.00
Per capita  2.53 x
1 Based on population of 594,130.
As a result of this, the per capita cost of metropolitan health services can be shown
to be $2.53, which, coupled with the previously mentioned per capita figure, shows a total
per capita cost over the whole Province of $2.14.
As health units develop, there is less need and less opportunity for experienced
personnel to move to new locations to assume new appointments. Thus, staff are
becoming more permanently fixed in their present locations. This offers definite advantages, but raises the question of provision of opportunities for further advancement in
newer developments in public health and clinical medicine. Thus, study is being given
toward provision of some type of refresher courses for those members of the staff who
have given continuous service over periods of years, and who would gain particularly
from instruction in newer developments in public health administration, public health
practice, and clinical medicine.
ADMINISTRATION
Administration of the Bureau of Local Health Services has continued to function
throughout the year as it has in the past, guided by two advisory groups, namely, The
Local Health Services Council, composed of Divisional Directors, meeting weekly, and
the Medical Health Officers' Group, composed of all the full-time Medical Health Officers
throughout the Province, meeting bi-annually.
The Local Health Services Council has continued to act as an informed central
committee in all phases of local health services, so that each member is kept acquainted
with developments in the field, while continuing to suggest alterations and modifications
of existing policies and programmes. The work which was commenced some two years
ago on a manual of recommended procedures, a policy manual for local health services,
has progressed very slowly, but is being continued with the hope that it can be completed
shortly. ^
It is probably from the Medical Health Officers' group that the major recommendations for changes in Departmental programmes and policies originate, and the meetings
of this group have become increasingly valuable each year, particularly as more stability
occurs within the ranks of the Health Officers and they become better acquainted with
the needs in promotion of efficiency and adequacy of their services.
One major development resulting from their deliberations this year was the complete revision of school health services. The need for changes in the school health
services programme had been discussed repeatedly at meetings of the Medical Health
Officers' Group, without tangible results, until the work was delegated to a sub-committee,
which brought in a report which was thoroughly discussed at the April meeting, thereby
prompting final recommendations. A more complete review of this revision will be
found in the section of this report dealing with School Health Services. Arising from
the work of the committee, however, has been a Standing Committee on School Health
 L 20 »     ■     •        ■ ■     BRITISH COLUMBIA
Services, which will continue to carefully examine school health programmes from time
to time in order that they may be kept as practical as possible.
Another Standing Committee of the Health Officers' Group—that dealing with
communicable-disease control—has as its primary function the study of regulations and
control measures, so that effective revision of regulations is maintained in keeping with
epidemiological knowledge of the spread factors. During the year this sub-committee
has studied the recommendations presented by the Department of National Health and
Welfare designed to promote uniform reporting of notifiable diseases across Canada,
Principally, these recommendations indicate a desire to bring reporting more in line with
practical experience, and to omit those minor conditions which are very infrequently or
sporadically reported, and in which little, if anything, can be gained in attempted control,
It had been planned to have a Dominion-Provincial conference on these recommendations in the late fall of the year, but this has now been postponed until early spring, when
an opportunity will be provided to air the opinions of the various Provinces toward the
proposed change in uniform reporting. The sub-committee is headed by the newly
appointed Consultant in Epidemiology, who will probably represent this Province in the
conference deliberations.
Apart from these two accomplishments, the Medical Health Officers' Group has
served to bring a number of other problems up for consideration and has prompted the
drafting of swimming-pool regulations, which are designed to detail standards which
should be followed in construction of swimming-pools in the various communities. The
preliminary work in this connection has been undertaken by the Director of the Division
of Public Health Engineering, assisted by advice from Health Officers and one or two
Physical Recreational Directors from the University of British Columbia.
In addition to this accomplishment, other items which have received consideration
during the year is one rather controversial subject dealing with tuberculosis infectivity
and interpretation of positive bacteriological cultures and smears. It was evident that
the varying opinions could not be thoroughly aired at any meeting of the Medical Health
Officers' Group, and consequently another sub-committee was struck to go into this
subject and bring forth definite recommendations for next year's meetings.
A number of other items have received attention in discussion, such as health-unit
budgets, health-unit administration, milk legislation, standards for private hospitals, and
foster-home placement. At previous meetings an outline of a pamphlet detailing the
duties and responsibilities of Union Boards of Health had been thoroughly discussed,
modified, and accepted. During the year this pamphlet was circulated to the various
Union Boards of Health throughout the Province, from whom suggested alterations or
additions in the material had been requested. The South Okanagan UMon Board of
Health presented one or two proposed changes, but the pamphlet was well received by
the remaining Union Boards of Health! The South Okanagan Union Board of Health,
however, did feel that there would be considerable merit in an annual meeting of representatives of Union Boards of Health, and has been seeking some means of organization
for that purpose. Departmentally, it had been suggested that one of the possible approaches might be through the Union of British Columbia Municipalities, which, at its
annual fall convention, mi^ht be able to arrange an opportunity for representatives of
Union Boards of Health to convene informally for discussion. Toward the end of tte
year it was possible to pursue this suggestion further with the executive secretary of the
Union of British Columbia Municipalities, with the result that an informal meeting of
representatives of Union Boards of Health was convened in October in Victoria during
the Union of British Columbia Municipalities Convention. There was exceptionally
good attendance and opportunity for thorough exploration as to the value of an annri
meeting of that type, with the result that a committee was struck to investigate ways and
means of meeting annually at the same time as the Union of British Columbia Municipalities Convention.    That committee is drafting proposals in anticipation of the ft*
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 21
formal convention of Union Boards of Health to be held in Prince George in October,
1955. The Health Branch, Department of Health and Welfare, was pleased to co-operate
in this matter, since it is felt that it will provide an excellent opportunity for discussion
of common inter-unit problems and for future planning in health-unit administration.
COMMUNITY HEALTH CENTRES
The plan, brought into being three years ago, to provide financial assistance toward
construction of more adequate office and clinic accommodation for local health services
has continued to demonstrate its value as more and more communities co-operate in the
plan. The proposals originally advanced were that the provision of a community health
centre should be originated in the community, either by the municipal authorities or by
some service club, to spark a drive to raise community funds for that purpose. Following this, a formal request was to be made for Provincial and Federal assistance through
Provincial grants and National health grants toward construction of the building. During
1954 four new community health centres were completed, construction got under way
on three more, and planning was under way in six other communities.
In Oliver a community health centre committee was organized to plan the construction of a sub-office for the South Okanagan Health Unit to provide office accommodation for the two public health nurses and clinic space for the various clinical services.
After much initial organization, it was possible to raise the local share, assisted by the
British Columbia Tuberculosis Society and the British Columbia Cancer Society. These
funds, coupled with the Provincial and National grants, were used to complete construction of a well-appointed spacious building that will serve all community health services,
both official and voluntary, in that area for many years to come. This building was formally opened by the Minister of Health and Welfare in September.
Past reports have recorded the considerable effort that has been made toward construction of a Nanaimo Community Health Centre to house the headquarters of the
Central Vancouver Island Health Unit. The financial arrangements reached during the
year permitted construction of the greater portion of the building, leaving certain space
incompleted until additional financing can be arranged. The completed quarters indicate
the degree of planning that has gone into this building to provide facilities for all the
community health needs of that municipality, co-ordinating all health programmes,
official and voluntary, under the one roof. Here again the British Columbia Tuberculosis
Society, the British Columbia Cancer Society, the British Columbia Branch of the Canadian Arthritis and Rheumatism Society, the British Columbia Branch of the Canadian Red
Cross Society, and other agencies have assisted financially and are provided with space in
the building for their local operations. This building was also opened formally by the
Minister of Health and Welfare during September.
The addition to the headquarters of the Simon Fraser Health Unit in New Westminster attained completion during the year. This large new double-storied structure
provides excellent accommodation for the health unit on the ground floor and for the New
Westminster Stationary Tuberculosis Clinic on the second floor. This released space in
the older building, which now houses the Welfare Branch, so that there is complete consolidation of all three related services in the one building. It was formally opened by the
Mayor of New Westminster in the early summer. jj|
The City of Vancouver has participated in this building programme with the construction of two community health centres to house two of their area health units. These
will be definite assets to the health-unit administration in Vancouver, where operations
have been conducted for a considerable number of years in old renovated accommodation
which was no longer suitable for the increasing clinic requirement and staff needs. First
of these two was formally opened by the Minister of Health and Welfare in December.
While these definite accomplishments reflect a credit upon the construction programme, the need for its continuity is evidenced in the fact that continual planning is going
 L 22 BRITISH COLUMBIA
forward for community health centres in other areas. The construction of one serves
a concrete example of accomplishment in a community, thereby creating a desire fe
similar health-department buildings in another community. At the moment, plans ^
been completed and excavations commenced for sub-offices at Ladner and Revelstoke
while plans are going forward for other sub-offices in Keremeos, Rossland, and Penticton
and an addition to the headquarters office at Cloverdale. Three others are planned, also
for the Greater Vancouver area.
The very definite contribution that is being given to this programme by the British
Columbia Tuberculosis Society, the British Columbia Cancer Society, the British Co-
lumbia Branch of the Canadian Red Cross Society, and other voluntary agencies must be
mentioned. While the Provincial grant and the National health grant provide a considerable part of the financing, it is, nevertheless, not always easy for the community to raise
the local share, which is often more than one-third of the total cost. To fill this breach
the contributions from these voluntary associations have aided materially in attaining the
financial goal, which, otherwise, might have been most difficult. Their assistance in this
programme has been much appreciated locally and is gratefully acknowledged by the
Health Branch.
In addition to the new housing that has arisen through this programme, reference
must be made to the accomplishment in certain communities through provision of more
suitably appointed accommodation in local Court-houses by the Provincial Government
In both Smithers and Nakusp, accommodation has been provided for the resident public
health nurse more in keeping with her service as a health worker. In both instances this
accommodation is more ideally located, more spacious, and provides room for the clinic
as well as the nurse's offices. I
In New Denver, a change in offices also occurred with the removal of a building
formerly on school property to a new location across the road from the school. The
building was placed on a more solid foundation and the interior renovated to provide a
small business office for the resident public health nurse and a larger separate clinic room.
With headquarters in Nelson, the Selkirk Health Unit, which came into being last
year, was able to negotiate, on a rental basis, new accommodation to house the staff more
adequately and provide space for their numerous clinic operations. Much credit is due
the local staff in this case, who did so much individual labour toward providing the necessary counters and cupboards, utilizing lumber provided through the Provincial Health
Branch for that purpose. The renovations of the space were completed to the specifications of the staff, so that the whole arrangement was designed to fit their needs for the
present and for some time to come. I
The most pressing accommodation needs are in relation to the East and West Koote-
nay Health Units at Cranbrook and Trail. The staff of both these units are operating out
of cramped, poorly designed, and inadequate offices. The situation, in so far as Cranbrook
is concerned, may be answered by the construction of a new Court-house now being
planned by the Provincial Government. Space for the health unit, designed in consultation with the staff to fit their present and future needs, is included. Some discussion has
gone on in Trail toward the possibility of a community health centre under the form*
plan of joint financing, but it would seem to be dependent upon the acceptance of the
construction as a project by some service club. With a service club to spearhead community organization, it may be possible to arrange local financing to permit construction
of an ideal community health centre. The Director of that health unit was continuing to
investigate the possibilities as the year came to an end.
HOME-CARE PROGRAMMES
There is an ever-increasing demand for home nursing-care programmes in certain
communities throughout British Columbia.   In large part, this demand originates from
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 23
the excellent progress that has been shown by the Vernon plan, originally set up to
provide home care to convalescent patients discharged from hospital earlier in order to
release hospital beds for more acute cases, and thus demonstrate that a home-care programme could provide an economic saving to the community in obviating the construction
of additional hospital space to provide additional beds. Since the patient could only be
admitted to the service from hospital by the attending physician, the service could be
considered an extension of hospital care to the home. The public health nurses within the
health unit were prepared to give nursing care in the home on an hourly basis, while a
housekeeping service was also available to patients requiring home help. For both
nursing and housekeeping service, a small daily charge was to be made.
It is now possible to compare two annual periods during which the programme has
been in continuous service, and to report that there has been a gradual increase in the
scope of the service. It has been ably demonstrated, however, that the success of the
whole programme is dependent upon co-operation of medical staff, hospital staff, patients,
and public health staff in fostering emphasis upon the service, so that patients are discharged from hospital to their homes under the programme. In one period of the year
when there was little emphasis to that end, there was a definite lowering in the numbers
served and it was only when emphasis was again placed on the programme that it became
more widely used and further accepted.
As the year was drawing to a close, the demands upon the service were becoming so
great that consideration was being given to the addition of another public health nurse to
the health-unit staff, in order that dispersal of the case load among a greater number of
nurses could be undertaken.
In a period from January to August, 1953, each patient on nursing care had an
average of 5.6 visits to save 14.3 hospital-days, or one visit every 2.6 hospital-days saved.
In the same period in 1954, each patient had 6.6 visits to save 14.7 hospital-days, or one
visit every 2.3 hospital-days saved. In other words, in 1954, patients requiring nursing
care have needed more visits more closely spaced, indicating that possibly a more acute
type of nursing care has been required.
In the same period in 1953, each patient on housekeeping service required 42.5
hours of housekeeping care to save 10.0 hospital-days, or 4.3 hours of care per hospital-
day saved, as compared to 51.4 hours of care to save 14.5 days in 1954, or 3.5 hours
of care per hospital-day saved.
Regarding time of public health nurses, the visits were slightly less lengthy in the
over-all in 1954 than in 1953, requiring 22 minutes, of which 14 were service, in comparison with 25 minutes, of which 14 were service, the reduction being confined mainly
to travel. Each of three public health nurses averaged 361 minutes or about 6 hours
per month given to this service in 1953, compared to 402 minutes or 6.7 hours per month
in 1954.   Comparative tables for these two periods are shown as follows:—
January to January to
August, 1953 August, 1954
Patients receiving nursing care only  54 60
:|g        Patients receiving housekeeping services only  7 17
Patients receiving both nursing care and housekeeping services  12 7
Totals -       73 84
Nursing visits      370 439
Nursing visits per patient      5.6 6.6
Housekeeping visits      196 257
 JL 24 BRITISH COLUMBIA
Hospital-days saved—
By nursing  773 881
By housekeeping  69 246
By both  177 119
Totals   1,019 1,246
Time of public health nurses' travel minutes 3,863 3,651
Time of public health nurses' service minutes 5,274 5,991
Totals minutes 9,137 9,642
Average time per public health nursing visit for
travel minutes    10.4 8.3
Average time per public health nursing visit for
service minutes    14.3 13.7
Totals minutes    24.7 22.0
Housekeeping hours  807.5        1,234.75
Hospital-days saved—
Per patient receiving nursing care only     14.3 14.7
Per patient receiving housekeeping services
only      10.0 14.5
Per patient receiving both nursing care and
housekeeping services     14.8 17.0
Average number of hospital-days saved per patient on the home-care programme     14.0 14.8
Costs
Cost from January to August, 1953  $1,851.46
Hospital-days saved  1,019
Cost per day  $1.82
Cost from January to August, 1954  $2,034.04
Hospital-days saved  1,246
Cost per day  $1.63
Total cost from January, 1953, to August, 1954  $4,869.63
Hospital-days saved  2,849
Cost per day  $1.71
The cost of the service deserves special mention, since, during the initial stages of
the study, in the period from November, 1951, to May, 1952, it amounted to $4 per
day. Since then, costs have been reckoned on a different basis, with the result that during 1953 the cost per day was shown to be $1.82. Experience with the plan and better
organization have brought a further decrease, so that the cost per day during 1954 has
been estimated to be $1.63. These figures are significant when compared with the hospital per diem cost of $11.35. Apart from this economic advantage, there has been the
additional fact that the service has increased the facilities of the Vernon Jubilee Hospital
to the extent of 5.2 beds in continuous use during 1954, as compared to an increase in
1953 of 4.3 beds. It demonstrates very ably that a properly organized and supervised
home-care programme can provide economic advantages to the community and service
individually to the patient.
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 25
The publicity attendant with this programme has promoted desire for similar programmes in other communities. However, it must be recorded that a considerable portion of home-care nursing is presently being provided by the public health staffs throughout British Columbia, and that careful study and investigation are necessary before new
plans are introduced for additional services, either on an official basis through health
units or on a voluntary basis through the Victorian Order of Nurses. In Nanaimo this
situation had to be faced a year ago when community request for Victorian Order of
Nurses service was considerable. Community organization resulted in the adoption of
such a programme in Nanaimo, and Victorian Order nursing service was originated and
is now operating throughout the city. It has substantiated itself during the year of operation and will be continued into the future, with consideration toward extension to neighbouring areas with the employment of additional staff.
In the Municipality of Saanich, considerable local demand for bedside nursing care
was presented to the Municipal Council through a local branch of the Women's Institute.
The Council, agreeing to the request in principle, turned the matter over to committee
for investigation, which committee studied the possibilities of obtaining the service
through the Victorian Order of Nurses or through their official health department, the
Saanich and South Vancouver Island Health Unit. After discussions with their local
Medical Health Officer and the Health Branch, Department of Health and Welfare, as
well as officials of the Victorian Order of Nurses, a decision was made to recommend
to the Council provision of the service through the health department, with financing by
an increased local contribution of 10 cents per capita. For this amount, the Health
Branch, Department of Health and Welfare, agreed to employ the services of an additional public health nurse, provide transportation, and pay operational costs, but the
provision of service would be allocated uniformly through the total staff of public health
nurses. The service has been in operation since July, and has been able to meet satisfactorily all the needs referred to it. In actual fact, the addition of the programme has
not created any additional work load as far as the public health nurses are concerned,
and would seem to indicate that the volume of home nursing was already being adequately
met before the formal acceptance of the programme was engineered. It is possible,
however, that the initial introduction of the programme has not presented all the demands
that may have to be met, and a continued study of the programme is going to be required
to determine the requirements that the service will have to face.
A programme of home nursing and housekeeping care has been in effect in the
City of Kelowna for some years, operating quietly with very little publicity and yet
satisfying the needs of that community. More recently the City of Penticton has become
interested in a visiting nurse programme, through the Hospital Board, which has been
studying the reports on the service from the Vernon Jubilee Hospital. That Board has
set up a committee who are investigating the possibilities and are seeking advice and
guidance from senior members of the North Okanagan Health Unit, as well as officials
of the Health Branch, Department of Health and Welfare. It has been suggested to the
committee that they should discuss the proposals most carefully with the medical staff
of the hospital and investigate to ensure that some of the potential cases are not already
receiving service.
Additionally, similar requests have been received from organizations in the Courtenay area and Powell River. Any plans in those communities would be modelled along
the plan introduced in the Municipality of Saanich, requiring an increased contribution
on the part of the local area toward financing of the service. In each case the committees
investigating the possibilities have been advised to inquire very carefully to be sure that
existing needs are not being met and to make certain that it is not housekeeping services
that are being required rather than nursing services. In so many communities the opinion
is voiced that home nursing service is required, when actual investigation reveals that it
is more likely housekeeping assistance that is required for the convalescent patient or
 L 26 BRITISH COLUMBIA
the chronically ill pensioner.   It is possible to set up both within the community, as ha
been &o capably demonstrated in Kelowna and Vernon over the past few years, p
quently the demands on the housekeeping service are greater in number and motepreT
ing than the demands on the nursing service.   It behooves any community contempt
latin
such a departure to make careful study to ascertain the community needs, since it is not
advisable to tie up professional nurses, when they are in such short supply, for services
which can actually be provided by efficient housekeepers.
RESIDENT PHYSICIANS' GRANTS
For some years the Health Branch, Department of Health and Welfare, has cooperated with the Department of the Provincial Secretary in supervision of a programme
of grants-in-aid to resident physicians, which is designed to encourage physicians to take
up residence in remote communities and to provide service on a periodic schedule of
visits to neighbouring communities which are not sufficiently large enough in themselves
to support a physician. The amount of the grant was based upon a definite formula of
grants on a sliding scale, proportionate to the population density and distances to be
travelled. As the organization required a degree of intimate negotiation with practising
physicians, it was felt that it could probably better be handled entirely through the Health
Branch, Department of Health and Welfare, and, as a result, the whole programme was
turned over to that Department during the past year. |
No essential change has been effected in the method of administration, with each
physician under the grants being required to present a report, on a quarterly basis, of
the services provided, following which a quarterly payment of the grant is rendered,
At present, grants are being paid to some seventeen physicians to provide medical care
to some thirty rural locations of the Province. During the year, negotiations were conducted under the plan on behalf of the communities at Atlin and Telegraph Creek, as
well as communities on the Queen Charlotte Islands. |
It was possible, toward the close of the year, to reorganize the service in so far as
Atlin was concerned, as the Red Cross Society assumed responsibility for the operation
of a Red Cross Outpost Hospital, under the jurisdiction of the resident Red Cross nurse,
The resident physician's grant continued to play a part, however, through provision of
regular periodic visits from physicians at Whitehorse to Atlin, on a twice-a-month schedule, to see patients referred by the resident nurse to them for consultation. In this way,
this grant serves to meet, at least in part, the medical-care needs of these remote communities.
SCHOOL HEALTH SERVICES
Health is a primary objective of modern education. A recent report has stated:
"An educated person knows the basic facts concerning health and disease—works to
improve his own health and that of his dependents—and works to improve community
health."
Every school has tremendous opportunities to promote the health of its pupils and
of its community. From early childhood to early adulthood, most children are enrolled
in schools and are under the supervision of school staffs for a substantial part of the day,
for approximately half the days of the year. The conditions under which they live io
school, the help which they are given in solving their health problems, the ideals of
individual and community health which they are taught to envisage, and the information
and understanding that they acquire themselves as living organisms are factors wW
operate to develop attitudes and behaviour conducive to healthy, happy, and successtu
living. In all of its efforts the school must consider the total personality of each studefl
and the mutual interdependence of physical, mental, and emotional health. Policies m^
be organized toward development of a school health programme which recognizesi tw
the total health of the total child and his total life situation is the prime objective ot any
school health programme.
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 27
With this in mind, the scope and aims of school health services have been the subject
of much discussion at meetings of public health physicians, who, employed as health-unit
directors, are charged with the responsibility of providing school health services within
the community health services programme under the Union Boards of Health operating
the health units. From these discussions it was apparent that there was a unanimous
desire for some revision of existing school health services programmes to promote
uniformity throughout the Province, assess the present services, and to reorganize the
programme to provide the maximum service to the pupils and the teachers, while
utilizing to the best advantage the professional staffs involved.   I
A sub-committee of the Health Officers, set up under the chairmanship of the
Director of the North Okanagan Health Unit, studied the present programme. They
recommended a revision of the programme, outlining in the beginning the objectives
desired, which were as follows:—
To inspire the pupils with the desire to be well and happy.
To discover early any physical or emotional defect the pupils might have.
To secure their correction to the extent that they are remediable, and to assist
the pupils to adapt themselves to any irremediable handicap they might
have.
To protect the pupils against preventable and communicable disease and
avoidable physical defects by providing effective public health control
measures throughout the school and community.
To impart effectively to the pupils scientifically accurate health knowledge.
To foster attitudes in the pupils which will cause them to conserve and promote
their own health in an intelligent manner.
To see that the physical aspects of the school are maintained at a level which
will allow the students to do their best work, and to see that no defects
are present which will affect the health of the pupils and teachers.
It was recommended that in order to work toward these objectives, certain services
should be given to the schools within their school area.   Routine medical examinations
should be done in some of the grades, but because it is not possible to set a uniform
number of grades to be examined throughout the Province, due to the great variation in
the number of school-children in the different areas, an order of priority is suggested as
follows:—
(1) Grade I, preferably before the child starts school and with a parent present.
(2) Referred pupils from any grade.        -fl IP P-
(3) Pupils previously found to have serious defects, if the defects are not
known to have been corrected.
(4) New arrivals from whom a medical record is not available.
(5) Grade VII or X.
(6) Grade IV.
The committee went on to emphasize the value of a teacher-nurse conference in
stating that the nurse should hold a scheduled discussion with every classroom teacher
about the children in his, or her, register at least once and preferably twice every year.
The first conference should be very brief, held as soon after school opens in September
as practical, and is for the purpose of telling the teacher about any of the pupils in the
class who may have specific health or emotional problems. The purpose of the second
conference, which should be delayed until the teacher knows her pupils well, is to get the
names of those pupils that the teacher feels might have specific or emotional problems
that could be aided by the school health service. It is suggested that the conference will
be most acceptable if it is held during school-hours, not in the hearing of the students,
and that both nurse and teacher use a "guide" as a basis for their discussion.
When a teacher, from the physical appearance or action of a child, suggests that he
or she should not have returned to school after an illness, the school medical service
should examine the child at the request of the teacher and recommend appropriate action.
 L 28 BRITISH COLUMBIA
It was recommended that heights and weights should be taken and recorded ve
vision testing of all pupils should be done yearly, and that audiometer testing should?
done on children in any grade who are referred by their teacher as having possible hear' °
defects. It was proposed that the school medical service endeavour to interest the teac?
and older pupils in the taking and recording of the yearly heights and weights, and *
doing the yearly vision testing and incorporating these procedures into the lessons htm
taught on health subjects, on the basis that they could serve as practical exercises. Wher
the vision testing was done by the teacher, the nurse should recheck all pupils showin
less than 20/20 vision in both eyes. °
It was further recommended that, where equipment is available, the school health
service should attempt to have every student receive a miniature X-ray just prior to
leaving school. Mass tuberculin testing was not recommended as a routine, but this
procedure was reserved for those pupils where there was a specific indication. It was
suggested that the school health service should advocate and encourage yearly miniature
X-raying of all School Board personnel who come in contact with pupils and advocate
compulsory pre-employment X-rays and compulsory re-X-raying of all such school per-
sonnel every two years.
A suggested policy of supervision of students taking part in the more major form of
school athletics was proposed, as follows:—
(1) Students should be required to present to the school a consent form signed
4               by a parent before they may participate in major athletics.
(2) The health records of all students participating in major athletics should
be screened by the nurse.
(3) Students whose records show a history of illness, or for whom there are
no records, should be requested to bring a note from their family physician
or be seen by the School Medical Officer before taking part in major
athletics.
It was proposed that a programme of immunization against diphtheria and tetanus
and vaccination against smallpox should be carried out and should include as a
minimum:—
(a) Checking individual records and immunizing all who need it in Grades I,
V, and X, on receipt of consent from the parents.
(b) Immunizing all new pupils who need it, in any grade. S.       J|
(c) When local needs and availability of staff make it possible, this minimum
programme may be increased by immunizing pupils other than in the
grades mentioned above.
A complete reorganization of the basis of grading the physical condition of pupils
was recommended, utilizing letter symbols as follows:—
A—no observable defect.
Ap—a physical defect which has not yet appreciably affected the pupil's health.
Ae—an emotional defect which has not yet appreciably affected the pupil's
health. *
Bp—a physical defect which is affecting the pupil's health to a moderate degree.
Be—an emotional defect which is affecting the pupil's health to a moderate
degree.
Cp—a physical defect which is affecting the pupil's health to a marked degree.
Ce—an emotional defect which is affecting the pupil's health to a marked
degree.
Dp—a physical defect of such a nature that the child is unable to fit int0 tlie
standard school system.
De—an emotional defect of such a nature that the child is unable to fit int0 *
standard school system.
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 29
The referral of pupils by their teachers to the school health service was to be actively
encouraged. The quotation " team concept" appears to offer the most fruitful approach
to this aspect of the school health programme. The " team " might well consist of teaching
personnel (teacher, principal, inspector), health personnel (nurse, doctor, specialist),
parent, and family physician. The teachers should be considered the key persons in the
" teams " because of their special opportunity of recognizing the earliest manifestations of
the deviation from normal in their pupils. The school health programme cannot be considered to be complete if the teaching personnel do not take a full and active part in it.
The particular role of the teacher should be:—
(1) Check and report to the nurse any physical and emotional deviations from
normal in her pupils.
(2) To be aware of, and to supervise in the school, the activities of those of
her pupils with defects that might require special care or particular first-aid
measures.
(3) To apply minor first aid to her pupils and to report other than minor
injuries or illnesses to the parent at once.
(4) To exclude from the school any child suspected of having a communicable
disease.
(5) To be responsible for seeing that pupils who become ill are returned to
their homes in a suitable manner.
(6) To impart to the pupils "health knowledge" which will cause them to
adopt a scientific attitude toward the conservation and promotion of their
health.
(7) To foster attitudes in the children which will cause them to make intelligent
" health " decisions.
(8) Where possible, to weigh, measure, and test the vision and hearing of all
pupils as a practical part of the lessons in health.
A referral should not be considered complete until the school medical service has
reported its finding and actions to the referring teacher.
It was recommended that the school health service should actively promote good
dental practices, and where a good dental service is not available through the health unit
it should encourage the formation of community dental clinics in every way possible.
^Recommendations were made that home visiting should be considered an integral
part of school health services, and should be arranged primarily for those children who
are repeatedly absent due to ill health, and those children referred by their teacher if it
seems that this would be helpful. The parents may be visited at their home or asked to
come to the school or health-unit office, depending on individual circumstances. Home
visits in the case of suspected or confirmed communicable disease should not be considered a routine part of the service offered, but should be made mainly where a visit would
appear to contribute toward prevention of spread of the disease through the community.
Consideration was given to the physical education programme in the schools, and it
was proposed that the school medical service take a keener interest in the programme, in
becoming acquainted with the various physical activities carried on under that programme.
It was felt that some knowledge of the accepted degrees of physical activity at various
levels of growth should be obtained to determine what participation should be expected
by children in the various grades. The sub-committee is to give further study to this phase
of the school health programme with a view to providing standard recommendations.
The complete revision, following acceptance by the Health Officers' Group, was
forwarded to the Department of Education for its consideration, as it was desired to
frame a programme consistent with the views of educational personnel as well as health
personnel. The revision was reviewed in detail with officials of the Department of
Education and accepted by them, with the suggestion that they should be presented to
 L 30 BRITISH COLUMBIA
the School Inspectors throughout the Province. Outlines of the revision were then f
warded to each of the Health Unit Directors, who, in their capacity as School Medii
Inspectors, were asked to get in touch with the School Inspectors and outline the pr0pos i
to them, finally approaching the various school principals in each health unit. In additio
officials of the Health Branch, Department of Health and Welfare, are to meet with ft
School Inspectors as a group at their next gathering to discuss the whole school m.
gramme and to deal with any questions and comments presented.
From all this, it is hoped to evolve a school health programme uniformly acceptable
to both Departments which can be presented to the School Boards as the best that is
possible for the pupils attending the various schools. It is the first time that a complete
revision of the programme has originated with the staffs expected to carry out the work
and it is hoped that it will be a practical programme designed to meet the needs of pupils'
teachers, parents, and school medical personnel.
Some criticism has been levelled at the present methods of vision testing in the
schools, which the British Columbia Optometrists' Association feels overlooks certain
defects, particularly of muscle imbalance. The association has argued that testing with
the Snellen Chart alone will always leave something to be desired, and that improved
methods of testing with telebinocular equipment should be introduced into the schools of
the Province, which testing could be interpreted by the optometrists themselves, who now
have members located in nearly every part of the Province. In defence of the Snellen
Chart method of vision testing of school pupils is presented the argument that it is merely
a screening tool, the same as all other phases of the medical examination programme,
and that it possibly may overlook some few cases, but, on the other hand, is serving its
purpose of selecting the maximum number of pupils requiring further specialized examination. While there has been nothing new forthcoming in research into this matter, and
information presented to the Department has continued to recommend the Snellen Chart
as an adequate screening tool for vision testing, it was felt that further inquiry might be
indicated. The matter was, therefore, referred to the Ophthalmological Section of the
British Columbia Medical Association, who are investigating methods of vision testing
in the Vancouver schools to determine their efficacy, or otherwise. A report from that
section is awaited to determine whether changes should be made in the vision-testing
programme within the school medical service.
During the year the Department of Education established committees to bring forth
recommendations of minimum standards for schools which would serve as a guide for
School Boards and architects in designing new schools. The Health Branch, Department
of Health and Welfare, was approached to bring forth recommendations in regard to
school lunchrooms, medical and first-aid rooms, heating and ventilation, lighting, washroom facilities, toilets, water-supply, and sewage-disposal. A committee, composed of
divisional directors within the Bureau of Local Health Services, was assigned to this
task, completing its report within the designated time to be forwarded to the Department
of Education, following which an opportunity was presented for discussion with committees set up within that Department, and the general recommendations of the report
accepted. The Department of Education plans now to bring all the recommendations
from the various requested participants together into a text of recommended standards
Which will be circulated to school medical personnel, School Inspectors, School Boards,
and architects, so that each may know what standards of construction can be proposed
as acceptable to the Department of Education. It is anticipated that this project will be
released for distribution shortly. |tr.
Within the sections of this Annual Report dealing with dental health services,
nutrition services, sanitation services, and health education will be found reference to
other services relating to the school health services programme. It must again be
emphasized, however, that much of the public health service supplied as community
health service has a direct bearing on the school health services, from which it canno
 DEPARTMENT OF HEALTH AND WELFARE, 1954
L 31
be entirely divorced as the school-child is duly influenced by conditions within the
community itself. .
¥ ¥    THE HEALTH OF THE SCHOOL-CHILD
The major objective of the school health programme is to promote optimum health
for the school-children throughout British Columbia, and it seems desirable in an annual
analysis of the school health programme to attempt to determine whether the health of
the school-child has been benefited thereby. So many features affect physical status, it
is difficult to determine any definite reason for minor fluctuation in the health of the
school-child, since it is difficult to find a satisfactory measure of health status. Over the
past four years the analysis of the health of the school-child has been based on immunological status, physical status, and morbidity figures of notifiable diseases. In the absence
of a better measuring tool and for the purposes of comparison, it is probably advisable
to carry out the same analysis this year for school-children as a group.
The school health programme operates within the academic year, so that the analysis
is based on the programme from September, 1953, to June, 1954, during which school
health services were provided in the 1,033 schools included in the eighty large school
districts and the twenty-five small school districts. Enrolled in the grades examined were
194,920 school-children, a further increase again over the enrolment for previous years.
Out of the 194,920 enrolled in the grades examined, only 52,814 (27.1 per cent) received
medical examinations, a figure which is admittedly low but is explainable by the fact that
special attention is being proffered to those referred by screening methods, whether those
screening methods consist of ancillary devices, such as the Wetzel Grid or teacher-nurse
conferences. An examination of the results of the medical examinations by grades
reveals a much more reassuring situation in the fact that 82.9 per cent of the pupils in
Grade I were examined, which is as it should be, concentrating attention on the child
entering school. Usually this was done with the parent present and was productive of
greater results as the parents endeavoured to ensure the child's complete preparation to
a new phase of development and education. In the later grades, screening methods were
used to select the pupils most likely in need of physical examination. The results are
presented in detail in the various statistical tables.
Table I.—Physical Status of Pupils Examined, Showing Percentage
in Each Group, 1947-48 to 1953-54
Academic Group
Percentage of
Pupils, A Group1
Percentage of
Pupils, B Group2
Percentage of
Pupils, C Group8
1947-48    .	
1948-49
1949-50	
1950-51. _i	
1951-52...:	
91.7
93.3
93.4
93.1
93.5
93.0
92.6
7.8
6.4
6.5
6.8
6.4
6.8
7.3
0.5
0.3
0.1
0.1
0.1
1952-53	
0.2
1953-54	
0.1
1 A Group: A, Ad, Ae, and Ade categories.
2 B Group: Bd, Be, and Bde categories.
8 C Group: Cd, Ce, and Cde categories.
 L 32
BRITISH COLUMBIA
Table II.
-Physical Status of Total Pupils Examined in the Schools
for the Years Ended June 30th, 1950 to 1954
1949-50
1950-51
1951-52
1952-53
Total pupils enrolled in grades examined	
Total pupils examined	
Percentage of enrolled pupils examined 1	
Physical status—percentage of pupils examined—
A	
Ad	
Ae	
Ade	
Bd	
Be	
Bde	
Cd 	
Ce	
Cde	
128,724
45,049
35.0
38.8
52.5
0.8
1.3
5.6
0.1
0.8
0.1
154,517
46,028
29.8
34.4
56.3
0.7
1.7
5.8
0.1
0.9
0.1
1953-54
161,408
42,401
26.3
36.5
54.2
0.8
2.0
5.4
0.2
0.8
0.1
186,912
52,296
28.0
33.6
57.2
0.6
1.6
5.8
0.1
0.9
0.1
0.1
52,814
27.1
36.2
53.6
0.7
2.1
6.1
0,1
1.1
0.1
Table III.—Physical Status of Total Pupils Examined in Grades I, IV, VII, and
X for the Years Ended June 30th, 1950 to 1954
1949-50
Total pupils enrolled in grades examined I
Total pupils examined 	
Percentage of enrolled pupils examined	
Physical status—percentage of pupils examined—
a :	
Ad	
Ae  	
Ade ...
Bd	
Be	
Bde	
Cd .	
Ce 	
Cde ._    ...
41,688
30,515
73.2
38.8
53.3
0.6
1.0
5.6
0.1
0.5
0.1
1950-51   |   1951-52
1952-53
56,491
36,468
64.6
34.8
56.3
0.6
1.7
5.5
0.1
0.8
0.1
0.1
58,930
33,118
56.2
36.7
54.7
0.7
1.7
5.2
0.1
0.8
0.1
70,222
38,273
54.5
34.9
57.1
0.5
1.4
5.1
0.1
0.7
0.1
0.1
1953-54
73,616
39,995
54.3
37.7
53.1
0.7
2.1
5.3
0.1
0.9
Table IV.—Summary of Physical Status of Pupils Examined,
According to School Grades, 1953-54
Total
Pupils,
All
Schools
Examined in Grades
Grade
I
Grades
II-VI
Grades
VII-IX
Grades
X-XIfl
Total pupils enrolled in grades examined	
Total pupils examined	
Percentage of enrolled pupils examined B
Physical status—percentage of pupils examined
A	
Ad	
Ae      __
Ade	
Bd	
Be : '
Bde     	
Cd	
Ce	
Cde i	
194,920
52,814
27.1
36.2
53.6
0.7
2.1
6.1
0.1
1.1
0.1
26,577
22,029
82.9
34.8
55.7
0.8
1.6
6.1
0.1
0.8
0.1
99,369
13,847
13.9
32.8
54.1
0.8
2.1
8.5
0.1
1.4
0.1
0.1
44,994
10,651
23.7
39.8
50.6
0.8
3.1
4.2
0.1
1.3
0.1
23,98(1
6,287
41.9
50.3
0.4
2.3
4.2
0.1
0,7
 DEPARTMENT OF HEALTH AND WELFARE, 1954
L 33
Table V.—Physical Status by Individual Grades of Total Schools, 1953-54
All
Schools
Grade
I
Grade
II
Grade
m
Grade
IV
Grade
V
Total pupils enrolled in grades examined	
Total pupils examined	
Percentage of enrolled pupils examined	
Physical status—percentage of pupils examined
A    	
Ad	
Ae	
Ade	
Bd	
Be	
Bde	
Cd 	
Ce I	
Cde 	
Grade
VI
194,920
26,577
22,765
19,533
19,550
19,222
52,814
22,029
3,126
3,172
4,339
1,710
27.1
82.9
13.7
16.2
22.2
8.9
36.2
34.8
29.2
25.3
40.7
30.6
53.6
55.7
57.0
60.7
47.5
55.6
0.7
0.8
1.0
0.5
0.8
0.6
2.1
1.6
2.5
1.5
2.3
2.4
6.1
6.1
8.7
10.2
7.2
9.1
0.1
1.1
0.1
0.8
0.1
1.3
0.1
1.3
0.1
1.3
1.4
0.1
0.1
0.2
0.3
0.1
0.2
0.1
0.1
18,299
1,500
8.2
36.0
51.1
0.9
1.7
7.4
0.2
2.4
0.3
Grade
VII
Grade
VIII
Grade
IX
Grade
X
Grade
XI
Grade
xn
Grade
xm
Total pupils enrolled in grades examined	
Total pupils examined	
Percentage of enrolled pupils examined	
Physical status—percentage of pupils examined—
A :	
Ad	
Ae	
Ade	
Bd	
Be 	
Bde	
Cd	
Ce	
Cde	
17,073
15,029
12,892
10,416
7,413
5,479
8,270
1,316
1,065
5,357
582
307
48.4
8.8
8.3
51.4
7.9
5.6
41.7
30.6
36.2
41.9
39.7
45.9
50.1
54.5
49.1
51.2
46.6
40.7
0.9
1.0
0.6
0.3
1.2
1.0
2.8
4.5
3.4
2.4
1.5
2.3
3.3
6.5
7.9
0.1
2.4
3.4
0.1
0.6
8.2
9.4
1.1
2.7
2.4
0.7
0.1
0.1
0.1
0.2
0.1
0.2
0.1
	
0.2
672
41
6.1
43.9
48.8
4.9
2.4
Table VI.—Number Employed and X-rayed amongst School Personnel, 1953-54
Total
Organized
Unorganized
Number employed    _.   .
