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Sixty-eighth Annual Report of the Public Health Services of British Columbia HEALTH BRANCH DEPARTMENT… British Columbia. Legislative Assembly 1965

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 PROVINCE OF BRITISH COLUMBIA
Sixty-eighth Annual Report of the
Public Health Services
of British Columbia
HEALTH BRANCH
Department of Health Services and Hospital Insurance
YEAR ENDED DECEMBER 31
1964
 1
 Office of the Minister of Health Services
and Hospital Insurance
Victoria, B.C., January 21, 1965.
To Major-General the Honourable George Randolph Pearkes,
V.C., P.C., C.B., D.S.O., M.C.,
Lieutenant-Governor of the Province of British Columbia.
May it please Your Honour:
The undersigned respectfully submits the Sixty-eighth Annual Report of the
Public Health Services of British Columbia for the year ended December 31, 1964.
 Department of Health Services and Hospital Insurance
(Health Branch),
Victoria, B.C., January 21, 1965.
The Honourable Eric Martin,
Minister of Health Services and Hospital Insurance,
Victoria, B.C.
Sir,—I have the honour to submit the Sixty-eighth Annual Report of the Public Health Services of British Columbia for the year ended December 31,1964.
  The Department of Health Services and Hospital Insurance consists of
three branches—the Health Branch, the Branch of Mental Health Services,
and the British Columbia Hospital Insurance Service. Each of these is headed
by a Deputy Minister under the jurisdiction of the Minister of Health Services
and Hospital Insurance.
The chart on the other side of this page deals only with the Health Branch.
For convenience of administration, the Health Branch is divided into three
Bureaux. The Deputy Minister of Health and the Bureaux Directors form the
central policy-making and planning group. The divisions within the Bureaux
provide consultative and special services. The general aims of the Deputy
Minister with his headquarters staff are to foster the development of local
health services, to provide advice and guidance to those local health services,
and to provide special services which cannot, for economic or other reasons,
be established on the local level. Included in these are the special services
provided by the Divisions of Tuberculosis Control, Venereal Disease Control,
Laboratories, Vital Statistics, Public Health Engineering, Public Health Edu-
Direct services to the people in their communities, homes, schools, and
places of business are provided by " local public health personnel." These
fall into two broad groups. In the metropolitan areas of Greater Vancouver
and Greater Victoria they are members of the city and municipal health departments, which, in these two cases, do not come under the direct jurisdiction of
the Health Branch. (However, they co-operate closely with the Health Branch
and, through it, receive substantial financial assistance with services from the
Provincial and Federal Governments.) Throughout the remainder of the Province the " local public health personnel" are members of the health units (local
health departments), which are under the jurisdiction of the Health Branch.
A health unit is defined as a modern local health department staffed by full-
time public health trained personnel serving one or more population centres and
the rural areas adjacent to them. Outside the two metropolitan areas mentioned above, there are 18 such health units covering the Province from the
International Boundary to the Prince Rupert-Peace River areas.
 TABLE OF CONTENTS
General Statemen
Bureau of Administration....
Division of Vital Statistics	
Division of Public Health Education-
Accounting Division	
Bureau of Local Health Services
Bureau of Special Preventive and Treatment Services-
Division of Tuberculosis Control	
Division of Venereal Disease Control	
Division of Laboratories	
Division of Occupational Health	
Registry and Rehabilitation Services	
  Sixty-eighth Annual Report of the
Public Health Services of British Columbia
HEALTH BRANCH
Department of Health Services and Hospital Insurance
YEAR ENDED DECEMBER 31, 1964
The Health Branch, as an integral section of the Department of Health Services
and Hospital Insurance, is charged primarily with the protection of the public health
of the Province. In pursuit of this goal it is required to develop, supervise, and
direct a broad range of services in the interests of prevention of ill health and the
encouragement of positive health. This Report relates the significant tasks involved
in that objective.
THE PROVINCE AND ITS PEOPLE
The number of people in the Province has been gaining at an increasingly
rapid rate since the 1961 Census. In 1962, 30,000 people were added to the
population, in 1963, 36,000, and in 1964, 43,000, a proportionate increase of
almost 7 per cent within three years. The 1964 mid-year figure of 1,738,000 is
very nearly twice the 1942 figure of 870,000. Indications are that the growth rate
is continuing at a high level. As the birth rate is declining, it can be assumed that
immigration must be a major factor in the population growth. In actual fact, the
number of births has shown a consistently downward trend since the record high
of 1960, when a rate of 25.0 per 1,000 population was created by the birth of
40,116 babies. Preliminary figures indicate that in 1964 a rate of 20.7 was
recorded, the lowest in the last 20 years. This may seem curious in a world that
is experiencing a population explosion. It has been customary to assume that the
reduced mortality from disease had been responsible for a rapidly rising world
population and consequent overcrowding. This is true for the developing countries
in which dramatic decreases in the death rates have not been accompanied by corresponding declines in the birth rates. In the economically advanced countries,
however, the birth rates and the death rates had reached moderately low levels
some years ago, and the recent declines in both these rates have not greatly affected
the rate of natural increase. In this Province the general mortality rate has been
gradually declining since the high of 11.1 in 1943, and reached close to a record
low of 8.9 per 1,000 population in 1963. In 1964, available figures establish
a rate of 9.2, a very slight increase.
Marriages were maintained in a frequency approximately the same as for the
last year, with a rate of 6.9 per 1,000 population, thus coinciding exactly with the
rate of the previous year. This is not particularly significant, except that it is considerably below the peak rate of 12.5 established in 1941 and, of course, that it is
a factor in the lower birth rate currently being experienced.
The preliminary infant mortality rate per 1,000 live births this year was 23.1,
a slight decline from the 1963 figure.
It appears that the number of maternal deaths occurring in 1964 will be a
record low, preliminary figures showing that only four occurred for the year.
 1
PUBLIC HEALTH SERVICES REPORT, 1
Twenty years ago there were 50 such deaths recorded, and when it is realized thatB
the number of births then was about half the number now, the significance of thisB
decline becomes even more apparent.
There was a slight increase in the total number of deaths, which led to the
establishment of a crude death rate per 1,000 population of 9.2. The rate of deaths 1
from diseases of the heart was 353.9 per 100,000 population in 1964, the highest I
point for some years and well above the 1963 rate of 334.2. Malignancies re- 1
corded a considerably higher than usual rate of death at 163.8 per 100,000 popu-1
lation, the highest ever registered. The 1963 rate was 156.4. The conditions I
referred to commonly as strokes or apoplexy also recorded a higher rate of deaths
this year than last with a rate of 99.8, the third successive year of increase.
While not quite equivalent to the low figure of a year ago, the accidental death I
rate for 1964 was only a little higher, there having been 63.6 accidental deaths per I
100,000 population in 1964 as compared to 62.4 for the previous year. The ]
proportions of accidental deaths ascribed to the various specific causes were not ]
greatly changed. Thirty-six per cent of these deaths resulted from motor-vehicle 1
accidents, while 16 per cent resulted from falls and 9 per cent from r.
Drownings created 12 per cent of the accidental deaths, and fires w
factor in loss of life in 5 per cent of the accidental deaths.
There is little reason for pride in the record in venereal diseases. British ]
Columbia achieved notable success in reducing the high incidence of venereal disease
during the war and post-war years. Now there is a reversal in a field which in most
parts of the continent was all too complacently considered under control. Infectious syphilis involved 56 cases in 1960, 64 cases in 1961, 183 cases in 1962, 280
cases in 1963, and 304 in 1964. The incidence of gonorrhoea, which attained a
record low in 1955, has been climbing slowly until the last two years, when there
was a sudden dramatic upsurge, with 5,012 cases in 1963 and 5,816 in 1964. This
means that gonorrhoea has attained a record high, while the incidence of infectious
syphilis was the highest recorded since 1947. While the greatest increase is in
the 20-39-year age-group, nevertheless the rate in the younger age-groups is
increasing also. The incidence is not occurring uniformly throughout the Province,
as is evidenced in the following table:—
 GENERAL STATEMENT
Gonorrhcea
Infectious Syphilis
Number
Rate
Number
Rate
East Kootena-
I
gi
I
w^fc^.	
—
?„°_h ny^8™	
fil
Upper Fraser	
's'S
Upper Wand                               ~            ~                  J
27~_1
5,816
334.6
304
This reveals the highest incidence to be occurring in the northern areas of the
Province, in the Cariboo, Skeena, Peace River, and Northern Interior Health Units
in so far as gonorrhoea is concerned, with an unexplainable high rate of infectious
syphilis for the South Central Health Unit. When these diseases were at a former
peak, there was a concerted effort by medical, legal, law-enforcement, church, and
public health groups in a case-finding, contact-tracing, treatment, law-enforcement,
and educational drive. This produced beneficial results. Then penicillin came
into popular use and the efforts were relaxed, because of reliance on the efficacy of
a drug as the perfect control agent. This position must now be re-examined.
Penicillin has not lost its effectiveness, but the social attitudes of the community may
have changed. What can be done about it? Certainly, the health profession cannot be expected to supply the complete solution; it can only deal with one factor
of a much more complicated situation. Each community will have to marshal its
ests on the more general social issues. Concurrent with the rise in venereal-
ise rates, there is a consistently increasing illegitimacy rate.
Numbers and Rates of Illegitimate Births, British Columbia, 1960-64
1960 ..
1961 ..
1962
1963 ..
1964 _
2,673
2,680
2,804
. 3,079
. 3,3601
66.6
69.5
73.5
It must be recorded that these figures relate to illegitimate births to both single
and married women, and that illegitimacy is not necessarily confined to unmarried
mothers. The table is a further reflection of an unfavourable trend in social morality, justifying a community examination into social trends among the population.
 q 12 PUBLIC HEALTH SERVICES
After a year of complete freedom from paralytic poliomyelitis, one severe case j
occurred this year in a non-vaccinated middle-aged male, emphasizing that this I
disease will arise in a community unless immunization is maintained. During the 1
year the oral poliomyelitis vaccine programme was completed, and everyone j
throughout the Province has now had an opportunity to avail themselves of three I
doses of Sabin vaccine. Just under 500,000 people, amounting to about 30 per cent 1
of the total population of the Province, accepted immunization, while more than 75 1
per cent of school-aged children have now been given protection. It has not yet been j
decided how frequently a reinforcing dose of this vaccine will be necessary, but the
maintenance of a community immunity status will become a feature of the routine j
immunization programme for the future.
Infectious hepatitis appears to be on the wane, as indeed it is all over North  i
America.   In 1962 there were 1,889 cases reported, while last year the total had
dropped to 1,736, and for this year a further reduction to 1,054 is recorded.   It is  j
felt that the reporting of clinical cases of this disease is fairly good because of the  j
physicians' awareness that it was assuming epidemic proportions, and because the
Health Branch makes free gamma globulin available to family contacts.   At this
time a Province-wide study is being carried out to determine the optimum dose of
this relatively scarce and expensive prophylactic.
Five cases of typhoid fever were diagnosed this year, which remains slightly
below the average for the past years. Most cases occurred due to the presence of
healthy carriers who can excrete this organism intermittently for years. Few, if any,
cases occur now in this country from contaminated milk or water, and every year
one or two more healthy carriers are located, these people generally being unaware
of their unfortunate ability to spread typhoid fever.
The incidence of bacillary dysentery, which has caused considerable concern
over the past four or five years, decreased in 1964. There were 131 reported cases
of bacillary dysentery, which may be contrasted to 169 in 1963 and 1,192 in 1960.
There were no cases of diphtheria reported in the Province this year, and the
incidence of healthy carriers, recognized from throat swabs taken at random, has
not increased, as is the case in certain of the Prairie Provinces. Immunization in this
field nevertheless must be maintained.
Botulism caused one death in 1964. As in the past, this resulted from the
eating of fermented salmon roe, a traditional native Indian delicacy. Fortunately
this food was confined to family groups rather than to a large group, in which a much
more serious situation might have resulted.
Scarlet fever and streptococcal sore throat infections seem to appear in cyclic
outbreaks. The relatively high incidence arose in 1950 with well over 4,000 cases,
but since then there has been a steady decline to 969 cases for this year. Fortunately
in recent years this infection has been relatively low in severity, but one danger
remains in that a proportion of the children who contract the infection may develop
rheumatic fever complications with resultant heart damage. For that reason a
rheumatic fever prophylaxis programme was introduced in 1958 and has been
continued. At the moment there are 1,200 children being carried on this programme. A careful study of the recurrences while under prophylaxis indicates that
the failure rate approximates 3.7 per cent, which is similar to the rate in one of the
most carefully controlled programmes on the continent carried out in New York City.
There is little doubt that the programme obtains results in prevention of cardiac
damage among this group, allowing them to attain maturity in as healthful physical
state as possible.
Dentally the health status of the people of the Province, and especially the
children, is far from ideal.   For example, the average 7-year-old child has been
 GENERAL STATEMENT Q 13
I shown to have 6 of his 20 deciduous teeth attacked by decay, and for close to 40 per
I cent of this age-group no adequate treatment of these decayed teeth has been under-
I taken. As the child increases in age, the number of decayed teeth is increased, and
I in the average 15-year-old there are nearly 12 of the 28 permanent teeth exhibiting
I dental caries. In this same age-group, 17 per cent of the children were noted to have
I disease of the gums and 35 per cent to have " severe " malocclusion to the degree
I that they were in obvious need of orthodontic treatment. Prevention of dental dis-
[ ease is the only rational solution—research the only hopeful approach. Conven-
I tional methods of repair require unobtainable numbers of dentists. Neither this nor
[ other countries of the world can hope to provide enough dentists to control dental
disease by therapeutic measures alone.
ENVIRONMENTAL POLLUTION
Public health has traditionally concerned itself with the tangible causes and
I effects of disease but it is fast becaming clear that other potential hazards to man are
arising from our technological advance, which is promoting a variety of changes in
! our environment. Some are good; some may be even harmful. In any event, as a
Health Branch it becomes necessary to become better informed on the effects of air
pollution, water pollution, pesticide exposure, and ionizing radiation, which are the
predominant hazards presenting themselves at the moment.
In the matter of air pollution, at least in so far as British Columbia is concerned,
there are not enough facts to make completely rational decisions on it as a factor in
health. Nobody has ever proved that long-time exposure to air pollution can cause
disability or chronic illness. However, it may a cumulative effect in encouraging
lung disease. Industrially the Province is yet a comparatively young society, but
exposure to air contaminants is creating obnoxious discomfort to some communities. Each of us breathes in about 15,000 quarts of air per day; that is about 55
pounds—8 to 10 times as much as our intake of water and food combined. Everyone in our modern civilization contributes to air pollution. There is no such thing
as a small amount of air pollution. Perfectly clean air is unobtainable, but cleaner
air is definitely obtainable. Clean air costs money; dirty air costs more. Action
toward control is probably justified. Some moves have begun. Comparative studies
of respiratory conditions in heavily exposed and moderately exposed populations
e being undertaken.
The latest addition to air pollution is radioactive fallout, which is merely one
factor in the total problem of ionizing radiation. Investigations of risk to community
health have become a major activity of the Division of Occupational Health. This
Division checks on X-radiation sources, control of radioisotopes, film monitoring,
and radioactive fallout. Understandably it is this latter item of fallout that arouses
the greatest amount of public interest, and yet it is but a minor item of radiation
exposure. Probably the effects are small compared with those from automobile and
industrial exhausts. Anyway, there is not much that can be done about radioactive
fallout but live with it; it is an international matter which can only be settled internationally. Nevertheless, it is an item on which information must be maintained.
The actual monitoring and reporting on radioactive fallout is handled by the Radiation Protection Division at Ottawa, which employs experienced physicists and
technical personnel best able to advise on this highly specialized subject. In then-
view, fallout must be kept in proper perspective with all other forms of radiation
exposures. Measurements of fallout reached peaks in the spring of 1963 and then
gradually decreased. However, the recent testing of the first Chinese nuclear
weapon revived concern.   Fresh fission materials were detected in Canada within
 q 14 PUBLIC HEALTH SERVICES REPORT, 1964
three days after the Chinese blast, but within a couple of weeks the values were 1
settling down again. Reports on the situation become available monthly and are j
carefully reviewed. From time to time there have been suggestions that the Province |
should embark on a Provincial monitoring radiation service, but it does appear that j
this would be needless duplication in a highly technical field that seems to be adequately monitored now by a well-qualified staff within the National department.
While air pollution is attracting some interest, the matter of water pollution is 3
becoming increasingly important. Some years ago a Pollution Control Board was j
set up with the objective of controlling the amount of industrial and domestic con- j
tamination escaping into the surface waters of the Prov'nce. The role of the Health ]
Branch in these activities has been to provide the public health engineering service, ]
and this has been increasing year by year in keeping with the industrial growth within ]
the Province.
Another possible threat arises through the ever-increasing use of pesticides. !
Like other elements that influence man's environment, they have both real values
and potential hazards. The challenge in their use is to ensure an adequate supply of
safe, wholesome, nutritious food, and sanitary living conditions free from pest-borne ]
diseases, and at the same time prevent hazards to the health of man and animals.
Pesticides are a modern necessity. In this Province there is no concrete evidence of
human harm from pesticides to any degree; there has been the occasional toxicity to
a handler, and some reports of fish kills in spraying to eliminate pests or protect
crops or control forest diseases. The use of pesticides is a subject vital to a number
of Government departments—Forests, Fisheries, Agriculture, Recreation and Conservation, as well as Health. From them an interdepartmental committee was set up
several years ago to examine the situation in British Columbia. That committee
advanced some recommendations, one of which deals with more regulatory controls
over the sale of the products. In any event, maintenance of vigilance in this field
seems justified.
HALL COMMISSION ON HEALTH SERVICES
The Royal Commission on Health Services was appointed in June, 1961,
specifically to determine the existing facilities and the future needs in health services
for the people of Canada, the resources necessary to such services, and to recommend such measures as would ensure the best possible health care being available
to all Canadians. Almost three years later the first volume of the report of the
findings was released. Volume 1 of the Royal Commission on Health Services contains 885 pages and is a valuable summation of the situation relative to health care
throughout the country. The report analyses the basic concepts involved in the
health-care field and supplies 200 recommendations under three major headings
dealing with (1) health-services; (2) health personnel, facilities and research; and
(3) financing and priorities.
The report was issued in late May, and a Ministerial conference was convened
in Ottawa to discuss its content in mid-July. It was obvious from the meeting that
no Province had had sufficient time to review and analyse the report, and it was proposed that a future Ministerial conference be convened, some six months later.
There was also an indication that there was a second volume of the report to be
released, and it was queried whether a true analysis of the first volume could be
undertaken until the contents of the second volume became known. That additional
volume is still awaited. In the meantime, analytical studies of the report and the
recommendations it contained are under review.
 r
GENERAL STATEMENT Q 15
ACKNOWLEDGMENTS
In the large field of public health, not all services are provided by official health
|  departments.   Other departments of government, professional groups, and voluntary
agencies all make a significant contribution to the general health of the Province, and
this Department gratefully acknowledges the excellent co-operation and the full
support it has received from these many agencies.
Finally, the Department would like to acknowledge the very major contribution
: provided by the clerical staff; without their considerable assistance, Departmental
routines would become chaotic, while policies, programmes, and services would
grind to a halt through lack of capable office operations. This was never more
clearly brought to attention than with the retirement of Miss Alison Chrow, who had
been the senior clerk with the Health Branch for a period of 45 years. When she
started, the Health Branch consisted of two individuals—a Provincial Health Officer
and herself. She watched it grow and in many ways guided the growth. She served
under three Deputy Ministers and, as every good secretary does, prompted them on
administration matters coming to her attention. The Department benefited from her
years of service, her knowledge of its early beginnings, and her advice in many areas.
The Department owes her much and is pleased to acknowledge in gratitude her
contribution to the health services of this Province.
 1
q i6 PUBLIC HEALTH SERVICES REPORT, 1964
REPORT OF THE BUREAU OF ADMINISTRATION
The Bureau of Administration consists of the general offices in the Health
Branch headquarters, the Division of Vital Statistics, and the Division of Public
Health Education. (The relationship is shown in the chart at the front of this
Annual Report.) The headquarters and these two Divisions are concerned with
programmes and procedures throughout the Health Branch as a whole. Their activities lend support to those of all other divisions and services.
The Directors of the Divisions of Vital Statistics and Public Health Education
have prepared reports which appear elsewhere in this volume.
This section of the Report deals with administrative and organizational matters
which are of general interest in the Health Branch's operations.
ORGANIZATION AND STAFF
As predicted in last year's Annual Report, the Health Branch assumed operational control of the Provincial Infirmaries (which had been under the jurisdiction of
the British Columbia Hospital Insurance Service since 1949) on May 1, 1964. For
many years the Provincial Infirmaries have consisted of two branches in or near
Vancouver—the Marpole Infirmary and the Allco Infirmary, both operated by the
Provincial Government. In addition, some infirmary patients have been accommodated in Mount St. Mary Hospital, operated by the Sisters of Saint Ann in Victoria.
In the latter part of May, the Provincial Infirmary at Allco was closed and its
patients transferred to Pearson Hospital. Marpole Infirmary was continued in
operation temporarily because of the need to provide an activity wing at Pearson
Hospital before the Marpole Infirmary patients could be given adequate care there.
At the year's end, planning of the activity room was well advanced. It was hoped
that the wing would be completed by July, 1965. Approximately 35 infirmary
patients continued to be accommodated in Mount St. Mary Hospital.