1
8,803                        7,584
4,560                        4,050
I
1,129
Number X-rayed      	
510
Table VII.-
—Immunization Status of Total Pupils Enrolled,
According to School Grade, 1953-54
Total
Pupils
Enrolled
by Grades
Percentage Immunized
Smallpox
Diphtheria
Tetanus
Typhoid
B.C.G.
Total, all grades 	
194,920
26,577
22,765
19,533
19,550
19,222
18,299
17,073
15,029
12,892
10,416
7,413
5,479
672
61.9                69.4
65.9                75.7
64.1 76.3
65.5 75.2
64.3 76.2
67.0                 76.1
67.2 72.9
60.2                 63.3
55.6 59.8
50.4 55.6
55.7 59.6
51.5 53.0
51.7                 50.8
50.6 !        48.7
29.4
53.6
43.5
34.9
t*     29.9
27.8
28.0
19.6
14.6
12.8
13.1
10.4
11.6
11.0
2.3
1.7
1.6
1.8
2.2
2.2
2.4
2.8
2.4
2.1
3.2
3.5
4.5
5.4
0.1
Grade 11
Grade II	
0.1
0.1
Grade III
0.1
Grade IV..
0.1
Grade V.
0.1
Grade VI
0.1
Grade VII
0.1
Grade VIIL.	
0.1
Grade IX	
0.1
Grade X
0.1
Grade XI....
Grade XII..
Grade XIII...
 L 34 BRITISH COLUMBIA
' An analysis of these tables is revealing, since it becomes evident from Table I th
the physical status of the school-children as shown by the medical examination presel
them in good physical condition clinically. Somewhat over 92 per cent of the Jl
are in A Group, with a lesser number, 7.3 per cent, in B Group, and 0.1 per centl
C Group. While these results show well over 90 per cent of the school-children in safe
factory physical condition, nevertheless an examination of the table will show that there
has been a decrease of 0.4 per cent in that group, as compared to the year previous
with a concomitant increase in the number in the B Group.
In Table VII is shown the immunological status of the school-children in the grades
examined, indicating that a majority of the pupils (more than 60 per cent of each group)
were immunized against such major communicable diseases as diphtheria and smallpox
maintaining their immunity status throughout their school-life. Actually it would k
desirable to have a somewhat better picture than this, since it is argued that at least
75 per cent of the population should be immunized against these diseases if epidemics
are to be avoided. There is, therefore, a definite need for increased activity in the im-
munization clinics throughout the schools of British Columbia. There have been diphtheria cases recorded in British Columbia every year, and, during this year, again a rate
of 0.5 per 100,000 population is evidenced, indicating the very necessary need to main-
tain diphtheria immunization throughout the total school population at an extremely
high level.
There has been a definite increase in the percentage immunized against tetanus
(29.4 per cent, as compared to 21.6 per cent a year ago) and in the number immunized
against typhoid fever (2.3 per cent, as compared to 0.08 per cent a year ago). This is
explainable by the fact that a combined diphtheria-tetanus toxoid is now being distributed, immunizing pupils against tetanus as well as diphtheria. It can be anticipated!
there will be a continued upswing in the percentage immunized against tetanus in
future as this practice is continued. This is desirable, since in periods of disaster it i
an advantage to have a high proportion immunized to tetanus as a protective measure,
The higher figure in typhoid fever immunization is entirely due to the campaign that was
organized in the spring of the year as a protective measure in' the face of potential
serious flooding. While the climate favoured a slower run-off, preventing the occurrence
of flooding conditions, nevertheless protective measures against typhoid and paratyphoid
fever had been undertaken and is reflected in the immunological status of the school-chili
The incidence of communicable diseases is a third method of gauging the health ol
the school-child, since a considerable majority of these occur in childhood. Fromi
point of view, the health of the school-child during 1954 could be stated to be vastly
improved, since there was a definite decrease in the volume of incidence of such childhood infections as chicken-pox, conjunctivitis, measles, mumps, rubella, scarlet fever,
and septic sore throat. It must be recognized, however, that many of these, such as
chicken-pox, measles, mumps, and rubella, recur with a cyclic periodicity in epidemic
proportions as new susceptible groups enter the school, and it is likely that during 1$
the Province was on the downward phase of one of those cycles.
Poliomyelitis showed a marked decrease during the year, with a rate of 16.7 p
100,000 population, compared to the rate of 64.0 per 100,000 the previous year, ft
incidence of poliomyelitis is receiving special attention, with study of the age-specific
attack rates as planning goes forward for the use of poliomyelitis vaccine in future p
as a possible control measure toward this dreaded infection. Diphtheria continued to
show its usual annual incidence, although in few numbers, but it emphasized the vigils
that must be exhibited toward control through immunization. The comparisons beW* J
years in so far as notifiable diseases are concerned may be studied in detail in Table vm
From the report of the Division of Preventive Dentistry can be gathered infofl^
relative to the dental health of the school-child. The health status, dentally, should^
considered as an additional factor influencing the total health of the school pup
At
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 35
this stage of development in preventive dentistry in this Province, maximum concentration is directed toward the dental examination of Grade I pupils and encouragement
toward remedial treatment, as indicated. Concurrently, an active campaign of dental-
health education explains to parents and children ways in which dental health may be
improved. '■<{
On the whole, during the academic year 1953-54, the health of the school-child
can be considered satisfactory, with certain reservations. Physically, the child continues
to show a high standard of physical status, and a somewhat higher level of resistance to
communicable infections, but there is a marked need for improvement in the immunity
status of the school population and further concentration on efforts toward improved
dental health. # W *   ^       ifp^
f DISEASE MORBIDITY AND STATISTICS
Previous reports over the past three years have mentioned the National Sickness
Survey, in which British Columbia, in common with the other Provinces, co-operated
with the Department of National Health and Welfare on the collection of information
concerning the illness experience of the population, the amount and kinds of health
services received, and the volume of expenditure, either directly or through insurance, for
those services. At the eighty-seventh annual meeting of the Canadian Medical Association, convened in Vancouver during June, 1954, the Deputy Minister of National Health
reviewed some of the statistics which have been presented in the five special compilations
released to date, based on the information gathered during the Sickness Survey. It
was indicated that Canadians as a whole, in the year of the survey, 1950-51, spent
$675,000,000 from public and private sources for health care, of which almost
$375,000,000 came directly from families, or from them through insurance plans.
Allowing for adjustments in the survey data, it was estimated that consumer payments
for physicians' services amounted to about $118,000,000, or an average of $26 for each
family. As far as could be told from the data, the amounts spent per family increased
significantly as income increases but do not go up as the size of the family increases;
rather, larger families spend less per person on all items of health care. Regional variations in average family expenditures are even more striking. It is estimated that families
in British Columbia spend on an average of about $100 each for all items, with those in
Quebec, Ontario, the Prairie Provinces, and the Maritimes spending successively smaller
amounts. Preliminary survey data showed that an estimated 2,000,000 visits were made
to out-patient departments by just under 5 per cent of the population. Such visits
represented about 8 per cent of the total of home, office, and clinic calls. Even considering that out-patient facilities are not evenly distributed, there were only minor
regional variations around this proportion, with the exception of British Columbia where
the proportion was about 12 per cent.
In reviewing the illness experience of the population, the Deputy Minister of
National Health indicated that Canadians on the average suffered an illness or disability
sufficiently serious to interfere with their normal activities for 11.9 days, including an
average of 5.6 days in bed at home or in the hospital. These same Canadians reported
a grand total of 51.4 days of "complaints," which may or may not have interrupted
normal activities. Viewing this from another aspect, it implies that out of every 100
Canadians 20 had no "complaints" whatever during the year, 22 reported some symptoms
of ill-health but not serious enough to interfere with their usual activities, 10 were prevented from carrying on such activities but not confined to bed, and 48 were confined
to bed, at home or in hospital, for one or more days.
Further study of the illness experience is under way, from which it is hoped to
publish national estimates of some ninety diseases and conditions, or groups of conditions,
causing illness. Of the preliminary evidence, it appears that over one-half of all the
diseases reported in the survey (54 per cent) can be grouped under diseases of the
 L 36 BRITISH COLUMBIA
respiratory system. In fact, the common cold and influenza represented no less tha
per cent of all the diseases reported. The second largest group, diseases of the digef
system, involved only 8 per cent of the total illness, followed by infective parasi&T
eases (6 per cent) and accidents, poisoning, and violence (5 per cent). These *
categories included about 75 per cent of all reported illnesses. In analysing the voir
of medical services, the Deputy Minister of National Health indicated that nearly thT
out of every five Canadians did not see a physician in the home or office during the ye*
Only one out of three visited the physician's office at least once, one out of five received
one or more home calls, and one out of twenty attended hospital out-patient clinics. A
might have been expected, older persons had a higher rate of physicians' calls. Those
over 65 years of age, both male and female, received 2.5 calls per person, compared with
about 2 calls for those between 25 and 64 years and about 1 call for children under 15
years. Persons 65 years of age and older represented 7.8 per cent of the population
which received 18.9 per cent of all the home calls. Higher-income groups, for example
appeared to have received on an average of 4 calls per family. The home and office call
rates were highest in British Columbia, 2.1 per person, compared to a national average
of 1.6. | There was wide variation in the ratio of home to office calls, as learned from the
fact that the proportion of home calls to total home and office calls was 45 per cent in
Quebec, 31 per cent in the Maritimes, 18 per cent in British Columbia, and 16 per cent
on the Prairies, indicating that such variations cannot be due to chance, but must have
specific reasons. Some of these obvious reasons are differences in geography, communication, and transportation, but perhaps more significant is the unequal development of
hospital bed capacity and the presence or absence of hospital and medical-care insurance,
It is apparent from this that a great wealth of information has been unearthed in the
National Sickness Survey, and that much more data are to be available as the study continues. As this additional information becomes available, it will be possible to relate it
more directly to British Columbia, so that some information can be gained on the medical-
care needs of the Province as a whole.
The disease morbidity picture in British Columbia over past years has shown it
there is a considerable proportion that should be more thoroughly investigated, with a view \
to control on an epidemiological basis.    Increases in certain infections, such as poliomyelitis  and shigellosis,  have resulted  in  some  epidemiological investigation which
indicated that more intensive study was desirable.   Thus, during the year, a Consultant I
in Epidemiology was appointed, as mentioned in the report of the Bureau of Special
Preventive and Treatment Services.    As a result of this appointment, it is hoped it
more thorough study of the notifiable diseases will occur, with special attention being ]
concentrated on suggestions of follow-up, as guidance to the various health-unit directors,
particularly in respect to disease-carriers in specific conditions.   Much groundwork was
laid during the year as this new service became organized, and in the future a specific
report dealing with disease morbidity and epidemiology will be presented as a separate
feature.
British Columbia, in 1954, experienced a decrease in the total incidence of noting
diseases, with a rate of 2,424 per 100,000 population, which is the lowest of the past ft
years, as evidenced in Table VIII.   In effect, this can be credited to the lowered incite*
of practically all notifiable diseases, with the exception of infectious hepatitis and t j
shigellosis-salmonellosis group.    Particularly gratifying was the decrease in the vop
of poliomyelitis experienced throughout the Province this year, in contrast to the m
tionally tremendous incidence of the year previous.    As a matter of fact, the lowe
incidence at 211 cases per 100,000 population was extremely fortuitous, asthef^
myelitis facilities of the Province were severely taxed by the load of patients stw u
treatment from the previous years.   If another heavy case rate had occurred, theh0SL
would have laboured under undue circumstances in endeavouring to accommodate ac
ill patients
 DEPARTMENT OF HEALTH AND WELFARE, 1954
L 37
As it is, credit must be given to the larger hospitals in Vancouver and Victoria for
the exceptional job performed in conversion of space to accommodate the patients
admitted. Had conditions warranted, the Vancouver General Hospital and the Royal
Jubilee Hospital in particular were prepared to make further sacrifices to handle an
increased volume of cases.
Fortunately, the situation will not have to continue, as the construction of a poliomyelitis pavilion, on the grounds of the Pearson Tuberculosis Hospital, now nearing completion, will provide accommodation for the long-term poliomyelitis patients requiring
lengthy specialized treatment in resuscitators, thus relieving the load on the acute hospitals
to permit them to assume the responsibility for acute care of the early stages of the illness.
It can be readily realized that these facilities in these large cities are exceedingly necessary
for the larger number of patients which are evacuated to those centres where they may
obtain the specialized medical and nursing treatment so vital to their welfare at the onset
of their illness. The easement on space will be a relief to those physician-nurse teams who
gave so unstintingly of their time and skill. The case fatality rate of 2.8 for 1954 is a
reflection of the capable treatment provided poliomyelitis patients by the hospitals,
physicians, and nurses. As a basis of comparison, the table that follows shows the trend
that has occurred in the case fatality figures in those years in which poliomyelitis was
most heavily reported,   if A-
Poliomyelitis Case Fatality Rates
Year
Cases
Deaths
Case Fatality Rates
Per Cent
1927  	
182
37
20.3
1928   	
102
19
18.6
1929  	
43
13
30.2
1930	
34
8
23.5
1931	
42
11
26.2
1947	
313
12
3.8
1952	
584
37
6.3
1953	
787
26
3.3
1954	
211
6
2.8
It must be recorded that the improved case fatality rates over recent years may in
part be due to improved reporting of cases, in which an undue number of non-paralytic
cases of low fatality influenced the fatality rates. On the other hand, a major factor in
the improvement can be stated to be the improved methods of treatment prevailing generally throughout the Province. ±
In a large measure, credit for the low case fatality rate belongs also to the Royal
Canadian Air Force Air-Sea Rescue Unit, which has provided evacuation transportation
of patients from Interior points to the larger treatment centres. This service, which has
operated so successfully and effectively for the past three years, has been a valiant aid
in the fight against poliomyelitis by accepting air-evacuation trips on exceedingly short
notice under all types of weather conditions. In addition, a medical officer from the
Air-Sea Rescue Squadron has continued to serve on the Poliomyelitis Committee in
Vancouver, which serves to supervise the plans for handling of poliomyelitis patients
with respect to their evacuation, acute treatment, and ultimate rehabilitation. This Committee had its origin during the epidemic of 1952, but has continued to function as the
poliomyelitis incidence has remained unduly high ever since.
Assistance has also been forthcoming from the British Columbia Foundation for
Poliomyelitis, a voluntary agency supported mainly through the efforts of the Kinsmen's
Clubs throughout the Province. Their campaign for funds was well oversubscribed,
which fortunately assists materially in providing major equipment in some cases, additional physiotherapists for rehabilitation services in other instances, and in assistance
toward the vital question of research.   For some few patients this agency has been able
 L 38 BRITISH COLUMBIA
to provide financial assistance for treatment where no other sources of financial aidco
be obtained; without the Poliomyelitis Foundation, such patients might have remain
crippled for life because of financial inability to obtain complete treatment and rehaft
tation services.
During the year, considerable publicity was aroused from the field trial being co
ducted in the United States toward the use of poliomyelitis vaccine as an effective Z
phylactic in the control of this infection. At the outset it had been decided to concen
trate the field trials in the United States, and that all poliomyelitis vaccine manufactured
by the Connaught Research Laboratories in Canada would be turned over to the US
Public Health Service for its use. Field trials were commenced in the United States in
the early spring, and as they progressed it became evident that there would be some supply
of poliomyelitis vaccine surplus to their needs, which resulted in an offer being made to
supply a quantity to Canada for distribution to the Provinces for use on an additional
field-trial basis.
As it was late in the spring before this information became available, decision as to
its administration in British Columbia had to be carefully weighed on the basis of a
number of complicating administrative factors, which resulted in the choice to forgo
any participation in the field trial as far as this Province was concerned. It was felt that
the information that would be obtained from the more intensive trials in the United States
under ideal administrative conditions would be of more value than a hasty participation
under less ideal conditions here. Consequently, plans were laid toward obtaining polio-
myelitis vaccine for administration to specific groups in 1955, following on the report
of the field trials conducted by the U.S. Public Health Service throughout the United
States. Financial arrangements were completed to permit the purchase of available
quantities so that the production of the vaccine by the Connaught Research Laboratories could get under way.
The attempts at control of poliomyelitis remained, therefore, with the prophylactic
administration of gamma globulin. New criteria for its use were established, however,
to permit injections only to household contacts between the ages of birth and 30 years,
or who are pregnant, whereas the previous year it had been confined to administration
of family contacts who were 16 years of age or less, or who were pregnant. It was definitely recommended that such prophylactic injections should be given within three days
following diagnosis of the original case, since gamma globulin is of no value after clinical
symptoms of the disease have appeared. The available supply did not permit of widespread community prophylaxis or an attempt at immunization of household contacts to
suspect cases.
Toward the end of the year it became evident that the quantities of gamma globulin
were improving to such an extent that the Dominion Council of Health, at its last meeting
in Ottawa, proposed extension of its use as a prophylactic for measles, infectious hepatitis, hypogammaglobulinemia, and for expectant mothers exposed to rubella. Recommendations toward that extension have been proposed to each of the Provinces, and tk
subject is under active consideration in British Columbia by the Committee on Communicable Disease Control as the year ends. Some careful consideration will have to
be given to the terms under which it will be permitted to be used in respect to infectious
hepatitis, since this is a disease that is very definitely on the increase. During 1953 a
case rate of 64.1 was recorded as much the highest to date, but this has been exceeded
further during 1954, when the case rate reached 96.4. This infection, vile in nature,
occurs most commonly amongst children and young adults, who seem to be most sitf-
ceptible. The infection tends to affect the largest numbers in the autumn and ear?
winter, the degree of severity varying from individual to individual. It is known ttt
gamma globulin does confer a certain protective quality to the infection, and it is argnf
that its administration to at least familial contacts might serve to materially reduce *
increasing annual incidence.   Before another year has passed, it is felt this prophp1
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 39
material will be available for that purpose, and the next report may produce some evidence of its effect, f }$
•Another major blemish on the notifiable-disease record of the Province during 1954
was that of enteric infections of the Shigella-Salmonella group, which have continued to
show a materially upward trend. Bacillary dysentery and the Shigella type was reported
in the case of 605 persons, to provide a case rate of 47.8 per 100,000 population. This
is a further upward trend in a condition which has been consistently increasing over the
past four years. It had been indicated in previous reports that this might be anticipated,
particularly in infection caused by Shigella sonnei, and further comment on this specific
infection may be noted in the Division of Laboratories section of this Report. With
respect to salmonellosis, almost the same incidence of typhoid fever (Salmonelli typhi)
was recorded, with a case rate of 0.9 per 100,000 population, as compared to 0.8 per
100,000 population in 1953. Sporadic cafces were reported in widely separated parts
of the Province, with the exception of the Skeena Health Unit, which reported five cases
among members of the Indian population. Among this same group, and in the same
area, were the majority of the cases of paratyphoid fever, although additional cases of
paratyphoid were located along other coastal communities, both on the Mainland and
on Vancouver Island, to create a significantly higher case rate for this disease (2.8 per
100,000 population for 1954, as compared to 1.8 per 100,000 population in 1953).
Other Salmonella types of infection remained on about the same level as on previous
years, with a case rate of 13.7 per 100,000 population.
This whole field of enteric infection needs some future investigation, and it is one
area of epidemiological investigation which is to occupy the services of the Consultant
in Epidemiology, in an endeavour to set up complete carrier registries, so that the most
likely source of infection can be kept track of and movement from place to place recorded
to the degree that local health services can be advised. Control of disease-carriers offers
one aspect of action toward reduction in the increasing incidence.
The Division of Laboratories section of this Report has made mention of the three
cases of botulism which occurred among Indians, contracted from fish products. The
Division of Laboratories has made special study of botulism in Canada over many years,
and is recognized as an authority adequately investigating all cases.
While the incidence of diphtheria continues to remain low, with a case rate of 0.5
per 100,000 population, nevertheless the fact that cases do occur is a reflection on total
immunization to this infection. As a matter of fact, a reference to the section of this
Report dealing with School Health Services indicates that only about 69.4 per cent of
all school-children are thus protected. This, coupled with the fact that the large adult
population has probably ignored suggestions for booster immunizations, indicates a
potentially susceptible situation in which opportunities for a diphtheria epidemic are
probable.   Intensification of the immunization programme does seem indicated.
Tetanus occurred in the case of one person; here again the need for administration
of tetanus antitoxin to traumatic patients does seem warranted, while the tendency to
include tetanus immunization with others, as is the present trend, is exemplified.
Plans have been made this year, as in previous years, for special studies of epidemic
influenza if it should occur in epidemic proportions. The Department of National Health
and Welfare sought to have all reporting promptly, while opportunity was provided for
typing of submitted specimens in the Laboratory of Hygiene at Ottawa. However, the
rate at 6.2 per 100,000 population was not significant, and this situation did not require
special attention.
Minor communicable infections, such as chicken-pox, measles, mumps, pertussis,
and rubella, continued to exact a toll throughout the year, accounting for approximately
two-thirds of the total notifiable diseases. These infections do seem to be uncontrollable,
and it is exceedingly doubtful whether all cases are reported in any case. It had been
hoped that the matter of reporting them would be the subject of discussion during the
 L 40
BRITISH COLUMBIA
meeting of Federal-Provincial epidemiologists, but unfortunately that meeting did
materialize and is now postponed into the forthcoming year. ol
The notifiable diseases are reported weekly by the Medical Health Officers to ft
Division of Vital Statistics and are presented in the statistical tables that follow, show*6
the totals and case rates for the past five years, and listing the incidence by health unit
throughout the year.
Table VIII.—Notifiable Diseases in British Columbia, 1950-54
(Including Indians)
(Rate per 100,000 population.)
Notifiable Disease
1950
Number
of
Cases
Rate
1951
Number
of
Cases
Rate
1952
Number
of
Cases
Rate
1953
Number
of
Cases
Actinomycosis	
Botulism .	
Brucellosis	
Cancer -3	
Chicken-pox	
Conjunctivitis	
Diphtheria	
Dysentery—
Amoebic	
Bacillary (Shigella)	
Encephalitis, infectious	
Hepatitis, epidemic	
Influenza, epidemic	
Leprosy	
Malaria	
Measles I	
Meningitis	
Mumps	
Pertussis	
Poliomyelitis	
Rubella 	
Salmonellosis—
Typhoid fever	
Paratyphoid fever	
Unqualified	
Streptococcal infections—
Erysipelas	
Scarlet fever	
Septic sore throat	
Puerperal septicaemia	
Tetanus	
Trachoma	
Tuberculosis	
Tularaemia	
Venereal disease—
Gonorrhoea ,	
Syphilis   (includes  non
specific   urethritis —
venereal)	
Chancroid	
Vincent's angina	
Totals	
1
22
3,125
5,001
280
63
1
189
1
46
460
5,648
15
8,634
1,740
73
7,935
11
35
152
36
871
183
1
1
5
1,828
3,579
630
6
0.1
1.9
274.6
439.5
24.6
5.5
0.1
16.6
0.1
4.0
40.4
496.3
1.3
758.7
152.9
6.4
697.3
1.0
3.1
13.4
3.2
76.5
16.1
0.1
0.1
0.4
160.6
314.5
55.4
0.5
18
2,850
6,671
374
5
253
90
11,033
2
6,269
30
5,835
1,134
92
2,288
18
7
149
38
4,146
300
8
1,662
3,301
568
48
1.6
247.2
578.5
32.4
0.4
21.9
7.8
956.9
0.2
543.7
2.6
506.1
98.4
8.0
198.4
1.6
0.6
12.9
3.3
359.6
26.0
0.7
144.1
286.3
49.3
4.2
12
3,366
6,266
346
11
1
102
2
212
548
2
8,227
33
7,088
976
594
1,986
30
8
109
26
4,163
536
2
3
1,411
3,057
541
19
1.0
281.0
523.0
28.9
0.9
0.1
8.5
0.2
17.7
45.7
0.2
686.7
2.7
591.6
81.4
49.6
165.8
2.5
0.7
9.1
2.2
347.5
44.7
0.2
0.3
117.8
255.2
45.2
1.6
40,572
3,565.2 I 47,189  I 4,092.7     39,677
3,312.0
1
5
2,785
6,869
193
8
1
588
4
789
808
1
1
7,646
42
8,071
717
787
1,095
10
23
83
24
2,220
206
1
2
13
1,494
1
2,969
691
11
26
Rate
0.1
0.4
226.4
558.4
15.8
0.6
0.1
47.8
0.3
64.1
65.7
0.1
0.1
621.6
3.4
656.2
58.3
64.0
89.0
0.8
1.8
6.7
1.9
180.5
16.7
0.1
0.2
1.1
121.5
0.1
241.4
1954
Number
of
Cases
1
3
7
3,600
6,085
64
7
605
47,8
1
ai
1,220
96.4
78
6,2
6,572
47
3,548
1,096
211
832
11
36
173
21
1,355
179
1
4
1,434
1
2,668
38,185
56.2       784
0.9 36
2.1 12
"3,104.4 \!0M\&i
Rate
0.1
0,2
0,5
im
480.6
5,1
0,5
519,1
3,7
65,7
2,8
13,7
1,7
1071
14,1
"II
0,3
113,3
0,1
210.7
61i
2,8
 DEPARTMENT OF HEALTH AND WELFARE, 1954
L 41
ON
CO
<
fa
<
o
w
HH
fa
HH
u
fa
fa
Q
co
H
H-1
B
H
fa
<
fa
fa
fa
o
fa
o
O
i
CO
HH
H
»-h
CO
fa
CO
i
fa
CO
fa
fa
fa
<
fa
H
O
X
fa
fa
fa
3
QDUlAOJd;
ouBuia^i-;Buiiji^i
pUBISJ JSAnOOUBA
JO JSBOO JS9M
jsboo isaAV
pUBHUBj^[
Xbuq;oo^[ ;s9Ai
jo pJBog uoiun
jrBunnbsa-BiJopiA
39WTUiuioo iftlBdH
UBjirodoijapi J3A
-uoouba J9JB9JO
puBjsi jaddn
jasBJj: jaddfi
CO
cd
<u
u
<
-a
cG
o
Oh
CO
m
g
cd
CO
■4-*
•«H
a
,G
+->
i—*
cd
<u
ubSbubjio tpnos
tBijnsO irinos
BU935IS
jasBJii uouijs
3TOPS
pUBJSJ J9AUO0UBA
irjnojs pun uoiubbs
J3Arg 00B9J
UBSBUBJIO tflJON
J9SBIJ U.UOM
xxjsiuiBnbs
-punoj§ 9A\oh
XBU9JOO>J JSBg
puBjsj jQAnoo
-UBA IBHU33
ooqiJBO
XJBpunog
IBJOX
CD
09
a
o
CO
IO
!0
ISO
t       •»
'co
OcO
cm cm
ooovo    rf
voovco    on
cm
CM    IrH
NO
<s
t^Tf   !cmo\vov>
COON    !CM
ON
CO
VO
oot-»on   ien   !   'i-i
O       CO
ivooo    th    cm
co
O
co   (vo    m^tON   irnoN
f*    !CM    ,"Sf I      Tf
i*-"    ! !      CM
"<*rH
m
oo
OS
o
cm
00
cm
co co ON v> On fO
vo    t-"«3-    vo
VO rH
cm
OOn
00^"
ic*
iO
!CM
'CM
CM
r-
00
cm
r»CMV©TtcOV£>rHrM
c-    >r> r-i oo oc vo m
r-l        "^t        ONCS        r-l
of
fM*-<l%
O
ONVO
o
|00
!CN
tnommcsoovoin
iOnt-hvo     rf
CM
CO
CO
CO
W*>      CM    i CO CS CS »/-> V> CO
I''*        C-VOrHrH
! ! CN
vo
5
Tf
!CO
I CM
rH      t~-     ! 00 CM CN CO «0 00
rH       00     !VO       TtONr-I^J-
ICO       rH
rHrHTfr
ON ON
Os
vo
CO
00
•n
o
vo
rH     | CO CO f- CO 00 VO ^ Tf
v*     |IO       <S       T|-CS       rH
fN
rHCOrH
IO0
ITf
<0       r-l
VO
IO
vo
CN
«nr»vo    csr^co
CO
CO
TfrHON
vo
ONOtJ-
OOt~-r-lr-l
CM
VO
ONCN
CM
100 00
ICN
ICN
ON
o
00 rH
ON CM
co
CO
cov©
CM
CM CO
r-rn
CO
00 rH r- ON CM ON
IO       ONCOrH n*
r-       i-»
!00l>
CO CM
vo
00
o
rH
vo
VOCOCM
o
rf-Tj- oo «n
CM CM
CO
!OV>
IVOrH
!CM
CO
vo
CM
OtJ-O^
rj-       CMrH
o
r*      CM
ICO
TfrH
»«o
co
icoo-^-JO
«oco
CO
CO
CM
CM
mcM ON rococo
"<d" rH        rH
rH       rHt^-CM
CM
ON
en
m
CO
CO
«M
CO
CO
:©
if*
ICM
rH«nrH00
COrH
r-t       rHTf
00^*
CM
CM
VO
' 00
ICM
rHt~-VOrH
O0t>CMCM
ICO
oo
CO
lONt-*
ll>rH
1 r-t
00      00 CO CO Th vo vo vo 00      r-*
iTfCM f-        OS        rHrH
1 rH        r-t        i-i
vo    com^-
rHln
Tf
I
t
It-CM
1 oo
1 y*
«n      "<* CM On (S 00 ON CO O         !
i»n    o    oovorHcs
1               CM        rH                                !
rH        fMrHON
vo
i       i
i      i
i       t
i co r~- o >*o rt t> «n'
ooovo o
vqo vo
COVD
lOOOCSr~OCVOrHf>J
csr-t-,Nt"^i-o\rHco
cs    >n    mocMoo
ivoco
ICOC-
•r-t IT) ON rH ■^,
cM«nr-
COrH
MH.
Oco
CM CM
VO
COrH
ooovo
VOONCO
VOrH
CM
Tl-CM
Os i—(
NO
oo
vo
VO
00
CM
oo
CM
ON
vo
o
CO
CO
•1—(
co
o
CJ CO
Isl
+•> •*-» 3
O O C
2 fl
co
o
On-n
COrG
IH   >H
Oh 55
co
T? O *»h *r!
CO      _"-H "H
*H !
CO
CO
^PQfavJUUQQ
c«r2 co «S      -jh    ' co
fa g &5C S I 3 S3
<2 o
s o
ftfco
o
>
•2'81
o >^S
a2g
HfaP
CO
a
o
•»H
u
«H
CJr-H«»H
a O. ca
2'St:
5? ^ O
£Wto
CO
cd
o
lH
rG
<u
o
co
+->   G
OhG
<U cd
^^
H
u
a}
co cd c
6
CO
o cd
a 8
• -Sf «h E       .SO       .S
_, « 2£ cdt3.G - O
co
+->
•»H
»H
HH>
u
G
o
<G^H
•3*
H G
3§0wU
cd
•_i i—i
oc cd
ggG
G
>
G
G
cd
rG
O
G
a>
a
Jh
o
«M
o
H>J
cd
V
>H
 L 42 BRITISH COLUMBIA ^
REPORT OF THE DIVISION OF PUBLIC HEALTH NURSING
Monica M. Frith, Director
The Public Health Nursing Division forms part of the Bureau of Local Health
Services. The Division not only provides public health nursing personnel for assignment
to local health services, but also assumes responsibility for the technical supervision oi
the public health nursing programme in order that the best type of public health nursing
service may be available to the people of the Province. As most nursing districts have
now been incorporated into health units, with the senior nurse or supervisor assuming
responsibility for the direct supervision of the public health nursing staff, it is now po$.
sible to direct more attention toward the provision of public health nursing consultative
services to the local health units. By assisting the staff to analyse their specialized pro-
grammes in relation to local need, time, and staff available, better public health nursing
services may be developed in each area within the framework of Provincial policy, The
Division has been active in recruiting nurses to the staff, arranging for new appointments
transferring nurses within the service, and in planning for both in-service and postgraduate training for members of the public health nursing staff.
STATUS OF THE SERVICE
The population of the Province continued its upward trend, with the younger age-
groups showing the greatest increase. Accordingly, the demand for public health nursing service has continued to increase as the emphasis of the service has been directed
toward the health of the expectant mother, infant, pre-school and school-age child,
111 Although it may be shown clearly that there is need for larger numbers of public
health nurses on the staff in order to keep pace with the rising population, it has not been
possible to increase the number of public health nurses in the field largely because of the
lack of available qualified public health nurses.
At the close of the year there were positions for 141 nurses on the staff. This
includes 4 positions in central administration, 1 public health nursing co-ordinator wi
the Division of Tuberculosis Control, 1 resident nurse, and the remainder of the positions
are allocated to local health services and include 6 supervisors, 14 senior nurses, and
110 staff public health nurses.
Because of the difficulty in recruiting nurses, it was not possible until this year to
fill four of the new positions established last year in such locations as the Saanich and
South Vancouver Island Health Unit, Coquitlam in the Simon Fraser Health Unit,
Williams Lake in the Cariboo Health Unit, and Nanaimo in the Central Vancouver Island
Health Unit. t
Two new positions were created this year to assist with the development of home
nursing-care programmes in the Saanich and South Vancouver Island Health Unit and
in the Vernon area of the North Okanagan Health Unit. The nursing establishment at
Quesnel in the Cariboo Health Unit was increased from one and one-half to two nurses.
Resident nurse positions at Atlin and Telegraph Creek were transferred to the Heai
Branch from the Provincial Secretary's Department. Both these positions were vacant
and increased the recruitment problem. However, in October a Red Cross Outpost
Hospital was opened at Atlin, so that this centre no longer required a resident nurse.
Tahsis., on Vancouver Island, was assisted with the organization of a part-time p*
health nursing service.
The Division suffered a serious loss when Miss Margaret Campbell, Assistan
Director, resigned to join the World Health Organization after having given faithful an
competent service with the Department over a period of twelve years. Miss Camp*
has not yet been replaced, so that the public health nursing administrative staff We
increased their responsibilities by accepting additional duties. 1
 1§| DEPARTMENT OF HEALTH AND WELFARE, 1954 L 43
Because of the shortage of qualified public health nurses, it has been necessary to
accept certain unsatisfactory conditions in order to make a maximum of service available
to local health units utilizing existing personnel, as illustrated below:—
(1) It has been necessary to employ nurses without public health nursing training to fill positions which normally require persons well trained in this
field of work. These nurses provide only a minimum service to the community and at the same time increase the supervisory problems for the
already heavily burdened senior nurses and supervisors. Twenty per
cent of the field staff do not have the required training.
(2) Qualified public health nurses have been accepted for employment on the
basis of their availaMlity, fulfilling at least part of the community need.
For example, two married nurses are working four days rather than five
each week, because they are the only public health nurses available for
appointment.
(3) Qualified and experienced public health nurses with married status are
employed in large numbers in the most desirable districts, thus forcing
inexperienced single nurses to accept the more difficult rural postings.
During the year there were forty-two new appointments made to the staff. In addition, eight nurses were reappointed to the service following the completion of the public
health nursing course at university. The situation with regard to recruitment of nurses
completing the public health nursing course at the University of British Columbia seems to
be similar to last year, as only two nurses could be interested in joining the service. The
remainder of the qualified staff are recruited from outside of the Province or from married
public health nurses and residents of communities in which vacancies occur. There were
thirty resignations from the staff. Of this group, twenty-two were married nurses who
returned to their homes, four nurses resigned to be married, and six left for employment
elsewhere. In addition, fifteen nurses received leave of absence to complete their public
health nursing training at university. Seventeen nurses were transferred within the
service, while one nurse transferred from the Division of Tuberculosis Control to the
public health nursing field staff.
As qualified public health nurses are required for placement in sub-centres of health
units and as no suitable applicants are available for appointment, it has not been possible
to fill the vacancies at Hope in the Upper Fraser Valley Health Unit, Greenwood in the
West Kootenay Health Unit, Salmon Arm in the South Okanagan Health Unit, Burns
Lake in the Cariboo Health Unit, and the public health nursing position at Kitimat.
Ocean Falls public health nursing service has not yet been established for the same
reason. When it is necessary to close a sub-centre, emergency public health nursing
services are provided by the remaining public health nursing staff.
During the year the nursing situation was relieved to some extent by an adjustment
in the nursing salaries. However, the salary levels do not yet compare favourably with
the salaries of the nurses on the staff of the Metropolitan Health Committee in Vancouver,
which also recruits trained public health nurses. It is not expected that satisfactory
numbers of qualified public health nursing staff will be available for placement in rural
public health nursing positions until a further adjustment takes place.
PUBLIC HEALTH NURSING CONSULTANT SERVICE
Under the direction of the Bureau of Local Health Services, the staff of the Division
of Public Health Nursing plan together to assist with the development of the public
health nursing service on a Province-wide basis to fit in with accepted standards of public
health nursing.
From information collected each year, a critical analysis is made of the case load
carried by each public health nursing member on the staff in order to determine the work
 L 44
BRITISH COLUMBIA
load, the need for staff, or reassignment of duties. Thus the numbers» <rf public health
nurs^ required for service on a Province-wide basis may be estabhshed
Each year a time study is conducted over a three-week period n order to find out
how the nursing staff are distributing their time to the various health Programmes and
to indicate the emphasis being placed on specialized services m different health units.
In this way it is possible to pick out trends in demand for public health nursing service
and to locate situations which may need adjustment.
The public health nursing consultant service to health units is provided by routine
visits to the districts when the public health nursing consultants meet with the health-unit
director and senior nurse to discuss the development of the local programme. The consultant helps to assess the service rendered, considering all aspects of the local situation.
She also assists the senior nurse to understand and carry out her supervisory duties in
order to obtain the best possible results. The consultant in the Kootenays last year gave
a short institute on public health nursing supervision to a number of senior nurses who
had not had the benefit of postgraduate training on this phase of their work.
In addition to assistance in the generalized field of public health nursing, consultant
services are available to local health units in certain specialized services on request.
Miss Margaret Campbell, Assistant Director, Public Health Nursing, gave valuable
assistance and direction to the staff of the North Okanagan Health Unit in the development of the Vernon home-care pilot study, as well as to the staff of the Saanich and
South Vancouver Island Health Unit in the establishment of a nursing-care service in
Saanich Municipality. Miss Lucille Giovando gave important specialized help to the
staff in the development of mental-health programmes. As a result, public health nurses
have made better use of the Child Guidance Clinic facilities in obtaining psychiatric
assistance for problem children, due to the improved co-ordination between the Child
Guidance Clinic and the public health nursing field staff. In July Miss Margaret Cam-
maert transferred her headquarters from Trail to Vancouver, where she is now working
from the office of the Assistant Provincial Health Officer, as maternal and child health
consultant. The major advantage would be close association with Dr. J. F. McCreary,
head of the Department of Paediatrics, University of British Columbia, who also serves
as consultant in paediatrics to the Health Branch; opportunities are thus provided for
ready consultation on the development of a child-care programme for the field staff.
Miss Cammaert is now in a position to have closer liaison with child-care agencies which
are located in Vancouver. These agencies include the Crippled Children's Registry,
the Health Centre for Children, the Western Society for Rehabilitation, the Cerebral
Palsy Association, the Canadian Arthritis and Rheumatism Society, and the Junior Red
Cross. As the result of this specialized assistance in public health nursing, child health
programmes in local health services have become more efficient and effective and more
group classes for expectant mothers have been organized. This fall, Mrs. Pauline
Yaholnitsky, who had been acting in a consultant public health nurse capacity to the
three northern units, accepted a transfer to Prince George, where she is now supervisor
of the Cariboo Health Unit.
The Division has been making its contribution to the Policy Manual and has been
particularly active in completing the section dealing with related agencies A start has
been made on the Nursing Care Procedure Manual, which should soon be completed.
Procedures have been recommended for immunizations and other injections with a view
to setting up new Provincial policies in this regard.
During the year public health nursing consultants have been on various committees
set up to improve local health services. Miss L. Giovando is secretary and adviser of
the Public Health Records Committee, which meets regularly to consider the Provincial
record system and its various forms. The Records Committee completed their study
of the family folder system of filing records and have recommended that it be adopted
 ■ DEPARTMENT OF HEALTH AND WELFARE, 1954 L 45
on a Province-wide basis. The Committee is now working on a record manual to bring
in the changes. Miss Cammaert was the public health nursing representative on the
School Health Committee which drew up a recommended school health programme.
The Division has worked closely with allied public health nursing agencies during
the year. With the Indian Health Services' appointment of a field public health nursing
supervisor for the coastal region, a better opportunity was provided for integration of
services. Public health nurses from the Indian Health Services attended the annual
public health institute for the first time this year. The public health nursing staff of the
Metropolitan Health Committee and the Public Health Nursing Division continued to
work together on matters of common concern, f This year more attention has been
directed toward the smooth transfer of health records between the two services. The
parentcraft classes given in Victoria by the Victorian Order of Nurses, the Victoria City
Health Department, and the Saanich and South Vancouver Island Health Unit illustrates
joint planning and participation in the provision of service on a local level. Once again
the School of Nursing at the University of British Columbia responded to an expressed
need in public health nursing training by adding a course in prenatal relaxation exercises
to the public health nursing curriculum.
Members of the Division have been taking part in a number of Provincial committees. These include the Provincial Junior Red Cross, the Junior Red Cross Crippled
and Handicapped Fund, the Red Cross Nursing Committee, the St. John Ambulance
Nursing Committee, the Public Health Nursing, Labour Relations, and Educational Policy
Committees of the Registered Nurses' Association of British Columbia, and the Advisory
Committee to the University of British Columbia School of Nursing.
PUBLIC HEALTH NURSING TRAINING
In-service training of nursing staff increased during the past year, as larger numbers
of nurses without formal public health nursing preparation joined the staff. Two-thirds
of all new nursing appointees lacked the required certificate or degree in public health
nursing. Nurses without public health training are given an orientation period in the
health unit to assist them to become familiar with the public health nursing programmes,
procedures, and policies. However, these nurses cannot be expected to carry as large
a district or deal with the same difficult public health nursing problems that can be
handled readily by trained personnel. Some health units have had to provide unusually
heavy in-serve training programmes as qualified public health nurses have not been available for more rural placements. The senior nurses and supervisors should be commended
for their part in preparing these nurses to make a good contribution to the service. It
should be pointed out that the senior nurses carry a heavy programme without the
addition of an intensive in-service training programme.   § k jL.
In an effort to raise the percentage of qualified public health nurses on staff, National
health-grant bursaries were increased this year from ten to fifteen. These bursaries
provide financial aid to suitable nurses who have been employed on the staff in order
that they may complete the required certificate in public health nursing at a university.
Following their training, these nurses return to the staff for a minimum of two years.
This year fifteen nurses are on leave of absence in order to complete the academic requirement for permanent appointment to the public health nursing staff.
During the year one month's supervised field experience was provided for seventeen
graduate nurses from the University of British Columbia and three from the University
of Saskatchewan, in order to give them the practical experience required for the public
health nursing course. In addition, observation periods have been made available to
undergraduate nurses from adjacent schools of nursing by the Saanich and South Vancouver Island Health Unit, the Simon Fraser Health Unit, and the South Central Health
Unit. pThrough this type of programme it is hoped to interest more nurses in a public
health nursing career.
 L 46
BRITISH COLUMBIA
Continuous in-service education programmes are carried onm^each health unit in
order to keep the staff up to date with new developments in public health. The pro-
gramme is usually built around the need of the particular health-unit staff in relation to
field service. At the institute, public health nursing field staff participated in the nursing
programme by presenting a symposium on tuberculosis nursing and a panel on the family
folder. The role of the public health nurse in the mental-health programme was ably
discussed by Miss Ruth Gilbert at this meeting.
A pediatric refresher course was held in Vancouver for public health nurses in
September in order to introduce more uniform health-teaching m pediatrics. The course
was planned jointly by the Division of Public Health Nursing and the Department of
Paediatrics of the University of British Columbia. Senior nurses and supervisors of
health units, and nurses who had served for a long time on the staff, attended the five-day
course, as well as representatives from the Metropolitan Health Committee in Vancouver,
the City of Victoria, and Oak Bay. Subject material included prenatal care, new-born
care, growth and development of the child both physically and emotionally, infant feedings,' common childhood complaints, allergies, gastro-intestinal upsets, etc. In addition,
field-trips were taken to the following child-care agencies: The School for the Deaf and
the Blind, the Children's Hospital, the Health Centre for Children, the Rehabilitation
Centre, and The Woodlands School. Nurses attending the course accepted responsibility
for passing on the content of the course to the public health nurses in their health units
who were not able to be present. The course was made possible through maternal and
child health funds of the National health grants.
LOCAL PUBLIC HEALTH NURSING SERVICE*
The public health nurse is a member of the local health-unit team. As she makes
regular and frequent contacts with all age-groups in the community, she is in a strategic
position to render health service to many individuals and groups requiring special
assistance. The public health nurse is assigned to her own district and carries responsibility for the generalized public health nursing service within its boundaries.
Maternal Health—Prenatal and Postnatal
The public health nurse offers guidance to the expectant mother in order that the
mother may make the best possible preparation for the birth of a healthy child. The
amount of work with expectant mothers has increased as the programme has become
better utilized. Twelve districts are now giving prenatal classes to groups of mothers.
Relaxation exercises are now included as part of the series in seven districts. Lectures
stress the hygiene of pregnancy, diet for the mother, rest, breast feeding, clothing, and
wholesome mental attitudes. During the year 1,781 visits were made to expectant
mothers. Prenatal classes showed an attendance of 1,832 mothers. It is expected that
this part of the programme will continue to expand as the demand for the service increases
and as the public health nurses become better prepared to carry out this part of the work.
Through National health-grant assistance it is expected that more teaching materials,
reference texts and demonstration equipment may soon be made available to all health
umts, so that further progress may be made.
Child Health—Infant and Pre-school
The public health nurse endeavours to visit the mother during the first week that she
1 JS? nnT   ^     7^ ?W baby I °rder to hdP and Assure her.   Assistance
ZgrlZ T *     needifnd may incIude additional home visits for demonstrations
°f cMd-Care P™cedures such as the baby's bath.    Some 12,556 visits were made to
* Figures shown in this section applv to the <»•***»*« i«~«i u   *^      .
departments of Vancouver and Victoria-Esquimalt Umts but do not delude the metropolitan health
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 47
mothers at home within six weeks of the birth of the baby. Mothers are encouraged to
continue with medical supervision and provided with supplementary help at child-health
conferences.
^Child-health conferences are held throughout the public health nursing areas at
centres where there are sufficient numbers of children to justify the setting-up of a clinic.
At these conferences general health supervision is provided for the child. The mother
receives anticipatory guidance on the growth and development of her child, as well as
specific information concerning problems such as diet, emotional upsets, etc. Immunizations are available to protect the child from certain communicable diseases. During the
year 52,448 infants and 42,989 pre-school children attended child-health conferences.
Public health nurses made 27,959 home visits regarding infants and 28,730 pre-school
children.
Child Health—School
The public health nurse supervises the health of the school-children in her district.
As the numbers of school-children have gradually increased, it has become necessary to
modify the school health programme to make the best use of the public health nurse's
time in the school. In the fall of this year the new school health programme (described
elsewhere) was put into effect. The public health nurse continues to make regular visits
to the schools in her district to confer with the school-teachers concerning health problems,
to inspect certain children referred, to complete needed immunizations, to arrange for
necessary X-rays, to plan and assist the School Health Inspector with medical examinations on selected children. Teacher-nurse conferences are held with each classroom
teacher at least once a year to discuss the health of each school-child. The public health
nurse visits the homes of school-children as indicated to talk with parents regarding such
things as the need for medical care for the correction of specific defects, improved dietary
habits, and health regimen, etc. While visiting in the home the public health nurse is in
an excellent position to interpret health matters and at the same time assist the parent to
understand the need for recommended action. Children needing financial aid for medical
care are referred to suitable agencies. The public health nurse has been active in stimulating local organizations to provide health resources locally. This would include the
organization of such services as local dental clinics, classes for handicapped children, etc.
During the year public health nurses assisted with 23,334 medical examinations and
made 80,044 examinations and inspections. The public health nurse held 48,207
conferences with members of the school staff, 40,533 with school pupils. Health problems
concerning 47,046 pupils were discussed. A total of 24,506 visits were made to the
homes of school-children, while 11,800 conferences were held in the office with parents.
Tuberculosis
The public health nurse supervises tuberculosis patients in the home and arranges
for the examinations of contacts to cases. Patients continue to be discharged earlier from
hospital on chemo-therapy. Streptomycin injections must therefore be given by the
public health nurse to patients as recommended by the Division of Tuberculosis Control.
Although patients are encouraged to come into the office for treatment, about two-thirds
of the ordered treatments must be given in the home. During the year 15,211 injections
of streptomycin were given by public health nurses, 7,925 visits were made to tuberculosis
cases, and 6,815 to tuberculosis contacts. A total of 3,361 tuberculin tests were done.
B.C.G. vaccinations were done last year on 578 negative reactors. Public health nurses
have participated in some areas with the organization of mobile chest X-ray survey clinics.
Venereal Disease %
The venereal-disease programme is concentrated in the Skeena and Cariboo Health
Units, as these units follow Vancouver as centres with the greatest number of cases
 L 48 ? BRITISH COLUMBIA
reported. With a view to solving this problem, an epidemiology worker was assigned in
November to the Cariboo Health Unit, with headquarters at Prince George. This worker
has taken over the venereal-disease case load at Prince George in order to make this
a demonstration unit in effective venereal-disease control practices. Through an educational programme it is expected that the staff will eventually be able to carry the programme along with the generalized service. New methods found effective in the Cariboo
Health Unit will be adopted in the Skeena Health Unit at a later date. A total of 1,899
visits were made in connection with this programme.
Other Communicable Diseases
The public health nurse assists with the communicable-disease control programme
by making immunizations available at the various clinics throughout her district. There
were 9,581 completing the series of injections for protection against whooping-cough,
13,085for diphtheria, 12,927 for tetanus, while 37,388 were vaccinated against smallpox
during the year. With the threat of floods in the spring in the Kootenays and the
Columbia Valley, the numbers of immunizations against typhoid increased to 8,124
injections. Plans are now being considered for protecting certain children against
poliomyelitis by a series of injections next year.
Nursing Care
Nursing care in the home is provided routinely by the public health nurse on a
short-term basis. This care includes nursing procedures such as hypodermic injections,
enemas, treatments, dressings, etc. The public health nurse will give more extensive care
in an emergency and then teach someone else to carry on the daily routine. The demand
for nursing care in the home has varied considerably throughout the Province. School
District No. 43 (Coquitlam) in the Simon Fraser Health Unit has been utilizing this type
of service most extensively. Certain health units have made provision for more complete
home nursing service. These include Kelowna and Keremeos in the South Okanagan
Health Unit, Vernon in the North Okanagan Health Unit, and New Westminster in the
Simon Fraser Health Unit. In July a complete home nursing-care service was set up in
the Saanich Municipality of the Saanich and South Vancouver Island Health Unit.   gt$
GENERAL M
In all, family health service was given in 82,219 homes by the public health nurses.
In addition to the types of services mentioned previously, public health nurses held 313
office conferences and made 1,723 home visits concerning mental-hygiene problems.
Public health nurses made good use of travelling consultative clinics in order to obtain
specialized help for referred patients. These clinics included the Tuberculosis Travelling
Clinic, the Children's Hospital Clinic, the Cancer Consultative Clinic, and the Child
Guidance Clinic. With the assistance of the Junior Red Cross Crippled and Handicapped
Fund, many children were able to get medical care locally, and in other instances they
were assisted to obtain specialized medical care which was not available locally.
The public health nurses should be commended for their untiring efforts in bringing
public health nursing service to the people of British Columbia. In order to accomplish
the work done, they have given many hours of their own time in direct service and in
participation in health matters on a community level.
The following statistical summary shows the volume of work completed in certain
public health nursing services during the year:	
 DEPARTMENT OF HEALTH AND^WELFARE, 1954 L 49
Home and Office Visits
Infant  27,959
Pre-school  28,730
Adult  43,564
Expectant mothers  1,781
Mothers within six weeks after birth of their babies  12,556
Total homes visited j  82,219
Clinic Attendance
Prenatal classes  1,832
Child-health conferences—
1 Infant M  52,448
Pre-school   42,989
Immunizations completed—
Whooping-cough   9,581    -
Diphtheria  13,085
Tetanus  12,927
Typhoid   2,089
Smallpox  .  37,388
B.C.G  578
Total immunization treatments  279,382
 L 50 # BRITISH COLUMBIA
REPORT OF THE DIVISION OF ENVIRONMENTAL MANAGEMENT
Thomas H. Patterson, Director
Two new sections appear in this report for the first time this year.
The Employees' Health Centre and the Hospital Statistics Research Project have
both been in operation throughout the year. The reports of these two sections are
therefore being added to the section reports on Nutrition Services, Sanitary Inspection
Services, and Civil Defence Health Services. -^ ^ ^    ^
In general, it may be noted that many of the services provided by these sections
are of a consultative or advisory nature. Such service is usuaUy best utilized by local
health departments and health units, as they have direct contact with those persons
requiring assistance.   Every effort is being made where possible to deal with requests
through the health units.
The remaining field of responsibility of this Division is in occupational health. If a
comprehensive service of this nature is to be developed, very extensive use of local health
services will be utilized, as there is no question that basic public health measures when
applied to industry bring about considerable improvement in working conditions and
the health of workers.
At present a limited service is being offered to industry. For instance, the nurse
staffing the Employees' Health Service has visited nurses now employed in private industry and is offering a limited consultative service to industrial nurses.
Several questions arose during the year regarding the safety of electrical vaporizing
devices for the dispersal of insecticides. Recommendations regarding the use of this
equipment were made to the field staff of the health units.
A disabling condition known as | fish poisoning," which affects the hands of fishermen during certain times of the year, was also investigated.
The Division is continuing to record the shipments and uses of radioactive isotopes
in British Columbia. It also receives copies of reports on the degree of exposure experienced by persons handling this material.
At the present time no serious public health hazard is recognized, but with the growing use of isotopes in industry, very strict observation of handling procedures will be
required.
Information regarding dangerous exposure to methanol, resulting from the use of
duplicating-machines, was brought to the attention of the Division, and steps have been
taken to disseminate this information to proper authorities. However, it will be necessary to study this problem further to make recommendations for the elimination of this
serious exposure to a very toxic chemical solvent. I 5-
The need for establishing a comprehensive occupational health service in the Government is increasing with the growth of industry in this Province. Such a service should
be required to act not only as a consultative service to industry in all matters related to
the health of employed people of this Province, but also to protect the health of workers
through the early investigation and recognition of occupational hazards.
An indication of the growing general interest in the field of occupational health may
be observed in the holding of the First Annual Pacific Northwest Industrial Health Conference m Portland this year. This Conference was sponsored by the Portland Chamber
of Commerce and was attended by representatives of management, personnel, and health
and safety services in industry, as well as representatives of the medical profession and
government services of Western United States and Canada.
A. NUTRITION SERVICES
Nutrition has been defined as the science of food and its relationship to life. To-day
it is well recognized that nutrition is an important environmental factor affecting health.
 8} DEPARTMENT OF HEALTH AND WELFARE, 1954 L 51
For this reason, education directed toward the wise selection of foods by individuals and
families is an essential and basic part of the public health programme.
In this Province we are fortunate to have a wide variety of foods available. Nevertheless, studies over the past several years have shown repeatedly that many children and
families throughout the Province do not obtain the benefits of nourishing meals, due to
lack of knowledge, indifference, or economic reasons. The need for practical information on wise food selection is still very evident.
During 1954 the programme of the Nutrition Services has been directed toward the
provision of consultant services to assist public health personnel and other key groups
in improving food habits throughout the Province.
Consultant Service to Local Public Health Personnel
Among the variety of services provided to the staff of local health units during the
year have been assistance with dietary studies, technical information and reference materials for use in dealing with local nutrition problems, and assistance with nutrition
education projects. Some of this service has been provided directly through visits made
to health-unit areas. During the year the Nutrition Consultant met with public health
personnel in six health units to review the latest nutrition information and to assist with
local nutrition problems.
Dietary Studies
Information about the variety of foods eaten by individuals and families is essential
in planning nutrition education programmes to meet the needs and problems of the community. One method of obtaining an indication of family food habits is through the use
of school dietary studies. In addition to providing useful information for the guidance
of public health personnel and teachers, these studies serve to arouse interest among
children and parents. The nutrition consultants have assisted with school dietary studies
in six areas of the Province during 1954. This assistance has included the analysis of
three-day food records and recommendations for a follow-up programme in each area.
The results of dietary studies among several thousand school-children over a five-
year period have indicated that the chief deficiencies in daily meals are milk, a Vitamin
D supplement for children, and foods rich in Vitamin C. It therefore continues to be
an important objective of nutrition education in this Province to inform people of the
importance of including these foods in their daily meals.
An additional problem revealed by dietary studies is the excessive consumption of
sweet foods such as candy, cake, and soft drinks by many school-children. Since these
items are low in nutritional value and have a proven relationship to tooth decay, continued emphasis has been given to health education projects directed toward reducing
the excessive consumption of sweet foods. It is gratifying to note that many school canteens now offer such foods as milk and fresh fruits in place of sweet foods. School apple
sales sponsored by the Junior Red Cross is another practical approach to this problem.
Rat-feeding Experiments
One of the most effective methods of illustrating the importance of well-planned
meals has been the rat-feeding experiment in schools. During 1954 these experiments
were conducted in sixty-two schools outside of the Greater Vancouver area. Although
this is slightly less than the number conducted during the previous year, it is interesting
to note that the requests for this experiment are still numerous.
During the experiment, one pair of rats receives the variety of foods recommended
in Canada's Food Rules, and the other pair is fed such foods as soft drinks, bread and
jam, candy, and cake. The difference in weight, appearance, and disposition between the
two pairs of rats is clearly illustrated to the children during the period of four weeks.
 L 52
BRITISH COLUMBIA
Appreciation is again expressed for the continued interest and co-operation of the
staff of the Animal Nutrition Laboratory at the University of British Columbia in pro-
viding white rats for experiments throughout the Province.
School-lunch Programmes
Many schools in this Province offer lunch supplemental, such as milk and soup, or
complete meals for those children who must remain at school over the lunch-hour. This
year numerous requests were met for consultant service relative to the organization and
operation of school-lunch programmes. During field-trips, visits were made to schools to
observe lunch programmes and provide information and advice to school administrators.
Menu plans and large-quantity recipes were compiled to assist lunchroom personnel in
several large schools. Assistance was provided in planning the kitchen layout and minimum equipment requirements for schools at Port Moody, Como Lake, and Dawson Creek.
Other Services
It is recognized that weight-control plays an important part in the prevention of some
of the diseases of middle and later life. Due to the extensive publicity given to overweight
in recent years, many people have become " weight conscious." It is unfortunate that
with this has come the problem of various reducing-diet fads, which are often a threat
to health and offer only a temporary solution to weight-control. The need for informing
people of a rational approach to weight-control is very evident and remains an objective
of the health education programme in this Province. Assistance provided in this field
during the year has included recommendations and reference materials for public health
personnel in three areas where group programmes for overweight persons have been
organized.
The preparation of a booklet, " Your Food in British Columbia," was completed
early in 1954, and copies were distributed to local health units and to British Columbia
House and immigration authorities in England. This booklet has been prepared to
acquaint newcomers to this Province, particularly those from the United Kingdom, with
Canadian foods and some of the differences in food products and methods of food purchasing and preparation. Assistance has been provided also to a committee of the Greater
Vancouver Health League in preparing the section dealing with food of a booklet for
new Canadians.
In co-operation with the Faculty of Pharmacy at the University of British Columbia
and the Vancouver nutrition consultants, an up-to-date list of available Vitamin D
preparations was completed early in 1954. Copies of this information have been distributed to each health unit for the reference of public health personnel.
A considerable number of requests were received during the year for assistance with
family food budgeting. Information on this subject has been compiled for the use of
health and welfare personnel in assisting low-income families with food-selection problems.
Consultant Service to Hospitals and Institutions
Consultant service is available to hospitals on the request of the administrator and
is provided in close co-operation with the British Columbia Hospital Insurance Service.
The Nutrition Consultant visited ten hospitals in the Kootenay area during the summer.
Assistance given to these hospitals included surveying kitchen facilities and information
on food-cost control, menu planning, tray service, sanitation, personnel problems, supper
menus, and diet therapy. Similar information was issued on request to hospitals in
several other areas during the year. The specifications for kitchen equipment for a proposed new hospital at Quesnel were reviewed in detail.
 mt DEPARTMENT OF HEALTH AND WELFARE, 1954 L 53
Assistance was provided to the Department of Public Works in planning the food
service, layout, and selection of equipment for the kitchen of the new poliomyelitis
pavilion in Vancouver.
In co-operation with the Divisions of Public Health Engineering and Tuberculosis
Control, a study was made of the dish-washing facilities at Pearson Hospital. As a result
of the recommendations from this study, improvements were made in the dish-washing
equipment and layout at the Hospital.
A report was made in 1953 recommending certain changes in the organization of
the dietary department at Tranquille. During this year, assistance has been provided in
implementing a number of the recommended changes.
Periodic visits have been made to Oakalla Prison Farm to discuss matters relating to
the food service with the Warden and Steward. Consideration is being given to working
in closer liaison with the out-patient dietitian of the Vancouver General Hospital in following up the patients requiring special dietary treatment who are discharged from
hospital and return to Oakalla. Assistance is now provided to the Warden and Steward
of Oakalla in reviewing quarterly requisitions for food.
Meat-free menus, using meal plans prepared by Doukhobor women at Oakalla, were
compiled for use at the Doukhobor children's home at New Denver.
At the request of the Department of Public Works, assistance was given in planning
the kitchen lay-out of the proposed Maple Ridge Vocational Institute at Haney and in
reviewing requisitions for kitchen equipment for the new Brannan Lake Boys' Industrial School.       If
The Girls' Industrial School was visited, at the request of the administrator, to
discuss nutritional problems at the School. It is hoped that there will be further development of the services provided to this School in the future.
Consultant Service to Other Government Departments
Assistance has been provided to the Purchasing Commission in studying the various
types of dishes and cutlery available for Government institutions, with the object of
determining whether a greater measure of standardization might be achieved in purchasing
these items.
Early in the year a committee, comprised of the Vancouver School Board dietitians,
nutrition consultants of the Vancouver Metropolitan Health Committee, and nutrition
consultants of this Department, prepared a report outlining the layout and basic equipment
recommended for school lunchrooms and kitchens of various sizes. This information was
requested by the School Planning Committee of the Department of Education. Considerable time and study was devoted to the preparation of this material, since the need for
this information has been evident from the numerous requests of school administrators.
Sections of the Foods, Nutrition, and Home Management Manual, a school textbook, are now under revision at the request of the Director of Home Economics, Department of Education.
Other Activities
During the year, monthly meetings of the Vancouver Nutrition Group have fostered
the close co-operation of nutritionists from various agencies in this Province. The group
is comprised of nutritionists from the University of British Columbia, the Greater Vancouver Metropolitan Health Committee, the Vancouver General Hospital, this Department, and other agencies. The object of the group is to work together on nutrition
problems of common interest and to plan activities co-operatively to avoid duplication of
services. During 1954 the group met with social workers from the School of Social Work
of the University of British Columbia and from the City of Vancouver to discuss related
problems, particularly family food budgeting. The group is presently studying the preva-
 L 54 BRITISH COLUMBIA
lence and variety of food fads, many of which are a hazard to good nutrition, with a view
to preparing information relative to this problem.
P iE co-operation with the Divisions of Vita Statistics and Preventive Dentistry, a
report was completed on a pilot study conducted m 1953 to determme whether there was
any indication of different food habits between edentulous persons and persons with
artificial dentures. The study was carried out among persons 65 years of age or over and
in receipt of social assistance. Social workers obtained diet records covering a period of
seven consecutive days from twenty-one persons who were without teeth and from forty-
four persons who used artificial dentures. The number for whom it was possible to obtain
diet records was considerably less than originally planned, and because of the smallness
of the final sample only limited observations could be made. The study gave no appreciable indication that any significant difference exists in the dietary habits of edentulous
and dentured persons. The food consumption in both groups was shown to be remarkably
similar.
In July, funds were made available from the National health grant for a nutrition
consultant to attend the Nutrition Conference and Workshop at the University of California for a period of two weeks. This course proved very valuable in providing an
up-to-date review of current developments and problems in nutrition.
A course in emergency feeding at the Civil Defence College in Arnprior, Ont, was
attended by a nutrition consultant in October. It is anticipated that the practical information obtained from this course will be utilized in assisting with emergency feeding
plans in this Province.
B. SANITARY INSPECTION SERVICES
To meet the demand for more service, the establishment of twenty-eight health-unit
sanitary inspectors was increased to thirty-three early in the year. This now provides
the service of one sanitarian per 17,000 population. The improved ratio appears to
have been justified as measurable improvement has been noted.
Three sanitary inspectors attended a three-day course conducted by the Oregon
State College. The knowledge gained from such refresher courses should have a permanent effect on the quality of performance of individuals privileged to attend.
Milk
In 1949 it was reported that a considerable amount of raw milk was distributed in
the Province, and that pasteurized milk was becoming available in most centres. A survey conducted in the health units this year revealed that more than 90 per cent of the
milk distributed was pasteurized. Four cities—Vancouver, Prince George, Cranbrook,
and Kimberley—by by-law prohibited the sale of other than pasteurized milk. It is
gratifying to report that three health-unit areas—North Fraser Valley, Upper Fraser
Valley, and Peace River—reported that 100 per cent of the milk distributed in their
respective areas was pasteurized.
For the fourth consecutive year an evaluation has been made on the bacteriological
quality of pasteurized milk from dairies throughout the Province. The quality of the
milk, which has been estimated to be very good in previous years, has improved even
more, as indicated by the following table. Sixty-five of the sixty-eight dairies on which
estimations were made were within the allowable limit of 50,000 colonies per cubic
centimetre. The average bacterial plate count for the entire group was 10,300 colonies
per cubic centimetre which is a very good record. Comparative figures for the four
years are summarized as follows:—
 DEPARTMENT OF HEALTH AND WELFARE, 1954
L 55
Average Plate Counts on Pasteurized Milk, 1950-53
Year
Number of
Dairies
Number of
Milk Samples
Average Plate
Count per C.C.
1950.
1951.
1952.
1953.
56
45
56
68
586
728
1,021
1,386
22,000
13,000
13,700
10,300
Municipal milk by-laws for the Village of McBride, the Village of Mission City, the
Village of Harrison Hot Springs, the District Municipality of Maple Ridge, and the
District Municipality of Mission were reviewed prior to submission to the Lieutenant-
Governor in Council for the required approval.
On several occasions since 1947, Alaska communities have attempted to import
fresh milk from British Columbia. However, it was not until this year that import
restrictions were removed, thus permitting Fraser Valley milk to be shipped to Alaska.
The close liaison continues between the Department of Agriculture and the Health
Branch to co-ordinate the grading activities of the Live Stock Branch, Department of
Agriculture, with the quality-control of milk by the local municipal authorities. The
desire on the part of Health Officers for a regulation to license milk vendors in unorganized territories has been discussed with the Department of Agriculture. In this particular
regard, a resolution that such a regulation be adopted was received from the South Central
Union Board of Health at Kamloops.
Food Premises
Restaurant inspection is a major activity of the sanitary inspectors. Many health
units conduct food-handling instruction classes, where the food-handler is taught the
proper technique in order to avoid the spread of those diseases and infections which are
transmissible through food. The South Central Health Unit held instruction classes
throughout its entire district during the month of November. Several units emphasized
medical examinations, particularly chest X-rays, in their food-handling programme.
Restaurant licensing by-laws were passed in the City of Trail and the City of Ross-
land.
Some municipalities, through their Trades Licence By-law, require that before a
food premises commences business, and prior to the annual renewal of their trade licence,
the approval of the Medical Health Officer must accompany the application for the
licence. The Director of the Selkirk Health Unit recently proposed this procedure to the
municipal representatives on the Selkirk Union Board of Health at Nelson.
The South Okanagan Union Board of Health by resolution requested that the Provincial | Trades Licences Act" be amended to require the Medical Health Officer's
approval before a licence is issued to any food premises in unorganized territory. This
Department concurred with the principle of the resolution.
Discussions were held with the Director of Licensing, Liquor Control Board, concerning matters of mutual concern in regard to licensed premises, particularly with respect
to the closing of premises on sanitation grounds and the approval of plans for proposed
improvements to existing premises.
A meeting was held with the British Columbia officials of the Federal Food and
Drugs Division concerning the expansion of Federal activities formerly limited to quality-
control of food and drugs. For the first time, plant sanitation will be included in those
fields which are not adequately covered by municipal and other agencies. The endeavour
is to work closely to avoid overlapping of inspection services.
 L 56 BRITISH COLUMBIA
I Locker Plants
Inspection of locker plants continued during 1954. Frequent inspections have been
maintained during the past two years, in keeping with the desires of the industry.
A survey of premises was made toward the year s end at the request of the sanitary
inspectors and with the co-operation of the health units. Only two complaints were
received by the Division. Both were in respect to the compulsory sharp-freezing clause
of the regulations. The first complaint was from an operator reporting that a plant
allegedly was not sharp-freezing all foodstuffs prior to storage. The second complaint
was from a patron who objected to the compulsory sharp-freezing and particularly the
attendant cost.
Slaughter-houses
Slaughter-houses are licensed under the "Stock-brands Act" as a means of preventing the slaughter of stolen cattle. Inspection of the slaughter-houses under the "Health
Act" is designed to prevent nuisances arising from this potentially offensive trade. For
five years the applicant for a new slaughter-house licence or a renewal has been required
to obtain an inspection certificate from the Medical Health Officer, to be submitted with
the new application and with the application for a renewal of the licence. Linking
sanitary inspection of the premises with the licence issued by the Department of Agriculture has resulted in the continual improvement of these premises. Seventy-five
slaughter-houses were licensed during 1954. No less than sixteen of the applicants, in
their initial application for a licence or a renewal of a licence, failed to include the
inspection certificate completed by the Medical Health Officer, and the licences were
withheld until the completed certificates were submitted. This Department appreciates
very much the co-operation of the Department of Agriculture.
Meat Inspection
In the past, two measures for meat inspection have been applied within the Province.
First, the abattoir operator is primarily interested in the export of his products from the
Province and is subject to meat inspection under Federal authority. Second, the Cities
of Vancouver, Penticton, Kelowna, Salmon Arm, and Kamloops have had meat inspection
under a municipal by-law. In recent years, Union Boards of Health, the Okanagan
Municipal Association, the British Columbia Cattle Growers' Association, and others
have directed inquiries to this Department for meat inspection on a Provincial level. On
April 14th, 1954, assent was given to an "Act respecting the Slaughtering of Animals
and the Inspection, Storage, Handling, and Preparation of Meat and Meat Products."
The Act, and the regulations to be made pursuant to the Act, will be administered by the
Department of Agriculture.
Industrial Camps
Both workers and camp operators agree with pride that the standards for accommodation and the accommodation provided in British Columbia are surpassed nowhere.
The East Kootenay Health Unit reports the camps in the area are satisfactory, and the
management and labour officials co-operated with health-unit personnel regarding sanitation problems in those camps. The Skeena Health Unit worked with the operators of
sub-standard camps in the area, with beneficial results. The South Central Health Unit
reports favourably on the camps in that area.     §
Despite the favourable and satisfactory situations, which are the general rule, some
complaints continue to be received. Sources of complaints during the year were the
District Council of the Industrial Woodworkers of America, Brotherhood of Carpenters
and Joiners, and the Vancouver, New Westminster, and District Trades and Labor
Council.   The odd individual complaint is also addressed to this Department.
 DEPARTMENT OF HEALTH AND WELFARE, 1954
L 57
Trailer bunk-house accommodation for twelve men was introduced in 1951. The
twelve-man accommodation of this type was discontinued January 1st, 1953. In 1954
two permits were issued for the use of trailers, and the approval was on the basis of six
men per trailer. This standard was adopted after receipt of views and opinions from
Health Officers throughout the Province. Representatives of the Trades and Labor
Council informally concurred with this standard. Several complaints were received concerning the failure of railway section-crew accommodation and railway running-trades
accommodation to conform to Provincial regulations. Such accommodation has been
deemed by the Federal Department of Justice to be under Federal control and exempt
from Provincial regulations.
Tg Summer Camps
§ For the fourth consecutive year the trend of improvements in summer camps continues. These camps are licensed under the "Welfare Institutions Licensing Act," and
the sanitary inspection report is considered when a licence is granted. Summer camps
operated by non-profit organizations have certain problems which other camps do not
have. There is usually a shortage of funds, and recommendations by sanitary inspectors
are made with the knowledge that economy is essential.
Seventy-six camps were reported upon in 1954, as compared to forty-seven the
previous year. In evaluating these camps by formulae, forty-eight of the camps or 63
per cent were classified as good; twenty-four camps or 32 per cent, as fair; three camps
or 4 per cent, as poor; and one camp was unsatisfactory. Comparative ratings for
inspections conducted in the years 1951 to 1954, inclusive, are given in the following
table:—
1951
1952
1953
1954
Number
of
Camps
Per
Cent
Number
of
Camps
Per
Cent
Number
of
Camps
Per
Cent
Number
of
Camps
Per
Cent
Good	
Fair	
Poor	
Unsatisfactory-
Totals
22
46.0
35
62.0
29
61.5
48
18
36.0
13
23.0
13
27.5
24
6
12.0
4
7.5
3
6.5
3
3
6.0
4
7.5
2
4.5
1
49
56
47
76      |
63.0
32.0
4.0
1.0
Schools
The study of environmental factors reported by the School Medical Inspector has
continued. In 1952 the Division circularized the School Medical Inspectors and summarized opinions gathered at that time for presentation to the Department of Education.
Further review was given to those findings in 1953, together with a review of the results
of findings from tabulated school reports. These findings, together with research on
school-building factors by the Division of Public Health Engineering, provided the basis
of compilation of the proposed manual under preparation by the Department of Education.
School environmental inspections in 1954-55 are to be reported on a simplified
form adopted at the September meeting of the Health Officers.
j; Plumbing
The National Plumbing Code, a part of the National Building Code, was completed
during the year. It has been a privilege and a pleasure to have had a representative on
the technical advisory committee on plumbing services to the National Research Council
on the production of this recommended plumbing code. The City of Victoria on October
30th, 1953, passed a plumbing by-law incorporating the up-to-date features of the Na-
 L 58 BRITISH COLUMBIA
itional Plumbing Code. Many of the features are less restrictive than those in the previous
by-laws. It is the desire of the Department, early in the new year to comply with the
numerous requests from municipalities for a model municipal plumbing by-law.
Rodent Survey
In 1942 a plague-infected flea was found on a domestic rodent (rat) in a neighbouring American seaport. Prior to that time, sylvan rodents (ground-squirrels and
marmots) in Western American States had been found to harbour fleas which in turn
were found infected with the plague organism. This Department co-operated with the
Department of National Health and Welfare, as a result of the foregomg episodes, in the
collection of specimens and submission of tissue specimens and ecto-parasites to the
Laboratory of Hygiene at Kamloops.
In 1950 this Department assumed the work of collecting specimens, when a full-time
field officer was appointed. That year a flea removed from a marmot was found to be
infected with the plague organism. In 1952 the role of the full-time field officer was
discontinued, as it was considered to be a comparatively expensive method of making
collections, except for the limited six-week period in the area when the positive plague
specimen was found in 1950. The City of Vancouver and the City of Victoria have
generously co-operated by making routine collections of specimens of rats and their ectoparasites. Sylvan-rodent collections were contributed to in a limited way by the East
Kootenay, Selkirk, and West Kootenay Health Units. In 1953 the South Okanagan
Health Unit made an outstanding contribution in the large number of specimens collected
and submitted to the Laboratory. In July, 1954, the Laboratory of Hygiene at Kamloops
was closed and operations shifted to Ottawa. The collection of specimens from British
Columbia has been discontinued. It has been proposed by all the aforementioned contributors to the rodent plague programme that specimen collections be instituted again.