In the Local Health Services organization, the new Coast-Garibaldi Health
Unit was established, with headquarters at Powell River. The new unit consists of
the former Gibsons-Howe Sound service and part of the Upper Island Health Unit.
There were no other major organizational changes during the year.
The following list shows the various parts (divisions, offices, clinics, etc.) of
the Health Branch with their locations and the approximate numbers of persons
employed at the end of the year:—
Health Branch headquarters (Victoria), Legislative Buildings,
Victoria     39
Health Branch office (Vancouver), 828 West 10th Avenue,
Vancouver     3 3
Division of Vital Statistics—
Headquarters and Victoria office, Legislative Buildings,
Victoria     62
Vancouver office, 828 West 10th Avenue, Vancouver 16
Division of Tuberculosis Control—
Headquarters, 2647 Willow Street, Vancouver     13
.   Willow Chest Centre, 2647 Willow Street, Vancouver..... 111
Pearson Hospital, 700 West 57th Avenue, Vancouver— 151
Poliomyelitis Pavilion, 700 West 57th Avenue, Vancouver 53
Pearson Infirmary, 700 West 57th Avenue, Vancouver _    11
 ADMINISTRATION
Division of Tuberculosis Control—Continued
Marpole Infirmary, Hudson and Marine Drive, Vancou-
Victoria and Island Chest Clinic, 1902 Fort Street, Vic-
New Westminster Stationary Clinic, Sixth and Cameron,
New Westminster-	
Travelling Clinics, 2647 Willow Street, Vancouver	
Survey programme, 2647 Willow Street, Vancouver	
Division of Laboratories—
Headquarters and Vancouver Laboratory,  828 West
10th Avenue, Vancouver.	
Nelson Branch Laboratory, Kootenay Lake General
Hospital	
Victoria Branch Laboratory, Royal Jubilee Hospital1	
Division of Venereal Disease Control—
Headquarters and Vancouver clinic, 828 West 10th Avenue, Vancouver	
Victoria clinic	
New Westminster clinic .»	
Local Public Health Services (health units)—
East Kootenay, Cranbrook 	
Selkirk, Nelson _   	
West Kootenay, Trail	
North Okanagan, Vernon. 	
South Okanagan, Kelowna   _
South Central, Kamloops	
Upper Fraser Valley, Chilliwack 1^ *^
North Fraser, Mission- 	
Boundary, Cloverdalc
Simon Fraser, New Westminster	
Coast-Garibaldi, Powell River__ ^Z_," '     ■"'   .
Central Vancouver Island, Nanaimo—
Upper Island, Courtenay  	
Cariboo, Williams Lake._	
Skeena, Prince Rupert	
Peace River, Dawson Creek 	
Northern Interior, Prince George	
 "I
'UBLIC HEALTH SERVICES REPORT, 1964
The total number, 1,105, was 84 more than that reported at the end of 1963.
Most of the increase was due to the transfer of the employees of the Provincial
Infirmaries from the British Columbia Hospital Insurance Service to the Health 1
Branch. (Offsetting this to some extent was a drop in the number of employees I
required for the care of tuberculosis patients at Pearson Hospital.) There _
also part-time employees in many of the places listed. These totalled the equivalent
of approximately 65 full-time employees.
The greatest staff problem was the recruiting and retaining of qualified physicians to serve as health unit directors in local health services. Throughout the year
there was an average of three vacancies among the 22 positions.
Although it was possible to fill most of the public health nursing positions, this
group presents other staffing difficulties. The turnover is higher than it should be,
and the positions could be kept filled only by employing some nurses not trained in
public health. The subsequent training of these nurses, as usual, produced its owr
problems of transfers and temporary replacements.
TRAINING
mpleted postgraduate training I
a diploma or master's degree
in one of the public health specialties.   Funds from National Health Grants v
used to help defray the costs, and, in accordance with long-standing policy, the I
trainees were required to sign agreements to serve with the Health Branch for
specified periods following completion of training.
The types of training, universities or other training centres (in parenthese
and numbers trained were as follows:—
Completed training—
Diploma in Public Health Nursing (British Columbia, 6; McGill,
2;  Western Ontario, 1)        9
Nursing Administration and Supervision (Toronto)    2
Diploma in Public Health (Toronto)  ....    3
Master of Public Health—Statistics (Minnesota) ...    1
Commenced training—
Diploma in Public Health Nursing (British Columbia, 11; McGill, 1; Western Ontario, 1)  ..... 13
Nursing Supervision and Administration (Toronto)     1
Master of Public Health Nursing (Pittsburgh)          1
Diploma in Public Health (Toronto)  _..   2
In addition, it was again possible to provide some members of the Health
Branch staff with relatively short-term training. National Health Grants helped t<
defray these costs also.   The courses and numbers attending were as follows:— I
Public Health Administration (University of California).       1
Public Health Refresher Course (University of TorontcO'il-J ._    1
Workshop on Fluorescent Antibody Techniques (Washington State
Department of Health, Seattle, Wash.)....      1
Research Conference in Pulmonary Diseases (Veterans' Administration—Armed Forces, Cincinnati, Ohio) ___uj;_.    1
Air Pollution Courses (Robert A. Taft Sanitary Engineering Centre,
Cincinnati, Ohio)     1
School Guidance and Counselling Services (University of Victoria)    1
Biostatistics and Statistical Methods in Epidemiology (University of
North Carolina)     1
 ADMINISTRATION Q 19
Problems of the School Age Child (University of Washington)    2
Special Instruction in Virology (Laboratory of Hygiene, Ottawa)     1
Special Instruction in Computer Programming  (Biology Branch,
Atomic Energy of Canada, Chalk River, Ont.)     1
Psychiatric Nursing (Provincial Mental Hospital)  10
The Public Health Institute was again held at the University of British Columbia in May. This provided training for the field staff of the Health Branch. In
I addition to speakers drawn from the Health Branch staff and the University of
I British Columbia, there were two guest speakers—Dr. F. Burns Roth, Professor
I and Head of the Department of Hospital Administration, University of Toronto,
| and Dr. H. B. Newcombe, Head of the Biology Branch, Atomic Energy of Canada
[ Limited, Chalk River, Ont.
ACCOMMODATIONS
For some time there has been a pressing need for more offices and stockroom
space for the Health Branch services housed in the Legislative Buildings in Victoria.
[ During the year, many discussions were held with the Deputy Minister of Public
[  Works and his staff, who made great efforts to improve the situation.   At the end
of the year, it appeared that a reasonable, although not ideal, solution had been
[ found.   Through the Department of Public Works, rented space was provided in
1   the " Mc & Mc Building " on Government Street.   By the end of December the
I necessary renovations were well advanced, and it was anticipated that the Health
Branch's central stockroom and the Division of Vital Statistics' records stored at
the vault on Topaz Avenue would be transferred to the new accommodations early
in February.   The Department of Public Works also indicated that in all probability an old house on Superior Street would be made available to the Health
Branch.   It was planned to place the Division of Public Health Education, including the Health Branch library, in this house as soon as certain modest renovations
could be made.   The space vacated by the stockroom and the Division of Public
Health Education will now be converted into much-needed offices.
The advantages of these changes were felt to be the provision of additional
space, the provision of improved working conditions for some employees who had
been occupying substandard offices, and the consolidation of some services which
had been scattered. The obvious disadvantage seemed to be the physical separation of two services (the stockroom and the Division of Public Health Education)
from the Health Branch's central group of offices in the Legislative Buildings.
ACCIDENT PREVENTION
Since 1962 the Provincial Government has conducted an accident-prevention
programme in which the principal officer has been the Co-ordinator of Accident
Prevention, a member of the staff of the Civil Service Commission. Within the
Health Branch, the co-ordination of the programme has been the responsibility of
the Director of Administration. Since July, 1963, " 12-month rolling averages "
have been calculated for the disabling-injury frequency rate per million man-hours.
During the period July, 1963, to February, 1964, the Health Branch's record improved steadily. After a short period with no change, the rate rose slightly and
remained almost constant from May to October, 1964, when it stood at 8.6 disabling
injuries per million man-hours, as compared with a rate of 21.7 for the Provincial
Government service as a whole. In the Health Branch, great emphasis has been
placed upon creating an " accident awareness " in all employees. An important
factor has been the insistence on a formal discussion between the injured employee
 q 20 PUBLIC HEALTH SERVICES REPORT, 1964
and the supervisor to determine the cause of each accident and to suggest ways of j
preventing recurrences.   In the Division of Tuberculosis Control, where most of the 1
accidents in the Health Branch occur, an accident-prevention committee was established under the chairmanship of the Assistant Administrator.   This committee,  j
through its regular formal meetings, instituted other measures which have apparently
done much to improve the situation.
Notwithstanding these efforts, it has proven very difficult to reduce the number   ;
of accidents below two or three each month.    Although these are fortunately
generally minor in nature, they cause the rate to be 8 to 10 disabling injuries per
million man-hours.
During the year the Health Branch purchased several sets of slides dealing with
seemg-habis in driving. Plans were made to use these in improving the driving
habits of the staff of Local Health Services, in which there are some 330 employees
who drive cars. The Motor-vehicle Branch indicated a willingness to participate
by helping with the driving instruction of newcomers to the Local Health Services
staff throughout the Province. It is hoped that the programme will be started early
in the new year.
RECIPROCAL AGREEMENTS (TUBERCULOSIS)
The agreements with Alberta, Manitoba, and Ontario continued at $10 per
diem and with Saskatchewan and Quebec at $8 per diem.
For varying lengths of time during the year (December 1, 1963, to November
30, 1964), nine British Columbia cases were hospitalized in other Provinces.   The
distribution Was as follows:  Total for Accounts
Alberta   ^ br      ,*t.........»_jant-    6 $6,810
Saskatchewan  	
Manitoba _....                                 1 1,280
Ontario    4% .._ kr-.. 2 1,440
Totals 9 $9,530
The number from other Provinces who r
during the same 12-month period totalled nit
follows:—
Quebec
 -         _      2
2,110
2,380
3,208
Totals     9 $10,858
It is noted that the total amount paid out by British Columbia was almost
offset by the total amount received.
 VITAL STATISTICS
REPORT OF THE DIVISION OF VITAL STATISTICS
The responsibilities of the Division of Vital Statistics fall into two broad
I categories—one relating to the operation of the civil registration system, the other
[ to the provision of a centralized biostatistical service to the Health Branch, the
Mental Health Services Branch, and to other health agencies. Included in the
I former is the administration of the Vital Statistics Act, the Marriage Act, the Change
\ of Name Act, and certain sections of the Wills Act.
REGISTRATION SERVICES
Administration of the Vital Statistics Act
The major part of the Division's administrative duties stem from the Vital
Statistics Act. This Act prescribes the registration requirements for all births, stillbirths, marriages, deaths, adoptions, and divorces that take place within the Province and regulates the issuance of certificates and other forms of certifications from
the registrations which are filed. The Act also controls the circumstances under
which registrations may be amended to reflect adoption, legitimation, or changes
of given name, or to rectify errors or omissions on registrations.
The registration of vital events proceeded in a very satisfactory manner during
1964, with no serious problems being evident. Compliance of the public with registration requirements was excellent, there being only a small number of delinquent
registrations outstanding at the end of the year. The majority of these related to
illegitimate births in situations where the local registrars had been unsuccessful in
tracing the mother.
The Division has continued to enjoy outstanding co-operation from the hospitals of the Province in matters relating to vital statistics registration. Hospitals
have been prompt in submitting the monthly returns of birth required by the Vital
Statistics Act, and most hospitals have agreed to distribute blank birth registration
forms and instructions to the mothers of newborn infants during their hospital stay.
Likewise, hospitals, have rendered valuable assistance in the completion of the nonmedical items on the Physician's Notice of Live Birth or Stillbirth and in ensuring
the prompt dispatch of these notices to the local District Registrars of Births,
Deaths, and Marriages.
During the year a revision of the Physician's Notice of Live Birth or Stillbirth
was undertaken, and the revised form will come into use on January 1, 1965. This
is the first major revision of the form since 1951, when the several items of medical
significance were first incorporated into it. Since that date these notices have constituted a valuable source of statistical data for use in connection with analyses of
births, stillbirths, infant deaths, and congenital malformations. The revised form
incorporates a number of improvements which have been recommended by physicians specializing in child and maternal care.
Administration of the Marriage Act
The Marriage Act prescribes the legal requirements which must be observed
in connection with the solemnization of marriage, the legal qualifications of individuals to marry, and the authorization of ministers and clergymen and of Marriage
Commissioners to perform the marriage ceremony. Under this Act the Division of
Vital Statistics is required to license ministers and clergymen of established religious
 q 22 PUBLIC HEALTH SERVICES REPORT, 1964
denominations who desire the authority to solemnize marriage. It is also the ]
responsibility of the Division to appoint Issuers of Marriage Licences throughout j
the Province and to supervise their work.
As at December 31, 1964, there were 171 Civil Marriage Commissioners in j
the Province and 41 persons authorized to issue marriage licences. There were also
2,222 ministers and clergymen, representing 139 autonomous religious bodies,
authorized to solemnize marriage in the Province. During the year, 246 clergymen
were vested with the authority to solemnize marriage, while 254 licences were cancelled due to transfer out of the Province or due to death. In addition, 56 temporary
licences were issued to non-resident clergymen who were ministering in the Province
for brief periods only. There were two new religious denominations registered
under the Marriage Act during the year.
Administration of the Change of Name Act
The Change of Name Act provides a means whereby persons may change either
their given names or their surnames upon meeting certain requirements set forth in
the Act. The Act expressly forbids any changes of name which are not made in
accordance with its provisions, although it exempts changes of name resulting from
marriage, adoption, or legitimation, or changes in the given name of a child made
under the Vital Statistics Act and prior to the child's 12th birthday.
Five hundred and twenty-one legal changes of name were granted during 1964,
this being the largest number in any one year since the Change of Name Act was
enacted in 1940.
Certification of Particulars of Adopted Children
For many years a very unsatisfactory situation has existed for children adopted
in this Province but who were born in certain other countries in which the registration practices will not permit the issuance of a birth certificate in the adopted
name. This Division has frequently been urged to issue a birth certificate based
on the adoption record, in spite of the fact that the child was not born in this
Province. However, this suggestion is quite unacceptable since it is a widely recognized principle of vital statistics registration that certificates should be issued only
by the Province or country in which the birth occurred. Unfortunately the policy
adhered to by the countries in question has forced many persons into the embarrassing position of having to reveal their adopted status in order to explain their
inability to produce a birth certificate in their present name.
This problem was further discussed with the Deputy Attorney-General and
the Superintendent of Child Welfare, and it was agreed that some relief might be
afforded to a person in this predicament if he could be issued with a simple statement
showing his name by adoption, his date of birth and place of birth, and certifying
that such information is on record in the files of this Division. A form of statement
was therefore drafted for this purpose and placed into use during 1964. Before
such a statement is issued, the Division must be in receipt of an official copy of
the Court Order of Adoption and the copy of the original birth certificate which
formed part of the documentation presented to the Court in connection with the
adoption proceedings, and these two documents are permanently retained in the
files of the Division.
While a statement as outlined above is clearly of lesser value than an official
birth certificate, and is likely unacceptable for certain purposes, it nevertheless
 VITAL STATISTICS Q 23
appears to meet many of the less formal requirements for evidence of date of birth
and place of birth.
Registry of Wills Notices
The Division maintains, under the Wills Act, a Registry of Wills Notices. This
registry makes it possible for a testator to file with the Division a notice stating
that he has executed a will and stating the location where the will is deposited.
The filing of a notice respecting a will is not mandatory, but this action is available
to all persons who wish to ensure that information which will lead to the discovery
of their wills will be readily available upon their deaths. The Courts require that a
search be made of the wills notices on file in this registry before they will proceed
with an application for probate of a will.
For the second year in succession, the number of new notices filed exceeded
11,000. At the end of 1964 there were over 100,000 wills notices on file with the
Division.
Volume of Registrations and Certifications
The volume of registrations received in 1964 was approximately 2 per cent
higher than that for 1963, while the volume of certifications issued was greater by
1 per cent. Revenue collected by the central office increased by approximately 3
per cent. Preliminary counts of the more important registration services rendered
by the Division in 1964 are as follows:—
Registrations accepted—
Birth registrations ___   37,430
Death registrations     16,054
Marriage registrations J  jJBfi 12,307
Stillbirth registrations 484
Adoption orders        1,689
Divorce orders "P* -___!    1,636
Delayed registrations of birth         408
Wills notices   I 11,475
       81,483
Legal change of name   521
Legitimations of birth  163
Alterations of given name __._____a____.L_  228
Certificates issued—
Birth certificates  54,130
Death certificates         8,394
Marriage certificates     5,642
Baptismal certificates   8
Change of name certificates        723
Divorce certificates          312
Photographic copies of registrations  11,591
      80,801
Searches of wills notices  _____        8,361
Non-revenue searches for Government departments       10,299
Central office revenue  $102,551
 1
q 24 PUBLIC HEALTH SERVICES REPORT, 1964
STATISTICAL RESPONSIBILITIES
The statistical activities of the Division are directed toward the production I
of a wide range of demographic statistics based upon the birth, death, and marriage j
registrations filed in the Province, the production of several series of morbidity 1
statistics, and the production of administrative statistics relating to the programmes
of the Health Branch, the Mental Health Services Branch, and other Government- ]
supported health agencies. These activities include the processing of original rec- j
ords using mechanical tabulation equipment, the drafting of statistical tables and
reports, and the application of statistical methods in analysing the resultant data,  j
The Division is committed to a number of large-scale statistical undertakings
which involve the preparation of extensive series of statistics on a continuing basis
for the Division of Tuberculosis Control, the Division of Venereal Disease Control,
the Division of Public Health Dentistry, the Division of Public Health Nursing, the
Registry for Handicapped Children and Adults, the Mental Health Services Branch,  !
the B.C. Government Employees Medical Services, the cytology service of the  ]
Vancouver General Hospital, the British Columbia Cancer Institute, and the G. F.   ;
Strong Rehabilitation Centre.   The details of these statistical programmes have
been outlined in previous Annual Reports, and although they constituted a major
part of the statistical work of the Division during 1964, they will not be commented
upon in this report except where new developments or unusual features warrant
In addition to the foregoing, the Division carries out a number of
utine assignments for various divisions and agencies.
H|p
 VITAL STATISTICS Q 25
Much of the statistical data compiled appears in the annual reports of the
I divisions and agencies mentioned above.   The demographic statistics in the Province are published annually in a separate volume entitled " Vital Statistics for the
Province of British Columbia."   A series of vital statistics special reports is main-
I tained to serve as a medium for releasing statistical data relating to special studies
or projects which would not otherwise appear in print.
Cancer Statistics
The notification system for the reporting of new cases of malignant neoplasms
[ has been the responsibility of the Division for many years, and during this time
[ the Division has solicited the co-operation of private physicians, hospitals, and
I treatment clinics in reporting all malignancies in an effort to obtain reliable statistics
I on the incidence of this group of diseases.   However, only limited success has been
I achieved in obtaining reports on cases as they are diagnosed, with the result that
a large proportion of cases of cancer have not become known to the Division until
they have been located upon a scrutiny of death registration.   Early in the year,
with the co-operation of the British Columbia Division of the Canadian Medical
Association and the British Columbia Hospitals Association, a special effort was
\   made to encourage all hospitals in the Province to submit reports on newly diagnosed
cases admitted to hospitals or diagnosed during hospital stay.   While it is too early
to assess the degree of success which has attended these efforts, the preliminary
i   results are encouraging.   By the end of the year over 1,800 new malignancies had
;   been reported directly from the hospitals throughout the Province.
Dental Health Statistics
During 1964 another in the series of community dental health surveys was
completed in the northern part of the Province, and the examination reports processed by the Division.
The analysis of data stemming from clinical dental examinations of two groups
of children participating in a study designed to evaluate the caries-inhibiting effect
of topical application of a fluoride phosphate solution was commenced during the
year. The results of the subsequent statistical analysis will be available early in
1965.
The Division also collaborated with the Division of Preventive Dentistry in
another study involving the effects of a fluoride phosphate solution in a programme
of supervised tooth-brushing. The results of the first phase of this study have been
compiled, and the material will shortly be published in a dental journal.
Two other technical articles were prepared jointly by the Division of Preventive
Dentistry and the Division of Vital Statistics and published during 1964 in the
journal of the Canadian Dental Association. These articles were " Relationships
between Gingivitis and Other Dental Conditions " and " Indices Reflecting Demand
for Dental Services in British Columbia, 1962."
Tuberculosis Statistics
The magnitude of the tuberculin-testing programme being carried out under
" Operation Doorstep " has resulted in a heavy demand for tabulating service on
the Mechanical Tabulation Section of the Division. During the year over 200,000
tuberculin-testing punch-card records were processed on the tabulating equipment,
making this one of the most massive assignments handled by the Division.   In addi-
 q 26 PUBLIC HEALTH SERVICES REPORT, 1964
tion to the statistical tables which were compiled from these punch-cards, alphabeti- ]
cal lists of all persons tested were tabulated for use in the follow-up programme.
In addition, special tabulations on tuberculin tests carried out in earlier years were  j
undertaken for research purposes.