This would require arrangements with the Laboratory in Ottawa.
Routine rodent collections in 1954 in the previously mentioned American seaport
again revealed the presence of a plague-carrying flea, and shipping authorities at our
seaports have been alerted to control rodents shipwise.
Because the danger of plague, although remote, is still with us, it is proposed that
arrangements be made to resume collections on a limited yet continuous basis.       J.
General Sanitation
Proposed municipal sanitation by-laws prepared and submitted by the Village of
Mission and by the City of Salmon Arm were reviewed.
The draft of regulations respecting barber-shops was completed and endorsed by
both the Medical Health Officers and the barbers' association.
The City of Vancouver kept this Division informed on its problem of gas poisonings
by submission of minutes of meetings held in respect to the study toward its municipal
by-law.
Many persons in the Province sending parcels of used clothing to relatives in European countries found the parcels were refused entry unless accompanied by a certificate
of approval by a Canadian agency as being in a clean condition. Arrangements were
made to have our local Medical Health Officers provide the official clearance at this end
to permit entry into the European country.
In 1935, regulations governing the sterilization of wiping-rags were passed as a
measure to assure sterile and clean rags entering the Province from abroad. After a lapse
of several years, wiping-rags are entering the country from the Orient, and they are
required to be accompanied by a declaration to the effect they have been thoroughly
washed and sterilized, or they must receive that treatment on arrival
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 59
The usual inquiries and complaints concerning improper sewage-disposal and
improper garbage-disposal continued to be received and were subsequently investigated.
C. CIVIL DEFENCE HEALTH SERVICES f|
During the past year Civil Defence has been the subject of considerable variation
in public interest. There has been little occurring in world affairs that should give us
assurance that war will never come again. However, from the view-point of organizing
health services for emergency, this continent has experienced several very serious disasters, and the need for preparation to meet such a situation cannot be questioned.
4 Hospital Disaster Plans
In April of this year a meeting was held in Victoria, attended by key representatives
from five strategically located hospitals in the Province and a similar number of representatives from Alberta. This meeting was sponsored by the Federal Civil Defence
Health Services and the Canadian Hospital Association. The purpose of the institute
was to demonstrate and discuss the hospital disaster plans of the Royal Jubilee Hospital,
Victoria, and the Rest Haven Hospital, Sidney. As a result, St. Paul's Hospital, Vancouver, and the Kelowna General Hospital, Kelowna, both of which were represented at
this meeting, have now developed suitable emergency plans of their own. These hospitals are now prepared to demonstrate their plans to local hospitals early in 1955. It is
intended that through this means most of the major hospitals will develop plans for meeting the demands of both civil and war disaster.
Emergency Medical Supplies
Along with the interest placed on developing major emergency plans in hospitals,
the question of stock-piling medical and surgical supplies has been receiving considerable
attention. Aside from the large amount of supplies now being purchased and packaged
for stock-piling by the Federal Government, a need has been indicated for increasing the
amount of supplies held in general hospitals. With larger supplies maintained in hospital, it may be possible for these hospitals to continue operating, independent of Federal
stock-piles, should any difficulty arise in transporting or maintaining this material. Proposals have been made to solve this particular problem and they are now under consideration.
Emergency Blood Service
Plans for establishing and maintaining emergency bleeding teams of doctors, nurses,
and technicians which would be prepared to obtain the large quantities of blood required
for a serious disaster have been developed. However, as it is realized that such teams
have not been organized anywhere else in Canada, the original objective of forming four
teams in British Columbia was reduced to one. An attempt now is being made to
organize this team on an experimental basis in co-operation with the Red Cross blood
transfusion service. When the team is in operation it will carry on regular blood-collecting clinics at intervals of approximately once a month. In this way the team will be
kept intact and experienced.
Study Forum
The Third Provincial Civil Defence Study Forum was held in the Okanagan Reception Area in September. The directors of various health units, acting in their capacity
as chiefs of Civil Defence Health Services, attended this meeting. The plans for receiving very large numbers of casualties and evacuees which might be moved from a Vancouver disaster to the Okanagan were studied and criticized.
This last Forum proved even more stimulating than the two previous ones, and
many very important observations were made to aid in the improvement of emergency
plans throughout British Columbia. W      '    1
 L 60 BRITISH COLUMBIA
Training
Lectures for retired and married registered nurses were given during the year,
bringing the nurses up to date on more recent steps in medical and surgical nursing.
Information was also given on the new antibiotics and other drugs now in common use
in treatment. . .     , , „
Five very large and well-equipped kits for traimng home nurses were received from
the Federal Civil Defence office. These kits have been placed on loan to the Red Cross
and the St John Ambulance Association for training of Civil Defence recruits.
Two courses on the Medical Aspects of Atomic, Bacteriological, and Chemical
Warfare were offered at Camp Borden, Ontario, by the Federal Civil Defence office.
Twelve physicians from British Columbia attended these courses, bringing the total number of physicians who have taken this training to twenty-six.
First-aid classes have continued throughout the year, thus providing more trained
workers for Civil Defence, as well as providing a valuable asset to our communities in
preparation for civil disaster or minor accident.
Some assistance was given in organizing employees in the Parliament Buildings for
Civil Defence. During the year several classes on first aid were given and attended by
Civil Servants. An interesting side development in offering this training may be noted
by the interest shown by several Government foresters and surveyors, who were of the
opinion that such training may prove extremely valuable to them when they are working
in remote places away from emergency medical services.
General
Success in the development of Civil Defence services ultimately depends on the
individual person's interest in his own safety and the preservation of his community.
The task of stimulating this interest and placing it in its proper light is the responsibility
of the leaders or heads of government and industry. The job of organizing Civil Defence
services is large enough and important enough that top officials must direct its progress.
There is no question that in time of disaster these are the people who will be blamed or
blessed for the results of any action taken to cope with death and destruction.
D. EMPLOYEES' HEALTH SERVICE
The development of a health service for the employees in the Parliament Buildings
in Victoria serves as a progressive step to demonstrate the use of a preventive health
programme in industry. The mounting evidence that the vast majority of sickness
absenteeism is due to diseases of non-occupational origin indicates that such services can
make extensive contributions toward solving this problem by providing on-the-job treatment and applying preventive measures. The aim of the Health Centre is to maintain and
improve mental and physical health of the employees by dealing with the total health
problems and the environment of the workers, thus contributing to improved working
interest and production. In addition to providing a direct service to Civil Servants, the
Health Centre is studying specific industrial and occupational hazards as well as providing professional advice to private industry with regard to the establishment and operation
of similar services.
Planning
Prior to the establishment of this service in February of this year, consideration was
given to the basic services required in such a programme. The location or distribution of
employees, the number of shifts worked, the extent or number of industrial hazards, the
type of work being carried out, the number, the age, and the sex of the employees, and
the location of the health services all had influence on the planning of this programme.
Effective use of employees' health services can only be made when the employees and
 fjf DEPARTMENT OF HEALTH AND WELFARE, 1954 L 61
supervisors understand the scope and purpose of such services. With the initiation of the
Health Centre, directives were forwarded to all Deputy Ministers and supervisors explaining the extent of this service. Information was also posted on bulletin-boards in the
general offices of the Buildings. Each employee attending the Health Centre is given a
verbal description and review of the health service. During Health Week of 1954, health
movies were shown, health posters were displayed, and many pamphlets dealing with
various health problems were distributed to employees.
Service
Immediate nursing care is given for any illness or injury which occurs among employees during the working-day. This includes care given to employees for on-the-job
illnesses or injuries which are not of a compensable nature, but which require emergency
treatment or attention. In this case, prompt arrangements are made for further medical
care of the employee by his private physician or hospital when such care is indicated.
Limited facilities are available for the convalescence of employees experiencing
minor illnesses which normally would not necessitate full-time absenteeism from work.
These facilities are also used by employees returning to work after a more serious illness,
in which case the employee probably only needs a resting period of twenty minutes or
half an hour during the day. Although such facilities were available to a very few
employees prior to the establishment of the health service, persons using these facilities
were not under the observation of a nurse or other qualified health worker.
Upon request from private physicians or dentists, the nurse in charge of the
employees' health service is prepared to and does give special treatments to individual
employees. In such cases the employee provides his own special medicine or biological
and the nurse only administers treatment upon instruction from the employee's personal
physician. It should be emphasized that the Health Centre does not provide a complete
medical-care programme. Treatment other than that outlined above is confined to
emergency treatment of on-the-job illnesses and accidents by the nurse in attendance. The
philosophy of the programme may be defined as keeping small things small by treating
minor conditions before they become serious. Such a programme, effectively operated,
must reduce unnecessary absenteeism.
Among conditions causing loss of time in industry, colds constitute a major factor.
Mental and emotional disturbances rank high and are not as easily definable, yet they
have a very serious effect on worker morale and productivity. The Health Centre does
provide a suitable outlet for many such employees, who only need to discuss their problems with someone who will not reveal their difficulties and will give them sound, unbiased
advice. The employee with more serious mental or emotional problems is referred to
more specialized professional assistance.
Health counselling is focused on such problems as absenteeism, hazardous exposures,
attainment of hygienic and comfortable working environment, major diseases of adult life,
and the adjustment of the home and community environment. Since the employee is the
product of his total environment, the best health service can be nullified by adverse home
or community conditions. For this reason, family problems which may affect the employees and their health, general morale, and attendance are explored, and the employee
is referred, if necessary, to family doctors or appropriate community agencies. In dealing
with these various problems, close liaison is maintained with the community health
services, and these services are made readily available to those employees desiring them.
The success of this health programme depends on contact with the employees as a
means of gaining their confidence and trust so that all their health problems are brought
under consideration. This service may then help to reduce the human element found in
accidents, illness, and absenteeism.   The Health Centre is interested in making poor
 L 62
BRITISH COLUMBIA
conditions good and good conditions better, | order to improve physical fitness, personal
efficiency, family relations, and the morale of the individual.
In this first year of operation, complete statistics are not availabte. However, tabulation of services rendered during the past six months reveal that 1,166 persons received
service. The majority of these cases were non-occupational in nature, and there were
twice as many men as women attending the Health Centre.
Records
The medical records of the Health Centre are confidential. Clinical findings may be
interpreted to the employee and supervising officials when they have a bearing on the
effective utilization of man-power as related to employees' adjustment to work, production, and maintenance of health. These records have been developed so that they may
be adopted by private industries, both large and small, at a minimum cost. Records serve
a very useful purpose in providing a basis for analysing the cost and value of the operation
of the Health Centre. They also permit statistical analysis of data related to employee
turnover, transfer, and placements as affected by the physical and mental health of
employees. This type of analysis provides a better picture of the demands placed on
individuals by specific jobs and permits the placement of employees in the type of work
for which they are most suitable from the physical and mental standpoint.
Surveys and Other Activities
Environmental inspections including sanitation have been conducted either by
request or because of complaints regarding such things as lighting or hazards which have
caused injury or discomfort during employment in the Parliament Buildings.
The allocation and maintenance of first-aid boxes throughout the Buildings has been
given considerable thought. The Civil Defence programme of conducting classes in first
aid will increase the number of trained first-aiders and will facilitate a better understanding
of health problems and accident prevention. This type of training will provide a nucleus
of trained first-aid workers throughout the Buildings who will be available to deal with
ordinary occupational emergencies as well as disasters.
The nurse from the Health Centre co-operates with the Red Cross Blood Collection
Clinic by aiding with the organization and operation of this clinic in the Buildings. Cooperation has also been given in other case-finding programmes, such as that of the
tuberculosis chest X-ray and other adult disease programmes.
A reference manual is now being prepared for use in the operation of the Health
Centre. It will also provide a basis for establishing and operating a similar service in
private industry.
An address was delivered to the Industrial Nurses' Section of the Registered Nurses'
Association of British Columbia outlining the purpose and development of this service.
Policy
A great many policies and procedures have evolved during this first year, to provide
a basic foundation upon which the service will be operated. It is well recognized that
industrial health services must be tailored to the needs of the particular industry concerned; therefore, as the health needs of employees in the Parliament Buildings are
determined, it will be necessary to alter the programme of the Health Centre accordingly.
Administrative personnel and the other employees may themselves help to design and
develop this service by the use they make of its facilities. As the policies for the Health
Centre change, this information will be brought to the attention of all concerned, in order
that the most effective use of the service may be continued.
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 63
■JSjL-r<      E. HEALTH-CARE RESEARCH PROJECT
This project, financed through a Federal health grant, was initiated in 1953 for the
purpose of studying and analysing hospital admission-discharge records. It is well recognized that extremely valuable data are contained in these records, but the task of compiling suitable tables, coupled with problems which have arisen out of the reorganization
of the Hospital Insurance Service, has caused unavoidable delay.
At present, study of the statistics related to obstetrical patients and infants is being
carried out. Consultation with representatives of the teaching and research staffs of the
University of British Columbia has proven that valuable research information may be
found from this source.
An indication of the extent of these data may be seen in the fact that the study
dealing with obstetrical patients alone now consists of thirty-four tables comprising 372
pages. Also, it may be recognized that to deal with the entire admission-discharge information it is necessary to cope with 250,000 such records during each year.
The result of these studies will provide a basis for recommending new administrative
procedures in operating hospital insurance and other types of health insurance. In
addition to the above, the areas in which greater emphasis should be placed in certain
preventive programmes will be indicated. Certain clinical information should also become apparent and lead to improved diagnostic and therapeutic techniques.
The over-all result of such study should have a definite effect on the improvement
of the quality and quantity of health care available to our population.
As an example of developments leading to improved preventive services, it may be
pointed out that the new hospital admission-discharge record now provides important
information regarding accidents. This information will permit the study of non-fatal
accidents which cause considerable disability and economic waste among British Columbia residents. Up to the present time the only reliable accident data available were those
on fatal accidents and, therefore, did not represent a true picture of the significance of
accidents. J
Because of difficulties encountered in securing tabulation services, the junior research
assistant of this project was assigned to assist British Columbia Hospital Insurance Service in carrying out a study of the need for hospital services in the Nelson-Castlegar area.
In carrying out this study, consideration had to be given not only to the health status,
medical care, and hospital experience of the community, but also to the geographic and
socio-economic factors which have a bearing on the need for increased hospital facilities
in any area.
 L 64 BRITISH COLUMBIA
REPORT OF THE DIVISION OF PREVENTIVE DENTISTRY
F. McCombie, Director
Dental public health can be defined as the art and science of preventing dental
disease and prolonging dental efficiency, through organized community effort.
Progress in such a field is, of course, not easy to measure precisely. In the past, in
other areas, rather comprehensive and time-consuming dental surveys have been carried
out for this'purpose. During the past three years throughout British Columbia a system
of reporting by full-time preventive dental services of their activities has been effected.
Whilst any conclusions drawn from statistical analyses are predicated upon the accuracy
of the individual reports from which the statistics are compiled, nevertheless some rather
cautious comparisons can now be made. |J
It is indeed pleasing to be able to report progress within the health-unit areas where
full-time preventive dental services have operated during the past three years. There is
indication that within these areas dental treatment for pre-school children by the family
dentists has increased to a remarkable degree. In one health unit where preventive dental
services have operated continuously during the past three years, in the first year of the
programme 91 per cent of the Grade I children receiving treatment through this service
had never before visited a dentist; in the second year of the programme this had been
reduced to 59 per cent, and during 1953-54 to only 32 per cent. Also within the records
of the full-time dental services within the health units during the past three years is
perhaps discernible some indication of a slight reduction in the incidence of dental caries.
It is also interesting to note that five years ago only two community preventive dental
clinics in which the local resident dentists co-operated on a part-time basis had been
organized.   By the end of 1954 there were fifty-seven such clinics successfully organized.
As long ago as 1925, the British Dental Association, when presenting evidence to
the Royal Commission on National Health Insurance, stated that " there was ample
medical and dental literature to show that the bad condition of the teeth of the people
constituted a danger to health and even to life."* Again in 1942 the Prudential, one of
the largest approved societies in the United Kingdom providing medical care on an insurance basis, stated that " neglect of teeth troubles was the cause of quite half the ill health
among the industrial classes."* In 1953 the British Dental Association reported that
" the experience of Insurance Committees under the National Insurance Act indicated that
anaemia, gastric troubles, debility, tonsillitis, neurasthenia, and rheumatism were attributable to, or aggravated by, defective teeth."*
During the school-year 1953-54, of 16,000 Grade I pupils in the public schools of
British Columbia who received a dental examination, three of every four were in need of
dental treatment. Of those children receiving treatment through the full-time preventive
dental services, six of every ten had never before visited a dentist. The 6-year-olds of this
group required on an average not less than nine tooth surfaces to be restored, and for
every 100 6-year-olds no less than sixty-five teeth were so badly decayed that they had to
be extracted.
'9» PREVENTION
Without doubt a tragedy exists to-day in the state of dental ill health of our children
—a condition which is bound to affect their general health. The poignancy of this tragedy
is intensified by the fact that the vast majority of dental disease is preventable, either by
individual action or by community action. For example, tooth-brushing immediately
after all meals and snacks, when achieved, has been shown to reduce the incidence of
dental decay by more than half. The fluoridation of community water-supplies has been
shown by itself to reduce dental decay by at least two-thirds amongst the children, with
^^^^^^^^^^S °<f M Pll Health Service> Evidenc* Presen<ed by the British Dental
Association,   British Dental Journal, XCVII, September, 1954.   Supplement, page 54.
 M DEPARTMENT OF HEALTH AND WELFARE, 1954 L 65
beneficial results lasting throughout life. The Council of the City of Prince George plans
to fluoridate the water-supply of that city in 1955. By public referendum the people of
Smithers and Kelowna expressed their wish that their respective water-supplies be so
treated. The Village of Westview voted against such a proposal.
J| Dental-health Education
It cannot be stressed too strongly that dental disease (dental decay and, after the
age of 35 years, diseases of the gums) is to-day almost entirely preventable. Therefore,
information whereby individuals themselves may prevent unnecessary dental ill health
and unnecessary lowering of the general health must be made available to as many persons in British Columbia as possible.
m To achieve such an objective, public health nurses are encouraged to include dental-
health education in prenatal classes and in well-baby clinics. Full-time dental health
officers attend teacher conferences in the schools and thereby provide assistance to the
teachers in their teaching of dental health in the classrooms. All members of the health-
unit staffs are encouraged to include within their meetings with adult groups, such as
Parent-Teacher Associations and Women's Institutes, talks on how dental disease may
be prevented.
II Though the task of providing this information to a total population of well over
1,000,000 persons is truly enormous, it is sincerely believed that over the years some
considerable progress and success in this field has been attained. gDuring the past year
increased emphasis has been placed on the educational aspects of all programmes administered or sponsored by this Division.
If Further dental-health educational aids have been reviewed during the past year in
co-operation with the Division of Public Health Education. Amongst the material considered suitable for purchase and distribution have been three additional films and three
film-strips. Two new pamphlets have also been purchased and distributed, and a most
excellent poster has been reprinted with the kind permission of the New Zealand Department of Health and made available for use in schools throughout the Province.
Regional Dental Consultants
m The Division of Preventive Dentistry was established early in 1949, and the pro
gramme of preventive dentistry for this Province was formulated during that year, in
consultation with the Dental Health Committee of the British Columbia Dental Association.   The keystone of the programme was to be the appointment of a full-time dental
officer (Dental Director) to each of the eighteen health units planned to provide public
1   health services to the rural areas of the Province.   The preventive dental services, whilst
m.  being fundamentally educational in purpose, were to include the dental rehabilitation
I   of the maximum possible number of pre-school and Grade I children.   It was hoped in
I   future years that this educational dental treatment might be continued in Grades II
I   and III.   As an interim measure it was planned to encourage community dental clinics
B   where full-time services were not immediately possible, and whereby dental treatment
I   would be provided by private dental practitioners operating on a part-time basis in their
i   own offices.   It was hoped that, over a period of some six years, full-time dental officers
I   would be recruited at an average rate of approximately three each year, and it was anticipated that during this time the community dental clinics would be disbanded in favour
■    of the full-time services.
I However, during the past five years the community dental clinics, in which private
j dental practitioners provide their services on a part-time basis, have continuously ex-
m panded in scope and in number.   These clinics, by providing continuing dental care in
I successive years, not only to pre-school children and pupils of Grade I, but also to pupils
 L 66
BRITISH COLUMBIA
of Grades II and III, have demonstrated how the average cost of treatment per child in
^1 nmar,mmeS can be successively reduced each year.
such programmes can be successively reduced each year.
Fiscal Year
Number of
Clinics
Number of
Dentists
Number of
Children
Receiving
Complete
Dental
Treatment
Average
Total Cost
Per Child
1948-49
1949-50
1950-51
1951-52
1952-53
1953-54
2
6
9
18
20
43
2
8
12
22
25
47
141
381
1,052
1,858
2,121
3,084
$18.46
15.76
13.26
12.78
15.45
Note —The increased average total cost per child for 1953-54 is due to the fact that during this year more than half
of the clinics were newly commenced, and, therefore, well over half the children were receiving dental treatment for the
first time during this year.
From the foregoing and from results demonstrated by one of the clinics continuously in operation during the above period, it is forecast that on the same basis the ultimate average total annual cost per child should be rather less than $10. Furthermore,
during the above period, not one community dental clinic has ceased to operate for reasons other than the sickness or departure of the only dentist in the community or the
replacement of the clinic by full-time services.
The lay groups and dentists who have so enthusiastically supported these clinics have
naturally, in most cases, little or no previous experience in dental-health education on a
community basis. The educational and, thereby to a large extent, the preventive aspects
of many of these programmes have therefore fallen short of the optimum which could be
attained with the assistance of persons especially trained and experienced in this field.
Notwithstanding, their achievements in this field cannot be overlooked and are indeed
appreciated.
The first full-time preventive dental services in health units were established in the
fall of 1951. As of June, 1954, only four such programmes were in operation, and in
only one health unit had the service operated continuously since its inception. Though
this service has been provided at different times within seven different health units, in no
instance has it been possible to offer treatment services to all Grade I pupils of all school
districts within the health unit, nor has it been possible to include, in addition, all preschool children or children of Grades II and III. The school enrolments for 1951-52
revealed that the average number of Grade I pupils alone within each health unit was
764, in three health units they exceeded 1,000, whilst in all except one (Peace River)
they exceeded 450. By comparison, the full-time dental officers during the school-year
1951-52 completed treatment on an average for only 373 children (Grade I pupils and
a minimum of pre-school children) and during 1952-53 only 380 children.
During the school-year 1952-53 there were approximately 11,000 Grade I pupils in
areas served by local health units. During that year full-time preventive dental services
in four health units provided treatment to only 977 of these 11,000 young children. In
no health unit has it been possible to offer treatment services within all school districts.
Furthermore, the demand for treatment in all cases has been so high that there has been
insufficient time for the dental officer to devote to the important task of preventing dental
disease through educational activities.
It was evident, therefore, that whilst the above programme was theoretically sound,
two factors have consistently and adversely affected its successful realization. These
factors will likely continue to influence the situation for many years to come. First, there
has been the difficulty of recruiting suitably qualified and experienced full-time dental
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 67
This, it is believed, is primarily due to the over-all shortage of dentists across Canada,
a situation which will not improve until increased training facilities for dental students
are provided. The second factor has been the continuing increase of child populations
within the health-unit areas. j|
On the other hand, the undoubted success achieved by the community preventive
dental clinics, as described above in detail, was such as not to be lightly discarded.
Therefore, our previous view-point of considering these clinics to be of the nature of an
interim expedient needed to be reconsidered.
A realistic appreciation of the experience of the past five years indicated that the
dental health of the people of this Province, especially the children, can and should be
better served by combining the best features of these two programmes.
In future, throughout all health-unit areas, preventive dental services, it is anticipated, will be encouraged through community preventive dental clinics, with the assistance
and guidance of full-time regional dental consultants. The community clinics will be
operated either on a local basis or correlated by the Board of Trustees of the school
district, or by the Union Board of Health, all with the guidance and assistance of the local
health-unit staff. Financial support for such programmes, it is hoped, will continue as
heretofore, and will provide, as the allocation of the necessary funds permits, for preventive dental treatment services for pre-school children and pupils of Grade I. It has
been carefully calculated that outside the metropolitan areas of Greater Vancouver and
Victoria there are sufficient dentists to provide such a service. This calculation is based
on these dentists, on the average, co-operating in such clinics to the extent of only two
morning sessions each week. In future years it is hoped that the time required from the
local dentists will probably be little more than an average of one session per week to
provide this service.
Two regional dental consultants were appointed in the fall of 1954. One will serve
the Boundary and Fraser Valley Health Units, while the other will serve the Simon Fraser
and North Fraser Valley Health Units and the Howe Sound and Gibsons Nursing Districts.  A third such appointment is planned for the fall of 1955.
The services of the regional dental consultants will be available within two or three
adjacent health-unit areas, depending on the total population and geographical area.
When working in a health-unit area, they will be part of the health-unit team, and will be
responsible to the health-unit director, and, through him, to the respective Union Board
of Health. The services provided by the regional dental consultants will be to assist
local agencies to ensure that the maximum possible benefits result from the funds invested
by them in the community preventive dental clinics and to assist other communities or
districts to organize such services. *
To provide such a service, the duties of the regional dental consultants can be
broadly described as falling into two categories—educational and administrative. Within
the educational field, they will be available to co-operate with School Inspectors and
school principals to provide guidance and assistance toward the improvement of the
teaching of dental health within the schools, including the provision of educational aids.
They will be available to attend teacher conferences with this object in view. It will also
be their duty to encourage the teaching of methods of preventing dental disease, through
attendance at regular meetings and by personal interviews with medical and dental practitioners and public health personnel within their area. They will also be available to
reinforce the dental-health teaching in the schools by addressing lay groups, such as
Parent-Teacher Associations and service clubs, in their respective health-unit areas.
In the administrative field the regional dental consultant will be available to the
agency sponsoring the community preventive dental clinic to provide advice so that the
clinic may operate at maximum efficiency. To this end he will meet the officials of the
sponsoring agency and the dentists co-operating in the clinic as required.   He will also
 BRITISH COLUMBIA
L 68
exDlain to the local agency the importance of dental-health educational activities and
nrovide advice as to how such activities may be most effectively earned out.
The regional dental consultant will also be available to assist communities without
a resident dentist to endeavour to attract a dentist to locate in that community or to
persuade a dentist to visit on a suitable schedule and durmg his visits to co-operate in a
community dental clinic for the younger children. In such areas where temporarily it
is not possible to have a dentist visit or the available part-time services of the local dentists are marginally insufficient for the successful organization of a community dental
clinic, the regional dental consultant may provide direct service within a community
dental clinic. .
Community dental clinics will be financially administered by the Union Board of
Health (by moneys contributed by Boards of Trustees of the school districts), or directly
by the Boards of Trustees of the school districts, or by local community organizations
such as the local Parent-Teacher Association, or by a committee specifically constituted
for this purpose. To qualify for Provincial financial aid, the sponsoring agency is
required to carry out a carefully planned community dental-health educational programme. Each community preventive dental programme will be submitted through the
health unit to the Provincial Health Branch for prior approval before any financial support is confirmed.
Preventive Dental Services in British Columbia
Within the Province of British Columbia during the school-year 1953-54, full-time
preventive dental services* operated in twenty-one metropolitan and rural school districts.
In a further thirty-two school districts, community preventive dental clinics were organized with the part-time co-operation of resident or visiting private dental practitioners.
Thus, during the past school-year, preventive dental services operated in fifty-three of
the eighty school districts of this Province. The previous year such services were provided in only thirty-seven school districts, and five years ago (1948—49) in only nine.
The full-time preventive dental services in metropolitan and rural areas* during
the past school-year examined 3,933 pre-school children, of which 34.2 per cent were
not in need of dental treatment at the time of examination. Of the pre-school children
examined, 1,631 received complete treatment from these services. These children accounted for 77.6 per cent of those who requested such treatment. No less than 2,751
parents of pre-school children were personally interviewed. Of the children receiving
treatment, 87.3 per cent had never before received dental treatment. There were 21.8
tooth surfaces restored for every tooth extracted, which indicates a high standard of
treatment.
Within the metropolitan and rural school districts providing full-time preventive
dental services* (exclusive of the three school districts of Central Vancouver Island
Health Unit, wherein operated a pre-school service only), 15,200 Grade I pupils were
enrolled during the past school-year. Of these, 14,990 received a dental examination.
Of those inspected, 26.8 per cent were not in need of dental treatment at the time of
examination, more than 16.2 per cent attended their family dentist, and 33.8 per cent
received complete treatment through the clinic. Only 24.3 per cent of the Grade I
pupils examined in these schools remained in poor dental health during the last school-
year. Of the 5,065 Grade I pupils receiving treatment in these clinics, 58.0 per cent
had never before received dental treatment. For the Grade I children, 14.5 tooth surfaces were restored for every tooth extracted. A total of 4,472 parents of these children
individually received chairside dental-health education. The average 6-year-old treated
in these clinics required 9.2 tooth surfaces to be restored, 0.6 deciduous teeth to be
extracted, and required 2 hours 34 minutes of the dentist's time.
aSan^GoutfnSOUVn and Sreater Victoria> New Westminster and PoweU River School Districts, and North Okanagan, South Okanagan, Upper Fraser Valley, and Central Vancouver Island Health Units.
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 69
In two Provincial health units, in some clinics of the Greater Vancouver Metropolitan Health Committee, in New Westminster and Powell River, 4,189 Grade II pupils
were examined, and 29.8 per cent of these were not in need of dental treatment at the
time of examination. Of these pupils, 1,159 received treatment at these clinics, and it
is interesting to note that dental treatment for the average Grade II 7-year-old of Greater
Vancouver and New Westminster (presumably previously treated in Grade I) required
1 hour 56 minutes.
In Grade III and the senior grades, 13,991 children were examined (11,457 in
Victoria), and 42.9 per cent of these did not require treatment at the time of examination.
Preventive Dental Services in Health Units
Within the four health units providing full-time preventive dental services, it is noted
that of the pre-school children examined during the past school-year, the percentage not
requiring dental treatment at the time of examination was 22.7 per cent, which compares
favourably with 14.4 per cent the previous year. Six hundred and ninety-two pre-school
children (72.9 per cent of those requesting this service) received complete dental treatment, and 930 parents of pre-school children were interviewed at the chairside. This past
year the average time to rehabilitate these children was the lowest yet recorded in each
age-group. Nevertheless, the standard of service to these children without doubt improved during the year, since 42 tooth surfaces were restored for every tooth extracted,
and in the two previous years this figure was 19.2 and 22. ^
Amongst the Grade I pupils of the three health units in which full-time preventive
dental services were offered to this group, 14.3 per cent of those examined were not in
need of dental treatment at that time, which also compares favourably with 11.5 per cent
the previous year. In 1950-51, the first year of these services, of those children treated
by the health-unit clinics, 78 per cent had never before visited a dentist, but the next year
this percentage had been reduced to 58 per cent, and in 1953-54 it was only 44 per cent.
In none of these three health units has it been possible to carry out extensive pre-school
dental-treatment programmes. The above reductions are, therefore, attributable to educational activities and the co-operation of the family dentists.
The average number of tooth surfaces restored for Grade I children has not decreased
during 1954. Since the number has not increased to any significant degree, despite the
use in the latter years of diagnostic X-rays, a slight reduction in the incidence of dental
disease in those areas is possibly indicated. Moreover, it is noted that the average time
required to provide complete dental treatment for these children during the past year is
very significantly lower than that previously recorded. Extraction rates are also lower
than ever before, and the ratio of twenty-seven tooth surfaces restored to every tooth
extracted stands as the highest yet recorded within these services for this group of
children. Amongst the 1,054 Grade I pupils receiving complete dental treatment within
health-unit preventive dental services, only one permanent tooth was extracted.
In summary, it may be stated that, during the past three years within the health units
wherein full-time preventive dental services have been provided, there is clear evidence of
increasing pre-school dental care being attained through the family dentists and perhaps
some indication of a slight reduction in the incidence of dental caries.
Approximately three-quarters of the costs of full-time preventive dental services in
the Provincial health units have been met through National health grants. The balance of
the costs of these services has been borne by the Boards of Trustees of the school districts
in receipt of these services.
Community Preventive Dental Clinics
In addition, a further 3,983 children (pre-schools and pupils of Grades I, II, and
HI) received complete dental treatment through forty-seven community preventive dental
 L 70 BRITISH COLUMBIA
clinics which operated during the 1953-54 school-year. A further ten clinics commenced
in the fall of 1954, so that at the close of the year no less than fifty-seven such clinics were
organized and in which fifty-eight different dentists were co-operating on a part-time basis
In some of these larger clinics four or five dentists are providing service within the one
clinic, whilst in other instances a single dentist may be providing service to a number of
different clinics. %
During the past school-year it is noted that 633 pre-school children received all
necessary treatment through these clinics, 1,030 Grade I pupils, 356 Grade II pupils, and
157 Grade III pupils. Classification of the remaining 1,804 children within these groups
awaits further reports from some of the clinics.
From the clinics which have at this time forwarded complete reports of their activities during the past year, it is noted that of 456 pre-school children enrolled in the clinics,
only 38 were not in need of treatment (8.6 per cent), of 837 Grade I pupils only 34 (4.1
per cent), of 232 Grade II pupils only 16 (1.4 per cent), and of 114 Grade III pupils
only 1 (0.9 percent).      §
Records for these children show that complete dental treatment for the average preschool child required 1 hour 13 minutes of dental time, and for the average Grade I pupil,
2 hours 13 minutes. There were 183 Grade II pupils who had presumably received
complete treatment the previous year included in clinics in their second or later year of
operation. These children required an average of 1 hour 23 minutes of dental time. In
contrast, 49 Grade II pupils of clinics in the first year of operation (it is not known if
these children had previously received dental treatment or not) required an average of 1
hour 48 minutes of dental time. Of the Grade III pupils, records are available of 90
children treated in clinics in their third or later year of operation. These children had
presumably received dental treatment the year previously and on an average required only
1 hour 18 minutes of dental time. In contrast, 24 Grade III pupils whose previous treatment history is unknown on an average required 2 hours 10 minutes of dental time.
Now that it is planned to organize the majority of the dental preventive-treatment
services in the health units through community dental clinics, the records which are
required to be maintained by these clinics have been carefully reviewed. In some cases
it has been possible to simplify the records with the hope that the accuracy of their
completion will be improved. In other cases, new records, one summarizing the activities
of the clinic during the previous school-year, have been introduced. A standard form
of application has also been prepared, and by the completion of which the sponsoring
agency may request approval for their proposed programme either newly commenced or
continuing to the next school-year.
It will be recalled that a few years ago few of these clinics were organized and were
often located in areas without the benefit of the full-time services of a health-unit
director. With the rapid expansion in the numbers of these clinics throughout the Province and the appointment of fifteen health-unit directors, a measure of decentralization of
administration is now advisable. Several changes in policies relating to these clinics have
therefore been introduced.
First, all correspondence relative to such clinics within health-unit areas will in
future be directed through the respective health units and not direct to this Division as
heretofore.   Also, monthly clinic reports will be retained in the future by the health unit
and not submitted to this Division.   Similarly, requests for authorization of such clinics
to commence or continue into the next school-year will need to be submitted through and
countersigned by the health unit and are required to be accompanied by a rather detailed
description of the dental educational programme concurrently planned by the community.
financial grants-in-aid to these clinics have been made available through National health
grants. to
 DEPARTMENT OF HEALTH AND WELFARE, 1954 l 71
Preventive Dental Services in Metropolitan Areas   §£■■■;
Financial grants-in-aid have continued to the dental services administered by the
Boards of Trustees of the School Districts of Greater Victoria and New Westminster and
by the Greater Vancouver Metropolitan Health Committee. A significant proportion of
the financial aid to Greater Vancouver during the past year has been made available
through National health grants, which have also provided to that area during this period
an additional dental X-ray unit and the necessary equipment to open two further dental
clinics.
Financial aid has also been provided through a National health grant toward the cost
of equipment and operation, since 1951, of a most effective full-time preventive denM
service operating within Powell River and district.
In summary, therefore, it may be recorded that in the public schools of this Province
it is estimated that approximately 27,000 Grade I pupils were enrolled during the school-
year 1953-54. In the communities where dental rehabilitation was available to the Grade
I pupils through either full-time preventive dental services or a community preventive
dental clinic, more than 19,000 pupils were enrolled in the schools. Of these children,
more than 16,000 were dentally examined. Of these, 25.3 per cent were not in need of
dental treatment at the time of their examination, at least 15.2 per cent visited their family
dentist, and more than 38.1 per cent received dental treatment through the available
service. Therefore, a total of at least 78.6 per cent of the Grade I pupils who received a
dental examination are known to have been dentally fit at the time of their examination
or were subsequently restored to dental health. This total represents more than 46.6 per
cent of all the Grade I pupils who were enrolled in the public schools of this Province
during the past school-year.
DENTAL PERSONNEL
During the past year the number of deaths and retirements within the dental profession was appreciably less than the average for the past ten years. As a result, as at
September 30th, 1954, the ratio of population to dentists (including those practising
under a temporary permit) was one dentist to every 2,009 persons. This is a marginal
improvement over the ratio on the same date in 1953, but one which is not anticipated
will be maintained.
However, of the total of 615 dentists practising in British Columbia at this time, only
190 are located outside the metropolitan areas of Greater Vancouver, Greater Victoria,
and New Westminster. For the remainder of this Province there is regrettably only one
dentist to every 3,111 persons.
Dental Services in the Rural Areas
Of the smaller communities of the Province previously without a resident dentist and
yet of sufficient size to require the full-time services throughout the year of an energetic
younger dentist, few, if any, now remain without dental services. During the past year
this Division arranged for two younger dentists to visit on a continuing schedule some
twenty smaller communities of this Province without a resident dentist. These two
dentists are in no sense employees of the Health Branch. Rather, this Division acts solely
as an agency which introduces them to various communities desirous of their services.
A set of this Division's transportable dental equipment is on loan to these dentists. When
they visit a community, they agree to provide two sessions each day, five days of the week,
to an organized preventive dental clinic for the younger children. Outside of clinic hours
these dentists provide services to older children and adults on a private-practitioner basis.
On a somewhat similar basis, arrangements have also been concluded during the past year
tor dentists to make regular visits to the communities of McBride and Fort St. James from
 BRITISH COLUMBIA
L 72
near-by larger centres.  Tahsis and Zeballos are now visited at intervals of six months,
and Tofino at yearly intervals.
Notwithstanding the success achieved in the field of providing dental services to the
smaller and more remote communities of this Province, there remains an acute shortage
of dentists outside of the metropolitan areas. Of the twenty-three dentists who newly
registered in this Province in the summer of 1954, only eight located outside the metropolitan areas, which is a better ratio in this regard than has been achivcd during the past
five years. The situation provides no grounds for complacency, when it is remembered
that 48 per cent of the population of this Province resides outside the metropolitan areas.