A diagnostic index of all known cases of significant non-tuberculous chest ,
conditions was prepared from the punch-card files for use in the Division of Tuber- ]
culosis Control. This index, which supplements the annual alphabetic and numeric j
indexes of all tuberculous and non-tuberculous cases known to the Division of
Tuberculosis Control, provides a ready reference to the medical-history files of
cases in specified diagnostic categories when these are required for special investiga- j
tion or review.   This diagnostic index will be updated periodically.
Juvenile Delinquency Statistics
During the year the first tabulations were prepared from the juvenile delinquency report forms which are processed by this Division. These reports are
completed by Court officials throughout the Province respecting each juvenile
delinquency case tried and are then submitted to the Attorney-General's Department. Certain items of information are coded in that Department prior to the forms .
being forwarded to the Division of Vital Statistics.
Sanitary Inspection Statistics
During the year, assistance was given to the consultant sanitary inspector in
developing procedures for obtaining statistics on the services carried out by the
sanitary inspectors and on the distribution of time devoted to performing these
services. Forms were developed and used on a trial basis in certain areas before
being issued to all Provincial health units.
Registry for Handicapped Children and Adults
The Division of Vital Statistics has a major responsibility u
the Registry for Handicapped Children and Adults. A senior research officer of
the Division acts as administrator to the Registry, while a second research officer
devotes considerable time to the statistical aspects of the Registry. The mechanical
processing of the statistical data stemming from the Registry and the preparation
of the annual statistical report is carried out by the Division. Administratively, the
Registry is under the supervision of the Director of the Division of Registry and
Rehabilitation, and a more detailed account of the Registry operation during 1964
appears in the report of that Division.
Mental Health Statistics
The Division co-operated with the Mental Health Services Branch in a detailed
follow-up study of one month's admissions to Crease Clinic. Based on the information obtained in this study, a more comprehensive statistical summary record of
each case was developed for use commencing April 1, 1965. This augmented
statistical record will be processed by the Division of Vital Statistics in place of the
more limited admission report which has been in use for many years. The significant feature of the new record is that it will make available for statistical analysis
additional information respecting symptoms
 VITAL STATISTICS Q 27
Cytology Statistics
The processing of the case reports of the cytology laboratory at the British
I Columbia Cancer Institute has become a major undertaking for the Division in view
I of the large numbers of women who are taking advantage of the cytological method
I of screening for cancer of the cervix uteri.   Over 160,000 records from this programme were handled during the year.
In addition to the annual statistical tabulations prepared for the cytology
I laboratory, the Division collaborated with the medical staff in preparing special
I statistical analyses relating to a general evaluation of the screening programme and
I its impact upon the incidence of cervical cancer in British Columbia. Estimates of
I the average duration of the pre-invasive period in cervical cancer and of the percentage of pre-invasive cases that progressed to the invasive stage were made from
[ the statistical material at hand. British Columbia is one of the few areas in the
[ world which has accumulated sufficient statistical data for analyses of this type.
Other Projects
Questionnaires from a survey of smoking habits and attitudes amongst 8,000
school-children in the South Okanagan Health Unit were mechanically processed
I by the Division during the year.   Tables were prepared from the data and provided
E to the director of the health unit.
The records of a survey to determine the optimum dosage of gamma globulin
; for the prophylaxis of infectious hepatitis were also processed on punch-cards and
[  statistical tables provided to the Director of Epidemiology.
Plans were made for the Division to co-operate with the Faculty of Medicine
of the University of British Columbia in a research study relating to deaths involving
a diagnosis of emphysema. All such deaths occurring during 1965 will be investigated, and, with the concurrence of the British Columbia Division of the Canadian
Medical Association, copies of the death registrations will be made available to the
research team. Two other Provinces are participating in this study by providing
copies of the relevant death registrations from their Provinces. The Division will
assist in the coding aspects of this research project.
During the year there appeared to be an increasing concern respecting the relatively high incidence of illegitimate births. In dealing with these inquiries, the
desirability of differentiating between illegitimate births to unmarried mothers and
illegitimate births to married mothers became apparent. Heretofore it has not been
possible to identify all illegitimate births to married women, but changes in registration procedure brought about by the new Vital Statistics Act now make this
possible. Accordingly, modifications were made in the coding and punching procedures to accommodate this refinement in the data.
Assistance was given to the Division of Public Health Education in connection
with two studies undertaken by that Division—namely, a study of attitudes toward
dental health practices among adults and a survey of health knowledge among
school-children.   For both studies, punch-cards were used to analyse the resultant
The Division continued to carry out the medical coding of all illnesses and
disabilities reported on the medical examination of driver reports of the Motor-
vehicle Branch. During 1964 the first group of punch-cards containing this
information became available from the Motor-vehicle Branch, and these were
tabulated within the Division to provide statistical information for the Director of
Epidemiology.
 Q 28 PUBLIC HEALTH SERVICES REPORT, 1964
In addition to the activities mentioned above, the Division continued to carry
out a number of other routine assignments in the statistical field. These included I
the maintenance of the Province-wide notifiable-disease reporting system, the main- I
tenance of the register of cases on the rheumatic fever prophylaxis programme, and I
the processing of the records of the obstetrical discharge study and the study relat- 1
ing to the neurological development of the newborn infant. The latter two studies I
are under the direction of the Faculty of Medicine of the University of British ]
Columbia. The Division also provided a wide range of consultant service to other 1
divisions and to research workers in the medical field.
 EDUCATION
REPORT OF THE DIVISION OF PUBLIC HEALTH
EDUCATION
At the close of the year, the Division was staffed by the Director, a consultant
I who is a specialist in in-service education of the field staff, a consultant in school
I health education, and a public health education assistant who is concerned prim-
I arily with photography and the preparation of audio-visual aids and written material.
I Clerical and stockroom personnel are employed in the operation of the Health
I Branch library and the facilities required for the ordering, stocking, and distribu-
i tion of educational aids.
The health educator for the Greater Vancouver Metropolitan Health Service,
Mr. Alex Buller, completed his postgraduate training in public health at the Uni-
I versity of California during the summer. At present the health education position
[ for the Greater Victoria Metropolitan Board of Health remains vacant.
SCHOOL HEALTH EDUCATION
The consultant in school health education continued to work in the three areas
| of, first, school health curriculum, in co-operation with the Department of Educa-
[ tion; second, the provision of consultant services to personnel in the field, both
public health and school; and, third, teacher-training, in co-operation with both the
I University of British Columbia and the University of Victoria.   In this latter regard,
I discussions initiated in November of 1963 with the British Columbia Division of
I the Canadian Medical Association, which has had a joint interest in the teaching of
health in the schools, have resulted in the establishment of a sub-committee of the
Medical Education Committee of the British Columbia Division.   It was agreed
with the British Columbia Division that in defining areas of responsibility the association will concentrate on advising and assisting the teacher-training institutions
|  with respect to the training of student teachers in the matter of health.   The prime
■  responsibility for liaison with the Department of Education in the development of
' health curricula rests with the Health Branch, through the consultant in school
health education.   In this connection, two teaching units were prepared during .the
j year for the Department of Education, one of which on posture is now being tried
out on an experimental basis in two schools.   A similar unit on venereal disease,
suitable for the Grade X level, has been under discussion with one School Board
| with the view to trying it out on an experimental basis, with the ultimate objective of
|  incorporating it, together with the posture unit and similar units whi^h have been
' d out on an experimental basis, into a revised health curriculum which the
Department of Education is proposing to develop within the near future.
Frequent consultations were made at the request of the field staff during the
year, particularly in the area of sex education and venereal-disease education.' In
addition, two studies were carried out in the field—one in the Boundary Health
Unit relating to a health-knowledge test directed at the Grade X level; the second,
conducted in the Upper Island Health Unit, centred on an analysis of the extent to
which teachers felt selected health pamphlets were of use to them in the classroom.
SMOKING AND HEALTH
As a result of the Federal-Provincial Conference_on Smoking and Health held
in Ottawa in November of 1963, two technical advisory committees were established
to advise the Federal Government on research and educational measures that might
 Q 30
PUBLIC HEALTH SERVICES REPORT, 1964
be undertaken on a nation-w.de basis.   The Director was appointed to the Com-1
mittee on Health Education and attended two meetings in Ottawa during the year,
at which time priorities were established and measures undertaken to develop a I
co-ordinated educational programme on a national basis. In this Province a measure I
of co-ordination had been achieved as the result of a meeting to which representa- f
tives of voluntary health agencies, the British Columbia Division of the Canadian
Medical Association, and the Non-smokers' Association of Canada were invited ir
order to determine the role that each agency not only was playing, but also could ]
play, in educating groups with respect to the hazards of cigarette smoking.   Since 1
that meeting in April, approaches have been made to other Provincial bodies, such 1
as the Pharmaceutical Association, Registered Nurses' Association, the British ]
Columbia Teachers' Federation, and other health and education groups, with a
view to exploring their respective roles within a comprehensive programme of I
health education regarding the hazards of smoking.   Copies of the information kit I
containing materials selected and reprinted by the Department of National Health I
and Welfare, together with teaching guides prepared by this Division specifically I
for use in Grades V, VIII, and X, were issued to schools throughout the Province |
at the commencement of the academic year.
AUDIO-VISUAL AIDS AND WRITTEN MATERIALS
Of the 64 films and filmstrips previewed during the year 10 films and 3 strips ]
were added as new titles to the Division's visual-education library.   An additional |
38 prints of existing films and 4 of filmstrips were purchased in order to meet the
increased demand on the library's facilities.   During the year confirmed film bookings increased by 13 per cent over those for 1963.
A considerable number of colour
transparencies and black-and-white j
photographs were taken throughout
the year.   While these were taken I
primarily to enlarge the library of I
visual  materials  operated  by  the
Division for health unit displays,   I
many were taken specifically for an
exhibit on the subject of venereal disease prepared by the Health Branch
for showing at the British Columbia
Medical  Association's  motherhood
display at the Pacific National Exhibition in Vancouver.    In addition,
colour transparencies were prepared
to replace existing black-and-white
photographs at the year-round Departmental exhibit at the Pacific National Exhibition.
 PUBLIC HEALTH EDUCATION Q 31
I One poster for use in the venereal-disease control programme was completed
Iby the end of the year, and another was under preparation. Both are directed at
Ehe high-risk groups.
IN-SERVICE EDUCATION
I In January some 70 public health inspectors, including representatives from
Ithe Greater Vancouver and Greater Victoria health departments, attended an
[intensive one-week training session designed to acquaint them with new concepts
lin the fields of sewage disposal, air pollution, occupational health, and common-
Icarrier inspection. The Division provided considerable assistance to the Sanitation
IService in both the planning and organization of this course.
For the second consecutive year the Annual Public Health Institute was held
Ion the campus of the University of British Columbia in Vancouver, utilizing on-
Icampus residences for the housing of the staff and classrooms for both general and
[sectional meetings. This year'two guest speakers from outside the Province were
(invited to participate. The first of these was Dr. F. Burns Roth, Professor and
[Head of the Department of Hospital Administration at the School of Hygiene,
j University of Toronto, who in two talks discussed principles of administration and
[the need for co-ordination of health resources within the community. The second
[speaker was Dr. H. B. Newcombe, Head of the Biology Branch at the plant of
[Atomic Energy of Canada Limited at Chalk River, who reviewed the relationship
between genetics and public health practice. The balance of the four-day pro-
[ gramme consisted of speakers drawn largely from Health Branch staff and the
i University of British Columbia.
SURVEYS AND RESEARCH
It was mentioned in the report for 1963 that a methodology was being designed
for the collection and analysis of base-line data on public health knowledge, attitudes, and habits with respect to commonly recommended health practices. At the
conclusion of 1963 such a methodology was developed as an instrument which
could be used in any part of the Province to collect information on various sets of
health practices—child rearing, nutrition, dental, etc.
During the first three months of 1964, residents of the Trail area of the West
Kootenay Health Unit were interviewed to determine their knowledge, attitudes, and
habits with respect to four dental health practices as they apply primarily to children
—namely, oral hygiene, dietary practices, visits to a dentist, and use of fluorides
(water, supplements, and topical application). From tabulations prepared, appraisal of the data collected has revealed to the health unit the level of knowledge,
attitudes, and habits that actually exist within a community and whether or not they
are as recommended by the health unit staff. Further analysis of the data has also
indicated to the health unit staff specific areas of dental health practice, or groups
of persons in the community, in which education emphasis appears to be necessary.
 PUBLIC HEALTH SERVICES REPORT, 1
REPORT OF THE ACCOUNTING DIVISION
For the Period April 1, 1963, to March 31, 1964
A gross amount of $8,841,972 was spent on public health services by the ■
Health Branch during the fiscal year 1963/64.
To provide the many services, such as administration, nursing, public health
engineering, sanitation, and other health services, required a staff of over 1,000
permanent and temporary employees. The total payroll was $5,193,865, or 58.74
per cent of the gross Health Branch expenditure.
Personnel in the course of their duties were required to do a considerable
amount of travelling, which amounted to an expenditure of $341,150. A great deal
of travelling was incurred in the operation of Government and privately owned
vehicles, which travelled 2,443,726 miles.
The tuberculosis institutions of Willow Chest Centre and Pearson Hospital
provided 73,528 patient-days' care during the fiscal year at a per capita per diem
rate of $19.28.
The Poliomyelitis Pavilion situated at the Pearson Hospital provided 11,531
patient-days' care during the fiscal year at a per capita per diem rate of $27.89.
The comparison table of public health services gross expenditure shows an
increase of $642,287 in expenditure between the fiscal years 1962/63 and 1963/64.
Approximately one-third of this increase is due to salary revisions granted Government employees.
The Division of Tuberculosis Control, while reflecting an increased expenditure over the previous fiscal year of 1.4 per cent, nevertheless continues to decline
in percentage of expenditure in relation to the total Health Branch expenditure.
To meet the demands of growing communities, local health services continue
to expand, resulting in an increase in expenditure of 8.7 per cent over the previous
fiscal year.
The group of expenditures headed " Cancer, arthritis, rehabilitation, research,
etc." has increased 12.2 per cent over the fiscal year 1962/63. The increase is due
to greater expenditure in cancer control, professional training, research, and larger
grants to health agencies.
The poliomyelitis section of expenditure has increased $46,925 or 12.3 per
cent. This increase reflects the oral and Salk vaccine campaign carried out during
the fiscal year.
The balance of services shown in the comparison table reflects increased
expenditures, largely due to salary increases granted employees during the fiscal
Comparison Table of Public Health Services Gross Expenditure
for the Fiscal Years 1961/62 to 1963/64
Gross Expenditure
Vt°SSSS^T
196J/62   |   1962/63
1963/6*
1961/62
,962/63!
1963/64
Division of Tuberculosis Control
1 12 031829
ii
n
I
23 3
l
as
SStSSSSS^^
DMsioS of WtSauito	
 LOCAL HEALTH SERVICES
REPORT OF THE BUREAU OF LOCAL HEALTH SERVICES
In order to provide knowledgeable support and consultation to local health
I services in the field, those personnel in central office who tend to be specialists in
I a given area of public health must keep themselves informed of the activities of their
I colleagues and of the Bureau as a whole. For this reason the Bureau report is
I presented as a whole, summarizing the work of the Divisions of Public Health
I Nursing, Preventive Dentistry, Epidemiology, Public Health Engineering, and the
I Nutrition Service.
Each year one particular aspect of the activities of the Bureau is highlighted;
I this year it is the turn of the sanitation services.
SANITATION PROGRAMME
The public health inspectors as members of the public health team are located
in the 18 health units throughout the Province, being responsible directly to the
I Medical Health Officer for the implementation of the sanitation programme. The
traditional role of the public health inspector has undergone drastic changes in an
attempt to meet ever-increasing demands within the scope of community health.
The main techniques used in dealing with the public are those of education and
persuasion, with enforcement used only as a last resort.
The following presents a few highlights of the health inspectors' work.
 PUBLIC HEALTH SERVICES REPORT, 1964
SANITAJUPN  SERVICES
#'
..*,«
m.
W/A
* 30
I coi^ftijhjty. he^lff^;t^ey|;
reach   out to   serve
all   the   people of   B.C.
1
 LOCAL HEALTH
Food Sanitation
The food industry is a large one, with almost 15 per cent of the work force in
I British Columbia employed in the production, processing, and distribution of food.
I For this reason alone it is of considerable importance. In the five-year period 1958
to 1963, the tourist income in British Columbia increased by over 40 per cent.   The
I restaurant industry caters to many thousands of tourists a year, with rapid multiplication in the number of eating and drinking places.   Both residents and tourists
[ are quick to notice poor standards, and, in turn, these tend to colour their impressions of | Beautiful British Columbia."    The public depends upon the food
i  industry to serve safe and wholesome food in clean premises, and both look to the
1 public health inspector to see that high standards of sanitation are maintained. This
he does by regular inspection of food premises and by continued education of
food-handlers both on the job and through training courses.   All food-handling
' premises, including bakeries, bottling plants, groceries, butcher-shops, and food-
processing plants, are inspected under the authority of the Health Act and local
by-laws. Up-to-date by-laws to regulate food establishments were recently adopted
by several municipalities in the Lower Fraser Valley.
 q 36 PUBLIC HEALTH SERVICES REPORT, 1964
School Health Programme
Each year the public health inspectors carry out environmental inspections of
the schools within their health unit jurisdiction.   Section 109 of the Public Schools
Act requires, among other duties, that the school Medical Health Officer examine  j
the school buildings and surroundings, and that he submit his recommendations   -j
to the Board of School Trustees.   A copy of the completed report on every school
is forwarded to the Board prior to December so that any necessary expenditures  \
may be included in the budget under preparation.   During 1962/63 four health  ■
units completed evaluation studies of school construction and environment.   The j
purpose of these studies, on which reports were available in 1964, was to determine   :
the effectiveness of the present school inspection programme, to recommend changes   i
in the school building manual, and to consider what further contributions could be . \
made by health unit staff.
Subdivisions
Rapid development within the Province has accelerated land subdivision
beyond areas serviced by sewers and water. In some areas this has created serious
sanitation problems, with unsuitable soil conditions interfering with the adequate
functioning of septic tanks to the extent that correction is costly and on occasion
wells within close proximity have been contaminated. Because of these and other
problems, approving officers now refer all proposed subdivisions to the Medical
Health Officer for approval, with specific reference to provision of safe water and
adequate sewage disposal. The old adage " an ounce of prevention is worth a
pound of cure " will pay dividends to the householder, benefit the municipality,
and help to make British Columbia a healthier place in which to live.
Occupational Health
As an example of activities in this field, public health inspectors carry out
surveys of the carbon monoxide content of air in commercial and Government
garages. Approximately 95 per cent are satisfactory, and in the remaining 5 per
cent action is taken to correct any problem and avoid the danger of carbon monoxide
poisoning. Readings have also been taken in food-packing plants, with particular
attention being paid to the operation of gasoline-operated fork lifts. In co-operation
with the Department of Labour, plant sanitation in other industrial establishments
has been checked, and potential health hazards in the form of dust, vapours, gases,
and mists have been identified. Improved methods of ventilation are necessary to
resolve these problems. The public health inspector is capable of doing a good
job in the field of industrial hygiene and enjoys the advantage of being able to
obtain medical and engineering advice from within the Health Branch as and when
problems of a more technical nature are involved.
Control of Water Supplies
Protection of public and private water supplies is an important day-to-day
function. Routine sampling to determine bacteriological quality is carried out on
all public water systems. Residents served by private supplies in the more rural
parts of the Province are encouraged to seek the advice of the public health inspector
to ensure the safety of their well water.
Swimming-pools
The swimming-pool standards were revised this year to upgrade and "-'"   '■•
their operation with respect to sanitation and safety.   These standards,
 LOCAL HEALTH SERVICES
Q 37
and supplied by the Health Branch, have been favourably received and are in
constant use as a guide by individual operators. Public swimming-pools are inspected regularly during the bathing season to maintain bacteriological standards
and to record chlorine residual, water clarity, and other pertinent information.
Sewage Disposal
Adequate sewage disposal plays an important part in the control of com-
I municable disease. Many problems arise in areas not served by municipal sewerage
I systems due to septic-tank failures occasioned by inadequate maintenance, faulty
I design, or poor soil conditions. Public health inspectors devote considerable time
I to the abatement of such nuisances, to the approving of new installations, and in
* undertaking " sanitary surveys " to assess the extent of a community problem.
> Survey information on sewage-disposal problems has assisted many municipalities
: to obtain public sewerage systems. Saturation of the soil with septic-tank effluent
[ is a common problem in growing suburban areas. Although he is not responsible
[ for the engineering details of design and operation, the public health inspector is
. responsible for the routine inspection of public sewerage systems to ensure that
satisfactory operation is maintained. This aspect of his work is co-ordinated with
that of the consultant engineers from the Division of Public Health Engineering.
In areas under the jurisdiction of the Pollution-control Board an	
with new outfalls, the public health inspector, through his Medical Health Officer,
may be requested by the Board to see that the proposed outfall point has been
 q 38 PUBLIC HEALTH SERVICES REPORT, 1964
posted, to take samples, and to advise as to other uses of the water that might be I
affected by the proposed outfall. Such uses include provision for drinking purposes,
for swimming, or for shellfish propagation. To a great extent the Pollution-control
Board is dependent upon the local Medical Health Officers and their inspectors for
local assistance and knowledge. Due to the network of health units blanketing the
Province, this information can be readily obtained.