Furthermore, during the past year five dentists moved from the rural to the metropolitan
areas, whilst only one gave up practice in a metropolitan area to move to a rural
community.
The Dental Health Committee of the British Columbia Dental Association is being
approached with the suggestion that they arrange for a survey outside the metropolitan
areas, to be carried out so that some indication may be gained as to which communities
are in need of additional dentists at this time. This information will then be made available to newly graduated dentists and others, so that they may be encouraged to locate in
these communities. It is suggested that the task is now to endeavour to attract additional
dentists to some of the communities now with resident dentists so that increased dental
services to the people of the rural areas may be achieved.
Dental Faculty
At this time no announcement has yet been made which would indicate that the
establishment of a Dental Faculty at the University of British Columbia is to-day any
further advanced than one year ago.
Throughout the year a committee of the Council of the College of Dental Surgeons
of British Columbia has met with officials of the University and others interested in the
establishment of a Dental Faculty. It would appear that whilst all are agreed as to the
need of a Dental Faculty in this Province at this time, nevertheless the major deterrents
the provision of the necessary funds. When approval is granted, it is unlikely that the
plans could be completed, the necessary buildings erected and equipped, staff engaged,
and the courses arranged in a period significantly less than two years. A further four years
would then elapse before the graduation of the first class of dental students and likely of
dental hygienists. Even if the period of waiting were no longer than this six years, it is
confidently forecast that it will be most unlikely if the ratio of population to dentists,
especially in the rural areas of this Province, does not steadily worsen from the already
most unsatisfactory ratios pertaining to-day. The lack of available dental services in the
areas of this Province outside the largest cities is to-day discouraging. This situation will
likely further deteriorate until a Dental Faculty at the University of British Columbia is in
operation and additional dentists are trained. J|
British Columbia Dental Association
Throughout the year the most pleasant relations and co-operation between this Division and the Dental Health Committee of the British Columbia Dental Association have
continued.
Early in 1954 the association, with some financial assistance by a National health
grant arranged for two selected members of the Vancouver Pedodontia Study Club to
visit four centres in the Interior of the Province. Some of the latest advances in children's
dentistry were demonstrated to the dentists residing in these areas. The reception by the
dentists of these demonstrations was enthusiastic. It is hoped that it will be possible next
year tor the local dental societies themselves to arrange for further visits and demonstrations by these or other specialists in the practice of children's dentistry.
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 73
In the coming year the association hopes to arrange a full day's dental-health conference on the day prior to its annual meeting. It is planned that this conference will be
primarily organized for the dentists co-operating on a part-time basis within the community preventive dental clinics, and also for representatives from the lay organizations
sponsoring these clinics and the full-time preventive dental services of this Province. For
the dentists, demonstrations in the latest techniques of children's dentistry will be included,
and for the lay representatives there will be lectures and demonstrations on how they may
help the children of their community prevent dental disease. To both groups it is planned
to present a symposium entitled | Dental Disease or Dental Health in British Columbia,"
in which will be discussed the programmes of this Province, whereby it is hoped that
dental disease may be very significantly reduced, if not eliminated. It is planned to have
Dr. J. Knutson, Chief, Division of Dental Public Health, United States Public Health
Service, to act as moderator to this symposium and also present an address to both groups
at luncheon.
GENERAL
At the commencement of this report, some of the difficulties of accurately recording
progress in the field of dental public health were indicated. Although some success in
this direction has been reported, plans are now being formulated whereby next summer
this Province will likely be the first to institute a new system of obtaining one or more
statistically reliable dental-health indices. The most helpful co-operation of a university
in Eastern Canada is anticipated in this regard, and plans to implement this new procedure
are now under preparation. These indices, it is hoped, will, when compared to similar
findings in future years, accurately portray the dental-health conditions in this Province
and, we trust, the improvement in dental health attained by the programmes of this
Division.
Three other major activities are foreseen for the coming year. First, it is anticipated
that the effectiveness, especially through their educational activities, of the community
preventive dental clinics will be considerably increased through the assistance they receive
from the regional dental consultants. Second, it is anticipated that a number of communities during the coming year will commence fluoridation of their water-supplies.
Third, it is hoped that it will be possible to encourage even more dentists to locate in the
rural areas of this Province.
It is therefore hoped that during the coming year dental disease will be further prevented and dental efficiency prolonged through the organized efforts of this Division, the
dental profession, and the communities of this Province.
 BRITISH COLUMBIA
L 74
REPORT OF THE DIVISION OF PUBLIC HEALTH ENGINEERING
R. Bowering, Director I
The Division of Public Health Engineering functions within the framework of the
Health Branch, as part of the Bureau of Local Health Services. Professional public health
engineering is being practised when the physical environment is controlled indirectly or
directly for the protection and improvement of the health and comfort of man, by controlling'the forces and materials of nature for the benefit of the human race.
Engineering in public health involves the planning of procedures and policies; the
review of the design of structures, equipment, and facilities; the investigation of conditions; and the control of natural forces—all for the purpose of affecting the physical
environment for the protection and improvement of the public health. The Division of
Public Health Engineering employs registered professional engineers who are trained for
that part of public health work which is directed toward the solution of problems in water-
supply, sewerage, waste collection and disposal, and the control of the environment in
the prevention of communicable diseases. Communicable diseases may often be prevented by employing engineering principles and techniques based upon the application of
sanitary science.
Public health engineering problems tend to increase simultaneously with increasing
population density and with the steady increase of industrialization throughout the Province. In addition, with the increasing wealth of the Province, improved living standards
have resulted in an increased demand for water and sewerage services in many of our
communities. In order to cope with the numerous diversified problems involved in
public health engineering, three fully trained public health engineers, with postgraduate
training, are on the staff of the Division, one of whom is employed under National health
grants.
WATER-SUPPLIES
The Division is responsible for reviewing plans for extensions, alterations, and
construction of waterworks systems. The "Health Act" requires that all plans of new
waterworks systems and alterations and extensions to existing waterworks systems be
submitted to the Minister for approval. A careful study of these plans, together with
inspections on the site in many cases, is one of the major duties of the Division. The
Division also keeps a check on new materials used in the waterworks-construction field.
During the year thirty-eight plans, in connection with waterworks construction, were
approved and eleven plans were provisionally approved. As well as approving plans,
engineers from the Division visit various waterworks systems in the Province from time
to time for the purpose of checking on sanitary hazards and giving advice and assisting
generally in the improvement of waterworks systems.
There are very few water-treatment plants in British Columbia, owing to the fact
that in British Columbia most sources of water provide satisfactory water for domestic
consumption without expensive treatment. In many cases only bactericidal treatment is
required, and a number of chlorinators have been installed to provide this treatment.
In several cases filtration equipment should be provided to take care of seasonal increases
in turbidity. In this connection, some study was made during the year on the problem
of the water-supply at Tranquille Sanatorium. This water is good most of the year,
but owing to slide conditions on the watershed the water can become very turbid at times.
It has been felt for some time that there is a need for better training of operators of
waterworks equipment, particularly water-treatment equipment. Some of the chlorinating
equipment, for example, could be better operated if the operators had some sort of training It was felt that the number of operators that would desire training might be too
small to warrant a short course in British Columbia. Contacts were made with the
training section of the United States Public Health Service and the State of Washington,
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 75
and it is now arranged that waterworks operators will be invited to short courses in
Washington State, f Several invitations were sent to waterworks operators this year. Also,
in connection with the American Waterworks Association, some investigation has been
made of methods of certifying waterworks operators.
The regular frequent sampling of water from public water-supply systems is the
responsibility of the local health unit. The Division of Laboratories performs the bacteriological examinations of the samples. Copies of all laboratory examinations are sent
to the Division of Public Health Engineering, where they are recorded under the proper
place-name. In this way a constant check is kept on the bacteriological quality of the
water served in British Columbia.
In addition to the bacteriological examination of water, there is some need for
chemical examination of water. At present the Health Branch does not operate a laboratory for doing these chemical analyses. For this service, reliance is placed upon the Public
Health Engineering Division of the Department of National Health and Welfare, which
operates a laboratory for chemical analyses of water. It is recommended that when the
new Public Health Building is opened in Vancouver, a laboratory be set up for the
chemical analysis of water and sewage.
The Division receives a number of inquiries each year concerning private water-
supplies. These are referred to local health units, whenever local health units exist.
A considerable amount of advice is given by mail and occasionally by visit.
It is gratifying to note that, in keeping with the normal trend, there have been no
known water-borne epidemics resulting from the use of public water-supplies in British
Columbia this year. The fact that there has been no evidence of water-borne illnesses in
our Province over the past several years indicates, to a certain extent, the care being taken
by the various water authorities to provide a safe water for the citizens of British
Columbia. This record, however, should not be allowed to bring about a feeling of complacency because the bacteriological quality of a number of water-supplies could be
improved through more efficient operation of the chlorinating equipment. The Public
Health Engineering Division stands ready to assist any water-supply authority with respect
to water-supply problems such as chlorination or filtration.
Sewage-disposal
The Division of Public Health Engineering has the responsibility of reviewing plans
for extensions, alterations, and construction of sewerage systems. The | Health Act"
requires that plans of all new sewerage construction be approved before construction
may commence. During the year twenty-two approvals were given in connection with
sewerage-works and thirteen plans were approved provisionally.
Study of the plans for approval includes the study of profiles and plans of appurtenances, so that a good standard of sewerage-work is constructed. Study also includes
treatment-works, if any, and studies of the receiving body of water, in order to determine
the degree of treatment required. One of the villages of the Province which built an
entirely new sewerage system this year was the Village of Sidney, located on Vancouver
Island. One of the areas of Vancouver Island that has long been in need of a clean-up
is the Gorge area in Greater Victoria. Work undertaken this year by the Municipality
of Esquimalt and the Municipality of Saanich has removed a considerable amount of
septic-tank effluent from the Gorge water.
Plans for the building of a sewage-treatment plant for the Colquitz Mental Home
were prepared this year. Next year, when this plant is brought into operation, another
fairly large source of contamination will have been removed from the Gorge watershed,
lhe Gorge waters will still receive contamination from unorganized territory, such as
View Royal area and portions of the Colquitz River drainage-basin and the Municipality
^anich, until such time as adequate sewerage systems are constructed.
 BRITISH COLUMBIA
L 76
It was mentioned in the 1953 report that the Vancouver and Districts Joint Sewerage and Drainage Board had published a report on the ultimate disposal of sewage
from the Greater Vancouver area. The organization needed for the implementation of
this report has not yet been formed. However, all approvals for new outfalls in the
Greater Vancouver area will now be made conditional, until such time as the communities concerned have decided to accept or reject the report's recommendations regarding
organization.
The problem of the unorganized urbanized area is still a major one as far as lack
of sewers is concerned. Some studies were made to determine costs of sewers in one of
these areas, View Royal, during the year. However, unless such an area wishes to form
a sewerage'district voluntarily, there appears to be no way by which it can be sewered.
A study was made during the year which indicated that in almost every case when
a city or a village had reached a population density of 4 persons per acre, a start, at
least, on the construction of sewers had become necessary. The study revealed that of
the thirty-four cities in the Province, excluding Vancouver, twenty-three have sewerage
systems and eleven do not. The average population density of the sewered cities is 6
persons per acre. The average population density of the eleven unsewered cities is 1.4
persons per acre. The population density of the most densely populated unsewered city
in British Columbia is 3.2 persons per acre.
As far as villages are concerned, there were forty-nine communities in the Province
incorporated as villages. Fifteen of these, with a population density average of 3.2
persons per acre, have at least a partial sewerage system. The average of the population
densities of the remaining thirty-four is 2.5 persons per acre. Of the thirty-four, eleven
are having frequent sewerage troubles now. The average population density of these
eleven villages is 3.2 persons per acre. Most of the unsewered villages that are not
having trouble now have a population density below 2 persons per acre. These studies
reveal that the need for sewers can be largely determined by the population density,
although other factors, such as topography, type of soil, and relative ease of disposal,
have a bearing. In some cases it was found that the cost of building an adequate septic-
tank type sewage-disposal system for each residence was not much less than that of
building a sewerage system for the whole community. There is need for more research
in the economics of disposal of sewage in small communities.
The question of sewage-disposal for private homes comes generally under the direction of local health services. However, the plans and specifications are provided by the
Division of Public Health Engineering. Also, advice is given to local health services
regarding private sewage-disposal problems. This year some time has been spent by the
Division in the redesign of our standard septic-tank plans. The research that has been
carried on in the past few years, both in North America and Europe, has been studied
carefully, and, as a result, a new booklet on sewage-disposal for private dwellings and
isolated institutions and schools will be published early in 1955.
The Division also gives advice and reviews plans of sewage-disposal systems for
schools. There is still need for research in order to determine the discharge characteristics
of sewage from schools on a per pupil basis. The Division also provides consultative
service regarding sewage-disposal problems for the Government institutions.
The percentage of the population of British Columbia served by sewers is fairly
high, being over 50 per cent, but there are still many communities where sewerage systems
are needed. The continued growth of the Province will necessitate the building of sewage-
treatment plants in communities which formerly disposed of sewage by dilution. Some
cost figures for treatment plants were prepared and given to health-unit directors, where
required Constant education of the public is necessary in order to have them realize
the need for essential sewerage services.
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 77
STREAM POLLUTION
One of the items that has been dealt with by the Division of Public Health Engineering is stream pollution. Although stream pollution may be a part of the sewage-disposal
problem and a part of the water-supply problem, it is felt that it is important enough to
discuss under a separate heading. j|
Stream pollution is caused by discharge of sewage and industrial wastes into surface
water. These discharges may have quite diverse effects on the receiving body of water
because of the extreme variations in the type and strength of the wastes and the quality
and volume of the receiving bodies of water. The net result of such discharges, however,
may make the water less desirable and less useful.
The extent of stream pollution in the Province is not extensive at present, as there
are only a few instances where waste discharges have affected down-stream water-users.
However, it is recognized that adequate control should be established in order to prevent
pollution, rather than to wait until it becomes a problem and then try to reduce it.
The Health Branch has had general legislation for the control of municipal wastes
for a number of years. Control of pollution by sewage under this legislation has made
it possible to prevent the discharge of sewage from affecting communities in lower
stretches of streams and rivers. In addition to the Health Branch, other departments of
Government have legislation for the control of industrial wrastes. The legislation is of
very general nature and is utilized by each department to protect its special interest. As
these interests involve such diverse things as fish, navigation, public water-supplies, and
irrigation, it is not surprising that different interpretations of the general Acts or legislation are made by each department.
In the administration of stream-pollution legislation, an effort is usually made to
obtain the opinions of officials of all departments which are interested in the specific discharge before a decision is made. This seems the best possible arrangement under the
circumstances, but there are a number of disadvantages. An industry is not required to
have its waste facilities approved prior to construction; consequently, if a problem arises
after operations commence, the solution involves the more difficult matter of alteration
rather than prevention. Sometimes the most restrictive recommendation is liable to be
adopted by the group, as there is no one person to decide on the relative value of the
suggested requirements. However, as far as public health is concerned, the activities of
the Health Branch have prevented the discharge of wastes into streams from becoming
a major health problem. Representatives from the Division have attended a number of
conferences on individual stream-pollution problems during the year. The control of
pollution depends to a great extent on co-operative effort and public interest. Both of
these are objectives of the British Columbia Natural Resources Conference, which is
concerned with all the natural resources of the Province.
During the last two annual conferences a special panel on pollution has been considering water, air, and land pollution. All the members of the Division have taken part
in the preparation and presentation of papers for this special panel. The three papers to
date include one on water-pollution control, one on air pollution, and one on a summarization of the Pollution Panel's findings. In order to arouse as much public interest
as possible in this problem of pollution, the Panel gave wide distribution to reprints of
the summarization.     '   w W
Also, during the year the Director of the Division was elected Chairman of the
Pacific Northwest Pollution Control Council, a council set up informally, with representatives of the Pacific Northwest States, Alaska, and British Columbia, to study all phases
of stream pollution peculiar to the Northwest. It is felt that in British Columbia, with
the co-operation of the other agencies interested in stream-pollution prevention, and with
improved methods of administering stream-pollution control, serious pollution of streams
can be kept to a minimum.
 BRITISH COLUMBIA
L 78
During the year a study of the waste problem created by the discharge of wastes
from a vegetable- and fruit-canning factory in the Interior was made. Plans showing how
the waste problem could be solved were prepared and presented to the cannery in question.   It is felt that during the coming years more attention will have to be paid to this
tvne of problem.
There are still no large pulp-mills located on our Interior streams. If any are built
on such locations, great care will have to be taken to see that the best possible means of
waste treatment is used.
In summary, stream pollution has not become a serious problem, except in a few
isolated instances! With the increasing industrialization of the Province, it could become
a very serious problem, unless sufficient steps are taken now to prevent it. It appears
that placing all classes of stream pollution under one jurisdiction might be the best way
of achieving this result.
SHELL-FISH
The Division of Public Health Engineering has the responsibility of enforcing the
Shell-fish Regulations. The inspection of shucking plants and handling procedures now
comes under the jurisdiction of local health units. There are six local health units that
have one or more shucking plants under their jurisdiction. Reports are made on uniform
records issued by this office. The Department of National Health and Welfare also has
an interest in shell-fish control, since it has to approve certificates for export purposes.
The Provincial regulations are such that any shell-fish produced in the Province, in conformity with the regulations, will conform with the requirements of the Department of
National Health and Welfare.
Oysters produced commercially in British Columbia are grown on leased ground.
Applications for all new leases and applications for renewal of existing leases are forwarded to this Department for approval. Any ground found unsuitable for production
of shell-fish for public health reasons will not be leased. In some areas a pollution survey
of a proposed oyster lease can be made relatively easily, but in others a considerable
amount of survey work is necessary. There were twenty-eight certified shucking plants
in operation in 1954, of which twenty were family operations. The certification must be
renewed annually. There are fourteen shell-stock shippers certified as well. Lists of
certified shucking plants and shell-stock shippers are forwarded to the Department of
National Health and Welfare, which, in turn, forwards this to the United States Public
Health Service. This makes it possible for American importers to know if shell-fish
come from certified plants and shippers. | A
The matter relating to shell-fish toxicity is one that is still before the Pacific Coast
Shell-fish Committee. Following a recommendation of this Committee in 1953, the West
Coast of Vancouver Island was opened for the taking of clams and mussels after a closure
of eleven years. Assaying of clams by the laboratory of the Department of National
Health and Welfare, in co-operation with the Federal and Provincial fisheries and health
agencies, was continued in 1954. There have been no deaths due to the ingestion of
toxic shell-fish in British Columbia since 1942.
SWIMMING AND BATHING PLACES
A considerable amount of time was spent during the summer in consultation work
on swimming-pools. The health units also spend a considerable amount of time studying
swimming-pool sanitation. In 1954, under the chairmanship of the Director of Public
Health Engineering, a Swimming-pool Regulation Committee was set up. This Committee has prepared a draft set of swimming-pool regulations. . Following the third draft,
copies were sent to each health unit for comments. It is hoped that these regulations wifl
be enforced early in 1955. There is still a good demand for the paper that was prepared
several years ago on suggested requirements for swimming-pools. These suggested
requirements should supplement the regulations when they are promulgated.
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 79
TOURIST ACCOMMODATION
The Director of the Division is one of five members of the licensing authority for
tourist accommodation. Inspection of tourist camps, auto courts, etc., is done on the
local level by the sanitary inspector. The reports of the sanitary inspectors are coordinated by the Division of Public Health Engineering, and recommendations for or
against licensing are made to the British Columbia Government Travel Bureau. There
are over 1,300 hcensed tourist camps in the Province at the present time, and the work
done by the Health Branch has a considerable effect in producing a fairly high standard
of tourist accommodation.    Three licences were cancelled on health grounds in 1954.
The star rating of tourist camps is not done by the Health Branch, but it is done by
inspectors employed directly by the Travel Bureau.
There appears to be an increasing demand on the part of the public for tenting and
camping space. The Parks Division of the Forest Service has provided a number of
camping-sites throughout the Province. These do not come under the licensing requirements of the Travel Bureau. However, the local health units provide some inspection
and consultation services to the persons in charge of such camping-sites. The Division
also, upon request, offers consultation advice with regard to sanitation in parks.
The requirement that tourist accommodation must be licensed has had an excellent
effect in the prevention of nuisance to tourist camps. The local sanitary inspector has
been able to visit a tourist-camp site before construction and give the owner advice on
water-supply, sewage-disposal, and other environmental health problems.
FROZEN-FOOD LOCKER PLANTS
Under the regulations governing the construction and operation of frozen-food locker
plants, plans of all new constructions of locker plants must be approved by the Deputy
Minister before construction may commence. The Division studies the plans and recommends approval where such is indicated. Approvals were given to three locker plants
during 1954. One locker-plant operator was charged in Court and found guilty of violating the Frozen Food Locker Plant Regulations.
In the review of locker-plant plans, care is taken to see that the required rooms
necessary for a locker plant are planned for, and care is also taken to see that the refrigeration equipment is adequate to maintain the temperatures required in the regulations.
Periodic inspection of the locker plants is made by the local sanitary inspector.
GENERAL
The Division of Public Health Engineering provides a consultative service to other
divisions of the Health Branch and to local health units on any matter dealing with engineering. This entails a considerable amount of work and of travel. During the year
most of the health units were visited at least once. During these visits the various problems requiring engineering for their solution are examined in the field. The position of
Chairman of the British Columbia Examining Board for sanitary inspectors' examinations is usually filled by this Division. Papers on public health engineering subjects were
presented during the year by members of the Division to the Annual Institute for Public
Health Workers in British Columbia, the Municipal Engineering Division of the British
Columbia Engineering Society, and the Pacific Northwest Pollution Control Council.
The continued expansion of the economy of the Province will lead to more and
more public health engineering problems. It is the intention of the Division to foresee
these problems and make plans for their reasonable control so that proper recommendations may be made for adoption by the Government and by local health services for
adequate control of the environment.
 BRITISH COLUMBIA
L 80
REPORT OF THE DIVISION OF VITAL STATISTICS
J. H. Doughty, Director
Two main types of service are provided by the Division of Vital Statistics to the
general public and to other branches of Government. On the one hand, the Division
performs the functions of civil registration, and, on the other, it renders statistical service
to all sections of the Health Branch. The Division is made responsible by Statute for the
administration of the "Vital Statistics Act," the ^'Marriage Act," and the "Change of
Name Act," as well as several sections of the " Wills Act." Statistical services comprise
the preparation of detailed analyses regarding births, deaths, marriages, stillbirths, adoptions, divorces, and of other data stemming from the registration function, as well as providing extensive statistical service required for the administration of other divisions of the
Health Branch.
A record high was reached in 1954 in the number of birth certificates issued by the
Victoria Office. As noted in the previous year, the demand for birth certificates was
heaviest in the month of June, when 4,334 were supplied, being an increase of 20 per
cent over the previous all-time high of June, 1953. The demand remained heavy during
the summer months, commencing a decline in September. It is evident that there is an
increasing awareness on the part of the general public of the value and convenience of
having a birth certificate readily available at all times. Wallet-sized laminated birth
certificates have become extremely popular, even on behalf of new-born babies. As
recently as ten years ago, few birth certificates were issued at the time the birth was registered, but at the present time at least one certificate is issued at the time of registration of
almost every birth. Many parents purchase both a parchment certificate and a laminated
certificate at the time of filing the birth registration.
The central office issued over 43,000 birth certificates during the year, which was
more than double the number issued during 1950. The issuance of death certificates
showed a slight increase over the previous year, while the issuance of marriage certificates
declined very slightly. The total of all revenue-producing certificates issued during the
year by the Victoria office amounted to 51,800. Revenue-producing searches increased
to 32,500 from the 30,500 for the previous year. In addition, 25,854 non-revenue
(current) searches were made, plus 5,500 free searches for other Government departments. A new record was also established for revenue collections by the Victoria office.
These amounted to $55,500, compared to the previous high of $53,246.
REGISTRATION OF BIRTHS, DEATHS, AND MARRIAGES
Current Registrations
The registration of births, deaths, and marriages has been a statutory requirement in
this Province since its creation in 1872. Many changes have been made in the form and
content of registrations in the ensuing years as the system developed and new needs
became manifest. The fact that to-day the Province has a well-developed and smoothly
operating registration system is due as much to the continued modification that has been
its history as it is to the underlying stability it has enjoyed. An unbroken series of registrations of births, deaths, and marriages, dating back to the first year of the Province's life
and earlier, is available for immediate reference in meeting the many needs such records
serve. The key to this entire sequence of registrations is a new index system which has
recently been completed. The index is now strictly alphabetical by year of event, and
Province-wide, regardless of where or when the registration was filed.
I The registration of marriages and deaths has proved to be a simpler matter than
birth registration from the administrative point of view, although there are problems
peculiar to each series.   The responsibility for registering a marriage rests with the clergy-
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 81
man or Marriage Commissioner solemnizing the ceremony, and the registration is a
straightforward record of the event. The responsibility for filing death registrations is
placed upon the undertaker or other person who disposes of the body. Because of its
very nature, being a record made concerning a person after his demise, the death registration is more prone to contain errors which the Division attempts to discover and rectify.
An important part of the death registration is the Medical Certificate of Cause of Death,
and because of the multiplicity of diagnoses and the need for interpreting these in terms
of the International Statistical Classification of the World Health Organization, a large
number of follow-up queries are required. |
The development of an adequate system of birth registration has presented different
problems. For many years following the inception of civil registration in 1872, the
Province was a vast sparsely settled region with many difficulties of transportation. Confinements usually took place in the family home, and in many instances without the
benefit of medical care. While the responsibility for the filing of birth registrations has
always been with the child's parents, there was not a great incentive for them to fulfil
their duty until the popularization of birth certificates in comparatively recent times.
These factors account for the lack of completeness and accuracy of birth registrations in
earlier years. However, the growth of population, combined with a tremendous improvement in transportation facilities, the high proportion of births which now occur in institutions, and the increased demand for proof of birth have now resulted in a very high level
of birth registration. The reporting of births by the hospital in which these occur and also
by the attending doctor provides an adequate cross-checking system for bringing to
attention registrations which are outstanding for longer than the period allowed by law.
While little difficulty is presently encountered in obtaining completed birth registrations from parents, there continues to be a certain lack of understanding of the legal
importance of a birth registration and the documents which may later be required t& be
issued from it. Although efforts are continually being made to simplify the content of
registration forms and to provide concise instructional material for the guidance of
parents, it is necessary to initiate numerous inquiries in order to obtain answers to items
which have been omitted or to which incorrect answers have obviously teen given. Such
steps are essential and in the public interest if the quality of registration is to be maintained
at a high level.
Delayed Registration of Births
Most applications for delayed registration of birth continue to come from persons
bom before the year 1920. The delayed-registration picture appears to be changing
somewhat in that first-class evidence is becoming increasingly rare, while verifications
pieced together from assorted fragments of evidence are more frequently presented. It is
not surprising that most persons having Class A (that is, first-class) evidence in their
possession have now been registered.
The continued high level of delayed-registration work appears to have two explanations. In the first instance, it is to be expected that more time will be taken to effect
registration in the cases where each piece of evidence is produced as the result of considerable research and exchange of letters. Secondly, it is evident that fewer applicants now
become discouraged and discontinue their efforts to obtain registration. Previously there
were relatively a large number of incompleted applications in the Division's files. The
Guide to Delayed Registration of Birth, introduced last year, together with several other
variations in approach to the problem, appears to have been helpful.
The verification material on file continues to be valuable. There is a small but
steady flow of fresh material into these records. Verification material consists mainly of
physician's notices of birth, hospital reports of birth, school returns of newly enrolled
Pupils, baptismal records, and miscellaneous records of institutions which are no longer
ui operation. The information provided from these sources is generally of first-class
value as supporting evidence for delayed registration of birth.
 BRITISH COLUMBIA
L 82
During the last few months the Tabulation Section has been preparing punch-cards
in order to provide an index to the sixty-one volumes of physicians' and nurses' notices
of births in our verification files. This particular set of notices relates to the early m
of the century for which many applications are received. When this index becomes
available the work of searching for such a record will be greatly simplified, and it will
be of assistance to the public in locating evidence m support of an application for a
delayed registration of birth. The punch-cards for this mdex are now complete, and it
is hoped to tabulate the index sheets during the next few months.
A new edition of the Guide to Delayed Registration of Birth is now in print. In
response to constructive suggestions from interested sources, a few minor changes have
been made. It is hoped that the new pamphlet will present inquirers with a clearer
picture of the problem and of the steps they should take to obtain a delayed registration.
Continued co-operation has been received from the Indian Commissioner for British
Columbia and from the Indian Superintendents in obtaining delayed registrations for
those Indians whose births were not previously registered.
DOCUMENTARY REVISION
Vital-statistics records are subject to continual change to accommodate new information resulting from adoptions, legitimations, divorces, changes of name, alterations
of Christian name, and corrections of error made at the time of registration. These
changes are handled by the Documentary Revision Section of the Division. This Section
is also charged with registering the orders of adoption and divorce transmitted from the
Supreme Court Registries and the processing of applications for legal change of name.
The number of adoption and divorce orders received during 1954 increased to 1,248
and 1,614 respectively from the 1,103 adoptions and 1,574 divorces registered during
the previous year. In addition, 144 notations of divorces granted in the Supreme Court
of British Columbia at Revelstoke, Nanaimo, Vernon, Rossland, Princeton, and Cranbrook prior to April, 1935, were placed on marriage registrations. This is part of a
programme designed to complete the records for divorces granted prior to the 1935
amendment to the " Vital Statistics Act" which required that all divorces be registered
with the Division. Alterations of given or Christian name numbered 296, while 386
legal changes of name were accepted. In addition, 215 applications for legitimation of
birth were investigated and accepted.
It has been discovered that in the earlier years of registration there were numerous
instances of duplication in the registration of births. This problem was overcome a
number of years ago when the Division began matching incoming birth registrations with
a corresponding physician's notice of birth or an entry in the returns of births submitted
by all hospitals. Since this procedure was instituted, no registrations have been accepted
without a corresponding notification or an adequate explanation as to why none was
available. As the existence of duplicate registrations is apt to lead to confusion, steps
have been taken to search the birth records for the years in which it is known duplications
occurred and to cancel them whenever found.
Steady progress was made on the correction and revision of Indian vital-statistics
registrations. The records of several Agencies, covering the period 1917 to 1946, inclusive, were reviewed, and many hundreds of corrections made. In addition, many delayed
registrations of Indian births were accepted, as well as legitimations and alterations of
given name. This long-range revision project is aimed at raising the standard of Indian
registrations to that enjoyed by the white population. Many difficulties have been
encountered Some of these stem from the fact that registration of Indian vital statistics
was on a voluntary basis until 1943, while others arose from the lack of appreciation by
inaians ot the value and significance of accurate registration, and from the completion
of Indian registration by well-meaning but misinformed persons.
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 83
Efforts have been made to ensure greater continuity and accuracy in the names and
birth dates used by Indian children by popularizing the use of birth certificates and by
checking enrolment records of children attending school for the first time during the
current school-year. In the 1953-54 school term, returns were submitted by 178 schools,
of which 44 indicated that there were no Indian pupils entering school for the first time.
Out of a total of 1,233 new pupils, the births of only 22 were found to be unregistered,
although in 749 cases the birth particulars which had been supplied on entering school
did not agree with the related birth registrations.
H Since the preparation and subsequent checking of school returns constitutes an
onerous task for school-teachers, Indian Superintendents, and this Division, an experiment
was made in September, 1954, to determine whether satisfactory results could be achieved
by requiring the production of birth certificates by children upon enrolment. Results of
the experiment are encouraging, but it is too early to make a full assessment of its
effectiveness.
Liaison visits have been made to the Indian Commissioner's office as well as to the
offices of several Superintendents in the field. This function is generally carried out by
the Inspector of Vital Statistics during the course of his inspection of registration offices,
and affords the Division direct contact with the Agency offices, as well as the opportunity
to provide technical instruction in vital-statistics procedures to the Agency staff.
MICROFILMING OF DOCUMENTS
The photographing of registrations of births, deaths, stillbirths, and marriages on
microfilm was continued on a weekly basis. In this way the Dominion Bureau of
Statistics is furnished with copies of all registrations, from which are prepared the
statistical tabulations required for National vital statistics and for the National index of
births, deaths, stillbirths, and marriages. In addition to the photographing of current
registrations, all registrations upon which notations have been made resulting from adoptions, divorces, changes of name, and other types of documentary revision were rephoto-
graphed and the amended images splices into the appropriate rolls of film. As in previous
years, miscellaneous projects were undertaken in order to bring up to date the filming of
special files, verification material, and other documents. Several sets of baptism and
marriage registers, loaned by various churches, were microfilmed and the books returned
to their owners. The Division is grateful for the co-operation extended by the churches
in this connection.
ADMINISTRATION OF THE " MARRIAGE ACT "
The administration of the "Marriage Act" is a major responsibility of the Division
of Vital Statistics. This Act covers all phases of the Province's jurisdiction over the
solemnization of marriage and the legal preliminaries thereto. The main duties of the
Division under this Act relate to the issuance of marriage licences and the vesting of
individual ministers and clergymen with the authority to solemnize marriages in British
Columbia. The Division also appoints Marriage Commissioners for the purpose of
solemnizing the civil marriage ceremony.
Because of the legal importance of the marriage contract and of the qualifications
which are required of the parties to the intended marriage, marriage licences are issued
only by specially appointed persons known as "issuers of marriage licences." This provision, which restricts the issuance of marriage licences to a limited number of specially
appointed persons, is one of the several safeguards written into the "Marriage Act" as
a protection to the public. It is the duty of the issuer of marriage licences to be reasonably
satisfied that the persons seeking a marriage licence are properly qualified before he may
issue the marriage licence.
 BRITISH COLUMBIA
L 84
The sections of the Act providing for the registration of ministers and clergymen
for the purpose of solemnizing marriage in this Provmce are also intended as protection
of the public against the performance of marriages by fraudulent or unauthorized individuals The Act provides that before registration is granted, the denomination to which
the clergyman belongs must fulfil certain requirements regarding continuity of existence
and must have established rites and usages respectmg the solemnization of marriage.
This legislation in various forms is common throughout the Canadian Provinces.
Although all of the larger religious denominations have been granted recognition pursuant to the "Marriage Act" many years ago, splinter groups and newly created denominations continue to seek recognition.
Two new religious groups were granted recognition during the year, while inquiries
were received from eleven other groups who wish to obtain the privilege of solemnizing
marriages for their clergymen.
All current marriage registrations are checked against the roll of authorized clergymen, and this year it was gratifying to find that no marriages had been solemnized by
ministers who were not properly authorized. This fact underlines the effectiveness of
the legislation and its value to the public.
Applications for an order permitting remarriage, pursuant to section 47 of the
I Marriage Act," numbered fifteen in 1954. Most of these applications were in respect
to couples who had previously been married to each other, were subsequently divorced,
and who then wished to remarry each other.
REGISTRATION OF NOTICES OF FILING OF A WILL
Since 1945, when an amendment was made to the " Wills Act," making it possible
for a person to file a notice with the Director showing the date of execution and the
location of his will, over 23,000 notices have been filed as part of the records of the
Division. During 1954 over 4,100 wills notices were received and filed. The use made
by the public of this facility has increased with each succeeding year.
CERTIFICATION SERVICES
Once again there has been a major increase in the volume of requests for certificates
and other forms of certification received by the Division. Although the year 1953 was
the previous peak year in this connection, the 1954 applications exceeded 1953 by fully
10 per cent. On many occasions throughout the year almost 300 separate applications
for certification were received on a single day. Each application must be processed
through the cash register, a search must be undertaken to locate the original registration
on file with the Division, the desired certificate must be prepared, the accounting procedures attended to, and the outgoing document dispatched in the mail. Many applications request priority service, alleging that the documents are required for Court purposes,
for immigration purposes, for travel to the United States, and other urgent needs. Every
effort is made to clear all applications routinely within the space of two business-days,
and priority attention is given to the special requests as far as possible. However, the
tremendous increase in the number of applications received and the limitations of space
in the central office, coupled with the fact that the records vault is located some 3 miles
away from the general office, make it increasingly difficult to handle this work with the
desired speed and efficiency.
Eff<£ts are continually being made to improve and refine forms and procedures used
in the office m order that accurate certifications may be produced with a minimum of
delay Toward the end of the year it was found that a more even flow of work throughout the week could be obtained by a revision of the system whereby the weekly returns
or registrations are submitted from the district offices at Vancouver and New Westminster.
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 85
DISTRICT REGISTRARS' OFFICES
Registration Districts
No changes were made during the year in the number or location of the district
offices. However, it was found that the District Registrar at Alert Bay, because of the
nature of his other duties, was required to be absent for long intervals, thus inconveniencing the public in obtaining marriage licences. Accordingly, it was deemed advisable
to appoint a local business-man as Marriage Commissioner and issuer of marriage licences
for the Registration District of Alert Bay, to act during the absence of the regular District Registrar. 4-
Inspections
The Inspector of Vital Statistics visited forty-seven offices and sub-offices during
the year. These covered Vancouver Island, the Sechelt Peninsula, the Fraser Valley,
the Okanagan Valley, Revelstoke, Cariboo District, Prince George, the Prince Rupert
District, the Queen Charlotte Islands, and the Peace River District extending as far north
as Fort Nelson.
Visits were also made to the Vancouver, North Vancouver, and New Westminster
offices and to thirteen Indian Agencies. The purpose of these visits is to check the procedures being carried out in the district offices and to ensure that the registration system
is working satisfactorily at the local level. The Inspector usually finds it expedient to
make contact with the doctors, clergymen, undertakers, hospital personnel, and health-
unit personnel in the areas visited.
In districts where Government Agents and Sub-Agents hold the District Registrar
appointment, very little direction is needed with respect to vital-statistics work. However, a closer supervision of procedures is required in those offices where there is a more
rapid turnover of personnel.
The success of the entire registration system is contingent upon the efficiency of
the District Registrars in collecting and transmitting vital-statistics registrations to the
central office. It is again gratifying to report that the District Registrars have maintained
a very high standard in the performance of their duties. This is especially appreciated
in view of the fact that, apart from the Vancouver and Victoria offices, which are under
the direct supervision of the Division, the District Registrars have other important duties
to carry out.
At the close of the year there were ninety offices and sub-offices operating in seventy-
one registration districts. Thirty-eight of the offices are located in Government Agencies
or Sub-Agencies, while in twenty-three other districts Royal Canadian Mounted Police
personnel hold the appointment of District Registrar. In eight other offices the appointment is held by other Provincial Government employees, in seven offices by Municipal
Clerks, and in fourteen offices by private individuals, including Game Wardens, Postmasters, Stipendiary Magistrates, and a Canadian Customs Officer. In addition, there
is a Marine Registrar located at Vancouver, and eighteen Indian Superintendents who
are ex officio District Registrars of Vital Statistics for Indians only.