Tourist Accommodation
Increased tourism throughout British Columbia has resulted in the mushrooming of tent and trailer camps.   Community planning regulations require approval
by the Medical Health Officer of plans for water and sewage- and garbage-disposal I
facilities. Recommended standards have been prepared by the Health Branch and
are presently used as a guide.   Again it should be recognized that this aspect of the
public health inspector's work will make or mar many a tourist's holiday in British 5
Columbia.
PATTERNS OF DISEASE
Except in the field of VENEREAL DISEASE, British Columbia has been
singularly free of major outbreaks of communicable disease during the year.   There  )
were 5,816 cases of GONORRHOEA reported to the Health Branch this year, and 1
this is the largest number ever recorded in this Province.   It should be appreciated  j
that only a proportion of cases are notified to the local Medical Health Officers, and
for this reason the total number of cases that actually occurred would be far larger.
This gives some idea of the problem facing health authorities.   Infectious SYPHILIS  i
was reported on 304 occasions, which is somewhat less than the increase shown
last year, when 280 cases were notified, but still demonstrates that in spite of
increased efforts to locate and treat the carriers of this disease, no reduction in
over-all incidence has been effected.
One immediate result of this outbreak has been the marked increase in the
work load of many health units in tracing and bringing to treatment all the sexual
contacts of those infected by both gonorrhoea and syphilis. In this regard, visits by
public health nurses totalled 8,413, to represent a 39-per-cent increase over last
year. This has required an increase in staff in one health unit which has had a
particularly heavy work load thrust upon it, while in others staff have had to be
diverted from other duties.
■ After a year of complete freedom from PARALYTIC POLIOMYELITIS,
one severe case occurred this year on Vancouver Island in a non-vaccinated middle-
aged male. This underlines repeated statements that poliomyelitis vaccine will only
protect those who have had an adequate course, and that this disease can still occur
in a community despite the fact that the majority of people in the community are
vacc'nated. During the latter part of the year the oral poliomyelitis vaccine programme was completed, and everyone throughout the Province has now had an
opportunity of receiving three doses of Sabin vaccine. Just under 500,000 people,
or 30 per cent of the total population of the Province, have taken advantage of this
programme, and more than 75 per cent of school-age children have been protected
It has not yet been decided how frequently a reinforcing dose of the vaccine should I
be given, but this will be incorporated into the routine immunization programme of
the Health Branch in the years to come.
For the last few years, small outbreaks of BOTULISM, to result in one or t
fatalities each, have occurred annually along our northern coast. These have resulted I
from the eating of salmon eggs prepared and preserved in the manner peculiar to I
the native Indian population.   This year was no exception, and, despite an intensive  I
  1
PUBLIC HEALTH SERVICES REPORT, 1964
education effort, fish eggs prepared in the traditional manner were again the cause. ]
Fortunately the toxicity of the eggs was discovered early enough to prevent their ■
being used for a feast.
Two years ago a very serious outbreak of DIARRHOEA OF THE NEWBORN
occurred on the east coast of Canada, resulting in many deaths. This condition was
shown to have been caused by an organism called Escherichia coli. Since that time
a very careful watch has been kept of the number and nature of such cases reported
in British Columbia. This year there were 52 cases of this disease diagnosed among
infants, compared with 27 the year before and 19 in 1962. These cases were scattered widely throughout the Province, so that, although the total incidence has risen,
there is no concentration of cases in any one area.
Once again there were no cases of DIPHTHERIA reported in the Province
this year, and the incidence of healthy carriers, recognized from throat swabs taken
at random, has not increased, as is the case in certain of the Prairie Provinces.
The incidence of BACILLARY DYSENTERY, which has caused considerable
concern over the past four or five years, decreased in 1964. There were 131
reported cases of bacillary dysentery, which may be contrasted with 169 in 1963
and 1,192 in 1960. The number of cases of dysentery for which the cause could
not be identified despite intensive laboratory investigation remained at the 300 mark,
where it has stood for the past four years.
Food poisoning due to STAPHYLOCOCCAL intoxication or SALMONELLA
infection was not so prevalent this year. Two hundred and twenty-nine cases were
reported, contrasting with 354 in 1963 and 556 in 1962. The highest number ever
recorded in British Columbia was 724 in 1960.
INFECTIOUS HEPATITIS also appears to be on the wane, as indeed it is
all over North America. In 1962 there were 1,889 cases reported, while last year
the total had dropped to 1,736, and for this year a further reduction to 1,054 is
recorded. It is felt that the reporting of clinical cases of this disease is fairly good
because of the physicians' awareness that it was assuming epidemic proportions, and
because the Health Branch makes free gamma globulin available to family contacts.
At this time a Province-wide study is being carried out to determine the optimum
dose of this relatively scarce and expensive prophylactic.
The Province has been singularly free of ASEPTIC MENINGITIS this year.
Very few of the usual causative organisms, such as the poliomyelitis, ECHO, or
coxsackie viruses, were isolated from the 37 reported cases.
There were 11 cases of MENINGOCOCCAL (SPINAL) MENINGITIS reported, which is approximately the same as in the past few years. Although modern
antibiotic treatment has removed much of the terror from this disease, small outbreaks still occur and call for prompt and energetic action. A recent American
outbreak, for example, has involved several hundred people.
SCARLET FEVER and STREPTOCOCCAL THROAT INFECTIONS wax
and wane over long periods of time. The relatively high incidence of this disease
in 1950, when well over 4,000 cases were reported, has been followed by a steady
decline this year to 969 cases. In the 1920's scarlet fever was a very serious and
often lethal communicable disease. More recently it has become relatively mild,
but one danger remains in that a proportion of children who have this disease go
on to develop rheumatic heart disease and all the complications that can occur from
that condition.
Five cases of TYPHOID FEVER were diagnosed this year, which remains
slightly below the average for the past five years.   Most cases occur due to the
 r
LOCAL HEALTH SERVICES
| presence of healthy carriers who can excrete this organism intermittently for years.
I Few, if any, cases occur now in this country from contaminated milk or water, and
I every year one or two more healthy carriers are located, these people generally being
I quite unaware of their unfortunate ability to spread typhoid fever.
WHOOPING-COUGH was far less prevalent this year, only 180 cases with
I one death being reported, which compares very favourably with an average of 603
| cases for the preceding five years. It is interesting to note that whooping-cough
I still causes some 25 to 30 deaths each year in Canada, generally in infants under
[ the age of 1 year.
The RHEUMATIC FEVER prophylaxis programme introduced in 1958 con-
[ tinues to increase slightly, and the number of children presently carried on the
| programme has reached 1,200.   A careful study of the recurrences while under
prophylaxis shows that the failure rate is approximately 3.7 per cent, which is simi-
l  lar to the rate shown in one of the most carefully controlled programmes on the
<■   continent carried out at the Irvington Clinic in New York City.   As far as possible,
every effort is made to limit the number of children on the programme to only those
who have had a very definite case of rheumatic fever.
Each year in one region of this Province the practising dentists together with
the Division of Preventive Dentistry examine some 1,300 school-children. Results
of these surveys show differences between the DENTAL HEALTH status of
children of different regions of the Province and, over a span of years, in the same
region. Children in the northern health units were examined in 1960 and again
in 1964. In this period a marked improvement in their state of dental health is
apparent. The percentage of children with no defects-—that is, not in need of any
form of dental treatment—has improved twofold. Also doubled is the percentage
of children not in need of treatment for dental decay. The percentages of children
with abnormal gingival conditions (diseases of the gums) and with abnormal
occlusion (incorrect bite) have also significantly decreased. The average caries
attack rate for children of all ages for deciduous and permanent teeth has decreased
from 9.5 to 8.2 teeth per child. It is of interest to note that of all the children
examined in this survey, some 40 per cent resided in communities which have
commenced fluoridation during the past nine years. In these communities the full
benefit of this public health measure on the dental health of these children will not
be demonstrated for another seven or more years.
At the present time, and in spite of the improvements reported above, the
average dental health status of the children of this area and indeed of the whole
Province is a matter of the most grave concern. For example, this survey showed
the average 7-year-old to have 6 of his 20 deciduous teeth attacked by decay, and
for close to 40 per cent of this age-group no adequate treatment of their decayed
deciduous teeth had been provided. This survey also showed the average 15-year-
old to have nearly 12 of his 28 permanent teeth attacked by decay. Of these 12
teeth, 5 had been restored (filled), five had open carious lesions, and 2 had either
been extracted or likely would be extracted. Of these young teen-age children,
17 per cent were noted to have disease of the gums and 35 per cent to have severe
malocclusion to the degree that they were in obvious need of orthodontic treatment.
The tragedy is that today dental research has clearly shown that dental caries, which
is the major oral disease and contributes to gingival disease and malocclusion, is a
controllable, if not entirely preventable, disease. Water fluoridation has been proven
effective and safe. Currently 11 communities in British Columbia benefit by water
fluoridation—approximately 4 per cent of the total population of the Province.
In addition, equipment is under installation at Squamish and Williams Lake.   In
 "1
PUBLIC HEALTH SERVICES REPORT, 1
plebiscites held at the year's end, the following communities voted in favour of
commencing this important public health measure:   Golden, Kimberley, Chapman |
Camp, Marysville, North Kamloops, Port Moody, and Terrace.
Another rather specialized programme is that developed for POISON CONTROL purposes. Approximately 1,000 cases of accidental poisoning were re- 1
ported to the Health Branch, and it is our feeling that this represents about half the I
number of cases that were treated in hospital emergency departments throughout J
the Province during the year. Again aspirin and aspirin compounds were respon- 1
sible for over 30 per cent of the poisonings reported. There were five deaths in j
children under 15 years during 1964. It was interesting to note that three children 1
were poisoned with the insecticide Parathion, two of whom were severely ill, one 1
being comatose for a period of about 18 hours. The source of the pesticide was 1
identified and found to result from the contamination of sheets which were sold to j
a second-hand dealer by an insurance company, whose property they became when 1
they were rejected by a department store due to discoloration. Investigation re- 1
vealed that the sheets were contaminated by a leaking barrel of Parathion, probably ]
while in transit to this Province.
In keeping with the trend which has taken place over the past few years   !
whereby more and more patients with TUBERCULOSIS are being treated at home  j
rather than being admitted to institutions, the public health nurses made 12,333   j
visits to tuberculosis patients and their contacts.   Within the same programme a
total of 21,535 tuberculin tests was done to include the routine testing of Grade II   I
pupils.   It is planned to discontinue routine testing of a selected grade during the   j
coming year because of the low incidence of cases found in most areas. Where the   j
need is demonstrated to exist, such routine testing will be continued.   It should be
recognized that the mass community surveys will continue to be done approximately   j
every five years, and in this way a close surveillance will be maintained of the incidence of tuberculosis throughout the Province.   Health unit staffs assist in the planning, organization, and interpretation of the results of these surveys.
In conjunction with the control of communicable disease in general, a large
number of PROPHYLACTIC INJECTIONS and IMMUNIZATIONS are carried
out each year, and, in addition, the public health nurses are involved in many home
visits. It is interesting to note that some 6,360 injections of gamma globulin were
given to the contacts of cases of infectious hepatitis, while 4,420 home visits were
made within the communicable-disease control programme. Some idea of the staggering amount of work involved in the immunization programme can be obtained
when one considers that a total of 571,634 children and adults received a complete
series to protect them against smallpox and poliomyelitis, while a further 139,000
immunizations were given against other diseases to include typhoid and cholera. On
the other hand, the communicable diseases represent only a small part of the over-all
disease picture, and concern with the chronic diseases becomes ever more apparent
from year to year. Such diseases include diseases of the cardiovascular and central
nervous systems, diabetes, arthritis, cancer, and various blood conditions. Some
42,724 nursing visits were made during the year to provide care to almost 2,000
patients who required nursing as a result of these conditions.
A few years ago in the field of MENTAL HEALTH almost all visits were
related to children, but a gradual change in this picture is now apparent in that
during the year 9,592 visits were made by public health nurses to people exper'encing
some form of mental illness, and of this total 40 per cent concerned adults.
In conclusion it might be added that the Director of the Division of Epidemiology is also a member of various committees concerned with accdent prevention,
 LOCAL HEALTH SERVICES
Q 43
[to include the St. John Ambulance Highway First Aid Station Committee and the
i Traffic Safety Committee of the British Columbia Division of the Canadian Medical
[Association, and is employed as medical consultant to the Motor-vehicle Branch,
I where he is presently involved in a long-term study of the effects of medical deficien-
Icies and driving ability.
Reported Communicable Diseases in British Columbia, 1960—64
(Including Indians)
ADMINISTRATIVE CONSIDERATIONS
It is
iportant to recognize that the staff of the local health units under their
respective health unit directors, although employed as Provincial Civil Servants,
are nonetheless seconded upon appointment to their local municipalities and School
Boards. However, it is important that an over-all standardization of service exist
throughout the Province, and in this regard much of the detail in administration and
personnel management is handled by staff in Central Office, Victoria.
 1
PUBLIC HEALTH SERVICES REPORT, 1964
In keeping with the trend to extend mental health services at
level, Health Branch personnel worked in close co-operation with Mental Health Ser- 1
vices' to extend the existing health centre in Trail as headquarters facilities for the 1
psychiatric team of the Kootenay Mental Health Clinic. Mental health clinics are 1
now in operation in the Okanagan, Vancouver Island, and Kootenay areas, and I
facilities are presently under construction in Prince George for the development of I
similar services to be offered to the Peace River and Northern Interior areas. To j
date it would seem that these clinics are fulfilling their purpose, and although staff j
shortages place a ceiling on the amount of psychiatric consultation, nonetheless by ;
utilizing resource personnel in the community, such as the family physician, public \
health nurse, social welfare worker, Probation Officer, and others, a vastly improved 1
programme of prevention and treatment has been made available at the community 1
Public health nurses have continued to provide services to Indians on certain j
reserves through agreement with the Medical Services Directorate, Department of
National Health and Welfare. During the year a further exchange of service was
arranged in the Lillooet and Lytton districts of the South Central Health Unit so that
each service took on an adjacent population, thus reducing travel time for each
nurse and providing a better service for both the white and Indian populations.
Altogether approximately one-third of the 31,000 Indians living on reserves within
the Province now receive routine public health nursing service from health unit
personnel.
The routine inspection of common carriers, formerly handled by the Engineering Division of the Department of National Health and Welfare, has now been
assumed in part by the staff of the health units, to include the sanitation of railway
yards and buildings, railway mobile work trains, airport ground facilities, B.C. Government ferries, privately operated ferries and dock facilities, In some areas, construction camps and Federal Government buildings are also included Ultimate
legal responsibility for correction remains with Federal authorities.
During the year, responsibility in the milk-sampling programme was transferred
from this Department to the Department of Agriculture. The quality of milk produced in British Columbia over the years has improved, to reach a very high standard, and diseases formerly associated with unpasteurized milk have all but
disappeared.
A time study on the work of the public health inspector was carried out during
the year and is to be repeated in the late spring of 1965. Results to date indicate
the need for a limitation of time spent in indirect service in some areas, and it is
anticipated that this time study will provide a sound base line from which a continuing programme can be developed in the years ahead. In addition, a policy and
procedure manual was developed to acquaint the public health inspectors with the
over-all sanitation programme. New multi-purpose inspection records have been
introduced on a service-wide basis, to replace a multiplicity of forms formerly
printed by health units.
The programme of health centre construction continued with completion of
health centres in West Vancouver, 100 Mile House, Sidney, Cloverdale, and Terrace, while others are under construction or in the planning stage in Rutland, Hope,
Courtenay, Merritt, Alberni, Kamloops, Fruitvale, and Chetwynd. The need to
extend existing health centres has been made apparent in Penticton and Salmon
Arm, while plans are presently being prepared for the extension of the Chilliwack-
Health Centre to house the mental health clinic team.
 LOCAL HEALTH SERVICES Q 45
In certain more remote areas of the Province, physicians are encouraged to
I take up residence in outlying communities where they may provide service on a
periodic schedule of visits to neighbouring communities which are not sufficiently
I large in themselves to support a physician.   Encouragement takes the form of a
I grant-in-aid programme, and 18 physicians are presently in receipt of these grants.
PERSONNEL
The turnover among nursing and clerical staff during the year was approxi-
\ mately as anticipated, but among medical health officers, dental officers, and public
[ health inspectors it was somewhat greater than usual.   Among Central Office staff,
the promotion of the Assistant Director of the Division of Public Health Engineering
|  to head the Division resulted in a vacancy which was filled early in the year.   In
[ April a new position was created to meet the increased demands put upon the
Division, but with the continued increase in the routine work load and with the
additional very heavy demands made by the Pollution-control Board, it has not
been possible within the limits of existing staff to provide adequate consultative
services either to the health unit staffs in the field or in the work of pollution
control.   It is anticipated that certain measures will be taken to relieve the situation
early in the coming year.
During the year three health officers returned, having completed the course
leading to the Diploma in Public Health at the University of Toronto, to take up
positions as health unit directors in the Northern Interior and Peace River Health
Units and in the new Coast-Garibaldi Health Unit with main office in Powell River.
Two other physicians proceeded on course to obtain the Diploma in Public Health
with the assistance of National Health Grants, and, in addition, three physicians
were recruited to fill vacancies with the West Kootenay, Cariboo, and Boundary
Health Units. Changes in the employment of physicians occurred in the Saanich
and South Vancouver Island Health Unit and in the Cariboo, Central Vancouver
Island, West Kootenay, Selkirk, North Okanagan, and Skeena Health Units. As
mentioned above, continuing vacancies in the position of health unit director existed
in four health units at the year's end.
The resignation of a regional dental consultant to accept the appointment of
Director, Dental Services Division, Department of Public Health and Welfare in
Saskatchewan, created a second vacancy in the establishment of five regional dental
consultants. Despite repeated advertisements, no suitable applications have been
received, and it will be appreciated that without these positions being filled, effective
dental health programmes cannot be carried out in 6 of the 18 health units in the
Province.
Changes in the employment of public health nurses have occurred due to the
need for staff adjustments in local health services. During the year six full-time
and five half-time public health nursing positions were added in an attempt to meet
the very large additional demand for service, occasioned by population increase in
certain areas of the Province, including Castlegar, Dawson Creek, Nanaimo,
Kelowna, Chilliwack, Golden, Abbotsford, Campbell River, and Burns Lake.
Recruitment involves provision of an active training and staff-development programme to enable suitably qualified nurses to fill the various positions. Eighty-
nine per cent of the public health nursing field staff are fully qualified, while the
remainder are temporary staff obtaining experience in the field before proceeding
to university. Fourteen per cent have university degree preparation in public
health nursing, with the remainder having a Diploma in Public Health Nursing.
 q 46 PUBLIC HEALTH SERVICES REPORT, 1964
An untimely loss was suffered through the death of Mrs. Jessica Field, senior nurse j
in the Central Vancouver Island Health Unit.
During the year the pattern of education and training of senior nursing staff j
continued, with attendance of selected individuals at university to complete the ;
Master of Public Health degree, subsidized under the National Health Grant training programme. In addition, a public health nursing consultant was thereby en- j
abled to spend four months in study at the School of Public Health, University of ]
California. In an effort to keep pace with changing concepts in the treatment and
care of persons with emotional health problems, an attempt is being made to improve the background of public health nurses in mental health. During the year
six public health nurses were given educational leave of absence, and National
Health Grant assistance was obtained to enable them to enroll in the three-month
affiliation programme at the Education Centre, Mental Health Services. One hundred and thirty-four public health nurses participated in a nine-month correspondence and discussion-group course arranged by the Department of Continuing Medical Education at the University of British Columbia entitled " The Scientific Method
in Public Health Nursing." Fourteen research studies in public health nursing were
submitted, and it is anticipated that other correspondence courses will be arranged.
It should be appreciated that the health units themselves provide education and
training facilities for student nurses with public health nurses on staff acting as field
guides. During the year 24 nurses from the University of British Columbia and
four from the University of Alberta had a month's field work, and 189 undergraduate nurses from six schools of nursing spent a week in observing public health.
Some 37 students completing the practical nurse course at the Nanaimo Vocational
School gained experience in Vancouver Island health units.
In order to overcome staff shortages in the ranks of the public health inspectors
and to meet the demand occasioned by population growth, industrial development,
increased tourism, multiplicity of subdivisions, and the over-all industrial expansion,
the policy of employing trainees for a 12-month period of in-service education,
during which time they complete the correspondence course provided by the Canadian Public Health Association to obtain the required certification, was continued.
Two persons were trained, and a further two were accepted for training during the
latter part of the year. In January, 1964, 72 inspectors, including representatives
from the Greater Vancouver and Greater Victoria health departments, attended an
intensive one-week training course designed to acquaint them with new concepts in
the fields of sewage disposal, air pollution, occupational health, and common-carrier
inspection.
The Health Branch is responsible for the development of Emergency Health
Services planning, to include the training of selected individuals throughout the
Province. Three courses were given during the year, beginning with one on " The
Principles of Traumatic Surgery in Mass Casualty Care " at the University of British
Columbia under the joint sponsorship of the Health Branch and the Department of
Surgery, Faculty of Medicine. This was attended by over 40 practising physicians
from all parts of the Province. Two hospital disaster institutes were held, in Nelson
and Prince George respectively. These were attended by the hospital a<__ninistra-
tive staffs of all hospitals in the areas concerned and were intended to induce these
hospitals to develop disaster plans so that they might be ready to do their share in
the event of a major community disaster. In addition, advanced treatment centres
were exercised in Kamloops under the sponsorship of the local medical society and
at Abbotsford under the direction of an interested militia commander. Individual
hospital disaster plans were exercised at Nelson and Prince George in c
 LOCAL HEALTH SERVICES Q 47
I with the institutes being held there, and in addition St. Joseph's Hospital in Victoria
and the Nanaimo General Hospital exercised their plans on their own initiative.