Vancouver Office
The vital-statistics office in Vancouver was established as an integral part of the
Division and withdrawn from the Government Agency in 1949. Owing to the fact that
approximately two-fifths of the total registrations for the Province are received by that
office, it plays an increasingly important part in the successful administration of the
Division's activities. The personnel employed in the Vancouver office have as their sole
responsibility the provision of vital-statistics services.
The number of registrations received during the year showed a slight decline. However, there was again a substantial increase in the revenue transferred to the central office,
 BRITISH COLUMBIA
L 86
indicating a marked increase in the number of requests for certification which could only
be issued from the Victoria office.   Most of these were for plasticized birth certificates,
The volume of incoming and outgoing correspondence again increased during the
vear Many birth registrations are submitted by mail, and many letters must be written
back to the parents eliciting correct answers to various items on the registration forms.
The office was extremely hard pressed on several occasions during the year due to
staff changes and shortages. Because of the nature of registration work, new employees
need considerable in-service training before they are able to carry out their duties in a
routine manner.
I GENERAL ADMINISTRATION
No major changes were made in the administrative organization of the central office,
although a number of adjustments were made in the assignment of duties with a view to
improving the flow of work. As far as possible, the general office and the Mechanical
Tabulation Section have been organized on a production-line basis, but this plan cannot
be followed entirely because of the several important phases of the Division's responsibilities which require individual and specialized attention. Hence, while the checking and the
processing of incoming registrations, the filing of routine applications for certificates and
certified copies, and the operation of the Mechanical Tabulation Section have been
developed along co-ordinated systematic lines, separate specialized units have been
assigned to handle such matters as legitimations of birth, fraudulent and improper registrations of birth, applications for delayed registration, the licensing of ministers and
clergymen under the | Marriage Act," applications for change of name, special statistical
requests, and other items requiring special attention.
The most serious problem in day-to-day administration is the shortage of working
space in the central office. The fact that the registrations, which are the basis of most of
the Division's work, must be located in a separate vault several miles from the central
office is most unfortunate. This arrangement considerably impedes the efficient operation
of the Division. It is now possible to retain in the central office not more than the last two
months' returns of current registrations. Experience has shown that the greatest reference
is made to registrations during the first several years of their existence. The problem thus
created has been met as far as possible by the use of microfilm in the central office, but
this is much less satisfactory than having the original records available, and for many
purposes, such as the posting of notations, corrections, and supplementary documentation,
resort must be had to the originals. In addition, it has now been found necessary to transfer many thousands of wills notices and many other special files to Topaz Avenue vault.
The space problem has become so acute that the Index Section of the office is completely allocated, with no room for the indexes of subsequent years. Careful investigations
have been made of alternative methods of reproducing such bulky material as indexes with
a view to the conservation of space, but no satisfactory method has yet been discovered.
The frequency of amendments to vital-statistics indexes, due to changes of name, adoptions, and the filing of delayed registrations, has thus far made any method of photographic or microfile indexing impractical.
The 1954 Session of the Legislature saw the passage of the "Anatomy Act," which
provides for the custody and control of cadavers for use in the advancement of anatomical
study. The administration of the "Anatomy Act" rests with the Deputy Minister of
Health, with power to appoint persons to carry out the administrative duties involved. In
order to make the operation of this Act as simple and as convenient as possible to all
parties concerned, it was agreed that the District Registrar of Births, Deaths, and Marriages at Vancouver was best able to provide the facilities for the administration of this
Act. The responsibility for recording and filing of all information required by the Act was
therefore vested with the District Registrar at Vancouver.
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 87
The amendment to the " Marriage Act," which was passed at the second session of
the 1953 sitting of the Legislature, and which provided for the registration of marriages
performed according to Doukhobor custom, has now been in operation for over one year.
To date no Doukhobor couples have taken advantage of the privilege of registering their
marriage in accordance with this amendment.
STATISTICAL SECTION
Introduction
During the last few years there has been a considerable change in emphasis with
respect to die work conducted by the Statistical Section. Formerly, the major duties of
this Section concerned the preparation and analysis of statistics derived from registrations
of births, deaths, and marriages. While the need for obtaining additional information
respecting the health status of the people was recognized, little was available statistically
apart from that which could be inferred from death registrations. However, while
certifications of cause of death still provide the largest single group of health statistics,
several other sources are being used to advantage by the Statistical Section.
Comprehensive statistics on tuberculosis and venereal disease are prepared from the
case reports of the Divisions of Tuberculosis and Venereal Disease Control on a current
basis. Statistics on cancer treatment and follow-up are produced on behalf of the British
Columbia Cancer Institute, and statistics on the incidence of this disease are collected
through a Province-wide cancer notification system. Statistics are also compiled with
respect to those communicable diseases which by law are notifiable to the Health Branch.
Through the use of an expanded form of the Physician's Notice of Live Birth and
Stillbirth, much useful data are being derived and analysed regarding the health of our
new-borns and the factors surrounding birth. The Division also supervises the Crippled
Children's Registry, and from it produces valuable statistics concerning infants injured
at birth and those congenitally malformed, as well as children who are victims of crippling
diseases. In 1953 the field of mental-health statistics was entered for the first time by the
Division with the extension of the punch-card system to cover the records of the Mental
Health Services. During the present year the first detailed annual tabulations were run
for the Mental Health Services, and further analysis of the data which are accumulating
will yield much of value in the field of mental health.
Another important source of morbidity data was being utilized for the first time in
1954. The Division began processing the claims records of the British Columbia
Employees' Medical Services and thereby made available for morbidity-statistics purposes
the sickness experience of over 16,000 of our population.
While the data from the several sources referred to above have limitations, their
value is considerable, and there is good reason to expect an improvement in quality and
extent as the various systems are more completely developed and utilized.
Staff-training
Postgraduate training in biostatistics was completed by a staff member this year at
the University of Toronto. On his return he assumed research duties in the Vancouver
office of the Division, thus making available for the first time the services of a trained
biostatistician in that area. Another member of the Statistical Section completed a
summer course in biostatistics at the Virginia Polytechnic Institute. These courses of
training were made possible by National health grants. fBll
Division of Vital Statistics Special Reports
During the year the Division commenced the issuance of a series of special
statistical reports on matters of public health interest.    These reports are intended to
 BRITISH COLUMBIA
L 88
serve as a channel of information to the Public Health administrative staff and field staff
respecting data collected and analysed in the Division which are not released in Annual
Reports of the Health Branch, the Annual Reports of the Divisions of Tuberculosis
Control and Venereal Disease Control, or the Annual Report of Vital Statistics. It {
hoped that through these non-periodic reports pertinent data will be made readily avail-
able to those who can make use of them. To date five such reports have been issued, and
their reception has been encouraging.
Following are brief summaries of the important features of the reports released
during 1954:— .
Report No. 1, entitled "Deaths by Suicide m British Columbia, 1949-1953," indicated that the suicide rate in the Province was higher than that for any other Province of
Canada. For the period covered, the rate was from two to two and one-half times higher
than that for the remainder of Canada. The high rate has existed for a considerable time
and has shown no sign of decline. The rate for Vancouver City was almost double that
for the remainder of the Province, but when suicides by gas poisoning were excluded, the
rates for the two areas were almost the same. The suicide rate was highest amongst
widowed and divorced persons and lowest for single persons. About three times as many
males committed suicide as females, and the age-groups from 40 onward showed much
higher rates than did the age-groups under 40.
Report No. 2, entitled "Health Unit Statistics in British Columbia, 1953," continued
the series which started in 1952 with a report covering Health Unit Statistics for 1948-
1951. The report consists of a series of tables showing births, stillbirths, and deaths by
age and cause for the Indian and non-Indian populations of each health unit, as well as
tuberculosis cases and venereal-disease notifications for the total population in each
health unit.
Report No. 3, entitled "Statistics on Poliomyelitis in British Columbia, 1953,"
was drawn up at the request of the Consultant in Epidemiology. It was based on the
individual epidemiological reports submitted for all poliomyelitis cases. The report
showed that while the case rate in the 1953 epidemic was higher than in 1952, being 64.0
per 100,000 population as compared to 48.8, the death rate was down from 3.1 in 1952
to 2.1 in 1953. The case fatality rate for paralytic poliomjielitis was considerably higher
in 1952 than in 1953, being 10.0 per 100,000 population in the former year, as compared
to 5.4 in 1953.
Report No. 4, entitled "Accidental Deaths in British Columbia, 1950-1953," presented an analysis of the accident mortality picture in this Province. It was compiled as
a follow-up to the Symposium on Accidents which was held at the 1954 Public Health
Institute, and which created considerable interest. The report revealed that British
Columbia has a rather high death rate from accidents, the average rate during 1950 to
1953 being 119.3 per 100,000 males and 39.6 per 100,000 females. The rates for the
remainder of Canada were 78.0 and 30.4. Since 1921 the annual rate in British Columbia has been exceeded only once by the rate for another Province. While the death rate
from motor-vehicle accidents in British Columbia is comparable to that for the remainder
of Canada, the rates for the other major accidental causes—namely, accidental injury by
fall, drowning, transport accidents other than motor-vehicle, and poisoning—are considerably higher in this Province. A final table in the report presented data on accidental
deaths in each health unit and metropolitan area of the Province.
Report No. 5, entitled "Cancer Morbidity and Mortality in British Columbia, 1953,"
set forth data on cancer cases reported to the Division during 1953 and on cancer deaths
registered in that year. For reported cancer cases, including those for which first notification was received after death, 36 per cent of male cases and 30 per cent of female cases
were shown as being of the digestive system. The next most important site for males was
the respiratory system, and for females, the breast. The genitalia were the third most
important site for both males and females, and the skin fourth.   Among both males and
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 89
females, cancer of the digestive system accounted for the greatest proportion of cancer
deaths namely 45.2 per cent for males and 37.3 per cent for females. Another 17 per
cent of male cancer deaths resulted from cancer of the respiratory system and 11 per cent
from cancer of the genital system. Amongst females, 22 per cent of the cancer deaths
were due to breast cancer and 18 per cent to cancer of the genital system.
Statistics for the Mental Health Services
The new statistical system which this Division inaugurated in 1953 for the Mental
Health Services saw its first full year of operation during 1954*Certain minor improvements were made during the year, and by the end of the year the routine established
appeared satisfactory in all respects. For the first time the tabulations required for the
statistical tables of the Mental Health Services Annual Report were produced by this
Division from the punch-card records.
The Division is continuing to co-operate with the Mental Health Services in the
development of further statistical measures which will be of assistance in the operation
of those Services.
:jf Morbidity Statistics
Reference was made in the 1953 report to the negotiations which were under way
between this Division and the British Columbia Government Employees' Medical Services
with a view to obtaining morbidity statistics from that organization. An agreement has
now been arrived at whereby the Division will process the claims records of the Employees'
Medical Services on a co-operative basis. The Division will provide monthly and annual
tabulations relating especially to financial and administrative statistics in return for the
privilege of compiling and using the morbidity statistics which are also obtainable from
the records. The information is transmitted to the Division in coded form, with the
exception of the medical diagnoses. Coding of the diagnoses is carried out by the trained
medical coders of the Division. The Division has also undertaken to produce from the
punch-cards the annual receipts required by the subscribers to the Medical Services for
income-tax purposes.
A noteworthy feature of the system which has been developed is that an up-to-date
set of population punch-cards is being maintained covering all persons embraced by the
plan. This will provide a basis for computing specific morbidity rates for the various types
of illness and for specific groups within the insured population.
Additional releases were received during the year covering information obtained from
the National Sickness Survey of 1950^-51. These reports presented regional estimates of
family expenditures for health care and National estimates of the volume of sickness.
Vancouver Statistical Office
The Vancouver statistical office extends the statistical services of the Division to all
allied agencies of the Health Branch situated in and around Vancouver. Therefore, much
of the staff's time was spent in liaison and consultant duties. With the addition of a
biostatistician during 1954, a more complete consultant service was made available.
The consultant services were extended principally to the Provincial Epidemiologist
and to the British Columbia Cancer Institute. However, considerable time was spent with
the Greater Vancouver Metropolitan Health Committee in a consultant capacity in connection with a review of their records and statistical services. To date, the Child Welfare
Uimc records have been under discussion and a study started in order to evaluate the
usefulness of the medical data on these records. In addition, the office was represented
on the Committee on the Infections of the New-born and the Committee for the Eve Study
for Pre-school Children. %
The Crippled Children's Registry, which was organized in 1952, is supervised almost
entirely by this office of the Division of Vital Statistics.  This Registry was organized to
 L 90 <#?■ BRITISH COLUMBIA gJK      VM
acquire a knowledge of the extent of crippling diseases in children and to assist problem
cases in the low-income groups. In order that the Registry may facilitate the care of the
child in the low-income group, it is necessary for it to have knowledge of all agencies
working with crippled children. Much work was done in this regard during 1954 with
voluntary health organizations, such as the Junior Red Cross, the Canadian National
Institute for the Blind, the British Columbia Cerebral Palsy Society, the Polio Foundation
and the British Columbia Crippled Children's Society. Also during the year the records
of the Registry were abstracted onto punch-cards in the Victoria office of the Division
thus making available more complete listings and statistical analyses of the case load oi
the Registry. At the end of 1954 there were approximately 4,600 case-histories in the
Registry, with an average of 150 cases being added monthly.
Close co-operation exists between the Vancouver office and the Division of Tuberculosis Control in connection with both the record forms and the statistical reports of that
Division. The annual statistical report on tuberculosis is reviewed each year with a view
to increasing the utility of the data presented. A major change in certain phases of the
tuberculosis record system has been proposed by one unit of the Division, and it has been
decided that the recommended system be placed on a trial basis in that unit. The Vancouver office will collaborate with the Division in assessing the merits of the proposed
system and in dealing with any changes that may be necessary in the manner of collecting
the required statistics.
Considerable time was spent with the Mental Health Services in developing their
new statistical system as outlined elsewhere in this report. A great deal of the preliminary
work and the planning of the statistical tables for the Annual Report of Mental Health
Services was carried out by the Vancouver office. It is intended to further extend this
work in 1955 to provide for machine-run statistics covering the resident population.
Through the co-operation of the Vancouver General Hospital, members of the statistical staff were permitted to attend medical lectures and rounds in subjects which were
of particular interest.
Special Studies
A number of special studies and assignments were undertaken during the year on
behalf of other Divisions of the Health Branch. Some of these studies involved special
tabulations and analyses of the punch-cards already on file in the Division, while others
were made from original records. Several of the more important assignments are
described briefly hereunder.
A questionnaire regarding features of hospital accommodation and facilities was
drawn up and distributed to the patients and staff at Pearson Hospital. The purpose of
this questionnaire was to elicit the comments and opinions of both patients and staff of
the Province's most modern tuberculosis institution for the benefit of future planning
and hospital administration. The completed questionnaires were returned to the Division of Vital Statistics, and the results were analysed and synopsized for the use of the
senior staff of the Health Branch.
In the latter part of the year, work was commenced on a study into the true cost of
the 1953 poliomyelitis epidemic to the population of British Columbia. A full assessment of this cost is considered to be valuable information in planning future policy to
deal with the effects of this disease.        ¥
From the contact investigation reports of the Division of Venereal Disease Control,
quarterly contact indices were prepared for each year from 1947 to 1953, inclusive.
A routine has been established whereby these indices will be reported routinely to the
Division of Venereal Disease Control henceforth.
Statistics for the Annual Report of the Crippled Children's Registry were tabulated
for the first time from the punch-cards which the Division has been accumulating from
the Registry.   In addition, three sets of indices on the case load of the Registry were
 DEPARTMENT OF HEALTH AND WELFARE, 1954
L 91
tabulated according to various attributes of the children registered. These indices have
proved to be of considerable value in the work of the Registry.
Assistance was given to the Division of Public Health Dentistry in connection with
the statistics of the fluoridation study carried out during the year. Assistance was also
riven to the Division of Environmental Management respecting food-study analyses.
Special work was undertaken for the Division of Tuberculosis Control in assessing
the results of B.C.G. vaccinations. A special mortality analysis, covering a fifteen-year
period, was also prepared for this Division. An alphabetical index of all known tuberculosis cases on Vancouver Island was tabulated for the Vancouver Island Stationary
Clinic.   Other classified listings of known cases of tuberculosis in this same area were
compiled.
CANCER REGISTRY
Since the year 1932 cancer has been a reportable disease in this Province and a
Province-wide reporting system has been operated by the Health Branch. The purpose
of this reporting is to make possible the provision of up-to-date data on the cancer problem in the Province and to make these data available to the medical profession and other
agencies interested in cancer. Reports of new cases are received from private physicians,
the British Columbia Cancer Institute, general hospitals, and from pathology laboratories. Death registrations are also used as a source of reporting cases which are not
known prior to death.
It has been recognized for some time that the Division has not enjoyed a full measure of success in obtaining complete reporting of all cancer cases diagnosed. However,
considerable efforts have been made to attain a better quality of reporting, and the
increase of over 20 per cent in the number of cases reported during 1954 is almost
certainly an indication of better reporting, rather than a sudden increase in the incidence
of this disease.
Preliminary figures showed that during 1954 there were 3,600 new cases of malignant neoplasm reported in the Province. Amongst males 305.7 new cases were reported
per 100,000 male population, and amongst females the rate was 276.8.
The following tables show the malignant neoplasms reported during 1954 classified
according to site, age-group, and sex:—
Table I.—Number and Percentage of New Cancer Notifications1
by Site and Sex, British Columbia, 1954
Site
Male
Female
Total
Number
Per Cent
Number
Per Cent
Number
Per Cent
Digestive system-
Genital system
567
231
317
2
303
130
146
124
42
15
48
29.4
12.0
16.5
0.1
15.7
6.8
7.6
6.4
2.2
0.8
2.5
428
329
196
439
51
74
44
29
26
22
37
25.6
19.7
11.7
26.2
3.0
4.4
2.6
1.7
1.6
1.3
2.2
995
560
513
441
354
204
190
153
68
37
85
27.6
15.5
Skin_
Breast
14.2
12.3
Respiratory system-
9.8
Lymphatic and haematopoietic tissue
5.7
Urinary system
5.3
Buccal cavity
Brain
4.3
1.9
Endocrine glands
1.0
Other and not stated-
2.4
Totals
1,925
100.0
1,675
100.0
3,600
100.0
	
1 deludes 1,593 cases reported for the first time at death.
 L 92
BRITISH COLUMBIA
Table II.—Number and Percentage of Reported Live Cancer Cases
by Site and Sex, British Columbia, 1954
Site
Male
Number
Per Cent
Skin	
Genital system	
Breast	
Digestive system—
Buccal cavity	
Respiratory system-
Urinary system
Lymphatic and haematopoietic tissue.
Endocrine glands	
Brain	
Other and not stated	
Totals.
300
124
1
160
110
97
88
48
7
12
24
971
30.9
12.8
0.1
16.5
11.3
10.0
9.1
4.9
0.7
1.2
2.5
100.0
Table III.—Cancer Notifications1 by Sex and Age-group,
British Columbia, 1954
(Age specific rates per 100,000 population.)
Male
Female
Total
Age-group
Number
Age
Specific
Rate
Number
Age
Specific
Rate
Number
Age
Specific
Rate
(W 9
14
12
31
53
120
243
529
595
245
83
10.8
14.2
38.5
59.2
146.8
396.1
945.2
1,577.9
2,713.8
9
8
25
114
231
257
416
376
165
74
7.3
10.0
30.1
116.9
300.6
460.8
857.8
1,212.7
1,937.1
23
20
56
167
351
500
945
971
410
157
9.1
10-10
12.1
?fU?Q
34.2
^n_/iQ
89.3
40-49
221.3
426.9
60-69
70-7Q
904.6
1,413.1
80 and over
Not stated
2,336.7
,
Totals
1,925
305.7
1,675
276.8
3.600     1    291.5
1 Includes 1,593 cases reported for the first time at death.
Table IV.—Live Cancer Cases Reported by Sex and Age-group,
British Columbia, 1954
(Age specific rates per 100,000 population.)
0- 9	
10-19	
20-29	
30-39	
40-49 U
50-59	
60-69	
70-79	
80 and over.
Not stated „
Age-group
Male
Number
Totals.
971
Age
Specific
Rate
7
5.4
7
8.3
18
22.4
40
44.7
69
84.4
137
223.3
233
416.3
292
774.4
93
1,030.1
75
154.2
Female
Number
5
6
21
88
180
163
257
185
63
68
1,036
Age
Specific
Rate
Total
Number
4.0
7.5
25.3
90.2
234.2
292.3
529.9
596.7
739.6
12
13
39
128
249
300
490
477
156
_143_
2,007
Age
Specific
Rate
4.7
7.9
23.8
68.4
157.0
256.2
469.1
694.2
889.1
 DEPARTMENT OF HEALTH AND WELFARE, 1954
L 93
POPULATION CHARACTERISTICS OF THE PEOPLE OF
BRITISH COLUMBIA
In previous years' reports, various features of the population composition of this
Province have been reviewed. A knowledge of the population structure is of considerable
importance to public health, since it has a direct bearing on the problems and programmes
which are the concern of public health workers. §
The population of British Columbia continued to increase during 1954, and the
mid-year estimate, provided by the Dominion Bureau of Statistics, placed the total
population at 1,266,000. This represents an increase of 36,000 over the 1953 population and is the largest increase since 1948. The Province's population has now increased
by 8.6 per cent since the 1951 Census, only slightly more than the national increase of
8.5 per cent. For the population under 5 years of age, there has been a 13.9-per-cent
increase since 1951, and for the population 5 to 9 years, inclusive, a 19.6-per-cent
increase. In the older age-groups, for males 60 years of age and over, the population has
increased only 3.7 per cent since 1951, but the female population at these ages has
increased by 9.5 per cent.
As the table below shows, since 1901 there has been a steady decrease in the pror
portion of the population which is in the age-group from 15 to 44 years, and a steady
increase in the number over 65. While the total population in the Province was seven
times larger in 1954 than in 1901, there were only five times as many in the 15-44 age-
group in 1954. The number in the 65-and-over age-group has increased more than
thirtyfold, and that in the 45-64 age-group more than tenfold.
Population in British Columbia by Age-group. 1901-54
(In thousands.)
Year
Age-group
0-14 Years
Number
Per Cent
15-44 Years
Number
Per Cent
45-64 Years
Number I Per Cent
65 Years and Over
Number
PerCent
Total
Number
Per Cent
1901
1911
1921
1931
1941
1951
1954
44.5
24.9
91.2
23.2
149.5
28.5
171.1
24.6
175.1
21.4
304.4
26.1
356.3
28.1
105.8
239.3
260.9
325.0
376.3
501.2
524.6
59.2
61.0
49.7
46.8
46.0
43.0
41.5
23.9
53.3
95.8
160.0
198.4
233.5
245.5
13.4
4.5
2.5
13.6
S3
2.2
IS.3
18.4
3.5
23.1
38.1
5.5
24.3
68.1
8.3
20.1
126.1
10.8
19.4
139.6
11.0
178.7
392.5
524.6
694.2
817.9
1,165.2
1,266.0
100.1*
100.0
100.0
100.0
100.0
100.0
100.0
Source:  Census of Canada, 1901 to 1951.   Figures for 1954 are Dominion Bureau of Statistics estimates.
BIRTH AND STILLBIRTH RATE
The preliminary birth rate for 1954 was 25.3 per 1,000 population, a decline from
the record rate of 25.8 established in 1953.
The stillbirth rate per 1,000 live births was 11.0 in 1954, a slight decline from the
1953 figure of 11.8, thus establishing the lowest rate yet recorded,   p
PRINCIPAL CAUSES OF MORTALITY IN BRITISH COLUMBIA
It has been mentioned earlier in this report that the Statistical Section is taking
increased advantage of the sources of morbidity data that are open to it. However,
mortality statistics continue to yield valuable information regarding the health status of
the people of the Province. Whereas morbidity statistics are still rather sketchy, mortality
statistics are much more complete and represent the most reliable comprehensive data
which can be derived at the present time.   The following discussion of mortality during
 L 94 BRITISH COLUMBIA
1954 is presented with the realization that it by no means gives a complete picture of
state of health of the population.   Nevertheless, it furnishes a useful indication 0f f
progress which is being made in public health and of problems which remain to be fa d
The crude death rate for 1954 was 9.6 deaths per 1,000 population, the lowest r t
experienced since 1939. In view of the ageing of the population which is known to h*
occurred since that time, this low rate represents a considerable improvement in fr
life-span.
§ The same four causes took the greatest toll of lives this year as for some time
namely, heart-disease, cancer, intracranial lesions of vascular origin, and accidents. These
causes were responsible for 71.7 per cent of all mortality during the year. The mortality
rate from heart-disease was down slightly this year, from 361 deaths per 100,000 population to 350, the lowest rate since 1951. Over 72 per cent of the deaths from heart-
disease in 1954 occurred as a result of arteriosclerotic heart-disease including coronary
disease. This represents over one-quarter of the deaths from all causes combined, thus
making it the most important single cause of death. Myocardial degeneration caused
12 per cent of the deaths from heart-disease, and hypertensive heart-disease 7 per cent.
The cancer death rate was up slightly to 164 per 100,000 population from the 1953
rate of 156. Slightly over 13 per cent of the cancer deaths occurred as a result of stomach
cancer. The lung was the site in 12 per cent of the deaths, the large intestine in 10 per
cent, and the breast in 9 per cent. Cancer of the prostate accounted for 6 per cent of all
cancer deaths, and cancer of the pancreas another 6 per cent.
The rate of deaths from vascular lesions declined from 106 to 101 per 100,000 in
1954. Almost 60 per cent of these deaths occurred as a result of cerebral haemorrhage,
while 28 per cent were due to cerebral thrombosis and cerebral embolism.
The accidental death rate was down sharply from 80 per 100,000 in 1953 to 64 in
1954. One-quarter of the accidental deaths resulted from motor-vehicle accidents, 18 per
cent from injury by fall, and 11 per cent from drowning.
The death rate from pneumonia was 39 per 100,000 population, as compared to the
rate of 35 for 1953. The rate of deaths from diseases of early infancy declined to 32 in
1954 from the rate of 36 in 1953. J||       Jf    I
The lowest infant and maternal mortality rates ever known in this Province were
recorded in 1954. Preliminary figures indicate an infant death rate of 23.7 per 1,000 live
births and a maternal mortality rate of 0.4 per 1,000 live births. Comparative rates for
1953 were 27.1 and 0.6 respectively.
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 95
REPORT OF THE DIVISION OF PUBLIC HEALTH EDUCATION
Raymond H. Goodacre, Director
Perhaps the most encouraging trend observed during 1954 was an increasing awareness on the part of public health personnel that the Division of Public Health Education
provides a professional service that is not merely limited to the effective utilization of
audio-visual aids and the writing of press releases.
The Division's role in the organizing of the Annual Public Health Institute, the
public health programme of the Eighth British Columbia National Resources Conference,
and the development of certain records are but three tangible examples reflecting a more
discriminating type of request for service.
It was not possible to complete the programme scheduled for the year, due to a
shortage of staff which reached its peak during the last quarter. Nevertheless, the following review of the year's work appears to indicate a reasonable degree of progress toward
the objectives of the division.
LOCAL HEALTH EDUCATORS
Four years ago, in 1950, two local health educators were placed in the field—one in
the Central Vancouver Island Health Unit, with headquarters in Nanaimo, the other in
the Victoria-Esquimalt Health Department. During the past two years the latter has
been on a leave of absence serving with the World Health Organization in Sarawak and
Formosa in an advisory capacity. He has now returned to the Victoria-Esquimalt Health
Department upon the termination of his appointment to resume his duties, which will
again be shared by the Saanich and South Vancouver Island Health Unit.
The health educator in Nanaimo continued to effect a liaison between the unit and
the teachers through interpretation of health-unit services and familiarization with the
audio-visual aids maintained by the Division of Health Education.
Considerable emphasis this year was, however, directed toward the commemoration
of Nanaimo's one hundredth birthday and the part played by the public health services in
that area. This event was highlighted by a | flier" type of presentation of the unit's
facilities which was distributed widely to all communities served by the Central Vancouver
Island Health Unit. i| W W f
IN-SERVICE TRAINING
As mentioned in last year's report, 1954 marked the first year in which the Division
assumed primary responsibility for organizing the Annual Public Health Institute. As the
Institute is an in-service type of training for the field staff, members of the Local Health
Services Council continued to act as an advisory council to the Division. This year's
session was held at the HoteJ Georgia in Vancouver during the week following Easter,
April 20th to 23rd. The Health Branch was fortunate in securing Miss Ruth Gilbert,
Assistant Professor of Nursing Education with Columbia University's Teachers College,
to provide a series of six lectures in mental hygiene. These talks were especially valuable
in that they were skilfully directed not merely to the public health nurses, but to all staff
from the health-unit director to the clerk. ||f
The remainder of the programme was devoted to a series of topics highlighted by a
symposium on safety designed to show health-unit personnel their roles in accident prevention in the home, the school, industry, and in recreation. Inasmuch as accidents still
constitute the leading cause of death between the ages of 1 and 39 years, this presentation
was considered to be especially timely.
Arrangements for orientation of new staff members and visitors were continued
during the year. One health-unit director and the recently appointed Rehabilitation Coordinator were provided with the complete orientation process, whereas only selected
 L 96 BRITISH COLUMBIA
orientation was arranged for visitors to the department. Among the latter were M\
gration training teams whose members are gathering information on this Province's nUbr"
health and hospitalization services, prior to posting to various points in Europe.        °
MATERIALS §
The Department of National Health and Welfare convened the Fifth Federal
Provincial Conference on Health Education in Ottawa, May 26th, 27th, and 28th
Called every two years, these meetings serve to bring together representatives in health
education from all ten Provinces and from the Federal Government's counterpart, Information Services Division. One of the most significant developments arising from this
Conference was a long-awaited decision regarding the controversial subject involving
sale of health pamphlets.
9|| In previous reports it has been mentioned that two booklets basic to maternal- and
child-health programmes throughout Canada have been in short supply. These are the
Canadian Mother and Child and Up the Years from One to Six. It has now been decided
that Provinces will receive a quota of each of these items, and that the same free distribution basis will apply to the Dental Health Manual and the Backward Child. However
these publications will also be available at a nominal cost to the public through the
Queen's Printer in Ottawa.
Although this decision was not received with favour by Provincial representatives,
the disadvantages of the new distribution system are outweighed by the guarantee that
sufficient copies of these materials will at least be available, a situation that has not
existed for the past three or four years. The one disheartening feature of the system is
that although the announcement was made in May, this Province has not yet received
its annual quotas.
The effects of short supply of the Canadian Mother and Child have not been felt
as strongly as they might have been, due to the existence of a series of twelve postnatal
letters distributed to mothers through local health services. These have now been completely revised and issued under a new format, together with a series of inserts dealing
with accident prevention for the infant.
Toward the latter part of the year a project involving the expenditure of funds from
the Maternal and Child Health Grant was submitted to the Department of National
Health and Welfare to cover the cost of books selected to serve as a basic library for
health units and their branch offices conducting prenatal classes. The purpose of the
library is considered to be twofold. First, it serves as a readily available depository for
selected reference texts used in organizing and maintaining classes, and, second, nurses
without public health training whose paediatric background is perhaps less broad than
is desirable will have an opportunity to develop their own knowledge and understanding
of child care.
Although this next item may not in itself be of profound significance, it is one more
reflection of the trend toward increasing recognition and acceptance of professional health
education by the field staff. During the fall the suggestion was raised by one of the
health units that all records requiring the signature or concurrence of parents should be
approved by this Division. Heretofore, there has been some criticism of the wording on
some forms which is felt to have provoked resentment on the part of the public. Although
some health units have requested this type of service in the past, it is encouraging to note
that the latest suggestion applies to forms common to all local health units.
Obtaining reference journals and texts for loan to health units has always been a
problem. § One library may, of course, borrow from another through the mter-hbrary
loan system common to both Canada and the United States. However, since media
publications are not numerous, they have often been difficult to obtain on a loan basis.
Nevertheless, the Victoria Medical Society library has continued to make available I
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 97
facilities wherever possible. In return, partial assistance to the libraiyiis being effected
through the provision of duplicate copies of journals to which the Health Branch sob-
scribes.
Toward the latter part of the year, word was received from the University of British
Columbia's bio-medical library that Journals and books would now be available on loan
to health-unit personnel. A system has been developed to enable efficient utilization of
these facilities, including the anticipated introduction for a photo-print method of reproduction for use with articles contained in journals that are not available on loan.
The Health Education library was augmented as the result of a most welcome
transfer of the Department of Education's reference material on alcohol and alcoholism.
Together with books and references currently maintained by the library, these additions
constitute the most readily accessible source for use by Government departments.
In addition to the new safety leaflets mentioned previously, revision of the dermatitis
series and the Physician's Reference Manual were effected in co-operation with the
Director of the Division of Venereal Disease Control and the Assistant Provincial Health
Officer respectively; another in the New Zealand dental-health poster series was reproduced in quantity; and the booklet § Information and Rules for Patients Applying for
Admission to Tuberculosis Institutions" was rewritten in conjunction with the Division
of Tuberculosis Control. Other service connected with the Division of Preventive
Dentistry will be found in that report.
Although there was marked decrease in the number of new films suitable for purchase, thirty-four new and duplicate items were added to the central film library.
Showings to almost 100,000 people reveal that maternal and child care was the most
popular topic, followed by mental health, dental health, sanitation, nutrition, and safety.
As listings maintained by the Division remain in relatively the same proportions, it is
interesting to note that in 1953 mental-health films topped the list, whereas in 1952
dental health outstripped all other in terms of film showings.
PUBLICATIONS AND PUBLICITY
During the year the Government completed organizational plans designed to allow
each department to include a display on its services at the recently opened British Columbia building located on the Pacific National Exhibition's grounds in Vancouver.
In conjunction with a Vancouver display firm the Division developed an exhibit
illustrating the many preventive health services that are organized on a health-unit basis
for mothers, school-children, and the community in general.
Although the display was well received, several modifications are anticipated with a
view to enhancing its attraction value as a medium for public education at a time when it
is competing for attention with other exhibits in the building.
At the February, 1954, session the subject of people as a resource was dealt with
for the first time during a British Columbia Natural Resources Conference. Two papers—
one a discussion of the waste of human resources and the other on conservation—were
presented, together with an outline of the history and origin of British Columbia's population. For the 1955 Conference, the executive has suggested that the story of people be
presented from the public health approach.
As a result, the Public Health Committee, chaired by the Director, has organized
a programme embracing two major topics, namely, the relationship betjveen public health
and human resources, which outlines the economic and social importance of public health,
and the relationship between public health and the natural resources.    The latter is
designed to demonstrate that although the development of natural resources has been
eneficial to the health of the people in general, this same development has also created
ew problems both to the public at large and to the workers employed to develop the
resources.
 L 98 BRITISH COLUMBIA
Jfc Following an analysis of the monthly staff bulletin to local health services person
entitled " News and Views," the suggestion was raised with Local Health Services Coun i
that this publication was not being utilized as extensively as it might. At the time it wa
noted that a publication of this type might serve as an in-service training medium rathe**
than merely a channel for instructions and changes in procedure, for which it wa'
originally developed some twenty-five years ago. s
As a result of further discussion, News and Views has evolved into an in-service
training medium serving three distinct functions. In the first place it continues to provide
a channel to the health units through which instructions and similar information may be
forwarded from the Health Branch. Secondly, original articles and reprints regarding
recent developments in the field of public health are selected for the staff by their counterparts in central office, and, thirdly, News and Views serves as a central source of information pertaining to programmes submitted by one unit which are potentially useful to other
units undertaking similar programmes. This third function is especially significant in
view of the fact that the lines of communication between the health units and central
office are well established, whereas they are not well defined between one unit and
another.
--|i STAFF '    -s|'
The Division continues to experience a mobility in staff, due to difficulties encountered in both recruiting and retaining suitably qualified personnel. Although leave of
absence was granted to the most recently appointed health education assistant for the
purpose of securing a master's degree in public health at Columbia University under
National health grants, no suitable applicant has been found to fill the vacancy created
by the resignation of another member whose six years' service terminated in September.
This latest unsuccessful recruiting experience appears to confirm the belief that
suitable applicants are not readily available at the present salary offered, and that potential
candidates are being drawn to related fields which, although requiring similar qualifications, provide a more satisfactory remuneration. It is to be hoped, therefore, that the
current salary negotiations will prove sufficiently fruitful to enable the recruitment of
acceptable personnel in order to meet the increasing demand for this Division's services.
I
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 99
REPORT OF THE HEALTH BRANCH OFFICE, VANCOUVER AREA
G. R. F. Elliot, Assistant Provincial Health Officer
This year has been an active one in all phases of the work of the Vancouver area
office of the Health Branch, in charge of the Assistant Provincial Health Officer. The
latter is responsible for the Bureau of Special Preventive and Treatment Services, liaison
with voluntary health agencies in Vancouver, and the administration of National health
grants to British Columbia.
The Bureau of Special Preventive and Treatment Services includes the Divisions
of Laboratories, Tuberculosis Control, and Venereal Disease Control. The Assistant
Provincial Health Officer is primarily concerned with matters of policy respecting these
Divisions, including co-ordination between these services, as well as between them and
the local health services. A detailed review of the work of each Division, which has been
submitted by the Director, follows this report. Consultants in public health nursing and
in nutrition, who have been seconded to the Vancouver area by the Bureau of Local
Health Services, are located in the office of the Assistant Provincial Health Officer. Also
housed within this office is the Vancouver office of the Statistical Section of the Division
of Vital Statistics, and the usefulness of this policy continues to grow each year.
BUILDINGS
The construction of the new Provincial Health Building in Vancouver, mentioned in
the 1953 Annual Report, is progressing in a satisfactory manner and will, in all likelihood,
be ready for occupancy around July or August of 1955.
During 1953 it will be recalled that poliomyelitis reached an all-time high in the
Province of British Columbia. It became apparent that if this Province experienced a
similar epidemic in the near future, hospital facilities for the proper care of these patients
would be taxed. Planning was quickly undertaken, and a new wing at the Pearson
Tuberculosis Hospital on West Fifty-seventh Avenue, Vancouver, is being constructed to
meet this need. This wing will offer the most modern facilities available for the treatment
of post-poliomyelitis cases and will accommodate some fifty patients. The type of patient
to be hospitalized in this wing will be either the long-term type or the patient who on
transfer from an acute general hopsital will receive early rehabilitation prior to transfer
to the Western Society for Rehabilitation for more active rehabilitation.
PERSONNEL
During the year the responsibilities of the personnel officer of the Division of Tuberculosis Control were increased, and he became the personnel officer of the Bureau of
Special Preventive and Treatment Services. This has been a most forward step as the
appointment has co-ordinated and stream-lined personnel policies not only in the three
major divisions of this Bureau, but has been of great assistance to those voluntary health
agencies with which the Health Branch has a direct working relationship.
During 1954 the former Director of the Division of Venereal Disease Control was
appointed Consultant in Epidemiology and seconded to this Bureau. The Consultant in
Epidemiology has given valuable assistance in the control of outbreaks of salmonellosis,
shigellosis, etc., and has also brought forward valuable information relative to the statistical approach to poliomyelitis. The work of the Consultant in Epidemiology in the field
of tuberculosis is being developed, and one looks forward in future years to a close
analysis from a statistical and epidemiological view-point of many of the programmes in
the Health Branch. This appointment has done much to strengthen the services of the
Health Branch.
s
 L 100
BRITISH COLUMBIA
During 1954 one of the consultants in public health nursing, who has special to'
ing in child and maternal health, was attached to this office.    This arrangement will
result in a much closer relationship between the Local Health Services and the work of
imn^oii'ToH orrp.nr'ip'c in Vnnrrmvp.r rp.snonsihlp for the carp, nf th<* ci^V r.u\iA    r
specialized agencies in Vancouver responsible for the care of the sick child. In partic
ular, the work of the Crippled Children's Registry and the newly opened Health Centre
for Children in Vancouver will be more closely integrated with public health nursing at
the local health-service level.
The work of the consultant nutritionist attached to this office from Local Health
Services continues to prove the value of having this consultant located in Vancouver
Detailed information regarding this work is given earlier in this Report, in the Nutrition
Service section, Division of Environmental Management.
FACULTY OF MEDICINE, UNIVERSITY OF BRITISH COLUMBIA
| As mentioned in the 1953 Annual Report, the very satisfactory working relationship
with the Dean of the Faculty of Medicine, University of British Columbia, and in
particular with the heads of the Departments of Paediatrics and Preventive Medicine
continues to expand.
During the year a most valuable refresher course was organized by the Department
of Paediatrics, University of British Columbia, for public health nurses of the Provincial
Health Branch and the metropolitan areas of Vancouver and Victoria.
VOLUNTARY HEALTH AGENCIES
The voluntary health agencies located in the City of Vancouver which receive grants
from the Provincial Government continue to receive close supervision, and once again it
is felt that the programmes of these organizations are sound and the money invested in
them by the people of this Province, through the Provincial Government, is well spent.
Hf The activities of the British Columbia Cancer Foundation, the Western Society for
Rehabilitation, and the Canadian Arthritis and Rheumatism Society (British Columbia
Division) are outlined separately in this report. In general, however, the Assistant
Provincial Health Officer has actively participated in the programme-planning of these
organizations, and a most amicable relationship has existed. Budgets are reviewed with
great care, and it is felt that economy is being practised in a satisfactory manner.
In addition to these organizations, limited attention was given to the Vancouver
Preventorium, British Columbia Poliomyelitis Foundation, British Columbia Tuberculosis Society, Canadian Red Cross Society, John Howard Society, Cerebral Palsy Association, Canadian Cancer Society (British Columbia Division), Alcoholism Foundation,
Multiple Sclerosis Society, and other similar organizations related to health matters in the
Province of British Columbia.
*
During the year, visits were made to many of the larger hospitals in this Province
on Departmental matters, such as co-ordination of the Provincial biopsy service and
requests for assistance from the National health grants.
British Columbia Cancer Foundation
This organization, named as the agent of the Provincial Government for the treatment and control of cancer in this Province, made forward strides in its programme.
Funds are provided by the Cancer Control Grant of the National health grants and by
the Province of British Columbia on an equal basis to pay the operating expenses o
the main diagnostic and treatment centre, known as the I British Columbia Cance
Institute," and the nursing home, both located in Vancouver, and of the consultativ
and diagnostic clinics located throughout the Province.   These consultative clinics n
operate at ten centres in the Province.
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 101
The diagnostic and treatment centre of the British Columbia Cancer Foundation
at the Royal Jubilee Hospital in Victoria continues to provide a needed and expanding
service.
Late in 1954 a start was made upon the construction of a new 28-bed nursing home
adjoining the British Columbia Cancer Institute in Vancouver. This is a much-needed
development, since the present nursing home is an old converted home, and besides being
inadequate in size, it is also a definite fire-hazard.
Western Society for Rehabilitation
As pointed out in previous reports, this organization continues to give leadership
to all of Canada in this field, in addition to supplying unexcelled rehabilitation services
to the people of British Columbia.
The additional 20 beds and 15,062 square feet of diagnostic, treatment, and outpatient facilities mentioned in the 1953 report were opened in January of 1954, and are
admirably meeting the needs of increasing rehabilitation requirements in this Province.
Canadian Arthritis and Rheumatism Society
(British Columbia Division)
The travelling consultant service mentioned in the 1953 report is functioning in
a satisfactory manner.
Mobile physiotherapy service is given from the treatment centres listed in the 1953
report, bringing the advantage of home care to at least seventy-five communities throughout the Province. In all areas medical and lay committees give practical and financial
support.
The staff consists of forty-nine, including a medical director, research director,
three medical consultants, one nurse, two occupational therapists, twenty-seven physiotherapists, two social workers, one driver, and four research and record stenographers.
A shortage of physiotherapists delays the programme and increases its cost.
Three research projects are being conducted under the auspices of the Canadian
Arthritis and Rheumatism Society—one at the Department of Biochemistry at the
University of British Columbia on the basic aspects of rheumatism and arthritis, one
on rheumatic fever and heart-disease, and one on rheumatoid arthritis. These are
supported by the National Public Health Research Grant.
Alcoholism Foundation of British Columbia
|J The Alcoholism Foundation of British Columbia mentioned in the 1953 report has
become active in its responsibilities, and early in the new year should see the development
of a programme based on out-patient and rehabilitation services. This is a voluntary
health agency, but the board of trustees of the Foundation has Provincial Government
representation from the Attorney-General's Department, Mental Health Services of the
Provincial Secretary's Department, and from both the Health Branch and Welfare Branch
of the Department of Health and Welfare. Jl-
GENERAL
The research programme related to narcotic addiction continues to function with
support from National health grants and the Attorney-General's Department of this
Province. At this time there is a brief prepared by the Community Chest and Council
in the hands of the Provincial Government recommending establishment of a programme
tor the treatment of narcotic addiction in this Province, with particular emphasis on
rehabilitation.    It is possible that some of the funds now being used for research should
 L 102
BRITISH COLUMBIA
be diverted to a pilot rehabilitation programme, and, at the same time, research could h
carried on jointly with rehabilitation in this centre. De
1 This most frustrating problem of narcotic addiction is, of course, a problem through
out the world, but with the University of British Columbia taking the responsibility fo
the direction of this research project, it is felt that some progress toward the eventual
solution in this Province will be made.
In the field of poliomyelitis this office continues to act as the co-ordinator of all
the agencies concerned. To date in 1954 the problem has been easily handled. ||
however, imperative that once again recognition be given to the outstanding co-operation
received from the Royal Canadian Air Force in carrying out mercy flights in the evacuation of poliomyelitis patients to Vancouver. In addition, the work of the British
Columbia Poliomyelitis Foundation and the Poliomyelitis Committee of the Vancouver
General Hospital is sincerely acknowledged. 'j*
Gamma globulin was once again made available on a somewhat less restricted basis
than in 1953 due to an improved supply. Plans are now being made for the use of
poliomyelitis vaccine in 1955.
NATIONAL HEALTH GRANTS
General
The total amount of funds available to British Columbia for the fiscal year 1954-55
is $4,210,444, excluding the Public Health Research Grant, which is allocated in Ottawa.
The increase of approximately $360,000 from the previous year is largely due to an
increase in per capita amount under the Mental Health and Laboratory and Radiological
Services Grants, to substantial increases in the Medical Rehabilitation and Child and
Maternal Health Grants, and to an increase in the amount revoted under the Hospital
Construction Grant.
The General Public Health Grant was increased by $123,000 as the result of a
transfer of $83,000 from the Cancer Control Grant, $10,000 from the Tuberculosis
Control Grant, and $30,000 from the Laboratory and Radiological Services Grant. The
Professional Training Grant was increased by the transfer of $5,000 from the Tuberculosis
Control Grant.
Administration
The various opportunities provided during the year for personal discussion with
officials of the Department of National Health and Welfare of problems arising in connection with the National health-grants programme undoubtedly contributes to the
satisfactory administration of the grants. Also of assistance is the revision of the
National Health Grants Program Reference Manual, which was received this year.
One of the provisions of the National health grants is that not more than 75 per cent
of any grant may be committed for continuing services, and in this connection some
difficulty was experienced when the submissions for 1954-55 were under consideration
in Ottawa. This applied particularly to the General Public Health Grant, and it was
necessary to make certain adjustments and recommendations in regard to several submissions.   Steps have been taken to ensure that the situation does not recur.
During the year the Federal auditors have visited several of the general hospitals
participating in the biopsy service and admission X-ray programmes to review their
records and corresponding claims. Where any discrepancy occurred, action was immediately taken to rectify it. As a result, the hospitals are aware of the need for accurate
records in connection with any assistance received from National health grants.
 DEPARTMENT OF HEALTH AND WELFARE, 1954
Grants Received for the Year Ended March 31st, 1954
L 103
Total expenditures for the year ended March 31st, 1954, were $2,617,625 or 68
per cent of the total available, as compared with $1,986,279 or 45 per cent of the total
grants available in the year ended March 31st, 1953. This increased use of the National
health grants is due to an increase in expenditures under each of the original grantor
It should also be noted that these increased expenditures offset the small expenditures
under the three new grants for Laboratory and Radiological Services, Medical Rehabilitation, and Child and Maternal Health; only about 10 per cent of each of these grants
was expended, due to various difficulties encountered in the utilization of the new grants.
Detailed figures are given in the following table:—
Comparison of Amounts Approved and Actual Expenditures with Total Grants
for the Year Ended March 31st, 1954
Grant
Total Grant
Approved
Amount
Per Cent
Actual Expenditures
Amount
Per Cent
Crippled Children	
Professional Training	
Hospital Construction r~
Venereal Disease Control	
Mental Health	
Tuberculosis Control  —
Public Health Research -_
General Public Health	
Cancer Control	
Laboratory and Radiological Services
Medical Rehabilitation	
Child and Maternal Health	
Totals	
$43,612
72,612
1,497,340
43,612
518,779
347,585
26,251
699,000
209,781
339,400
42,877
34,849
$23,312
53,198
1,416,934
43,612
503,468
329,317
26,251
678,998
196,276
50,373
8,510
12,050
53
73
95
100
97
95
100
97
94
15
20
35
$3,875,698
$3,342,299
85
$21,850
50,323
886,495
43,612
469,734
275,714
22,626
618,582
187,226
33,162
4,140
4,161
50
69
59
100
91
79
86
88
89
10
10
12
$2,617,625
68
There was a definite improvement this year in the position of British Columbia in
relation to all Provinces. Excluding the Public Health Research Grant, the percentage
of funds allocated was 86 per cent in British Columbia, as compared with 79 per cent
for all Provinces. Similarly, the amount expended in British Columbia was 67 per cent
of the total available, as compared with 60 per cent for all Provinces. For the previous
year ended March 31st, 1953, the percentage for British Columbia was lower than the
average for all Provinces both with respect to funds allocated and the amount expended.
Crippled Children's Grant
Assistance is being given this year to three branches of the Cerebral Palsy Association of British Columbia, namely, Greater Vancouver, Vancouver Island, and Fraser
Valley. Although these branches operate independently, co-ordination is achieved
through the Provincial organization. It is expected that through the leadership being
given by the Chairman of the Cerebral Palsy Association of British Columbia, Dr. Donald
Paterson, a satisfactory Provincial programme for the care of cerebral palsy children will
gradually evolve. #      jfe
The Crippled Children's Registry is becoming increasingly important. The number
of cases registered and the number of agencies registering cases have both increased
wiring the past year. In addition, the Registry is being used as a co-ordinating unit for
the care of children by supplying information as to the facilities available and giving
assistance in planning care for children who are registered. Some assistance has also
heen given in regard to the rehabilitation of children whose handicap has been treated
medically to the maximum degree.
The Western Society for Rehabilitation and the Health Centre for Children continue
to receive assistance under this grant. #
 L 104
BRITISH COLUMBIA
Professional Training Grant
The number of persons completing training under all projects during the calend
year 1954 was thirty-two.   In addition, seventy-seven persons have taken courses varvif
in length from a few days to three or four weeks.   Funds for this training have been
provided by other grants in addition to the Professional Training Grant.
Included in the short-course group are forty-five public health nurses who attended
a refresher course in paediatrics given in Vancouver by the staff of the Department of
Paediatrics, Faculty of Medicine, University of British Columbia. Ten members of the
nursing staff of the Provincial Division of Tuberculosis Control attended two other short
courses for nurses, namely, the Nursing Service Administration Institute and the
Rehabilitation Nursing Institute. I
I Assistance is being continued this year toward the training of public health staff and
the staff of general hospitals, as well as training in specialized fields such as medical
rehabilitation, tuberculosis, mental health, and psychiatric social work.
Hospital Construction Grant
The Hospital Construction Grant for 1954-55 increased only slightly over 1953-54,
The amount available is $1,610,391, including $1,055,187 revoted from the accumulated
unexpended funds from previous years. If
Although the number of projects for construction of general hospitals initiated during
the current fiscal year has remained comparatively small, the need for new construction
has not yet been met and there are still a number of projects to be undertaken. Construe*
tion has commenced on a combined Child Guidance Clinic and Day Hospital for the
Provincial Mental Health Services, for which assistance is being requested under this
grant. Since 1951, when provision was made for assistance in the construction of
community health centres, approval has been given to twelve such projects, which has
resulted in greatly improved accommodation for the local health services in these areas.
Venereal Disease Control Grant
This grant is on a matching basis, and the total amount is therefore paid to the
Province, as expenditures by the Province on venereal-disease control are considerably
in excess of the amount of the grant. The standard and extent of service given during
the year 1948-49 are being maintained.
As all services for the control of venereal disease in British Columbia are provided
by the Provincial Government, the annual report of this Division, which appears in
another section of this Health Branch report, constitutes the report made on the use of
this grant.
Mental Health Grant
The Mental Health Grant is devoted principally to projects presented by the
Provincial Mental Health Services, Department of the Provincial Secretary. The policies
established in previous years have been continued with little change. ||
3f All units of the Mental Health Services have been benefited by the provision of both
staff and special equipment for the therapeutic programmes. The developments in certain
units and services are particularly interesting.
|§|| The surgical centre in the Crease Clinic is now functioning in a very efficient
manner, and through the services provided by the consultants in neuro-surgery, general
surgery, and orthopaedic surgery, these special needs of the mentally ill are satisfactorily
met. ;^||:   |j|j| [ ,
The reactivation programme for the continued-treatment patients of the Province
Mental Hospital has been increased in scope because it has contributed greatly to tlie
well-being of the withdrawn type of patient.    Closely associated with this programme
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 105
have been efforts to introduce occupational-therapy services to wards where formerly the
treatment programme was handicapped by their lack. In this connection special note
should be made of the new shop for the West Lawn Building of the Provincial Mental
Hospital at Essondale.
The care of the tubercular mentally ill will shortly be greatly enhanced by the
opening of the North Lawn Building, Provincial Mental Hospital, Essondale, where
facilities to treat this group of patients will be centralized. In anticipation of the opening
of this new unit, projects have been submitted and approved to provide equipment for
the X-ray Department, the ward surgeries, and the Occupational Therapy Department.
The equipment is now on order and the suppliers have commenced deliveries.
The over-all programme of The Woodlands School in caring for the mentally
defective child has been continued. Special mention should be made of the project to
provide for the establishment of a physiotherapy department here. This is considered
to be a very significant development for the rehabilitation of the child in whom cerebral
palsy and mental retardation are associated.
The mental-health research programme at the University of British Columbia has
again received support. This year the research project on narcotic addiction in British
Columbia received special emphasis. It is expected that the neurophysiological studies
that have been pursued for several years in connection with the neuro-surgical procedure
of lobotomy will be concluded next year.
Community education in mental health has been enhanced by the sustained efforts
of the British Columbia Division of the Canadian Mental Health Association. This group
has also sponsored and developed a volunteer service for the Provincial Mental Hospital,
Crease Clinic, and Home for the Aged, Essondale. The British Columbia Division of the
Canadian Mental Health Association receives a portion of its funds from a Mental Health
Grant project.
With funds provided under this grant in 1948-49 the University of British Columbia
set up a programme for postgraduate training in clinical psychology. During the past
three years the University has gradually taken over the cost of this programme until this
year, when all costs were completely absorbed by the University. Assistance is being
continued to the psychiatric services in the Vancouver General Hospital and Royal
Jubilee Hospital, Victoria, and the mental-health programmes in the Cities of Victoria
and Vancouver.
Tuberculosis Control Grant
This grant is similar to those for Mental Health and Venereal Disease Control in
that the majority of the tuberculosis services are provided by the Provincial Government,
and the largest proportion of this grant therefore is used by this government department.
Detailed information regarding these services is given in the report of the Division of
Tuberculosis Control, which appears in a later section of this Health Branch Report.
Public Health Research Grant
The investigation of ABO foetal-maternal incompatibility is the subject of a new
research project approved this year. This study is being carried out by members of the
staff of the Department of Paediatrics, University of British Columbia, in co-operation
with the Red Cross blood transfusion service and the Department of Pathology,
Vancouver General Hospital. fi
One research project was completed this year, namely, the investigation of schistosome dermatitis in British Columbia lakes. This work was under the direction of
Dr. J. R. Adams, Department of Zoology, University of British Columbia, and preliminary
reports indicate that a satisfactory method has been determined for eliminating the
problem.   The final report is now in preparation and will be available shortly.
 L 106 BRITISH COLUMBIA
General Public Health Grant
The transfer of $123,000 to this grant from the Laboratory and Radiological
Services, Cancer Control, and Tuberculosis Control Grants was required primarily f0
the procurement of gamma globulin, the purchase of equipment for the treatment of
poliomyelitis, and the purchase of poliomyelitis vaccine. Arrangements were made this
year whereby the cost of equipment purchased for the treatment centres at the Vancouver
General Hospital and the Royal Jubilee Hospital, Victoria, would be borne jointly by
National health grants, British Columbia Hospital Insurance Service, and the British
Columbia Poliomyelitis Foundation; in previous years National health grants have
assumed a larger proportion of the costs.
Under an approved project, three third-year medical students from the University
were again employed during the summer months in health units, to the satisfaction of all
concerned. Considerable interest in this development has been displayed by the directors
of the health units where students have not yet been placed, and requests have been
received from some of these units for the placement of students next year.
All phases of the general public health programme carried on by the local health
services staff continued to receive assistance from this grant. Detailed information in
regard to these services is given earlier in this Report, in the report of the Bureau of
Local Health Services. Assistance was also continued to the Metropolitan Health
Committee of Greater Vancouver and the Victoria-Esquimalt Board of Health, ft
Cancer Control Grant
The operations of the British Columbia Cancer Foundation, which are financed
jointly by this grant and matching Provincial funds, are outlined earlier in this report, in
the section on Voluntary Health Agencies.
The number of examinations done under the Provincial biopsy service has steadily
increased since the inception of the service. The average number of tissue examinations
per quarter referred under the biopsy request form was 2,792 in 1951; the average
number per quarter for the first nine months of 1954 was 4,833. These figures do not
include biopsy examinations originating in the hospital having pathologists on their staff,
but the number of these examinations has also increased. The quarterly average number
of all biopsy examinations was 9,660 in 1953 and 10,888 for the first nine months
of 1954. |
Provision is made under this grant and matching Provincial funds for the operation
of a cytology laboratory at the British Columbia Cancer Institute, Vancouver, where
specimens may be examined free of charge. The volume of work done in this laboratory,
which is under the direction of the Director, Pathology Department, Vancouver General
Hospital, has also increased greatly. There were 6,581 specimens examined in 1952,
8,272 in 1953, and 8,948 during the first nine months of 1954.g
Laboratory and Radiological Services Grant
Plans for the appointment of advisory councils to the Provincial Health Branch
with respect to laboratory services and to radiological services have been presented to the
Canadian Medical Association (British Columbia Division), and it is hoped that the
plans will be finalized within the next two or three months. One of the primary responsibilities of these two councils will be to review and assess requests for assistance under
this grant. Pending the appointment of these councils, only immediate and obvious needs
have been considered, and, as a result, the utilization of this grant has been restncted.
^ The plan for the development of improved clinical laboratory services in tm
Province was approved by the Department of National Health and Welfare, but in
implementation of this plan has been delayed pending appointment of the advisory
council mentioned above.   In order to ensure proper direction of the programme,
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 107
plan provides for the services of consultants as well as a technical supervisor of laboratory
services.
Assistance under this grant has been given to the Trail-Tadanac Hospital toward
the establishment of a pathology department in order to meet the need for this type of
service in this area.    In addition, the pathology department will assist in raising the
standard of medical care in this area through the educational benefit derived from the
evaluation of surgical tissue, and it will also result in improved correlation of the cancer
work performed in this region.
Medical Rehabilitation Grant
Reference was made in the 1953 Annual Report to the appointment under the
Crippled Children's Grant of a person well qualified in the field of logopaedics and the
possibility of the establishment of a training programme in logopaedics at the University
of British Columbia. Provision for this programme was transferred to the Medical
Rehabilitation Grant this year. In addition to the satisfactory development of the speech-
therapy programme at the Western Society for Rehabilitation, a course is being given
this year at the University under the Faculty of Arts which, it is hoped, will eventually
develop into a complete training programme in logopaedics.
Approval was given this year to the establishment of a pilot plan at the Glen and
Grandview Hospitals, Vancouver, to assess the nursing services for convalescent and
chronic patients, with emphasis on the medical and social rehabilitation and self-care
of patients.   The project has been designed:—
(1) To determine whether the provision of adequate rehabilitative measures
to an unselected group of nursing-home cases would result in:—
(a) Better utilization of nursing-home beds by permitting recate-
gorization of some cases to boarding-home status or even home care, and
so easing the shortage of nursing-home beds by permitting a more rapid
turnover rate.
(b) Easier nursing of cases who must remain in nursing homes.
(c) Increased happiness and comfort of the patient.
(2) To determine whether the results obtained by rehabilitative measures
justify the added costs.
Preliminary organization of this plan has been undertaken, but no results are available
as the plan is not yet in full operation. ||
The recent appointment of a Provincial Co-ordinator of Rehabilitation under the
provisions of the agreement between the Federal and Provincial Departments of Labour
will materially assist in the development of a rehabilitation programme for the Province,
including the most effective use of funds available under this grant.
Child and Maternal Health Grant
The child and maternal health services in this Province are an integral and important
part of the general public health programme carried on by the staff of the local health
department, and this grant is being used to strengthen and expand this phase of the
general programme. I
In January of this year a well-trained public health nurse on the staff of the Metropolitan Health Committee of Greater Vancouver was seconded to the Health Centre for
Children to provide a liaison service between these paediatric services and the general
public health services. All discharges, both in-patient and out-patient, from the Health
Centre for Children are referred to the liaison nurse, who keeps the public health nurse
m the field informed. This programme of closer co-operation between the paediatric
services of the Vancouver General Hospital and the general public health services in the
Greater Vancouver area and adjoining municipalities is gradually developing, and it will
 L 108
BRITISH COLUMBIA
undoubtedly result in improved care of these children as well as promoting a better under
standing between the various children's services and the private physician.
Equipment for the care of premature infants has been purchased under this grant
this year for nineteen general hospitals. In addition, a copy of the book published bv
the American Academy of Paediatrics, which deals with the standards and recommenda-
i*   „   i :*«1   s-.^«.si   r\f  i-ie»vi7_1-%rvn"i   infcmtc     wsic   ciityiVIipH   trv   oil   V»/^o*,.U~i_   -   , .,
tions for hospital care of new-born infants, was supplied to all hospitals outside the
Vancouver and Victoria areas. I
ACKNOWLEDGMENT
Valuable assistance and co-operation have been received from officials of the
Department of National Health and Welfare, the Provincial Health Branch, the Department of the Provincial Secretary, particularly the Provincial Mental Hospitals Staff, and
the Commissioner and staff of the British Columbia Hospital Insurance Service.
Harmonious working relationships exist with the city health departments of Vancouver and Victoria, the voluntary health organizations, and general and specialized
hospitals.
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 109,
REPORT OF THE DIVISION OF LABORATORIES
C. E. Dolman, Director
' In the annals of this Division, 1954 will be chiefly memorable as the last full year
of occupancy of the Hornby Street quarters by the central laboratories. Ever since the
establishment of the Provincial Laboratory in 1931, its output and responsibilities have
outstripped its accommodation and resources. This situation should be alleviated by the
more spacious quarters planned for the Division in the new Provincial Health Building
in Vancouver, which is now nearing completion.
For the first time in many years, a decline of about 10 per cent must be reported in
the total number of tests performed at the central laboratories. However, the actual workload underwent little change, since there were substantial increases in many of the more
time-consuming types of work; for example, cultural examinations for M. tuberculosis,
for the Salmonella-Shigella groups of organisms, and for gonococci, and bacteriological
tests of water and milk samples. On the other hand, the greatest reduction in numbers
involved the sero-diagnostic tests for syphilis, certain of which may be speedily performed.
In view of the numerous changes in technical staff, and of the fact that for some months
we were unable to replace several who had resigned, the year was no less onerous than
its predecessors. The work of the central laboratories is summarized in Table I, corresponding figures for 1953 being supplied for purposes of comparison.
The branch laboratories at Victoria and Nelson showed similar declines in total tests
done, again mainly reflecting the diminishing significance of syphilis as a public health
problem. The work done in these two branches, and in the Prince George branch for
the first three months of the year (after which this branch was closed), is shown in
Table II. The combined total for branch laboratories was around 55,000 tests, and the
Division as a whole carried out nearly 400,000 tests.
 L 110
BRITISH COLUMBIA
Table I.—Statistical Report of Examinations Done during the Year 1954
Main Laboratory
Out of Town
Animal inoculations	
Blood serum agglutination tests—
Typhoid-paratyphoid group	
Brucella group	
Paul-Bunnell	
Miscellaneous	
Cultures—
M. tuberculosis	
Salmonella and Shigella organisms	
C. diphtherias	
Hemolytic staphylococci and streptococci
N. gonorrhoea	
Miscellaneous	
Direct microscopic examinations—
N. gonorrhoea	
M. tuberculosis (sputum)	
M. tuberculosis (miscellaneous)	
Treponema pallidum	
Vincent's spirillum	
Intestinal parasites	
Miscellaneous	
Serological tests for syphilis—
Blood-
Presumptive Kahn	
Standard Kahn ,	
Quantitative Kahn	
Complement fixation	
V.D.R.L	
V.D.R.L. quantitative	
Cerebrospinal fluid—
Complement fixation	
Quantitative fixation	
Cerebrospinal fluid—
Cell count	
Protein	
Colloidal reaction	
Milk-
Standard plate count	
Coli-aerogenes	
Phosphatase	
Water-
Standard plate count	
Coli-aerogenes	
Ice-cream—
Standard plate count	
Coli-aerogenes	
Phosph atase	
Cottage cheese—Standard plate count	
Unclassified tests	
Totals      	
242
5,144
1,825
1,127
26
9,364
4,849
1,575
1,035
1,154
4,933
9,499
1,663
28
27
235
736
14,428
2,493
262
6,929
26,288
682
834
15
266
683
846
3,259
3,242
1,991
6,361
Metropolitan
Health Area
167
205
5,472
4,810
2,170
27
9,260
7,564
7,154
2,392
7,845
1,159
20,070
7,063
2,922
410
219
1,117
893
41,368
5,635
635
14,690
67,755
1,691
1,665
59
285
1,243
1,815
1,781
1,773
1,389
928
1,595
238
238
234
89
132
Total in 1954
447
10,616
6,635
3,297
53
18,624
12,413
8,729
3,427
7,845
2,313
25,003
16,562
4,585
438
246
1,352
1,629
55,796
8,128
897
21,619
94,043
2,373
2,499
74
551
1,926
2,661
5,040
5,015
3,380
928
7,956
238
238
234
89
299
Total in 1953
464
11,212
7,071
2,937
88
17,476
9,808
14,917
3,011
6,516
2,350
25,221
15,765
4,912
234
225
978
1,867
139,947
21,868
2,057
26,734
27,938
2,727
87
710
2,063
2,775
3,732
3,707
2,568
931
7,168
140
140
124
72
210
112,208
225,990
338,198
370,750
I
 DEPARTMENT OF HEALTH AND WELFARE, 1954
L 111
Table IL—Statistical Report of Examinations Done during the Year 1954,
Branch Laboratories
Prince George
Nelson
Victoria
Animal inoculations	
Blood serum agglutination tests—
Typhoid-paratyphoid group	
Brucella group —	
Paul-Bunnell	
Cultures—
M. tuberculosis	
Typhoid-Salmonella-dysentery group	
C. diphtheria ~
Hsmolytic staphylococci and streptococci..
N. gonorrhoea	
Miscellaneous j	
Direct microscopic examinations—
N. gonorrhoea	
M. tuberculosis (sputum)	
M. tuberculosis (miscellaneous)	
Treponema pallidum	
Vincent's spirillum—	
Intestinal parasites	
Serological tests for syphilis—
Blood-
Presumptive Kahn	
Standard Kahn	
Quantitative Kahn	
Complement fixation	
v.d.r.l	
V.D.R.L. quantitative	
Cerebrospinal fluid—Complement fixation.
Cerebrospinal fluid—
Cell count	
Protein	
Colloidal reaction	
Milk-
Standard plate count I	
Coli-aerogenes	
Phosphatase	
Water-
Standard plate count j	
Coli-aerogenes	
Alkalinity — ,        	
Unclassified tests-    	
Totals.
234
215
215
94
142
900
566
114
176
231
326
233
202
483
49
3,337
27
1,163
18
5
50
72
1,019
1,005
354
36
748
17
312
102
85
3,055
700
2,001
2,001
383
20
566
5,871
100
10
88
314
18,942
787
162
1,381
382
313
313
355
1,234
1,234
1,234
1,353
1,353
92
/*79
10,216
44,945
Grand total, 56,061.
TESTS FOR DIAGNOSIS AND CONTROL OF VENEREAL DISEASES
The continuing low incidence of syphilis in this Province is reflected in a lesser
number of blood specimens sent in for sero-diagnostic tests. This trend also reduced
the number of confirmatory tests which needed to be carried out on specimens giving
positive or doubtful reactions with the preliminary test. Apart from these factors, which
lie outside the Division's control, a significant reduction in the work of this section was
made possible by official adoption of the V.D.R.L. (Venereal Disease Research Laboratory) test, in place of the presumptive and standard Kahn tests. This change was made
during the summer, after its desirability had become apparent to both this Division and
to the Division of Venereal Disease Control. Exhaustive comparisons involving many
thousands of blood specimens, and extending over about two years seemed to bear out
the claims of the Venereal Disease Research Laboratory of the United States Public
Health Service, that the V.D.R.L. test, which it has sponsored, is superior in specificity
and sensitivity to the Kahn tests. Substitution of this single microscopic precipitation
test for the presumptive (screening) and standard (diagnostic) Kahn tests has eliminated
a considerable amount of repetition. Other advantages include less glassware-cleaning
and less dependence upon a highly integrated team of technicians, whose efficiency could
be so easily hampered by the absence of any one person.   The reduction in numbers of
 L 112
BRITISH COLUMBIA
the Kolmer-Wassermann complement fixation test, reserved for confirmatory purpose
as before, can be ascribed solely to the diminished incidence of syphilis. S
Coincident with this change-over in methods, the Division introduced a combined
requisition and report form, of a type which has been used successfully in several other
Provinces. Adoption of this type of form has appreciably reduced the time spent by
office staff in a particularly tedious task. The desirability of introducing these changes
was generally acknowledged at the 1953 meeting of Provincial laboratory directors in
Ottawa, and it is gratifying to record that such major innovations were accepted unreservedly by the local medical profession.
In October the central laboratories began a participation in the seventh in the series
of regular surveys of sero-diagnostic procedures performed by the various Provincial
laboratories throughout Canada, which has been supervised every year or two by the
Laboratory of Hygiene, Ottawa. There is good reason to feel confident that our performance of the standard procedures on 100 selected specimens sent us from Ottawa will
again prove very satisfactory.
The importance of gonorrhoea as a public health problem has not declined to the
same degree as in the case of syphilis. Around 25,000 microscopic examinations for
gonococci were carried out in the central laboratories during the year—a high figure when
it is borne in mind that such tests, in contrast to the blood-testing situation for syphilis,
are seldom requested routinely by physicians. Cultural examinations for gonococci
increased by nearly 20 per cent, thus giving the transport medium, described in the 1953
Annual Report, ample opportunity to prove its worth.
TESTS RELATING TO CONTROL OF TUBERCULOSIS
Laboratory tests for M. tuberculosis, especially cultures, continued to mount. This
upward trend, which has now persisted for over twenty years, has always been a major
cause of anxiety and difficulty to this Division. The infectivity of the specimens, the
time-consuming nature of the tests, the necessity to hold cultures under observation for
several weeks, and the maintenance of a supply of guinea-pigs are among the factors
which have recurrently created problems.
Over the years the changing emphases in the programme of the Division of Tuberculosis Control all seem to have entailed a heavier load of laboratory work. First there
was a broadening of case-finding activities; then came the demand for more sensitive
methods of detecting the presence of tubercle bacilli, for example, by culturing stomach
washings; and now cultures of sputum are almost routinely desired as a means of following and assessing the rapid improvement in the patient's condition which may be induced
by modern therapeutic agents. Yet this Division can safely claim to have met these
challenges, and to have contributed as indispensably to the declining mortality from
tuberculosis as it has done to the diminished incidence of syphilis.
SALMONELLA-SHIGELLA INFECTIONS
For several years successive annual reports of this Division have drawn attention to
the unduly high excreta-borne infection hazard in this Province. These warnings seem to
have been fully justified in the light of the 1954 record, which has been exceeded only in
1946. In that year post-war conditions encouraged poor standards in public eating-
places, and a mobile overcrowded population grew careless over personal hygiene, in
1954 there were roughly 240 instances of salmonellosis, almost double last year's figure,
involving fifteen different Salmonella types. There were sixteen cases and carriers or
S. typhi, while over 120 cultures, or roughly one-half of the total, were identified as
S. typhi-murium. These two types are mentioned because the former is responsible to
an especially severe and prolonged form of salmonellosis (classically known, of coursj^
typhoid fever), as well as being particularly prone to give rise to water-borne or ^ '
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 113
borne epidemics, while the latter is very liable to become established in animals, domestic
or wild. Indeed, several other Salmonella types, isolated each year in the Division, have
been implicated elsewhere as frequent causes of human infection due to % animal reservoirs." In Alberta a similarity of Salmonella-type distribution among men and domestic
animals, especially poultry, has been reported. But in British Columbia there is little
evidence that the unduly high incidence of salmonellosis in recent years has been other
than man-to-man conveyed. I
In Shigella infections the possibility that animals may serve as reservoirs need not
be seriously considered. |j Poor standards of personal hygiene, and sometimes of community sanitation, must therefore be held responsible for the disconcertingly high total
of nearly 600 cases of shigellosis identified in 1954, which is an even higher figure than
the 1953 record. Fortunately, about 98 per cent of these infections were due to the
relatively benign Shigella sonnei, or the consequences might have been far more serious.
These cases of shigellosis developed all over the Province, mostly as small, scattered,
intra-familial episodes. But there were some larger outbreaks, one at Campbell River
being particularly widespread. While it may be hoped that 1954 was a peak year, it is
likely that for many years to come this sort of pattern will recur.
In some instances, in co-operation with the Consultant in Epidemiology and the
local health-unit director, the source and mode of spread of an outbreak could be deduced.
This was true, for example, of two episodes in which S. typhi-murium and 5. bareilly
respectively were involved. The first outbreak followed a banquet at a naval training
establishment, and the second affected a working party of gaol inmates. In other
instances, notably an outbreak of intestinal trouble at Ceepeecee, no casual microorganism could be isolated from the many faeces specimens submitted.
A brief account can hardly convey the extreme pressure under which this section
operated during most of the year. It must suffice to add only that the maximum incidence
of these excreta-borne infections almost invariably coincides with the summer vacation
period, when our staff is depleted and new-comers are being trained.
OTHER TYPES OF TESTS
Bacteriological Analyses of Milk and Milk Products and Water
There was a notable increase, of more than one-third, in the numbers of milk samples
submitted to the central laboratories for standard plate counts and coli-aerogenes tests.
Some of this increase was attributable to absorption of the Prince George branch
laboratory work after the first quarter of the year. Another factor was the introduction
of light-weight shipping containers, which lowered the air express charges and also
simplified the packaging and refrigerating procedures. In addition, it appears that health
units throughout the Province are making real efforts to apply this type of sanitary bacteriology as co-operatively and effectively as possible. Still more can be done in this
direction, and the Division is anxious to develop further this aspect of its activities, both
in Vancouver and in the Victoria and Nelson branch laboratories.
Examinations of ice-cream and cottage-cheese samples from the Greater Vancouver
metropolitan area almost doubled in number. This is a gratifying trend because it indicates a growing realization that milk products are no less important than milk itself as
potential vectors of infection. Moreover, such tests relate essentially to prevention, and
though they may seem less dramatic than post hoc investigations, they should carry a
greater appeal to community intelligence.
Milk or milk products were the suspected vehicles in several episodes of miscellaneous nature, including a few cases of acute brucellosis. In one clear-cut case, Brucella
abortus was isolated from the blood-stream of a raw-milk consumer in the Kootenays.
The foregoing general remarks apply equally to bacteriological analyses of drinking-
water supplies.   As the Province's sparsely inhabited areas become populated, every
 L H4 BRITISH COLUMBIA
precaution to secure safe water-supplies will be justified, in view of the already discu
Salmonella-Shigella situation.  There was an increase during the year of nearly 10
the
health unit seems to be working quite well. BSE !2 °Cal
cent in coli-aerogenes tests of water samples.  Very few water samples now reach th
laboratories from private parties, and the system of referring such requests to the
Bacterial Food Poisoning
Apart from the occasional implication of foodstuffs as vehicles for Salmonella infections, there were various staphylococcal food-intoxication episodes. In addition, early in
November another instance of fish-borne Type E botulism was identified with the cooperation of the Department of Bacteriology and Immunology at the University and the
Western Division of the Connaught Medical Research Laboratories. Three young Indian
women were made ill, and one died, after eating salmon-egg cheese. This delicacy is
made by kneading a mass of salmon-eggs, which have been washed in a running stream
overnight, suspended in a gunny sack. Apart from a period in the smoke-house, the
eggs are in no way subjected to heat, so that conditions are conducive to the elaboration
of botulinus toxin. This is the fourth outbreak of Type E botulism in British Columbia
in the last ten years, all of them due to uncooked fish or fish products.
At the very end of 1953 there were two occurrences of Type A botulism, whose
circumstances were reported in the Canadian Medical Association Journal for September,
1954. Home-bottled corn on the cob caused two fatalities at Grand Forks, while home-
bottled spinach was responsible for two mild cases at Rock Creek. These outbreaks
illustrated that mere boiling of such foodstuffs in the course of processing does not ensure
destruction of the remarkably heat-resistant spores of Type A botulinum bacilli. The
importance of the pressure-cooker in this respect is not yet sufficiently realized.