Fourteen public health personnel attended intensive week-long courses at the Cana-
[ dian Civil Defence College at Arnprior, to include four health unit directors, five
I  public health nurses, and five public health inspectors.    In addition, the Director
i   of Emergency Health Services attended a Federal-Provincial Directors' Conference
in the East and the Health Supplies Officer attended two week-long courses of
!   instruction in the detailed management of the emergency hospitals and advanced
treatment centres.   During the year a series of meetings was held with the St. John
Ambulance Association and the civil defence organization in an attempt to arrive
at a more realistic policy in respect of first-aid training.    It has now been agreed
that first-aid training courses will only be paid for by the civil defence organization
when the candidate volunteers for a civil defence post where such training is needed,
and that priority will be given to those volunteering to work in the Emergency
Health Services.
SERVICES AND PROGRAMMES
Public Health Nursing*
Public health nurses provide service on a generalized basis, directing their activities primarily toward the promotion of family health and giving service to all ages
as required. This involves direct care, health instruction, counselling, planning, and
organizing special care. Certain specific services have been selected for comment,
as follows.
Public health nurses offered group classes to EXPECTANT PARENTS in all
the larger centres. Health-teaching at this time not only helps the mother prepare
physically and emotionally for the new baby, but through group discussion focuses
attention on basic mental health concepts directed toward improving family health
practices. During the year 10,131 mothers and 1,751 fathers attended these classes,
slightly fewer than last year, but the over-all birth rate was down correspondingly.
Ten per cent of the mothers of new babies attended, and, what is more important,
approximately one-third of all primipara took part in the classes. At this time the
content, method of teaching, and length of each series of prenatal classes are under
study, and it is expected that some reorganization will serve to increase their value.
In addition, some 4,361 home visits were made to expectant mothers with special
problems or who were unable to attend classes. Two per cent of the total nursing
time was spent on this programme.
Instruction is provided to parents of INFANT AND PRE-SCHOOL CHILDREN to help them meet the physical and emotional needs of their children. This
is accomplished through home visits and by counselling at child health conferences.
Public health nurses made 24,588 postnatal visits to new mothers and visited 21,857
new babies under the age of 6 weeks. This represents 95 per cent of all new babies.
In addition, home visits to infants amounted to 16,320, and 35,601 visits were made
to pre-school children. Child health conferences are made available at regular intervals in all centres of population so that mothers may bring their children to receive
selected services, such as screening for hearing or vision defects, immunization, and
the benefits of counselling and guidance. A total of 55,556 infants and 65,655 preschool children attended at child health conferences, and although this represents a
slight reduction in the infant attendances compared to last year, this still represents
 q 48                           PUBLIC HEALTH SERVICES REPORT, 1964
60 per cent of all infants.  The infant and pre-school programme absorbs 13.6 per 1
cent of the public health nurse's time, compared to 18.3 per cent 10 years ago.
The SCHOOL HEALTH PROGRAMME as adopted in 1.962 remains basically unchanged and has proved to be practical and effective.   A complete review of 1
the programme is planned early in 1965, at which time consideration will be given 1
to studies conducted by the health units.  Certain changes were implemented for the J
school-year 1964/65 as a result of recommendations from the health units, such that
public health nurses now assume responsibility for vision screening in those grades
formerly screened by teachers, with the exception of Grade X.   In this grade the
arrangement of classes calls for special planning, and the " blitz " method is often
used, with screening done by teachers for all Grade X classes simultaneously.  The
second change involves a number of teacher-nurse conferences.   In the elementary 1
school the number of grades in which conferences are held has been reduced from
seven to four, and as a result the nurses have been able to devote more time to
follow-up of pupils referred by the teachers.   Continued evaluation of this programme will undoubtedly result in further modification to meet changing situations
and new concepts of service to the school-age child. The following tables give information for areas served by the Greater Vancouver and Greater Victoria Metropolitan
Boards of Health and for the Provincial health units.
Table I.—Number of Schools and Enrolment by Type of School, lune, 1964
Vancouver
Victoria
Remainder of Province
Type of School
H
Enrolment
Sc&C
Enroltne,
Sclols
Enrolment
Grp,"*0O'S~
M
n
I
32$1
1,034
2W9W
KiSe^^-—
_4„6              4^
Private	
Figures are given for the
grade schools (public and priv
children.   In grade schools enr
Greater Vancouver area, by 2,
the remainder of the Province.
first tin
ate), pi
lment I
851 in
blic kinde
as increas
he Greats
edinth
r Victo
n three types of schools—
, and schools for retarded
e past year by 5,804 in the
da area, and by 10,233 in
Table II.—Number of Pupils with Immunizations Up ti
Grade I, September, 1963
Item
Vancouver
V-ria          |      g|g!|
Total pupils enrolled
12,758
|§|f|
23 826
Diphtheria, pertussis, tetanus, and poliomyelitis	
14,865(62.4%)
11 be noted that over 60 per cent of pupils are up to date in their i
le time they enter Grade I. This figure is slightly higher than last year and
 LOCAL HEALTH SERVICES Q 49
I indicates an active immunization programme for pre-school children. All areas
I continue to maintain a high immunization status for children in elementary and
[ secondary schools.
[      Table III.—Number of Pupils in All Grades with Immunizations Up to Date,
June, 1964
Item
Vancouver
Victoria
Rema
,tz°\
IZ^ZZZ'Zzzr-       ._-
llllli
30.605 !
iiii
ll
(84.2%)
Table IV.—Number of School Medical Examinations (All Grades), 1963/64
The number of routine examinations in the Greater Vancouver a
essentially the same as last year, but the number of " referral" s
decreased by 3,373. In the Greater Victoria area there is a slight increase in both
figures. The changing pattern of medical examination of school-children is evident
in areas served by the Health Branch, where examinations by the school medical
officer have decreased markedly and the number of school beginners examined by
the family physician has increased by 1,138. The number of "referral" examinations by the school medical officer is less than half the 1963 figure. It seems probable
that the increased availability of medical care has resulted in many children being
referred by public health nurses direct to the family physician. This is particularly
evident in the more heavily populated areas. Increased facilities, such as regional
mental health clinics, speech clinics, and travelling clinics, may also have reduced
the need for children to be seen by the school medical officer.
Tab
leV.—S
ohool Health Programm
e in Public
Kindergartens
1964
Item
Vancouver
gg
BBS
Number of pup
dsrefmdltc
~48
iff
KSofpi;
Vubncr^nursff^oS
88 (92.6%)
Number of refe
rralexamina
ions by school medical officer...
8
The total enrolment in kindergartens operated by the Boards of School Trustees
is 10,412, which is 25 per cent of the Grade I enrolment. A marked increase in
enrolment has occurred this year in areas served by the Health Branch, where the
number of pupils has .increased from 1,384 to 2,512.   It is gratifying to note that
 q 50 PUBLIC HEALTH SERVICES REPORT, 1964
teacher-nurse conferences were held for 92.6 per cent of the divisions, a substantial §
increase from last year.
Considerable activity continued relative to SCHOOL HEALTH INSTRUC- ]
TION in elementary and secondary schools.   A test of health knowledge was pre- 1
pared and given to 1,739 students in Grade X in the Boundary Health Unit, this 1
study being planned as a device which might indicate whether students are familiar f
with the course content and can apply their knowledge to simple health problems.
Out of 100 items, scores ranged from 14 to 90, with a median of 55.   It is interest- '.
ing to note that the areas of least knowledge concerned the so-called health habits I
relating to posture, care of teeth, problems of overweight, prevention of the common 1
cold, vitamins, and body elimination.   Further work was done on teaching aids for j
posture and smoking and the venereal diseases.   Considerable liaison work h
continued with all three universities and with the British Columbia Division of the (
Canadian Medical Association as progress is made toward an over-all revision, not
only of the health education curriculum in schools, but also of the type of health-
teaching offered to teachers in university.   A survey of sex education practice in
the schools revealed that the " menstrual hygiene " programme is very well accepted  I
throughout the Province, and that " changes of puberty for boys " is a programme j
which is developing rapidly.   Some 38 school districts (exclusive of the metropolitan
areas) are providing a variety of programmes in sex education in secondary schools
Public health nurses have continued to increase their activities in the field o
MENTAL HEALTH, due largely to an increase in the psychiatric resources mad
available in many Interior communities. More emphasis is being placed on _
tance to adults, and during the year 40 per cent of the visits were made to this
group. A total of 9,592 home visits was made to persons with mental disturbances
Two hundred patients were referred for follow-up on discharge from psychiai
hospital or ward of a general hospital, and health unit staffs have been active both I
in helping The Woodlands School with the assessment of children on their waiting
list and in reorganization planning for retarded schools at the local level. In al,
a total of 1,877 home visits was made on behalf of retarded children.
The HOME CARE PROGRAMME has continued to become a basic
of health unit operation as more areas have indicated their wish for such hom I
nursing service to be provided. During the year the Upper Fraser Valley Healt
Unit commenced home nursing service in the Matsqui-Sumas-Abbotsford area
completed organization for the service to commence early in the new year in Chill
wack. This means that 60 per cent of the population within the Provincial health
units now receives home nursing through the local health units, and when the home
nursing service of the Victorian Order of Nurses is added, as provided in the metro-
politan health services of Vancouver and Victoria and in one or two other large
centres, a total of 81 per cent of the population of the Province has home nursii
service available. A five-year statistical study covering the period 1959-63, ii
elusive, was completed in September to provide a detailed analysis of the home
nursing programme over this period. It is of interest to note that in 1963 service
was provided to a population of 441,390 in 39 communities, compared with 159,500
in 10 communities in 1959, an increase of 170 per cent within the five-year period. T
The number of patients given service increased from 627 in 1959 to 1,737 in 1963, [
to represent an increase of 185 per cent. Some 12,225 visits were made in 195 ,
while in 1963 the number had risen to 36,350, to represent a 200-per-cent incre
Certain figures remain much the same from year to year, to include age distribut
with 71.4 per cent given care being over the age of 60, while the number of v
per patient remains at an average of 21, with the total time per visit being approx -
mately 30 minutes.   On the other hand, there has been a very large increase ir
 LOCAL HEALTH SERVICES Q 51
I number of patients received into the home-care programme directly from hospital,
increasing from 145 in 1959 to 518 in 1963, an increase of 257 per cent. This is
probably a result of improved hospital liaison.
The estimated number of hospital days saved per patient remains high, at 14.0
[in 1963. This represents a total of 3,464 acute hospital days, 15,037 chronic, and
5,813 days for other types of institution, for a total of 24,314 days, compared to
13,727 in 1959, an increase of 77 per cent. At an estimated $20 per day for an
acute hospital bed, $12 per day for a chronic, and $7 for other institutional care,
this represents a saving in institutional costs of $281,111. During 1964 some
42,724 visits were made, compared with 40,408 the previous year, an increase of
5 per cent. The health units continue to provide the most economical and efficient
method of co-ordinating these home-care services, and two half-time consultant
physiotherapists have been provided to give in-service education on rehabilitation
nursing and to assist with the assessment and planning of home care for certain
patients. One of the physiotherapists works with the staff in the Greater Victoria
metropolitan area, including the Victorian Order of Nurses. The other serves in
the Lower Fraser Valley area, including New Westminster. During the year the
Manual of Home Nursing Care was revised, and a new and original section added
on nursing rehabilitation exercises.
The nursing staff have been active in assisting with other special programmes,
such as speech and hearing, poison-control follow-up, special health educational
projects, well-women's cancer clinics, etc. A programme whereby health consultation is provided to operators of boarding homes and nursing homes has commenced,
with special interest being given toward food services. Altogether, public health
nurses made 133,761 visits to homes and provided 721,291 services by telephone.
Nutrition
The people of British Columbia are fortunate to live in one of the few areas
of the world where both an adequate amount and the right kinds of food are available. Without this, nutritional well-being is impossible, but even with it nutritional
health cannot be guaranteed unless sensible attitudes toward food and a knowledge
of the kind and amounts of food required are recognized in the home. The nutrition
service contributes to this end by acting in a consultant capacity to public health
personnel directly involved with the general public, to those involved with group
feeding, to other Government departments, and finally to those concerned in any
way with the dissemination of nutrition knowledge. A great deal of correspondence
is carried out with small hospitals, and the Nutrition Consultant has visited 12
during the past year. Further time is spent in reviewing and advising on plans for
hospital kitchens, and additional guidance is given to young people's camps, private
schools, and hospitals. At the year's end a manual on food service for boarding
homes neared completion. The Nutrition Consultant also acts on a committee of
the British Columbia Dietetic Association which is working to develop a course
at the vocational-school level for food supervisors in hospitals. Homemaker services
and home nursing groups have requested and received talks on nutrition and meal
planning.
Preventive Dentistry
dental services in the metropolitan areas continue to pay increasing
attention to pre-school children, as shown in Table VI below. Of all Grade I pupils
in the public schools of Greater Vancouver and Greater Victoria, by classroom
examination 48.5 per cent did not appear to be in need of treatment for dental
decay, 18.7 per cent were subsequently treated by their family dentist, and 25.1
per cent by the school dental clinics (Vancouver only).
 PUBLIC HEALTH SERVICES REPORT, 1964
Table VI.—Full-ti
n British Columbia,
H
111
Grade I Pupils
School-year
li.
l
(2)
I
£<SS
1958/59	
1
1
lilM
|
|
l
13547
llTuilzzzzzzzzzzzzzzzzz
|||1
"SvancouverMetropolitanHealth
5
3,527
12,6,3
3,739
5,803
2.255
6
3,527
14,902
3,739
7,223
During the past year, 79 community preventive dental programmes were in
operation in every health unit area, involving the participation of 122 dentists
normally practising within the community concerned and giving service to 4,525
pre-school children and 2,642 Grade I children. It will be noted that no less than
55 per cent of children treated were pre-school, and that of all children benefiting
by these programmes, 74 per cent received the additional decay-preventing benefits
of a topical application of a fluoride solution.
Since 1951 the Division of Preventive Dentistry has arranged for a dentist to
visit communities without a resident dentist to provide services in preventive programmes for the younger children. This work has been carried out in 55 communities by five dental public health externs appointed on a year-to-year basis.
During the school-year 1963/64, 60 per cent of the total grants-in-aid were allocated
to programmes to be operated by resident dentists and 40 per cent to programmes
supported by the clinical services of dental externs. It is generally agreed that these
extern programmes are providing an invaluable service to the smaller and often
remote communities of this Province. It is not perhaps so generally appreciated
that provision of dental services to such communities in British Columbia far surpasses anything achieved by any other Province in Canada.
Careful evaluations of a number of resident programmes have been completed
during the past year, and it has been found that in many communities more than
70 per cent of all 5-year-olds are now receiving dental care. At the same time, in
most communities resident dentists are providing the maximum of the time they
consider they can fairly devote to these programmes. The younger the age-group
enrolled in the programme, the greater the number who can benefit in the dental
time available. In the five largest 5-year-old programmes the average time required
to make each child dentally fit is 2.95 hours. In a pilot 3-year-old programme
conducted in White Rock in 1960, the average time spent per child amounted to
only 1.9 hours. During the year the following policies were adopted in co-operation
with the British Columbia Dental Association and have been approved by the
Minister of Health Services and Hospital Insurance:—
(a) Extern Programmes.—No changes to these programmes are planned at
this time, except a slow expansion, as funds and personnel permit, into
 LOCAL HEALTH SERVICES Q 53
areas where services have been previously provided to Indian children
by the Department of National Health and Welfare.
(b) Resident Programmes.—At the earliest possible date these programmes
will be confined to one yearly age-group of pre-school children with every
encouragement to programmes for 3-year-olds only. To encourage this
development, grants are now being made available on a sliding scale, with
maximum subsidy to programmes for 3-year-olds.
(c) Pilot Programmes.—Seven such programmes have been initiated in
selected communities and will replace existing programmes in agreement
with local sponsors and the local dentists. In each of these communities,
as each child reaches his third birthday he receives a birthday card from
the local health unit. This card authorizes the family dentist to provide,
at no cost to the parent, examination, X-rays as necessary, counselling,
treatment planning, and a topical fluoride application, provided these
services are completed before the child's fourth birthday. The dentist
will be remunerated for these services by return of the card (appropriately
completed) to the health unit. Costs of restorative and other treatment,
recall examinations, and all further treatment are at the parents' expense.
These pilot programmes will be evaluated as they proceed and may require
some modification. If successful, it is hoped that they will progressively
replace present resident programmes during the next several years.
Another new development which took place during the year was the engage-
nt by the South Okanagan Union Board of Health of a dental hygienist. The
as which will benefit by her services have a school population of approximately
7,000, being about one-half of the total number of school-children within the health
unit area. The dental hygienist is providing free examination, counselling, prophylaxis, and a topical fluoride application to 3- and 4-year-olds in the communities
concerned and gives every encouragement toward further examination and treatment by the family dentists. Utilizing the services of press, radio, and television,
acceptance of this service has risen from 25 per cent of those children eligible to
approximately 50 per cent. The hygienist also carries out a dental health educational programme in co-operation with elementary schools, especially at the Grade I
level. A study will be conducted to determine the effectiveness of this type of programme over the next year.
At the beginning of 1964 the ratio of dentists to population in British Columbia
5 1:2,335. However, over the past 10 years the number of dentists in British
Columbia has not increased as rapidly as the population. Over the next 10 years
the age-group requiring most dental care will be increasing at an explosive rate.
Furthermore, as the population's per capita income and years of education increase,
a corresponding increase in the demand for dental services can be confidently anticipated. The long-awaited Faculty of Dentistry at the University of British Columbia
admitted its first dental undergradute students this fall—a class of eight. It is encouraging to be informed that this year there were 65 applicants for admission, but
ras frustrating to note that only 40 of these had the required academic standing.
Public Health Engineering
The entire field of environmental sanitation as it relates to community water
supplies, sewerage systems, sewage-disposal methods, stream pollution, and the
technical administration of the Pollution-control Board is conducted by the Division
of Public Health Engineering. This work is fulfilled by a staff of engineers who,
working in conjunction with the Medical Health Officers and their public health
 q 54 PUBLIC HEALTH SERVICES REPORT, 1964
inspectors in the field, conduct sanitary surveys and extend various advisory services
to municipalities, consulting engineers, and private citizens. The Division thus offers
consultative services to health unit staffs in a wide variety of subjects, to include
subdivision approvals, slaughter-houses, shellfish, private drinking-water wells,
septic-tank systems, control of watersheds, fluoridation, and many others.
Much of the work of the public health inspector has already been presented as
a highlight at the beginning of this report. This section will therefore deal primarily
with the work of the engineers employed within the Division.
During 1964, 95 projects and sets of plans dealing with waterworks construction were classified as acceptable for approval, to represent an increase of 30 per
cent over last year and almost 100 per cent over 1962. Today approximately 85
per cent of the potable drinking-water used in the Province is protected by chlorina-
tion. Of concern, however, are those communities which draw their domestic water
from the rivers of the Province since, with the rapid industrial and population growth
now being experienced, it is not possible to prevent an increase of contamination
in these rivers. In the past, river supplies and other unprotected sources of domestic
water have enjoyed a degree of purity as a result of an undeveloped hinterland, but
the residents of this Province cannot expect to use such sources as drinking-water
much longer unless adequate treatment be provided to ensure that the distributed
water complies with public health drinking-water standards. In this regard, this
Province is one of the few remaining areas where, as a result of the abundance of
natural waters coming from uninhabited mountain watersheds, it is still reasonable
to require no more than chlorination as the only means of treatment. It is anticipated that within the next decade a number of communities now obtaining water
from large rivers will have to build filtration plants. As a result of discussions
between the Division of Public Health Engineering and representatives of British
Columbia Hydro and Power Authority, the latter is making active preparations to
ensure that despite the development of the High Arrow Dam on the Columbia River
above Castlegar, the downstream water-users will not be adversely affected by such
construction, and provision has been made to provide the Villages of Kinnaird and
East Trail each with two wells and the Villages of Tadanac and Warfield with water-
There has been tremendous activity in the development of public sewerage
systems throughout the Province. One hundred and twenty sets of plans were prepared for approval under the Health Act during the year, to represent the greatest
number to date in any one year, again reflecting the growth of the Province. It is
estimated that 72 per cent of the incorporated population is served by public sewerage systems. The remainder of the incorporated population and those living in the
unorganized areas continue to utilize the well-known household septic-tank system
with varying and, in some cases, doubtful degrees of success. Many of these
approved projects incorporate treatment of the sewage, an aspect of sewage development encouraged by the Division and one much needed in many areas to compensate for the polluting effects of a rapidly growing population. Today, out of a total
of over 90 incorporated areas with sewerage systems, about 70 per cent provide
some form of treatment, and in fact over two-thirds of the treatment systems in
the Province can be classified as secondary treatment, to indicate a high degree of
proficiency. It is interesting to reflect that only a decade ago no more than 10
community systems could claim to be providing any form of treatment. Of the
many methods of treating sewage, particularly for small to medium-sized communities, lagoons or oxidation ponds continue to be the most popular, as recommended
by consulting engineers in the Province. This trend is in keeping with that of the
United States, where over 2,000 lagoons are now in use for treating domestic and
 LOCAL HEALTH SERVICES Q 55
I industrial waste.   The United States Public Health Service recognizes lagoons as
an acceptable medium for treatment of domestic waste.
The terms of the Pollution-control Act allow that the Health Branch may pro-
[ vide for the administration of the Act.   In this regard the Director of the Division
I is appointed executive engineer to the Board.   With the growth of sewerage systems
and sewage-treatment facilities as outlined above and the rapid industrial expansion
I within the Province, the Division has had to assume increasingly heavy responsibili-
[  ties in providing technical and administrative services to the Pollution-control Board.
I This Board, which deals specifically with the pollution of water, was set up in 1956,
I   at which time the territorial area of jurisdiction was limited to the Lower Fraser
i   River basin, downstream of the Village of Hope, including the Boundary Bay area.
In 1961 the territorial area under the authority of the Board was extended to
include all of the Columbia River drainage basin which lies to the north of the 49th
!   parallel, or that which lies solely in British Columbia.   Again, and effective January
1, 1963, the jurisdiction of the Board was enlarged to take in the remainder of the
Fraser River basin above Hope and most of the populated area of Vancouver Island.
The effect of these extensions on the work load carried by the Division is well reflected in the number of permits issued annually by the Board permitting waste to
be discharged.   For the years 1961, 1962, 1963, and 1964 the numbers of permits
issued annually were respectively 8, 12, 19, and 32.   It is safe to predict that this
explosive increase will continue under the favourable economic conditions prevailing
in the Province.   Considered thought is currently being given to evaluating how
best to cope with this increasing activity.   In addition to the routine processing and
issuing of permits, the Division, in conjunction with the health units in the areas
concerned, undertakes surveys of rivers in order to evaluate the effects of waste
discharge.   In 1964 a water-sampling programme was set up to evaluate the current
status of the water quality in the Fraser and Thompson Rivers.   The purpose of
this survey is to develop background information for monitoring these river systems
in the future and is immediately related to the present development of pulp-mills
in the respective watersheds.   In last year's Annual Report it was mentioned that
as a result of the findings of the Columbia River Water Quality Survey, the Pollution-
control Board advised that the practice of discharging raw sewage to the Columbia
River and its tributaries should be discontinued.   As a result of this counsel, it is
gratifying to report that two major incorporated areas in the Columbia Basin have
already submitted engineering reports indicating how they propose to comply with
the Board's wishes.   The reports received are from the City of Nelson and the City
of Revelstoke.   The City of Kimberley has advised that it has retained the services
of a consulting engineer to study the Kimberley waste-disposal problem.    Other
communities have actively participated in various ways to deal with this matter; for
example, Creston has advised that it has set aside land for a treatment area to meet
its need as its sewer programme proceeds.
Further pollution-control activities participated in during 1964 are related to
a hydrographic survey in Cordova Bay and a limnological study of Kootenay Lake.
The former was carried out to predetermine the most suitable location for a sewer
outfall so that the natural recreational resources of the area be not inhibited. The
Kootenay Lake study required the provision of analytical laboratory facilities to
help the Research Section of the Fish and Game Branch to carry forward a two-
year study. These laboratory facilities were provided by the Health Branch's Division of Laboratories after careful evaluation of the programme had been carried
out. Much of the evidence collected will be essential for establishing water-quality
standards in the Columbia Basin area.
 q 56 PUBLIC HEALTH SERVICES REPORT, 1964
Emergency Health Services
During the year the emergency health services programme of the'Health Branch I
concentrated on the pre-positioning of medical supplies, training courses for health 1
personnel (mentioned earlier in this report), exercises, and demonstrations. The ]
first of a large number of 200-bed emergency surgical hospitals was pre-positioned j
at Jordan River, west of Victoria, in a building especially constructed for this j
purpose. Advanced Treatment Centres have now been pre-positioned in Duncan, ]
Nanaimo, Sidney, Mission City, Abbotsford, Penticton, Nelson, and Kamloops, 1
and plans are under way to pre-position others at Douglas on the Canadian-United
States Border, Aldergrove, Squamish, Vernon, Port Alberni, Prince George, and |
Dawson Creek. In addition, plans are on the drawing-board for another storage 1
depot for an emergency hospital at Abbotsford. It is hoped that further hospitals
can be located in White Rock and Hope in the very near future.
Shellfish Programme
During the year a further 18 parcels of foreshore were leased in approved
areas, with an additional parcel being approved on a restricted basis.   One application was denied and six applications were pending at the year's end.   Shucking and
packing plants increased by one to a total of 35.   The bacteriological testing of
growing-waters and oyster shell-stock was accelerated and extended, two separate j
bacteriological surveys being conducted, with the first involving the collection of
more than 400 water samples, which appeared to confirm the opinion of the Pacific j
Coast Shellfish Committee that the growing-waters in Boundary Bay are bacterio-
logically unsuitable for direct marketing under prevailing international standards.
The second survey involved sampling of growing-waters and oyster shell-stock
within the other main growing areas, to include Sooke, Esquimalt, Ladysmith, Thetis
Island, Nanoose Bay, Crofton, Fanny Bay, Denman Island, Comox, and Pender
Harbour.   Early in the year some 600 water samples and 85 shell-stock samples
were collected, and, as a result, official restrictions of portions of several growing  I
areas were imposed in two areas with a ban on the harvesting of oysters for c
mercial purposes.   In the late fall a further 500 water and 86 shell-stock samples  I
showed less favourable results and are presently under review by the Pacific Coast
Shellfish Committee.
During the year 323 routine samples were collected on clams to test for toxicity.
Of these, 25 per cent exceeded the international standard. The ban on the collection I
of butter clams for commercial purposes imposed in 1963, extending from the
northern tip of Vancouver Island to the Alaska Border, continued, and it is interesting to note that despite the publicity given to the presence of toxicity in clams in
the affected areas, the public continued to ignore the warning from time to time.
One instance involved seven persons who consumed clams from the closed area
and were promptly stricken with paralytic shellfish poisoning. The valuable assistance of the Public Health Engineering Division of the Department of National
Health and Welfare, of the portable laboratory facility and personnel of the Federal
Department of Fisheries, and of the oyster-growers of British Columbia i
conduct of the above surveys is gratefully acknowledged.
RESEARCH
In addition to various studies mentioned earlier in this report, each year certain
operational studies are conducted to provide data for improved adm:
to evaluate individual programmes.
 LOCAL HEALTH SERVICES Q 57
During the past year this included a case-load analysis drawn up by each public
■health nurse to indicate the health problems of her district and a time study which,
Bin the case of public health nurses, is carried out annually to determine whether they
■are using their time completely for activities requiring public health nursing skills
■ or whether adjustments should be made in the utilization of other persons to provide
I non-professional services. It is also possible, from the information obtained, to
I analyse the cost of the -various public health nursing services. Preliminary planning
I and organization have taken place so that an evaluation study on the quality of
I public health nursing service can proceed during the first six months of 1965. These
1 studies follow the general pattern of the patient progress studies developed recently
by the United States Public Health Service, and we have been fortunate in obtaining
I some guidance from their nursing consultants. It is expected that this will provide
I valuable data for programme assessment and at the same time provide public health'
[ nursing staff with a method of improving the quality of their service.
In addition, in the fall of the year and for the first time a time study was carried
' out on the work of the public health inspectors employed in Provincial health units
[ throughout the Province in an attempt to establish a base line so that they may
[ become aware of those areas in which some change of emphasis is required.
In more specific areas of service, studies have been initiated or continued from
[ the previous year to include an evaluation of the results of the rheumatic fever
prophylaxis programme; the use of gamma globulin in the prophylaxis of infectious
hepatitis; a study of community facilities for transporting the sick and injured; an
attempt to assess, in collaboration with the Motor-vehicle Branch, the value of
[ medical examinations as a means of screening the fitness of motor-vehicle drivers;
1 certain studies continue within the framework of the school health programme.
Within the Division of Preventive Dentistry, a comprehensive programme of
field studies and research has continued, and various papers have been published
I by members of the Division, as noted at the end of this report. .A continuing study
involves supervised tooth-brushing among Grade I pupils with an acidulated fluoride-phosphate solution, and at this time early indications are of extremely satisfactory results relative to caries prevention. During the present school-year the
numbers involved in this study have been increased, with 1,000 children at the
Grade VII level being studied in the schools of New Westminster and Coquitlam.
"t is planned that this study will continue over a three-year period. With the
o-operation of the dentists in Chilliwack, the School Board, and parents, another
; project has been carried out to test the effectiveness of a similar acidulated fluoride-
phosphate solution when topically applied (painted) by the dentists on the children's
teeth. In this study, half of some 500 Grade I pupils received this treatment, while
the others were treated similarly but with distilled water. All subjects were reexamined precisely 12 months after the topical applications, and these examinations
were completed in the fall of 1964. Tabulation and analysis of the findings of this
study are currently under way. The above studies are supported by financial assistance received from the National Health Grant programme, and the helpful cooperation of the Faculty of Pharmacy of the University of British Columbia in the
preparation of the test solution is gratefully acknowledged. A further study is being
conducted to try to determine whether a paste can be used incorporating the same
acidulated fluoride-phosphate in gel-form which can be applied to the teeth in much
'- _ time than that required with the present solution.
Once again it has to be recognized that prevention of dental disease is the only
rational solution, research the only hopeful approach. Conventional methods of
repair require unobtainable numbers of dentists.    Neither this nor most other
 PUBLIC HEALTH SERVICES REPORT, 1964
;s of the world can hope to provide enough dentists to control dental disease j
by therapeutic methods alone.
PUBLICATIONS, 1964
(Prepared by personnel, Bureau of Local Health Services.)
I Let's Look at School Health Services," by Alice Beattie, Canad. Nurs., November,  j
1964.
" The Shellfish Industry in British Columbia," by L. E. Benham, Canadian Sani- j
tarian, June, 1964.
"A New Approach to the School Health Programme," by K. I. G. Benson and   j
Alice Beattie, Canad. J. Public Health, September, 1964.
I More Effective Liaison between Community Health Services," by K. I. G. Benson,   '
Canad. J. Public Health, February, 1964.
" Industrial Health and the Public Health Inspector," by H. B. Catlin, Canadian
Sanitarian, September, 1964.
"School Safety," by R. G. Colebrook, Canadian Sanitarian, December, 1964.
"A Design for Home Care," by Lavinia M. Crane, Canad. Nurs., November, 1964.   i
" Observation of Children's Teeth as a Diagnostic Aid, A Review: Part I—Dentition in the Assessment of Development; Part II—Developmental Difficulties
Reflected and Pigment Changes," by W. M. Gibson and J. M. Conchie, Canad.
Med. Ass. J., January, 1964, and J. Canad. D.A., January and February, 1964.
■ Caries Prevalence Related to Fluoridated Water Intake of Six-year-old Children,"
by A. S. Gray and M. Luttrell, J. Canad. D.A., September, 1964.
" Fluid Intake Patterns of Six-year-old Children in a Northern Fluoridated Community," by G. H. Bonham, A. S. Gray, and M. Luttrell, Canad. Med. Ass. J.,
October, 1964.
"Prevalence of Opacities and Hypoplasias of Non-fluoride Origin in Permanent
Teeth of Children," by A. S. Gray, J. Canad. D.A., March, 1964.
I Retrospect," by Christine W. Leach, Canadian Physiotherapy Journal, June, 1964.
" Indices Reflecting Demand for Dental Services in British Columbia, 1962," by
F. McCombie and D. Stothard, J. Canad. DA., February, 1964.
I Relationships between Gingivitis and Other Dental Conditions," F. McCombie
and D. Stothard, J. Canad. D.A., August, 1964.
I Community Mental Health Services," by M. Hazel Whittington and Madeline M.
Werts, Canad. Nurs., November, 1964.
 SPECIAL PREVENTIVE AND TREATMENT SERVICES
REPORT OF THE BUREAU OF SPECIAL PREVENTIVE AND
TREATMENT SERVICES
The Bureau operation includes the Divisions of Tuberculosis Control, Venereal
Disease Control, Laboratories, Occupational Health, and the Registry and Rehabili-
I   tation Services.   A major change in the operation of the Bureau was the assumption
I   of the responsibility for administration of the Provincial Infirmaries, which is dis-
I   cussed elsewhere in this Annual Report.
The total staff of the Division of Tuberculosis Control has been increased by
[ 80 employees from the Marpole Infirmary. However, a reduction and adjustment
I   in staff will be necessary when the final amalgamation takes place.
The Division of Tuberculosis Control has had a decrease in the number of
in-patients during the year.   However, the extensive case-finding programme carried
|   out in the Vancouver area during the year has increased the out-patient programme.
The venereal-disease programme has experienced a continual increase in the
number of cases treated.   An expansion of the total programme is planned for 1965
to meet the increased demand on the services.
The Division of Laboratories has put into effect this year the expansion programme planned in 1963. The training and development programme is now under
way, and the necessary professional and technical staff were added to the various
sections of the Division to carry out its expanded programme.
The occupational health programme has been expanded by the addition of a
public health nurse. The medical director has been able to expand his programme
in the area of employee health care by providing counselling services to both the
employees and supervisors.
VOLUNTARY HEALTH AGENCIES
The Health Branch of the Department of Health Services and Hospital Insurance has again, as in past years, made grants to a number of voluntary agencies.
As it is not possible to include a comprehensive report from each agency, only a few
sentences highlighting their services are given this year.
British Columbia Cancer Foundation
The British Columbia Cancer Foundation has again provided an in-patient
care programme as well as an extensive out-patient care service. During the year
a total of 98,400 treatments was given, with an increased demand being experienced
for most services.
The services, which were expanded in 1963 to enlarge the scope of the Victoria
Cancer Clinic at the Royal Jubilee Hospital in Victoria, served 470 patients and
carried out 17,760 e_     '     '
Plans have also been finalized to construct a fourth floor at the Cancer Institute, commencing January 1, 1965. The total cost of the construction programme
is estimated at $450,000 and will be paid entirely out of foundation funds.
British Columbia Medical Research Foundation
In the last five years the foundation received and reviewed 89 applications for
research projects and granted 74.   The income for the foundation has been received
chiefly from the Province and the Community Chest and Councils of Greater Van-
 "I
q 60 PUBLIC HEALTH SERVICES REPORT, 1964
couver.    However, a benefactors' fund was started last year in the amount of 1
$10,000.   The board feels that such contributions should be encouraged in the j
coming years as this provides an opportunity for the public to share in the foundation's work as well as adding an element of continuity in the foundation's research i
G. F. Strong Rehabilitation Centre
The facilities of this well-known centre have again had extensive effective .
utilization during the past year through an integrated programme provided by a
competent professional staff. The number of bed-days recorded increased to an ]
all-time high, but the number of in-patients admitted showed a small decrease. The 1
average length of stay was 82 days, as compared to the previous year of 62 days.
This increase was due mainly to the admission of an increased number of more !
seyerely disabled patients. No one was refused admission because of inability to 1
pay. There was a waiting-list of over 30 patients throughout the year. This is even j
more significant when viewed against the number of patient beds available (54).
Out-patient attendance in the general programme was down from the previous j
year, which helped to offset the increase in services required by the in-patient j
population.
The most significant development of the year was the planned introduction of   '
children handicapped by conditions other than cerebral palsy.   As a result, there
has been a substantial increase in the attendance in this clinic as well as the number
of new referrals.
During the year 20 full-time professional and lay staff terminated their services
and 21 new employees were engaged. The lack of a continuous full complement
in some departments considerably interfered with the services rendered.
Multiple Sclerosis Society of British Columbia
The society has shown continuous growth in its various activities. There was
an increasing awareness of the value of physiotherapy in the management of multiple
sclerosis. Provision, therefore, must be made for higher costs as the number of
patients increases. There is also an increased demand for equipment and aids as
the patients become more aware of their ability to develop toward a greater independence. During the year there has been an increase in the number of patients
receiving prescribed injection drugs.
Canadian Arthritis and Rheumatism Society
In the past year the society has extended its services to persons suffering from
chronic illness other than arthritic and rheumatic diseases,-and has provided such
additional rehabilitation services as were possible within their present capacity. ■
The list of patients requiring in-patient care has continued to grow, and the
out-patient care has been taxed to capacity. The society advocates a 200-bed unit
at Vancouver General Hospital as a special treatment unit for arthritic patients.
Emphasis was also given to vocational rehabilitation; but so far it has not been
possible to find a community group to sponsor co-ordinated sheltered employment
for the disabled. It has been possible to maintain the physiotherapy service in
most areas of the Province during the past year. Sixty-eight per cent of the treatments were given in out-patient centres and 14 per cent in hospitals and 18 per cent
DM the patient's home.
 SPECIAL PREVENTIVE AND TREATMENT SERVICES Q 61
British Columbia Epilepsy Society
In the past year the society has carried out an extensive educational programme
I with a twofold objective:  one aimed at developing public understanding of epilepsy
I and the other assisting the epileptic to understand and five with his disability.   To
meet the growing demands on the service, the society is contemplating a new centre
I on Vancouver Island similar to the one in Vancouver.
Research in epilepsy is carried out in conjunction with the British Columbia
I Neurological Institute and Foundation.    As there are approximately 18,000 epileptics in British Columbia, there is a constant demand for direct aid, such as
I anti-convulsant medication, transportation costs to Vancouver, etc.
British Columbia Heart Foundation
Research has continued to be the primary function and responsibility of .the
| foundation, and there is some evidence that research scientists are gaining more
|  confidence in the foundation's ability to assume continuing support for the approved
research activities.   The continual loss of our best scientists to the United States
has caused major concern in this field of endeavour.   However, there are now some
S   inquiries from research scientists wishing to return to Canada.    The foundation
!  supported some 20 research projects in Vancouyer and Victoria, and also supported
the National fellowship programme, which awarded 22 fellowships throughout
!   Canada.
Another area that requires attention and motivation is the rehabilitation of
cardiacs back into productive roles into the community.
Canadian Cystic Fibrosis Foundation, Vancouver Chapter
1964 marked the first year that the Health Branch has been requested to make
a grant to the work of the Cystic Fibrosis Foundation. Cystic fibrosis is a hereditary
disease affecting the lungs and pancreas of children, and until recent years resulted
in death prior to the age of 5. The disease requires lengthy and expensive treatment.
To relieve this situation a foundation was formed about four years ago to assist the
patient and the parents. There are approximately 60 young children afflicted by this
disease in British Columbia.
NATIONAL HEALTH GRANTS
The National Health Grants programme promotes a working partnership between National and Provincial Governments'whereby annual grants-hi-aid are made
available to the Provinces and the Territories in Canada to assist in the-development,
improvement, and extension of health services for the people of Canada. Most of
the grants are designated for specific areas of health needs in a fixed amount for each
Province, except the Public Health Research Grant. The following are the individual grants: Professional Training Grant, Hospital Construction Grant, Mental
Health Grant, Tuberculosis Control Grant, Public Health Research Grant, General
Public Health Grant, Cancer Control Grant, Medical Rehabilitation and Crippled
Children's Grant, and-Child and Maternal Health Grant.
These grants, with the exception of the Public Health Research Grant, provide
funds for services in the above areas, including assistance to the local health services, dentistry, assistance to the metropolitan health boards of Greater Victoria
and Greater Vancouver, professional training of health personnel, the Provincial
venereal-disease control programme, drugs for the poliomyelitis and rheumatic
 1
PUBLIC HEALTH SERVICES REPORT, 1
fever programmes, purchase of equipment (except for hospitals), o
equipping of health centres, construction of hospitals, and the setting-up of the 1
virology laboratory in the Division of Laboratories.   The British Columbia Cancer
Foundation and the Cytological Diagnostic Laboratory received considerable support in their increasing programmes.   Funds were made available to the Canadian I
Council on Hospital Accreditation, the Canadian Hospitals' Association, the University of British Columbia, the Notre Dame University, and the British Columbia i
Pharmaceutical Association to assist in their educational programmes.   Research
in the fields of general public health, mental health, and child and maternal health
also has been sponsored under the respective grants.
Specific amounts are not allotted to each Province for the Public Health :
Research Grant, but rather the funds are allocated by the Department of National '■
Health and Welfare in Ottawa. Research under this grant is for areas other than
the above which are of national as well as of regional interest. Research in this
Province has been mainly carried out by the various departments of the University )
of British Columbia, the University of Victoria, the Health Branch Divisions of
Preventive Dentistry and Laboratories, the British Columbia Research Council, the
British Columbia Division of the Canadian Arthritis and Rheumatism Society, and
the Medical Research Foundation of Victoria. These studies are in the areas of
speech and hearing difficulties, glaucoma, schistosome dermatitis, heart surgery,
respiratory functions, the salmonella problem, peptic ulcer disease, arthritis, atmospheric pollutants, and many other phases of health problems.
The total amount allocated to this Province for all grants this year was
$6,675,897.
LABORATORY ADVISORY SERVICES
A pathologist was appointed to direct regional laboratory services emanating
from the Prince George Regional Hospital. The laboratories at Vanderhoof,
Quesnel, and McBride came under the jurisdiction of this pathologist. The prospect
of a new hospital at Cranbrook stimulated an interest for improved laboratory
services in the East Kootenay area, and the hospital at Princeton hired a technologist to set up a laboratory to provide diagnostic procedures.