Diphtheria
Cultural examinations for C. diphtherue showed a further sharp decline. This
apparently reflects less rigid institutional policies with regard to routine throat swabbing—
a justifiable change of attitude in view of the present very low incidence of diphtheria and
the high degree of community protection conferred by immunization with toxoid. However, the diphtheria bacillus has by no means vanished from our midst, and a few cases
were identified during the year.
Intestinal Parasites
The central laboratories experienced an increase of nearly 40 per cent in requests
for microscopic examinations for intestinal parasites. This upward trend may be due
largely to the population influx from diverse parts of the world. At any rate, a broadening
variety of infestations is being encountered, and we must obviously be prepared to identify
the rarer and more exotic types of parasites. A few specimens of animal tissues (moose
and deer) were received, showing evidence of infestation with parasitic species nonpathogenic to man.    .
Several requests reached us for skin-testing materials for detection of trichinosis ana
echinococcosis. Both these types of infestation are known to be endemic in certain
regions of the Province, and alert physicians and health officers should bear this in mind.
We were able to supply these antigens free of charge through the courtesy of the
Laboratory of Hygiene, Ottawa, the only proviso being that we should have a brief outline
of the case concerned and a report on the reaction obtained.
Fungus Infections ' ]m.
Over the past few years local doctors have shown greater awareness of fungus in actions.   Mycological procedures are now being carried out often enough to warrant
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 115
separate listing in Table I, instead of being included, as heretofore, under "Miscellaneous" headings. Most requisitions to date have involved the commoner ringworm infections of skin and hair, but Candida albicans has also assumed considerable importance
from the widespread use of antibiotics which inhibit bacterial species normally suppressive
to this fungus. A few inquiries reached us during the year about certain rarer fungal
conditions, such as blastomycosis and histoplasmosis. From one hospital patient, with
multiple intractable abscesses of obscure aetiology, Cryptococcus neoformans was isolated,
probably for the first time in this Province. All signs point to further expansion in activities under this heading.
Virus Infections
The need to develop a virus diagnostic section has become increasingly evident.
Comparatively little could be done in this connection until supplies of standardized
antigens became available for detection of specific viral antibodies by complement-
fixation tests. Since the Virus Section of the Laboratory of Hygiene, Ottawa, began
supplying such antigens a year or two ago, the central laboratories have offered a limited
range of facilities in this field. Reagents are now on hand for performing complement-
fixation tests on specimens from patients suspected of influenza, Newcastle disease,
mumps, smallpox, vaccinia, lymphocytic chorio-meningitis, psittacosis, Q fever, Rocky
Mountain spotted fever, and certain of the encephalitides.
To be reliable, these tests should be performed on paired specimens (usually blood,
occasionally cerebrospinal fluid)—one taken during the acute phase and the other during
convalescence—and our attitude has therefore been that there is seldom much purpose in
carrying out the test unless both such specimens are available. Another prerequisite has
been an undertaking to supply the laboratories with a brief case-history on each patient.
Only thus can this Division (which does the tests) and the Laboratory of Hygiene (which
supplies the reagents) hope to correlate the clinical and laboratory data, and hence to
determine the specificity of such tests and the suitability of the reagents.
During 1954 nearly 100 complement-fixation tests for various viral infections were
carried out in the central laboratories. Positive findings were obtained in a few instances
of influenza and mumps meningitis. These tests have been listed for the first time under
a separate heading in Table I.
Actual isolations of viruses cannot possibly be attempted in the present quarters.
Adequate provision has been made in the new building for work of this type, and it is
hoped that in the near future a well-trained medical virologist can be engaged to develop
this important section of the Division's future activities.
BRANCH LABORATORIES
As already indicated, the work of the branch laboratories declined slightly during
the year, chiefly because of reduced demands for sero-diagnostic tests for syphilis.
Closure of the branch laboratory at Prince George, which was foreshadowed in last
year's report, took effect after the end of March. The decision was based on four years'
experience of the operation of this one-person laboratory, which shared quarters occu-*
pied by a full-time health unit, and concerned itself mostly with bacteriological tests of
milk and water supplies. The experiment was terminated reluctantly, on the grounds
of relatively high costs per test, inability to provide satisfactory staff replacements, and
unproved transportation facilities between the Prince George area and Vancouver.
A new type of metal picnic basket was located, which could be packed with a plastic
material cooled in the refrigerator so as to maintain milk and water samples at satisfactory
temperatures during transit, and arrangements were made with an airport taxi sendee
for prompt pick-up of these containers. Almost all the laboratory equipment at Prince
ueorge was transferred to Vancouver for immediate or future use. The bacteriologist,
who had been stationed there for nearly two years, was transferred to Nelson, after
 L 116 BRITISH COLUMBIA
spending the summer gaining experience in the central laboratories.   The changes we
effected smoothly and no adverse consequences have been noted. re
After serving at the Nelson branch laboratory for over a year, the bacteriolo^i
and technician there were both replaced late in the summer and returned to the cento
laboratories.    In October two technicians from the Victoria branch laboratory at th
Royal Jubilee Hospital spent a few days in Vancouver, in order to familiarize themselves
with the V.D.R.L. test prior to its adoption in Victoria.
GENERAL COMMENTS
In July proposals for reclassification of technical-staff positions, made by the Director to the Civil Service Commission some time ago, were officially approved. Their chief
intents were to rectify certain anomalies in existing classifications, to provide higher
salary ranges for technical staff with more advanced academic qualifications, and to
recognize that many years of specialized experience may for certain positions be a worthy
substitute for a university degree.
These changes should appeal particularly to male applicants for prospective vacancies in technical or professional categories. As the time approaches for transfer of the
Division's headquarters to the new building, the desirability of recruiting a few first-class
men to public health laboratory work becomes even more pressing than before. A predominantly female staff has done admirable work throughout the twenty-three years of
the central laboratories' existence, and women will certainly continue to carry out a high
proportion of these types of work. But the Division simply cannot undertake the desirable broadening of its programme in such directions as, for example, virology, mycology,
and public health chemistry until it has built up a larger nucleus of responsible people
anxious to make a permanent career for themselves in this field. Hitherto we have been
perforce too dependent upon young women, who carry out the procedures assigned to
them competently and faithfully, but whose ambitions usually and naturally lean in other
directions, so that their average stay with the Division is barely long enough to justify
the time spent in training them. At present, apart from the Director, there are only two
male bacteriologists among a technical and professional staff numbering thirty-three.
Every effort must be made to rectify this imbalance.
These remarks require immediate qualification by praise for the selfless devotion
to duty displayed in their respective spheres of supervision by the Assistant Director,
Miss D. E. Kerr, and all her senior colleagues. One of this group, Miss Mabel Malcolm,
who retired on superannuation at the end of September, conspicuously exemplified those
characteristics which have contributed so much to building the Division's present enviable reputation despite heavy odds. Miss Malcolm had served as a senior bacteriologist
in the Provincial Laboratories since their establishment on Hornby Street in 1931. In
fact, long before then she had been mainly responsible for the public health work done
at the Vancouver General Hospital laboratory. Engaged by that hospital as a stenographer in October, 1917 (at a salary of $55 per month), she was shown how to do
Wassermann tests on her second day of duty. Although Miss Malcolm soon became
proficient in the performance of all the accepted techniques, throughout her thirty-seven
years of service she never lost her special interest in the sero-diagnostic tests for syphilis,
and became an authority in this field.   Her record will be hard to match.
The Division's relations with the medical profession have never been better. Very
satisfactory co-operation has also been enjoyed with health units and other divisions of
the Provincial Department, as well as with representatives of the Greater Vancouver
Metropolitan Health Committee and of the Department of National Health and Welfare.
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 117
REPORT OF THE DIVISION OF VENEREAL DISEASE CONTROL
W. Stuart Maddin, Director
INTRODUCTION
During this past year the total number of venereal-disease cases reported in the
Province showed a decline as compared with previous years. Early syphilis, including
the secondary stage, has continued to be a clinical rarity. Late syphilis and prenatal
syphilis, as reported to this Division, have also shown an appreciable decline. On reviewing the other forms of venereal disease an increase was noted in the total number of
reported cases of chancroid; however, these cases were found to be mainly among
mariners and other persons entering the port of Vancouver.
TREATMENT
This Division continued, as in the past, to overtreat gonorrhoea patients with massive
doses of penicillin, and the results to date have shown that such treatment has been
successful in preventing concomitantly acquired syphilis. Prior to the adoption of this
overtreatment schedule, authorities reported a small percentage (3 per cent) of patients
contracted syphilis along with their gonorrhoea.
A clinical survey is now under way to determine the usefulness of a newer long-
acting form of penicillin; it is hoped that with the addition of this therapeutic modality,
results in the treatment of a sizeable group of promiscuous offenders will be enhanced.
After observing the decrease in the patient case loads in the New Westminster and
Victoria clinics, several changes were made. The facilities of the Victoria clinic, which
was previously set up as a separate treatment unit, were incorporated in July, 1954, into
the Vancouver Island Chest Centre, 2345 Richmond Road, Victoria, B.C. The New
Westminster clinic has now become a part of the Simon Fraser Health Unit programme in
that the unit staff have assumed responsibility for case-holding and treatment of V.D.
patients. The economy effected by these changes has in no way detracted from the
diagnostic or treatment services offered to the public in either of those communities.
In co-operation with the Welfare Branch, the Division has continued to provide
service to the Juvenile Detention Home and the Girls' Industrial School. The number
of clinics at Oakalla Prison Farm has been increased in order to render a more
complete and effective screening of the gaol population for venereal disease. Because of
the V.D. problem which prevails both at Prince Rupert and Prince George, clinics have
been continued at the city gaols in both of these centres.
Free drugs are still supplied to all private physicians for the treatment of venereal
disease. A supply of drugs is made available to all health units throughout the Province
in order that drugs can be dispensed locally to the private physician.
This Division has continued to receive excellent co-operation from private physicians
and other agencies within the Province in regard to the matter of reporting clinical cases
of venereal disease. Private physicians are continuing to avail themselves of the consultative services furnished by the Division. j
EPIDEMIOLOGY
Epidemiological methods employed by the Division continue to be a most important
factor in the suppression of venereal disease. With the further education of the private
physician as to his place and importance in the over-all programme, it is hoped venereal
disease will become a minor problem in the general health programme of the Province.
Epidemiological workers have altered some of their interviewing techniques. Greater
emphasis is being placed on the initial interview, both as a means of educating the patient
 L 118
BRITISH COLUMBIA
with venereal disease and in securing from him sufficient data to enable workers to tr
the contact in the shortest possible time. ace
The modified programme of speed zone epidemiology was recently reviewed b
members of this Division and showed that a higher percentage of contacts could h
brought in for investigation and treatment within the first seventy-two hours.   Th'6
newer concept has completely revised our older and previously described method.     B
The Vancouver City Gaol clinic continues to function as a most important part of
our programme. Treatment at this clinic is offered to all patients who present clinical
evidence of disease or who are known to be promiscuous.
The Indian Health Service, Department of National Health and Welfare, reorganized
its staff in the field, which has enabled them to accept increased responsibility toward
their V.D. patients. In the month of June a serologic survey was made among Indians
employed in the Sardis hop-yards, with a member of our staff assisting in this work.
A statistical analysis of this survey will be completed in the near future.
Due to increased case-reporting in certain areas of the Province, this Division has
found it necessary to supply, temporarily, a specially trained epidemiological worker to
augment the existing services at the local health-unit level.
SOCIAL SERVICE
Counselling on a casework basis continued to be given by the social worker at the
Vancouver clinic, and during the year 778 patients were interviewed as part of their
treatment for a venereal disease. This was a decrease from the previous year in the
number of patients interviewed. Again this year the department was without social-work
Staff for a three months' period.
The clinic social worker's evaluation of the capacity of individual patients to modify
promiscuous behaviour showed much the same pattern as in the previous year. Approximately two-thirds of the patients interviewed were people who utilized the discussion with
the social worker to gain some insight into their difficulties. The remainder were patients
with repeated infections whose promiscuity was a reflection of their casual way of life.
In the current year there was an increase in the proportion of patients whose behaviour
was symptomatic of some more basic personality problem, 29 per cent being so classified
this year, as against 22 per cent in the previous year. For those patients the counselling
interview was an opportunity to sort out their problems and make a start at seeking some
solution to them.
In addition to the routine interviewing of patients following treatment, the clinic
social worker participated in a study project undertaken in the Division to investigate the
problem of recidivism in venereal disease. A detailed sociological analysis was made of
the case histories of seventy-seven patients treated at the Vancouver clinic between February and July, 1953, who came within the definition of a repeater patient. Information
for the case-histories was obtained by the clinic social worker in an interview with each
of the patients included in the study. Although the interview appeared to the patient to
be spontaneous, it had been carefully standardized by the author of the study in co-operation with the clinic social worker and the Provincial Supervisor of the Social Service
Department of the Division, in order to give specific information about the life of the
repeater patient. The social worker experienced very little difficulty in enlisting the
co-operation of the patients in the study project, and each interview lasted about one hour.
As in previous years, the clinic social worker took part in the training programme in
venereal-disease control, arranged for the student-nurses, public health nursing students,
social-work students, and other professional personnel.
EDUCATION
The policy with regard to public health education has continued to function as m
previous years.   On occasion we have been called upon to assist other branches o
Government in the matter of venereal-disease education.
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 119
Lectures by members of the staff of the Division of Venereal Disease Control have
been given to student-nurses at Vancouver General, St. Paul's, Royal Columbian, and
Essondale Hospitals, as well as to the fourth-year medical students at the University of
British Columbia. In addition to this, practical experience is provided by the Vancouver
clinics to undergraduate nurses of the Vancouver General Hospital. A similar and more
concentrated programme is provided for students taking the public health nursing course
at the University of British Columbia. Certain members of the nursing staff of the Indian
Health Service were afforded an orientation period at the Division during the year.
The following articles were written and published during the course of the year:—
(1) "Challenging Trends in Venereal Disease Control," by Drs. Ben Kanee
and A. John Nelson. Published in the American Journal of Syphilis,
Gonorrhoea and Venereal Diseases, September, 1954.
(2) " Observations on the Applied Epidemiology of Gonorrhoea," by Drs.
A. John Nelson and D. O. Anderson. Published in the Canadian Journal
of Public Health, September, 1954. J**
(3) " Recent Advances in Venereal Disease Control," by Dr. A. John Nelson.
Published in the Canadian Nurse, March, 1954.
(4) I Syphilis Today," by Drs. W. S. Maddin and A. John Nelson. Published
in the Vancouver Medical Association Bulletin, July, 1954.
GENERAL
The Federal Government has continued its grant to this Division. From this grant,
funds were made available to the bio-medical library, University of British Columbia, for
a proportion of the operating costs and the purchase of up-to-date literature on venereal
disease.
Mr. D. O. Anderson, a University of British Columbia medical student, was attached
to the Division during the summer period in the capacity of epidemiology worker.
A research project undertaken by Mr. Anderson at this time was supervised by Dr. A.
John Nelson, Consultant in Epidemiology to the Health Branch. This project was also
used to fulfil the thesis requirements for the degree of Doctor of Medicine at the University. During this period Mr. Anderson collected data dealing with one of the major
venereal-disease control problems, that of the repeater patient. The project was completed in all detail in the spring of 1954, and the final thesis will serve as a very excellent
guide in the future management of the repeater problem.
Special appreciation should be extended this year to the Ontario Department of
Health, Division of Venereal Disease Control and Central Laboratory, for the services
they have provided this Division in respect to the Treponema pallidum immobilization
test for selected patients.
It is our wish to express appreciation for the services and co-operation of the Division
of Laboratories, Division of Vital Statistics, and Division of Public Health Education.
In addition, the Division is most appreciative of the co-operation extended by the
Vancouver City Police, the Royal Canadian Mounted Police, the British Columbia Hotels
Association, the Liquor Control Board, Indian Affairs Branch of the Department of
Citizenship and Immigration, the Armed Forces Disciplinary Control Board of the United
States, 13th Naval District, and the American Social Hygiene Association.
 JL/    1 jL\J
BRITISH COLUMBIA
REPORT OF THE DIVISION OF TUBERCULOSIS CONTROL
. F. Kincade, Director
Since the inception of tuberculosis-control programmes our energies have b
directed mainly toward two objectives—the finding of cases and their treatment oT
the years our attention has been chiefly focused on the saving of lives as reflected thro/h
mortality rates. This was natural when, at the outset of this campaign, tuberculosis was
the leading cause of death. Treatment was paramount because it was realized that through
treatment lives could be saved, and in bringing the disease under control through treatment, the spread of tuberculosis to the rest of the population would be controlled, Case-
finding was a necessary adjunct to successful treatment, because early diagnosis gave more
hope of successful treatment.
That we have been successful in the treatment of tuberculosis is now very evident
and with the advent of antimicrobials and the advances in chest surgery we are now able
to cure tuberculosis. This is reflected in the falling death rates, which have declined
precipitously since 1946, when streptomycin was first introduced. Although we do not
as yet have the perfect antimicrobial, the present agents used in combination are proving
most effective. How successful we have been is evident from the following table, which
shows the reduction in deaths from tuberculosis in hospitals and other institutions.
Deaths
from Tuberculosis by P]
lace of Death, 1945-54
Place of Death
19541
1953
1952
1951
1950
1949
1948
1947
1946
1945
General hospitals..      	
34
45
16
7
42
44
17
16
45
96
16
23
76
83
20
33
96
80
25
41
88
143
26
45
81
143
27
49
108
189
24
53
127
175
21
63
105
Sanatoria     	
164
Mental institutions - - 	
27
Homes	
60
Total deaths  	
102
119
180
212
242
302
300
374
386
356
1 Preliminary figures only (excludes Indians).
Admissions to Tuberculosis Institutions, 1945-53
1953
1952
1951
1950
1949
1948
1947
1946
1945
First admissions.-.   ..	
557
985
56.5
566
989
57.2
541
926
58.4
526
928
56.7
547
973
56.2
486
814
59.7
546
898
60.8
534
851
62.7
611
Total admissions ._ 	
Percentage, first admissions	
889
68.7
Between 1945 and 1953, although the total admissions to sanatoria increased from
889 to 985, the deaths in that group reached their peak in 1947 with 189 deaths, but
in 1954 there were only 45 deaths.
Besides the saving of lives, the results of treatment have had other beneficial effects
in that many patients are now treated following discharge from sanatorium for prolonged
periods of time and are rendered non-infectious. This has markedly reduced the infection in the community and greatly lessened the hazard of tuberculosis to the population
at large. ll
There were 118 deaths from tuberculosis during 1954, for a rate of 9.3 per 100,000.
This includes Indians and is a preliminary figure only. This is a drop from 17.9 in 1*>
and 57.4 in 1946. During the past three years the mortality rate has been falling oy
about one-third each year. Of 118 deaths in 1954, 84 were in males and 34 in females,
and the rates were 13.0 and 5.5 respectively, showing that the male mortality rate l
over twice as high as the female. Moreover, out of 84 male deaths 61 were in m
over 50 years old and represent 72.6 per cent of the total male deaths.
 DEPARTMENT OF HEALTH AND WELFARE, 1954
L 121
On the other end of the scale, only three deaths from tuberculosis in 1954 were
recorded in the other than Indians under 20 years—two in the 1-4 age-group and one
in the 10-19 age-group. In 1953 there were no tuberculosis deaths in the 10-19 age-
group.   Formerly tuberculosis was a leading cause of death in late adolescence.
During 1953 an analysis of the length of treatment of discharged cases following
first admission showed that of 546 cases discharged 39 (7.1 per cent) were treated
under one month, 76 (13.9 per cent) were treated one to four months, 137 (25.0 per
cent) were treated four to eight months, and 114 (20.8 per cent) were treated eight to
twelve months. ^
Therefore, 366 or 66.8 per cent of new cases were treated in sanatorium under one
year and 46 per cent of new cases were treated less than eight months.
The improving situation has also led to a lessened demand on the treatment-beds,
as will be shown later, with the result that where previously it was necessary to discharge
patients from sanatorium earlier than we would have desired, it is now possible to treat
them as long as necessary in sanatorium.
The tremendous improvement in mortality from tuberculosis has not been paralleled
by a similar decline in the morbidity rate. However, there has been a marked improvement in this situation in recent years, with fewer cases found in spite of increasing effort.
The success of case-finding is in direct ratio to the energy expended in the intelligent application of certain accepted principles in the epidemiology of tuberculosis.
Although with the introduction of the miniature X-ray film it became possible, theoretically, to examine the total population, selectivity has been exercised in concentrating on
certain groups where from experience it was known tuberculosis could be expected to
exist. Special emphasis has always been placed on examination of contacts of known
cases, of certain groups of workers whose occupation showed a high incidence of tuberculosis, of certain social groups, and of those suffering from lesions associated with
tuberculosis.   Selection is also on the basis of age and economic status.
The following table will clearly demonstrate the reduction in morbidity:—
New Cases of Tuberculosis by Year of Notification, 1947-54
19541
1953
1952
1951
1950
1949
1948
1947
Active	
Quiescent	
Activity undetermined	
Total	
Total tuberculous
668
179
482
182
621
208
699
185
847
1,437
664
1,501
829
1,383
804
1,688
694
185
998
246
8552
163
929
224
879
1,699
1,242
2,202
1,018
2,108
1,153
2,616^
1 Preliminary figures only.
2 The active cases are estimated, as figures are available for the second six months only in 1948.
The peak of new cases discovered was in 1947, when 2,616 new cases were found
in 180,000 persons examined. In 1954, 1,437 new cases were found in 347,018 persons examined. This was an increase of 14,418 persons examined in 1954 and an
increase of approximately 65,000 persons examined over two years ago. During this
penod between 1947 and 1954 the number of new cases that could be classified as active
decreased from 1,153 to 847. Therefore, it can be shown that in spite of increased
searching, morbidity from tuberculosis in British Columbia is showing a marked
reduction.
It is becoming increasingly difficult and more costly to find new tuberculosis cases
as *e situation improves. On the basis of 40 cents for each miniature X-ray, it will be
seen that the direct cost of detecting an active case of tuberculosis is about $700. Howler, the indirect costs would add considerably to this figure. At what point the yield
0 new cases makes it impractical to continue case-finding by this method is not yet
 L 122
BRITISH COLUMBIA
apparent, but it is generally agreed that this point is not yet reached.   The saving throu r,
early detection, with removal of infection in the community, is undoubtedly greater th
the costs of later treatment and the spread of infection.   It is obviously better to find 7
active case at the cost of $1,000 than to treat several that might develop from this souk?
at an estimated cost of $15,000 per case. ce
SANATORIUM ACCOMMODATION
There has been a marked change in the picture as regards sanatorium accommodation and, indeed, a much-lessened demand on the beds. This has undoubtedly been
brought about by two factors—the modern treatment of tuberculosis and the decreased
number of new cases found.
In the first ten months of this year there were 790 applications for admission to
sanatorium, compared to 799 for the first ten months of 1953 and 804 in 1952, actually
very little change. However, discharges showed a marked increase, with 840 discharges
in the first ten months of 1953 and 929 in the first ten months of 1954. At the time of
the opening of Pearson Tuberculosis Hospital there were approximately 200 patients
awaiting admission to our institutions. At this time last year the waiting list had been
eliminated, except for elective cases. It became apparent that the Division was in a
position to close certain unsatisfactory sanatorium beds, and plans were laid for the
evacuation of Jericho Beach Hospital.   This took place at the end of October.
At the present time it has been possible to abandon all the temporary accommodation
which was once occupied, namely, St. Joseph's Oriental Hospital, the temporary addition
at Willow Chest Centre, and Jericho Beach Hospital. The opening of Pearson Tuberculosis Hospital provided 264 beds, but simultaneously we closed 164 beds in the
Vancouver area, hence there was a net gain of 100 beds. With the closing of Jericho
Beach Hospital, having a capacity of 91 beds, one might say that Pearson Hospital
represents a replacement of the temporary accommodation that was being operated in
Vancouver. However, in the meantime, with the renovation at Tranquille Sanatorium,
approximately 60 extra beds became available at that institution this spring. With a
complement of 833 beds, there are available 70 more beds than before the opening of
Pearson Hospital.
A census of the sanatorium patients has again been made as of October 31st this
year, and this emphasizes the fact that the problem of tuberculosis in the older person
is increasing.
Age Distribution in Sanatorium, October 31st, 1954
Age-group
Males
Total
Pearson
Willow
Victoria
Tranquille
Females
Total
Pearson
Willow
Vic-
toria
Tranquille
Orand
Total
0- 4	
5- 9	
10-14	
15-19	
20-24	
25-29 	
30-39	
40-49	
50-59	
60-69 	
70-79 	
80 and over	
Totals
1
13
30
37
66
79
96
95
48
15
5
11
12
21
30
33
39
15
8
3
5
3
14
11
8
6
4
1
480
174
55
5
4
5
7
6
7
12
1
1
5
9
18
26
31
49
43
17
5
47
204
1
3
20
33
47
75
30
17
8
3
2
8
9
16
30
10
7
3
2
1
2
3
7
9
12
6
1
239
85
2
3
6
9
4
1
7
14
16
24
16
4
3
1
2
88
1
4
33
63
84
141
109
113
103
51
17
Out of 719 patients in sanatorium, 284 were age 50 or over; that is, 39.5 percent
which is an increase over 32.3 per cent in 1952 and 35.1 per cent in 1953.  Thera
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 123
of males to females in the total sanatorium population has not changed and remains at
2 to 1, but males to females over 50 years are in the ratio of 8.5 to 1. In 1953, 26.6 per
cent of the admissions were for persons over 50 years. On the other hand, this group
represents 39.5 per cent of the total population of the sanatoria. Of the male sanatorium
population, 52.9 per cent are over 50 years of age, an increase from 45.6 per cent in 1952
and 48.2 per cent in 1953. Of the 262 admissions of persons over 50 years of age, only
38 were females, there being six times as many males as females admitted in the older
age-groups. Females over 50 years represent 12.5 per cent of female population, and
this is an increase from 8.6 per cent in 1952.
The increase of the older age-groups in sanatorium is due to several factors, as
follows:—
(1) Increased emphasis on case-finding in this age-group has uncovered many
cases.
(2) Advances in medical and surgical treatment have made it possible to offer
hope to these people through active therapy.
(3) Availability of beds has made it possible to admit and retain this group
of people, where formerly it was necessary to give priority to the younger
and more treatable patients.
However, there is an increasing concentration of older persons in our institutions
for whom little can be done either in the matter of curing their disease or in vocational
rehabilitation. They must be cared for, and because many have no adequate domicile,
they must be retained so that they will not become spreaders of disease, which would
occur if allowed to return to inadequate surroundings.
It was shown earlier that the problem of tuberculosis is shifting from the younger
to the older age-groups: 60.1 per cent of deaths are in persons 50 years and over and
39.5 per cent of those under treatment in sanatorium are over 50 years of age. This has
considerable economic significance. Obviously fewer young people are developing tuberculosis and fewer are dying of it. It used to be that the disease affected persons in their
most productive years, and meant a great loss to the country through loss of production.
Incapacitation of the bread-winner while the children still needed support and longer
periods of disability than under modern therapy placed many families on social assistance.
As the disease shifts to the older age-groups, while it does create problems in chronic care,
it is alleviating many of the problems connected with the disease in the younger groups
and should prove less of a burden on the economic structure of the country.
NATIONAL HEALTH GRANTS
The amount available in the Tuberculosis Control Grant for the present fiscal year
is slightly higher than last year at $351,213. At the present time $313,632 has been
assigned to various projects, practically all of which have been approved.
In 1953-54, 94.7 per cent of the grant was approved for expenditure in the amount
of $329,317. Because of the fact that some of the equipment was not delivered and other
accounts were not submitted before the cut-off date, this was only utilized to the extent of
$275,714, which was 79.3 per cent utilization. However, this was an increase from 65
per cent utilization in the previous year.
In this the seventh year of National health grants, a continuing pattern in their use
becomes apparent. About 85 per cent of the money is committed to continuing projects
and is distributed as follows:—       I
(1) Provision of antimicrobials, $70,500.
(2) X-ray survey programme, $120,000. This provides for payment of hospital admission X-rays, both large and small, together with the operating
costs of all the miniature equipment outside of our institutions and clinics.
(3) Rehabilitation, $26,756. W
 L 124 BRITISH COLUMBIA
i§(4) Provision of staff, $87,293.   There are twenty-nine positions n   *H
twenty-four of these being in the Division. Pr°viaed,
Over the years a great deal of this money has been spent on the installation of oh
roentgen X-ray equipment for admission X-ray purposes, but this need has been far 1
met, and at the present time only one or two units a year are being added.  Simik l
much money has been spent on equipment for the institutions and the clinics of th'
Division, but this need seems to have been largely met, because in the present year ih
total for new equipment in this grant amounts to only $29,150.   In fact, the total f °
completely new projects is only $1,000 more than this figure. ' 0r
It will be seen that the Tuberculosis Control Grant plays an important part in case-
finding, treatment, and rehabilitation. In actual expenditure, vocational rehabilitation
represents less than 10 per cent of the total grant, but it has enabled us to build up an
effective service, and the total project is supported by these funds. It was possible to
reach our objective of having three rehabilitation officers—one in each of our major
sanatoria with the necessary clerical assistance—earlier this year, but this staff has now
been reduced to two rehabilitation officers through the resignation of our Director to
assume duties in a broader field. It is hoped that when a suitable candidate becomes
available, we shall again have a complete staff in this department.
It has also been possible through National health grants to provide most of the antimicrobials that are used both for in-patient and out-patient care, and, of course, this is the
most important single factor in the control and treatment of tuberculosis at the present
time. Besides this, most of the staff provided, and much of the equipment is directed
toward, the treatment of the patient.
National health grants have also made the admission X-ray programme possible and,
besides having provided the equipment, continue to pay the costs of the operation. In
1953, 78,740 miniature X-rays were taken on patients admitted to hospital. In the
smaller hospitals using their own equipment, an additional 11,251 X-rays were taken
on large films. In those hospitals where photoroentgen equipment has been installed,
27,120 out-patients were also examined. In these hospitals there has been an increase in
coverage of about 10 per cent in 1954, and approximately 65 per cent of hospital admissions are now X-rayed. All told, in 1953 there were 105,860 miniature films taken and
24,511 large films taken in these hospital surveys.
RECALCITRANT PATIENTS |f
For many years there have been regulations providing for the forcible admission of
infectious cases of tuberculosis to institution if they are proving a public health menace
and refusing treatment. During the time there was a bed shortage for cases seeking
voluntary admission it was not thought advisable to use these powers provided to control
recalcitrants. However, with the improving bed situation during the past year, action has
been taken for such cases, and they have been forcibly committed to institutions—three
of these to Tranquille Sanatorium and one to Shaughnessy Chest Unit. For the most part,
these patients have been co-operative, but one case proved difficult from a point of view
of security and management. Moreover, several prisoners from Oakalla under sentence
were transferred to Tranquille for treatment against their wishes, and again the problem
of management proved very difficult.
If the regulations for forcible admission to institution are applied more broadly, l
becomes apparent that the problem of security and care for these patients will becoin
increasingly difficult, and if we are to continue this programme and large numbers
persons are committed, we must be prepared to provide special accommodation a ^
indeed, to employ special types of staff whose training would be somewhat simiia
that provided at Essondale or Oakalla.
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 125
In the past these cases have been sent to Tranquille because barred rooms are available there. However, these are very limited in number, and as this programme expands,
it will be necessary to provide this type of accommodation in all unite where special
security measures must be enforced. It would appear that eventually the bulk of these
cases would be amongst the chronic offenders, such as drug addicts and alcoholics, where
little co-operation from the patients while in institution can be expected. Moreover, with
the need to provide special security accommodation and close supervision of these
patients, it would appear that the cost of looking after this type of patient would be
greater than the cost for ordinary patients.
CONTROL OF TUBERCULOSIS
The control of tuberculosis in this Province is a co-ordinated effort and involves
Federal, Provincial, and municipal authorities. The Federal authorities are charged with
the responsibility for the control of tuberculosis amongst Indians and have also assumed
the responsibility for the treatment of war veterans. One is happy to relate that the
closest co-operation exists among these groups. Our programmes of control and treatment are similar, and our exchange of services and information leaves little to be desired.
Within the Provincial authority the closest co-operation between the Division and local
health services must,be maintained to produce the highest degree of integration of these
services. While the units of the Division are responsible for the patients while under
treatment and for their follow-up examinations when these patients are outside of institutions, their supervision rests with the local health organization. To deal intelligently
with these patients and to advise them on the basis of the findings of the tuberculosis
clinics, it is therefore essential that the field-workers be kept fully informed and in possession of all the essential information that is pertinent to the case. This becomes even
more important when such large numbers of patients are continuing treatment in their
homes with antimicrobials after discharge from sanatoria.
Although it is realized that vast amounts of information are constantly being sent
out to the health units and that close liaison is maintained through co-ordinating nurses,
there are sometimes oversights and misunderstandings that are annoying and should be
avoided if at all possible. Of course, the exchange of information is a two-way street,
and only if all of us keep this total picture in mind and realize how many workers are
involved in the complete rehabilitation of a patient can the maximum co-ordination of
our efforts be achieved.
 L 126 BRITISH COLUMBIA
REPORT OF THE REHABILITATION CO-ORDINATOR
C. E. Bradbury
REHABILITATION
Rehabilitation of the disabled is a subject which merits increasing considerat'
from all segments of our population. Certainly, more and more, it is occupying the sob?
attention of those responsible for the planning of community health programmes. In J
last two decades particularly, the rapid advances of medical knowledge, the applicatio
of improved public health measures, and the increase in hospital facilities are responsible
for hundreds of our people being alive to-day who, fifty years ago, would have died
To-day, with our knowledge and developing skills, we can offer hope for a useful and
productive life to many of those who, even twenty-five years ago, would have been beyond
the scope of rehabilitation.
Accidents and disease continue to take their toll, and thousands of victims are left
with physical disabilities. Some, of course, are still beyond our present knowledge and
skill, but it has been estimated that with co-ordinated rehabilitation service 80 percent
could become productive and live relatively normal, useful lives. It no longer is considered sufficient to save lives. Our society must face the challenge of giving meaning and
purpose to the life which is saved.
The Health Branch has been active in rehabilitation since April, 1949, when a
rehabilitation service was organized in the Division of Tuberculosis Control, the only
division of the Health Branch which maintains active-treatment beds. In May, 1954, the
Tuberculosis Rehabilitation Service was expanded, and two rehabilitation officers were
added to the staff. Integrated rehabilitation services, which include vocational counselling, pre-vocational training and academic instruction, occupational therapy, and post-
hospital vocational training and placement guidance are now offered to patients in all
sanatoria.
The Health Branch has continued its interest in the problems of those in our Province
who are handicapped because of a disability, and on April 15th, 1954, the Honourable
Eric Martin, Minister of Health and Welfare, signed the Co-ordination of the Rehabilitation of Disabled Persons Agreement. The Co-ordination of Rehabilitation Agreement,
by which it is better known, is a grant made available to the Provinces by the Federal
Department of Labour through which each Province can share up to $15,000 per annum
on a matching basis to pay the salaries and expenses of a Provincial Rehabiliation Coordinator, and to cover certain other expenses attendant on the organization and administration of a rehabilitation co-ordination service.
As a result of formal competition conducted under the auspices of the British
Columbia Civil Service Commission, the Minister of Health and Welfare, on September
16th, 1954, announced the appointment of a Provincial Co-ordinator of Rehabilitation
who is directly responsible to the Deputy Minister of Health. It is the duty of the Provincial Co-ordinator to assist in securing the co-operation and active participation oi
other departments of the Provincial Government, the services of which contribute to a
rehabilitation plan. He also is charged with the responsibility of co-ordinating the work
of those agencies, public and private, which, on the Provincial and local level, aid in tne
rehabilitation process, and to stimulate the interest of labour, management, and other
groups and individuals in the community. .   .
As this Annual Report of the Health Branch is being prepared for publication,
planning goes forward for the effective co-ordination of presentiy existing services contributing to the rehabilitation process.    The assistance and counsel of the other interested departments of the Government have been solicited, and effective liaison has bee
established.   The Health Branch, in embarking on this new programme, is ^at£ul
the participation of the senior officials and the staffs of the Welfare Branch, the JJep*
ments of Education and Labour, the Provincial Secretary's Department, and the w
men's Compensation Board.   Mention must also be made of the various private age
in British Columbia, too numerous to cite individually, who have exhibited a keen in
and a ready willingness to support the Health Branch in this expansion of its service
 DEPARTMENT OF HEALTH AND WELFARE, 1954 L 127
REPORT OF THE ACCOUNTING DIVISION
E. R. Rickinson, Departmental Comptroller
This being the first report of the Accounting Division of the Department of Health
and Welfare to be included in the Annual Report of the Health Branch, it was thought
that it would be very informative to all concerned to outline the actual function of the
Accounting Division.
The Accounting Division of the Department of Health and Welfare was first formed
in 1944 under the Department of the Provincial Secretary, and in the following year transferred to the new Department of Health and Welfare. Since that time it has carried out
the accounting services for both Departments. Throughout the years since the formation of the Accounting Division, a steady process of centralization of payment of accounts
has taken place, thus reducing the accounting details for the field offices. A complete
centralization of payment of accounts is now in force for the Health Branch.
The various functions of the Division may be summed up briefly as follows: Control of all expenditures, processing of accounts, preparation of payrolls, collection of
school district and municipal assessments for health services carried out by the Branch,
as well as preparation and finalization of the Health Branch annual estimates of revenue
and expenditure. Other duties include the accounting for all Federal health grants,
preparation and analysis of statistical data, inspection of mechanized equipment, records
of operation, and complete running costs of every vehicle within the Branch.
In order to assist the personnel of the Health Branch offices to become more
acquainted with the requirements of the Accounting Division and in particular for ready
reference for new staff members, an accounting manual is presently being prepared by
this Division, and it is hoped that this will be ready for distribution early in the coming
fiscal year.
This Division wishes to extend its thanks to all members of the Health Branch for
their very fine co-operation during the past year.
Hereunder is a chart showing percentagewise the distribution of the gross expenditure of the Health Branch for the fiscal year 1953-54:—
 L 128
BRITISH COLUMBIA
100%
90,
80,
70
60
50
40
30
20
10
0
»■•■■'•*■>-   '■»•».
... -V  . •.-.T
/•••*    '. * ,'-
•  " ' '••    ".*   '/
• •
• * •
1.5% RESEARCH,  TRAINING   etc
• 2. 1 V.  D.  CONTROL
" 2.9 ADMINISTRATION
"3.0 LABORATORIES
-3. 1 VITAL STATISTICS
1 CANCER,  ARTHRITIS,
-7.9 CRIPPLED CHILDREN,
REHABILITATION,  etc.
23. 1       LOCAL HEALTH SERVICES
56.4      T.  B. CONTROL
VICTORIA, B.C.
Printed by Don McDiarmid, Printer to the Queen's Most Excellent Majesty
1955
610-1054-3261

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
https://iiif.library.ubc.ca/presentation/cdm.bcsessional.1-0367835/manifest

Comment

Related Items