The British_Coiumbia Institute of Technology enrolled the first class of trainees
in medical laboratory technology in May. Six months' didactic training was given
before the students embarked on a year's practical training in a hospital laboratory.
However, the six months' didactic course was not considered long enough, and it
will be extended to one academic year. Thus only one class can be accommodated
each year instead of two, which was the original intent.
The correspondence course in clinical chemistry offered by the Department of
Continuing Medical Education in conjunction with the Department of Pathology
of the University of British Columbia continued throughout the year. Assignments
which accompanied each lecture were completed and forwarded to the Health
Branch's Technical Supervisor of Clinical Laboratory Services, who was responsible
for the marking.
The Seventh Annual Postgraduate Course in Medical Technology, held in
Kamloops in May, was successful. The work entailed in the organization of this
week was rewarded by the interest and enthusiasm of the 120 registrants.
The study of the " Future Needs in Pathology in Canada " pointed o
discrepancies in the methods of compiling laboratory statistics. The technical
supervisor worked with the senior technologists in the larger hospitals in the Province
in an effort to draw up some method whereby the work loads would be compiled ir
 SPECIAL PREVENTIVE AND TREATMENT SERVICES Q 63
■ a more uniform method. A draft of suggested unit values and method of recording
| was submitted to the British Columbia Association of Pathologists for consideration.
As hospital construction was active, the Laboratory Planning Subcommittee
I of the Laboratory Advisory Council spent considerable time meeting with hospital
I administrators, architects, and representatives of the Hospital Construction Division
of the British Columbia Hospital Insurance Service to evaluate the aseptic air
I system which was installed in one of the newer hospitals. This study was carried
I out by two pathologists and a report was submitted.
The technical supervisor was consulted regarding equipping new and enlarged
I laboratories, and the Technical Sub-committee of the Laboratory Advisory Council
advised the British Columbia Hospital Insurance Service on equipment grants.
The work loads in all laboratories increased, and automated equipment was
I installed in many hospitals in order to cope with the increasing demands
 PUBLIC HEALTH SERVICES REPORT, 1
REPORT OF THE DIVISION OF TUBERCULOSIS CONTROL
This is the 30th annual report of the Division of Tuberculosis Control and
outlines the activities for the calendar year 1964. Over the last decade these reports
have emphasized the changes that are taking place, with fewer sanatorium beds
required for treatment, the increasing emphasis on follow-up of patients after discharge from sanatorium, and on intensification of community surveys. This trend
still continues, with increasing emphasis on the continuing examination of previously
treated cases of tuberculosis because of the well-known tendency of tuberculosis to
relapse even after many years. However, the unknown case of tuberculosis remains
the greatest problem in tuberculosis control, and community surveys to detect these
persons continue to be stressed and at the same time more highly selective. This
report will show a continuing reduction in the number of sanatorium beds necessary
to care for the treatment needs of those discovered with active tuberculosis, while it
will also show that there has been very little reduction in the number of patients
found to have active tuberculosis each year. The explanation of this, of course, is
improved methods of treatment. This report will also show that it has been
possible during the current year to close tuberculosis beds and to assign them to
Another factor in the reduction of sanatorium beds is the treatment of tuberculous patients outside of sanatorium, many of whom are at work. At the present
time there are approximately a thousand such patients in British Columbia. This
type of treatment, of course, would not be possible without a highly organized
tuberculosis service which it is possible to provide throughout the Province as well
as a closely integrated field health service which also exists in British Columbia.
This again serves to emphasize the need of a well-developed clinical service, both
stationary and travelling, so that patients in all parts of the Province may be served.
COMMUNITY SURVEYS
Probably the most noteworthy achievement of the Division of Tuberculosis
Control during the year was the large-scale community tuberculosis survey conducted
in Vancouver.
Mass X-ray surveys started in British Columbia about 20 years ago and enjoyed
great success as a case-finding method for many years. Most areas of the Province
were visited on more than one occasion. As the population was resurveyed, the
case-finding returns diminished and more intensive efforts to ensure a larger participation by the people became indicated. The survey planning committee came to the
decision that this service must be brought to the people and that they must be canvassed personally. It was therefore decided in 1957 that the survey organization
would be set up in such a way that each family and householder would be canvassed
individually, and that the mobile units would be located so that no person would
have to go more than a block or two to obtain this service; hence the name " Operation Doorstep." In 1959 tuberculin testing was added to X-raying, the purpose
being to identify the positive tuberculin reactors so that in the future case-finding
could be directed toward the chest X-raying of the positive tuberculin reactors rather
than the whole population. It is expected that the Province will be completely
covered by late 1966 or early 1967.
After five years of operation in smaller communities, it was decided that the
team should move in and do a survey in the City of Vancouver, which, of course,
was the most difficult problem in the Province.   Surveys had been held on several
 TUBERCULOSIS CONTROL Q 65
n the slum areas of Vancouver with excellent results, but the proposition
of examining 385,000 people in Vancouver was rather overwhelming. From previous experience it was known that community surveys must be done in a 10- to 12-
week period at a maximum, because it is extremely difficult to maintain public
interest and support of the news media beyond that time at the level necessary to
obtain a 70-per-cent coverage of the population, which is considered a reasonable
Community surveys in British Columbia are a combined effort of the local
health department, which is chiefly concerned with the follow-up of the cases discovered, the British Columbia Tuberculosis Society, which does the organization,
education, and promotion, and the Division of Tuberculosis Control, which carries
out the technical aspects of the work, such as tuberculin testing, X-raying, reading
of films, and follow-up and investigation of those cases in whom abnormalities are
About two years of study and planning were put into the Vancouver survey.
Additional funds were required from the Division of Tuberculosis Control and from
the British Columbia Tuberculosis Society, and these were forthcoming. One of
the most important requirements, of course, was the additional mobile X-ray units
that would be needed to carry out the survey in the time allotted. It was necessary
to increase the equipment and professional staff fivefold; that is, from 2 to 10 units.
To obtain these, sister organizations in the Prairie Provinces and south of the border
were approached. The Division of Tuberculosis Control is most grateful to the
Manitoba Sanatorium Board, the Saskatchewan Anti-tuberculosis League, the Alberta Tuberculosis Association, the Pierce County Tuberculosis Association of
Tacoma, Wash., and the Washington State Department of Health for the loan of
X-ray equipment. Staff became available from many sources and training programmes were set up to familiarize them with the techniques of tuberculin testing
and reading, X-raying, and sterilization and preparation of equipment.
It had been found in previous surveys that a great deal of their success had been
due to the participation of volunteers. A large army of volunteer help was necessary
to carry out clerical duties, canvassing, and assisting with the preparation of equipment. In the Vancouver survey 100 volunteers were required each day, and a
total of about 7,000 participated in the project. Many organizations and groups
pledged their support, but special mention should be made of the Parent-Teacher
Association, which provided canvassers and clerks throughout the city, as well as
the Catholic Women's League and the Ladies of the Royal Purple, which also
assisted. The St. John Ambulance Corps gave valuable assistance, as did the Local
Council of Women and the Ladies' Auxiliary of the Royal Canadian Legion.
Plans for the locations for the mobile units had to be worked out well in
advance with the Vancouver traffic department, and over 7,000 individual sites
were arranged. Each of the 10 units had to be moved each night to a new location,
which necessitated hiring truck-drivers for this purpose. Moreover, each unit had
to be serviced at the end of the day's work, not only with gas and oil, but then-
supplies for the following day had to be delivered and their X-ray films, tuberculin-
testing equipment, and patients' cards had to be picked up and delivered to a central
point. The X-rays were developed overnight and read before 11 o'clock the next
morning.
The school tuberculin-testing programme was carried out prior to the community survey. The detailed planning for the school programme was started in
June of 1963 and was in high gear by late September of that year.
 q 66 PUBLIC HEALTH SERVICES REPORT, 1964
Public participation was most satisfactory in the survey. In the school survey
almost 100 per cent of the children were tuberculin-tested. The figures for the
community part of the survey reveal that 62 per cent attended, and this included
both pre-school children and adults. When it is realized that only a relatively small
percentage of the pre-school children were tested, this raises the percentage of adult
participation considerably. Moreover, during the period of the survey there was
little falling off in the attendance at the permanent X-ray survey units in the city,
and about 15,000 persons were examined in these in addition to those examined in
the mobile survey. During the year prior to the survey, about 35,000 persons had
been examined at the stationary clinics.
When all related factors are considered, it is felt that the coverage of the survey
in the City of Vancouver was at least 70 per cent of the adult population.
Clinical Findings
In the Vancouver tuberculosis survey, 219,985 persons were examined; of
these, 64,407 were examined in the school survey and 154,678 were examined in
the survey of the community. The school survey was primarily tuberculin testing,
and only the positive reactors were X-rayed. In the community survey, pre-school
children were tuberculin-tested and X-rayed only if positive, whereas the adults were
offered both the tuberculin test and the X-ray on the initial visit.
School Programme
Of the 62,859 children tuberculin-tested in the regular schools, 1„291 showed
positive tuberculin reactions. The positive reactor rate for those reporting was
2.2 per cent, with 3,850 children not reporting for reading of the tuberculin tests.
An additional 1,517 vocational-school students were tuberculin-tested, and 188
were positive, giving a percentage reaction of 14.7 among those reporting. In total
in the Vancouver schools 64,376 were tested, with 1,479 showing positive reactions
and a positive reactor rate of 2.4 per cent for the total school population tested
and read.
Amongst the school-children there were nine active cases of tuberculosis found,
and from the contacts of these active cases there were two additional children and
two adults found to have tuberculosis. There were also 15 tuberculin c
that were put on prophylaxis.
Community Survey
In the community survey 154,678 persons were examined, and 115 cases of
tuberculosis were found. The case-finding rate for total cases found was 1 new
case of tuberculosis for every 1,345 examinations. There were 76 active cases of
tuberculosis found, and this gave a rate of 1 active case of tuberculosis for every
2,035 examinations.
In the community survey 147,830 people were tuberculin-tested, including the
pre-school children and a sizeable group of school-children who were not able to
have the test done at their schools. Of this number, 36,552 were positive reactors.
A total of 30,017 did not report for reading of their tuberculin test. Of those read,
32.7 per cent proved positive reactors.
The positive reactors who had negative X-rays will have another X-ray provided for them one year after their original test. This will involve a sizeable X-ray
survey for these people in Vancouver in 1965.
As a result of this survey, 1,493 cases were put on clinic follow-up immediately
because of X-ray changes.   An additional 888 were put on clinic follow-up for a
 TUBERCULOSIS CONTROL
Q 67
I   year hence, and a further 883 were put on routine follow-up by
the stationary clinics.
A diagnosis of carcinoma of the lung was made in 24 cases. The majority
of these have come into the hands of the thoracic surgeons, and in most instances
the diagnosis of carcinoma of the lung has been confirmed.
Gross cardiovascular disease was found in 87 cases. There were an additional
54 cases found to have solitary lung densities, and these are being followed. Seven
hundred and forty-five cases were classified as diffuse or localized pulmonary fibrosis.
It is expected that in due course many of these will prove to be tuberculosis, although
at the state of the present investigation this has not been confirmed.
It is felt that the immediate results of this survey were most gratifying in the
uncovering of many pathological conditions, both tuberculous and non-tuberculous.
The finding of 115 cases of tuberculosis in the community survey and an additional
13 cases through the school survey, which alone would justify the effort expended,
does not represent the total benefits that have resulted. A total of 36,532 tuberculin
reactors have been identified, recorded, and will be followed up. This gives a lead
into our future case-finding, and it is from this group that most of the future cases
of tuberculosis will develop, particularly in those who presently have X-ray changes
and are being followed very closely.
Tuberculosis surveys were also carried out in various other parts of the Province. In keeping with the policy of re-X-raying positive tuberculin reactors with
negative X-rays, the mobile vans returned to those areas which were surveyed in
1963. These centres were the Surrey, White Rock, and Cloverdale area, Nanaimo
and Central Vancouver Island area, Prince Rupert and Skeena area, as well as
the north side of the Lower Fraser Valley and the Howe Sound
A total of 13,785 persons were X-rayed in these surveys.
I. This is the equipi
The largest area of the Province still to be surveyed is the south-eastern part,
made up of the West Kootenay, Selkirk, and East Kootenay Health Units. This
area was purposely left toward the last because previous surveys indicated that the
tuberculosis rate was low and because of the low population density. The West
Kootenay and the Selkirk Health Units were surveyed between the middle of August
and the middle of November.   The survey started along the Southern Trans-Pro-
 q 68 PUBLIC HEALTH SERVICES REPORT, 1964
vincial Highway from Bridesville to Grand Forks. From there it proceeded along
the Slocan and Arrow Lakes Valley as far north as Nakusp and Needles. The
survey then moved into the Kootenay Lake area and Nelson, finishing up in the
Trail-Castelgar area. Over 41,000 persons were examined. As was expected, the
number of new active cases discovered was small, but a large number of high-risk
groups were identified and placed under supervision. It is proposed to survey the
East Kootenay area in the summer and fall of 1965.
The Division was pleased to co-operate with the Yukon Territory in carrying
out a tuberculosis survey along the lines of those conducted in British Columbia.
The assistance given was in the nature of technical advice and the loan of a mobile
X-ray unit. This survey proved very successful and provided the first complete
survey for that area.
CLINIC SERVICES
The diagnostic clinics of the Division continue their important function of
supervising over 16,000 known cases of tuberculosis that are recorded. About 85
per cent of the patients in this category are inactive but require continued reexamination because of the high incidence of relapse in this group, which runs from
one-half to 1 per cent per annum. The clinics also offer a consultative service for
chest disease and are responsible for the examination and investigation of all cases
referred from private physicians and public health authorities. Referrals also come
from various other sources, such as community surveys and stationary survey units,
hospital admission X-ray surveys, and tuberculin-testing programmes which have
been set up to screen the population at large and to identify those persons where
more complete investigation is indicated. The clinic services are carried out through
stationary diagnostic clinics in the larger centres of Vancouver, Victoria, and New
Westminster and by travelling diagnostic clinics in all other parts of the Province
where visits are made on a regularly scheduled basis.
In the pursuit of this work, over 35,000 patients visit the clinics each year for
examination. Three-quarters of the patients who visit the clinics are for reexaminations, whereas one-quarter are being examined for the first time. About
two-thirds of these examinations are done by stationary clinics and one-third by
travelling clinics. For those areas covered by the travelling clinics, a referred X-ray
service has been arranged whereby patients may have large chest X-rays taken
between travelling clinic visits. This service involves over 13,000 chest X-rays
annually. A large number of tuberculin tests are also carried out by the clinics,
which in total amounts to about 18,000 per annum. In addition, the clinics review
over 35,000 chest X-rays each year which are taken in connection with the hospital
admission X-ray programme carried out by the hospitals throughout the Province.
There has been remarkably little change in the volume of work carried out by
the clinics in recent years because of the fact that while there are sizeable numbers
of new patients for examination each year, about an equal number are taken off
the lists when jt has been determined that they are not suffering from tuberculous
conditions.
The travelling clinics tend more and more to work in public health units
throughout the Province rather than in the local hospitals. This has become
possible through the installation of facilities for the developing of X-ray films, and
additional ones are being added each year. This, of course, is an ideal situation
because of the close liaison needed between the clinics of the Division and the field
health service for better exchange of information and closer supervision of the
patients.
 TUBERCULOSIS CONTROL Q 69
TREATMENT SERVICES
As of November 30, 1964, there were 163 patients under treatment for tuberculosis in the Willow Chest Centre and Pearson Tuberculosis Hospital. This was
a reduction of 43 patients from the previous year and represents about a 20-per-cent
reduction as compared to a 15-per-cent reduction each year over the previous 10
years. As a result of this, it was possible to reduce further the number of beds in
operation for the treatment of tuberculosis from 265 to 225. At the end of 1964
there were 132 beds for the treatment of tuberculosis at Pearson Hospital, and the
Willow Chest Centre remained unchanged at 93 beds. The 132 beds at Pearson
Hospital for tuberculosis are in one block, and another block of similar size has
been designated for the treatment of continuing-care patients.
Admissions to the two sanatoria in 1964, excluding review cases and transfers,
totalled 363, of which 256 were first admissions, 104 were readmissions, and 3
were continuation of treatment. This compares with 388 admissions in 1963, of
which 275 were first admissions, 109 were readmissions, and 4 were continuation
of treatment. As a comparison there were 932 admissions in 1956, of which 35
per cent were readmissions. During the last calendar year there were 27 cases
admitted to sanatorium for treatment of non-pulmonary tuberculosis conditions
other than pleurisy. This amounted to 7.4 per cent of the total admissions. Previous reports have indicated that surgery is now playing a small part in the treatment
of tuberculosis. The amount of surgery done in the Division of Tuberculosis Control continued at a low level during 1964. However, it should be noted that all
types of surgery are provided where indicated for both pulmonary and non-
pulmonary tuberculosis. Moreover, many patients while in sanatorium require
surgery for non-tuberculous conditions covering a wide variety of surgical procedures. These are also provided both by the staff of the Division and by specialists
in the various fields.
Patients in Sanatoria
The above table shows the continuing decline in total sanatorium population in
it years, as well as the increasing proportion of patients 50 years of age and
, In November, 1964, there were only 63 patients under 50 years of age in the
while there were 100 patients 50 years of age and over. These latter represented 61.3 per cent of the total population, and this percentage has almost doubled
the past 12 years.  This stresses the fact that tuberculosis is becoming
show that as a result of a
the younger people have
and more a problem of older peopl.
sustained tuberculosis programme over the past g<
been successfully protected against this disease.
Of the-total patients in sanatoria, only 37 were female and 126 were male,
a ratio of less than 1 to 4.
CONTINUING CARE
Besides facilities for tuberculous patients at Pearson Hospital, there are beds
re, and these consist of the Poliomyelitis Pavilion, which has been
 Q 70 PUBLIC HEALTH SERVICES
in operation for several years, and a block of 132 beds previously used for tuberculosis which have now been assigned to replace the Allco Infirmary and Marpole
Infirmary.
With the decline in poliomyelitis incidence there has been no demand for'the
admission of chronic poliomyelitis cases for about two years, and this has resulted
in some empty beds in the Poliomyelitis Pavilion. This unit was designed essentially
to deal with the respiratory problems of chronic poliomyelitis, and highly specialized
facilities have been set up for this purpose. When beds became vacant, it was decided
that other chronic and severe neurological conditions complicated by respiratory
problems could benefit from the facilities, such as iron lungs and rocking beds, and
should be admitted. As a result there are now six such cases in the poliomyelitis
unit as well as 30 poliomyelitis patients.
In May of 1964 all of the patients from Allco Infirmary were moved to Pearson
Hospital, and there are at present 27 of these cases in the institution. A programme
of activation was instituted for this group, and many of them are doing much more
for themselves than previously and seem much happier and more contented.
The transfer of the patients from Marpole Infirmary is dependent on the building of an activities area. This would include space for physiotherapy, occupational
therapy, and entertainment, as well as accommodation for the voluntary organization
that has been so active in working for the Marpole patients. Plans for this area have
been completed, and it is hoped that the building will start early in the new year.
CARDIAC SURGERY
In recent years there has been a reduction in chest surgery for tuberculosis
cases, with the result that the operating-rooms at the Willow Chest Centre have not
been used to capacity, and it became apparent that this facility could be put to other
use. The possibility was raised that cardiac surgery could be performed there as well
as tuberculosis surgery. A feasibility study was carried out to determine what
structural changes would be necessary and what administrative problems of staffing,
supervision, and co-ordination of services might arise, because the proposed plan
envisaged post-operative nursing care of cardiac patients at Willow Chest Centre as
well as the provision of operative facilities.
Detailed studies have been carried out by various branches of the Department
of Public Works as well as by the medical, nursing, and administrative departments
of the hospitals involved. These studies showed that the structural changes necessary
to provide this service were not too great, and that one of the operating-rooms could
be used for cardiac surgery and the other for tuberculosis surgery. The problems of
two hospital administrations being responsible for the patients and for the provision
of services to them did not present any insurmountable difficulty. Agreement has
now been reached that this plan is feasible, and we are prepared to proceed at
MENTAL HEALTH SERVICES
The tuberculosis programme carried out by the Division of Tuberculosis Control at the Provincial Mental Hospital, Essondale, continues relatively unchanged,
except for the fact that there has been a marked reduction in the number of patients
under treatment in the North Lawn Building. However, the other phases of the
work there continue at about the same volume. The North Lawn Building at Essondale was originally built as a tuberculosis institution with over 200 beds, but at the
present time only about one-quarter of its capacity is used for tuberculous patients,
and the rest of the beds are set aside for other types of cases.  At the end of the year
 TUBERCULOSIS CONTROL Q 71
there were only 15 tuberculous patients under treatment in the North Lawn unit,
and during the year there were 26 admissions and 123 discharges. Four transfers
from Pearson Tuberculosis Hospital and Willow Chest Centre were also cared for.
This reduction in the number of tuberculous patients in the North Lawn Building is
due to the fact that a great many cases became inactive and could be transferred
back to other parts of the institution. There are, however, 341 inactive cases of
tuberculosis at the Provincial Mental Hospital besides the 15 under active treatment.
All of these are kept under close observation.
It has been possible to reduce the medical services for the tuberculosis-control
programme, and there is no longer a full-time tuberculosis specialist assigned to
the Provincial Mental Hospital at Essondale. This service is now provided by the
physicians from the New Westminster Stationary Clinic. However, a full-time public
health nurse and a clerk are provided to supervise the programme, which includes
not only the care and supervision of the known tuberculous cases, but also admission
X-rays and periodic rechecks of all patients and staff at the institution.
As an indication of the volume of work entailed in this programme, it is noted
that over 13,500 chest X-rays were taken, 3,797 tuberculin tests were done, and 184
B.C.G. vaccinations against tuberculosis were carried out. It is gratifying to report
that no new cases of tuberculosis were discovered amongst the staff at the Provincial
Mental Hospital, but five new active cases of tuberculosis were found amongst the
patients, and these were placed under treatment.
HOSPITAL ADMISSION CHEST X-RAY PROGRAMME
About 10 years ago equipment for taking miniature X-ray films was provided
to all the major hospitals in British Columbia so that chest X-rays could be taken
on all persons admitted to hospital. This was because of the fact that there was a
higher incidence of tuberculosis in this group than average and these cases being
undetected were creating a tuberculosis problem amongst hospital staff. Initially
this programme was well supported and two-thirds of the patients admitted did actually have miniature chest X-rays. In the last five years there has been a falling-off,
and during 1964 somewhat less than a quarter of all patients admitted to general
hospitals had routine miniature chest X-rays.
A study was carried out to determine the effectiveness of this programme, and
it became apparent that while fewer miniature chest X-rays were being taken on
patients admitted to hospital, there was an increasing number of standard or large-
sized films being taken on this group. From this it is apparent that those responsible
for the patients are conscious of the tuberculosis problem that could be created if
this procedure is overlooked, and that in spite of the fact that fewer miniature films
are taken, an effective programme is still being carried out in most hospitals.
ACKNOWLEDGMENTS
In the provision of an over-all programme for tuberculosis control in the Province, this Division depends upon many official and voluntary organizations for its
implementation. Within the Health Branch the Divisions of Vital Statistics and
Laboratories, as well as the Local Health Services, have a significant part to play.
The Division of Laboratories provides for the bacteriological investigations that
are required by the tuberculosis clinics, and a special tuberculosis section is set up
within the Division of Laboratories for this purpose. This work involves smear and
cultures of sputum and gastric washings, guinea-pig inoculations, drug susceptibility
testing, and special investigations for atypical acid-fast bacilli, and represents over
35,000 tests performed annually.
 1
Q 72 PUBLIC HEALTH SERVICES REPORT, 1964
The Division of Vital Statistics collects and tabulates all of the clinical and ]
epidemiological information on the cases, which is used to direct the activities fear- j
ried out in the programme and for the provision of the tables which are included in 1
this annual report.
The tuberculosis-control programme in British Columbia is based on the well- j
developed public health service in the field. Supervision of the known cases and the j
suspects in the home is entirely the responsibility of this service, as are also the I
contact-tracing and the distribution of tuberculosis antimicrobials to those patients
who are taking treatment outside of sanatorium. The type of community tubercu- j
losis survey that is carried, on in British Columbia is not possible in most places I
throughout the continent because of the fact that there is no such field health service ]
that can undertake the follow-up of the cases that are detected. In this Province this 1
is efficiently carried out through the local health services. It will therefore be seen
that this service is an integral part in the tuberculosis-control programme through i
which the Division of Tuberculosis Control extends its services into all communities. ]
In accomplishing this, a very close liaison for exchange of information is maintained. 1
The Medical Services Directorate of the Department of National Health and
Welfare carries out a most successful programme of tuberculosis control for the j
native Indians living on the reserves throughout the Province.  This includes treatment, clinical, and case-finding facilities. This service works closely with the Division  ]
of Tuberculosis Control, and there is a frequent exchange of services.   While the   ]
Medical Services Directorate maintains sanatoria for the treatment of tuberculous
cases here, again the need for such facilities has been greatly reduced. This Division  j
during the year entered into a financial arrangement with the Medical Services Directorate that any chest surgery that was necessary for its cases could be done at Willow
Chest Centre by the staff of the Division.
Sunnyhill Hospital for Children (Vancouver Preventorium) continues to provide the necessary care for the treatment of children with tuberculosis. The need
for treatment beds for children with tuberculosis, however, continues to diminish,
with an average of about 10 cases under treatment throughout the year. The remaining beds in this hospital, with a capacity of 70, are used for other chronic conditions,
chiefly chest diseases.
Special mention should again be made of the significant contribution to tuberculosis control that is provided by the British Columbia Tuberculosis Society. This
contribution is chiefly in the nature of health education, organization of community
surveys, and assistance in the construction of health units. The society made an
outstanding contribution in the organization and provision of staff and equipment
for the Vancouver tuberculosis survey which was carried on during the past year,
which survey would not have been possible without its considerable support, both
financially and in manpower. As in previous years, the society has continued to help
in the construction of local health units, and, as a result of this, facilities have been
developed so that it is possible for travelling clinics of this Division to set up their
clinics and carry out their work from these health units in practically all parts of
the Province.
This report has emphasized the reduction of beds for the treatment of tuberculous patients and the increasing emphasis on the clinical and survey facilities in the
field. These become more highly developed each year, and it has also been indicated
that the highest standard of treatment is available to the patients in this Province.
It is interesting to note that the budget for tuberculosis control, which about 15 years
ago was $4VS million annually, is now less than half of that sum. The over-all cost
of tuberculosis has further decreased by the fact that, with the lessening incidence
of the disease, there has been a marked reduction in the number of tuberculous
persons receiving social a:
 VENEREAL DISEASE CONTROL                                      Q 73
REPORT OF THE DIVISION OF VENEREAL DISEASE
CONTROL
This is the 27th annual report of the Division of Venereal Disease Control and
1 outlines the disease situation in the Province and the Division's activities during 1964.
The situation in British Columbia reflected a trend which was generally evident
1 throughout Canada and other parts of the world.    The increase in incidence of
I syphilis and gonorrhoea caused much concern to public health authorities.   Serious
I attention is being given to means of limiting the spread of these diseases.
In 1964 the total of all syphilis cases reported increased from 476 to 557, rep-
1 resenting a 17-per-cent rise in incidence.    During the same period, 5,816 new
1   gonorrhoea infections were reported to the Division, which is an increase of 16 per
cent over 1963.
INFECTIOUS SYPHILIS
The 304 cases of syphilis reported in the infectious primary and secondary
[   stages of the disease were the greatest number that have been reported in any one
year since 1947.
Reported Venereal Disease, British Columbia, 1946-64
5SS
Ijfltfl
Another
Conors
Number
Ratet
Nntnber
Rate!
Number
Ratel
III
1
l
|
I
■
l
l
r-
1              l
EARLY LATENT SYPHILIS
Historically the ratio of infectious and early latent cases has been interpreted
as an index of infectious-syphilis case-finding.   When the number of infectious-
syphilis cases treated exceeds the number of early latent cases, this is an indication
that early treatment is inhibiting spread of disease. When early latent cases exceed
the number of infectious cases, this is an indication that spread of disease is not
being inhibited, since the majority of cases progress through the infectious primary
and secondary stages before they are detected.   During the last few years the early
latent cases have been rapidly increasing in British Columbia.
 PUBLIC HEALTH SERVICES REPORT, 1
|         1962
1963       |       1964
i
280        1         304
Early
| infectious syphil
s to early la.
2.1.1       |       1.7.1
While for each of these years infectious cases exceeded early latent cases, the }
ratio has declined from 2.7 to 1 in 1962 to 1.7 to 1 in 1964, thus indicating that j
increased programme emphasis to detect early syphilis cases is necessary, although
there are other factors requiring consideration.
TERTIARY AND LATE LATENT SYPHILIS
Tertiary and late latent syphilis have declined steadily in the last few years.
A slight increase is shown this year, however.
I960—
1961—.
1962—
The general trend until 1964 reflects a continuing lowering of the
old untreated cases.
CONGENITAL SYPHILIS
Cases of congenital syphilis continue to contribute less than 1 per cent to the
total incidence of syphilis. However, with the increases in infectious and early latent
syphilis, there is no room for complacency and a routine V.D.R.L. test should continue to be carried out early in the prenatal period.
GONORRHCEA
The total number of reported cases of gonorrhoea during 1964 has increased by
more than 800 over the 1963 total—5,816 compared with 5,012. Thus for two
consecutive years there has been the greatest number of cases of gonorrhoea ever
reported in British Columbia.
HOMOSEXUAL INFECTIONS
The number of syphilis and gonorrhoea infections due to homosexuality rose
22 per cent during 1964—92 cases to 112 cases—with the ratio of gonorrhoea and
syphilis infections being approximately 2 to 1.
EPIDEMIOLOGY
For controlling and eventually eradicating venereal disease, there is need for
studying in detail epidemiological procedure.   For example, success can be judged
by the number of patients for whom one or more contacts brought ii
tion are found to have primary, secondary, or early latent syphilis.
Failure of the epidemiology programme results from
failure to interview reported cases;
failure to si
failure tc
failure to identify spread or possible sources of infection; that is tfo
number of patients for whom no examined contacts were found t(
have primary, secondary, or early latent syphilis.
 VENEREAL DISEASE CONTROL Q 75
Evaluation of epidemiological procedures can be demonstrated as follows:—
rlmary*
dSecon
ary Syphil)
n
B
s?
bS
g
ofVene
ealDisea
eDMsio
1
75
61
In other words, for every 10 cases treated by the public health clinic about six
[ contacts were brought to treatment for syphilis, whereas only about half that number
I of infected contacts were turned up by private physicians. The disparity is under-
I standable as public health workers specialize in this field of contact-tracing, which
[ requires skill and time to interview and reinterview patients. This is not easily carried
j out in general practice, and it is stressed that once a patient has been treated in a
doctor's office and contact information is not forthcoming, the local health agency
[ should be notified promptly, then the Division personnel or public health nurse can
[   interview patients and so trace contacts and bring infected persons to treatment.
It has been decided that blood-testing of all new male admissions to Oakalla
Prison should be reintroduced. As there are about 40 or 50 admissions daily, this
will amount to between twelve and fourteen thousand V.D.R.L. specimens per year.
A nurse to do this work and related duties will be employed in January, 1965.
The Facilitation Committee, which considers measures to reduce the ease with
which contacts may be introduced, has met several times this year, as certain public
operations, particularly steam baths, have been causing considerable concern. In
this regard we continue to have excellent co-operation from the Vancouver authorities, including the police department, prosecu^sToffice. licensing department, and
the Metropolitan Board of Health.
EDUCATION
Educational programmes for the general public and professional groups have
received a lot of the Health Branch's attention during 1964.
In August the Honourable Eric Martin, Minister of Health Services and Hospital Insurance, called a press conference to inform the public of the serious situation
that was developing as far as venereal disease was concerned.
This was followed by letters from the Deputy Minister to the British Columbia
Medical Association and the Dean of the Faculty of Medicine at the University of
British Columbia requesting their assistance and co-operation.
The Sun newspaper, at the Health Branch's request, had its medical correspondent write a series of five articles on venereal-disease control, which were extremely
well received by the general public.
A display depicting the functions of the Division of Venereal Disease Control
was set up at the Pacific National Exhibition. This consisted of a series of slides
accompanied by a commentary.
The Division of Public Health Education has prepared material on " Family
Living " for use in schools, and arrangements are in hand to introduce this into the
curriculum at an early date.
Several sets of venereal-disease slides have been obtained, along with a few new
films, for use in public and professional health education.
Twelve students in the University of British Columbia's Public Health Nursing
Diploma Course spent one week each in the Division's clinic in order to get field
experience. Also, during the year, four public health nurses from health unit staffs
had periods of orientation at the clinic.
 q 76 PUBLIC HEALTH SERVICES REPORT, 1964
The Division of Public He
appeared at the 1964 Pacific N
operation with
The Division continued to contribute to the education of nursing students by
supplying films and literature for use at the various nursing-schools.
Following the public health education campaign referred to above, there has
been a marked increase in requests for literature and films for use by various interested groups. Also, members of the Division have been guest speakers to a variety
of organizations, including church groups and university students.
An article entitled " New Problems with an Old Disease," written by the Director, was published in the November, 1964, issue of The Canadian Nurses' Journal.
As mentioned in previous reports, the Division continued its policy of employing
part-time physicians for limited periods in its Vancouver clinic, working under the
direction of the senior medical consultant. The programme is designed to provide
opportunity for experience to as many general practitioners as possible.
PUBLIC AND SPECIAL CLINICS
In the health units, which represent the Division of Venereal Disease Control in
the rural area, the volume of venereal-disease work has increased to such an extent
as to warrant, in several, the use of a specially trained nurse and the operation of a
clinic as one of the health unit's functions. Such clinics operate to a greater or lesser
degree at Victoria, New Westminster, Prince Rupert, Prince George, Dawson Creek,
Kamloops, and, most recently, Haney. The special clinics at the Vancouver City
Gaol, Oakalla Prison, and Willingdon School for Girls continue to operate.
 r
VENEREAL DISEASE CONTROL
Vancouver Clinics
H
3E
M
SS
SS
10K1
11
m
12.799
B
8 1-1
Patient visits for 1964 show a decline. This is the result of measures adopted
to eliminate non-productive patient return visits, which consume staff and patient
time without additional benefit to the patient. Staff time conserved is more profitably invested in care to the infected person.
ADMINISTRATION
A major project of the Assistant Director has been to review the present workload content of Vancouver division employees, and to project future staff needs, if
the increase in venereal disease continues. As a result, one unfilled clerical position
has been re-established and the classification of one other clerical position revised
upward to be commensurate with employee qualifications required for adequate
performance. The desired academic and experience qualifications for professional
workers have been determined and recommendations for reclassification of positions
forwarded to the Civil Service Commission.
 "1
PUBLIC HEALTH SERVICES REPORT, 1
REPORT OF THE DIVISION OF LAHORATORIES
In 1964 the reorganized Division of Laboratories consolidated and increased
its services, mainly in the public health chemistry and virology sections.
In Table I the number of tests and the work load in units performed in 1964 at
the main laboratory are compared with the 1963 figures. There was an increase of
approximately 1 per cent, from 950,000 units in 1963 to 958,000 units in 1964.
These figures do not, however, include the work load associated with virology or
with the Salmonella project. In Table II the work loads in tests and units performed
in 1964 at the Nelson and at the Victoria branch laboratories are recorded. Each
Dominion Bureau of Statistics (D.B.S.) unit is equivalent to 10 minutes of work.
The total work load of the Division of Laboratories, excluding virology, in
1964 was as follows:— d.b.s. units
Main laboratory      958,210
Salmonella project        40,233
Nelson branch laboratory       32,941
Victoria branch laboratory      104,076
Total work load  1,135,460
In the five-year period 1958 to 1962, the demand for standard tests for syphilis
(S.T.S.) showed a significant decrease of 2 to 15 per cent per year. In 1963 the
demand increased by approximately 4 per cent, and a further increase of 7 per cent
occurred in 1964. This increase in 1963 and 1964 reflects the growing concern
occasioned by the increased incidence of syphilis in recent years. The Treponema
pallidum immobilization (T.P.I.) test was performed by the National Laboratory of
Hygiene and the Ontario Provincial Division of Laboratories on 204 sera; positive
results were reported on 90 patients (44 per cent). This free service is gratefully
acknowledged.
During 1964, 617 exudates from 397 individuals were examined by the dark-
field technique for the presence of Tr. pallidum. The number of patients yielding
positive results was 138 (35 per cent), compared with 31 per cent in 1963, 30 per
cent in 1962, and only 13 per cent in 1961.
The demand for tests in the diagnosis and control of gonorrhoea, which increased by nearly 20 per cent in 1963, increased by a further 8 per cent in 1964.
The increase in the number of smears submitted was in part offset by the decrease in
the number of specimens submitted for culture. Out of 43,900 smears examined,
7,500 were positive, 17 per cent in 1964 compared with 15 per cent in 1963; out
of 11,000 cultures investigated, 2,700 were positive, 24 per cent in 1964 compared
with 23 per cent in 1963. Studies of the use of transport medium for shipping specimens for culture from distant parts of the Province failed to show that culture was
superior to microscopy under these circumstances.
OTHER SEROLOGICAL PROCEDURES
The demand for serological tests used in the diagnosis of typhoid fever, glandular fever, and brucellosis again increased in 1964. The number of specimens
submitted for antistreptolysin 0 titre estimation rose from 2,500 in 1962 to 3,100
in 1963 and to 4,300 in 1964, a 70-per-cent increase in two years.
 Nearly 200 serum specimens were selected and shipped ii
the Frater virus antibody survey being conducted in London, Ont.
Out of 147 serological tests performed at reference laboratories in Canada
and the United States, 19 positive and 1 doubtful result were obtained: Positive—
10 toxoplasmosis Sabin-Feldman dye tests, 3 toxoplasmosis complement-fixation
tests, 3 histoplasmosis complement-fixation tests, 2 cat scratch complement-fixation
tests, and 1 trichinosis precipitin test; Doubtful—1 hydatid complement-fixation
test.
There was little change in the number of specimens submitted for culture or
in the number of smears prepared for microscopic examination for Mycobacterium
tuberculosis. Animal inoculations increased from 400 in 1963 to nearly 470 in
1964. There was a substantial increase in the number of strains tested for their
susceptibility, particularly to streptomycin, isoniazid, and para-animo salicylic acid.
The number of cultures requiring further investigation to differentiate M. tuberculosis
from other mycobacteria showed a slight increase.
This Division, collaborating closely with the Division of Tuberculosis Control,
continued to participate in the National Study of Primary Resistance conducted by
the Canadian Tuberculosis Association.
 "1
PUBLIC HEALTH SERVICES REPORT. 1
The number of specimens submitted for culture decreased from 15,600 in 1963
to 15,200 in 1964. Pathogenic enteric organisms were isolated from 551 individuals, compared with 671 in 1963. As shown in Table III, these included 257
Salmonella:, 134 Shigella:, and 160 enteropathogenic Escherichia Coli in 1964.
Twenty-eight different Salmonella types were isolated in 1964, compared with
22 in 1963. The most common types isolated from man in 1964 were Salmonella
typhimurium (77), S.heidelberg (51), S. thompson (26), and S.newport (20)
(Table IV). Two new Salmonella types were isolated during the year: S. brmnderup
for the first time in British Columbia and S. eimsbuettel for the first time in Canada.
There were no large outbreaks of salmonellosis.
Of the 134 patients with Shigella infection proved bacteriologically, 60 yielded
Shigella flexneri, 39 Sh. boydii, 34 Sh. sonnei, and 1 Sh. dysenterice. There were no
major outbreaks attributed to enteropathogenic Escherichia coli; the 160 strains
isolated were of the following serotype: 0119.B14 (51); 026:B6(42); 0111:B4
(20); 0127:B8 (13); 055:B5 (12); 0128:B12 (11); 0126:B16 (5); 086:B7
(3); and0125:B15 (3).
The Salmonella project continued in 1964 with support from Provincial funds
and from a National Health Grant. The third annual progress report covering the
period October 1,1963, to September 30, 1964, was submitted through the Deputy
Minister to the Department of National Health and Welfare with a request for
continued support in the fiscal year 1965/66.
OTHER BACTERIOLOGICAL TESTS
Diphtheria
No case of diphtheria was diagnosed in the laboratory during 1964. In the
past five years, 1960 to 1964, only five cases were diagnosed.
Streptococcal Infections
The Division participated in an international survey to determine the geographical distribution of types of Streptococcus pyogenes Group A. Forty Group A strains
were submitted for typing to the Laboratory of Hygiene, Ottawa.
Blood Culture
Of the 200 blood cultures submitted for examination, 13 yielded organisms.
The bacteria isolated were Staphylococcus albus (5), Neisseria meningitidis (3),
Streptococcus pneumonia; (1), Hemophilus influenza; (1), anaerobic diphtheroid
(1), Chromobacter species (1), and coliform organism (1).
Food Poisoning
A total of 92 foodstuffs suspected of transmitting food poisoning were examined bacteriologically.   Only four yielded food poisoning organisms, as follows:—
(1) A family of three was taken ill about 2 hours after supper. Coagulase-
positive Staphylococcus aureus was isolated from a remnant of bread
pudding.
(2) In a family outbreak, coagulase-positive Staphylococcus aureus was isolated from minced tuna remnants.
 LABORATORIES Q 81
(3) In the investigation of a small outbreak, Streptococcus fascalis was isolated
from a sample of the suspected turkey meat.
(4) Several persons were taken ill at two banquets supplied by the same
caterer. Clostridium welchii was isolated from turkey remnants and
gravy.
FUNGAL INFECTIONS
The demand for mycological investigations was 13 per cent higher than in
■ 1963. A total of 4,300 specimens was examined in 1964, compared with 3,800 in
[ 1963. Almost 30 per cent of specimens yielded positive results. The following
I dermatophytes were identified: Microsporon canis (81), Epidermophyton floccosum
(30), Trichophyton mentagrophytes (73), T. rubrum (170), and T. tonsurans
[ (5). In addition, Candida albicans (548) and members of the Candida group (297)
were isolated. Eleven infections with Malassezia furfur were diagnosed micro-
I scopically.
PARASITIC INFECTIONS
Requests for examination for intestinal parasites, which increased from 1,600
'  in 1955 to 5,000 in 1963, rose 7 per cent to over 5,400 in 1964.   The following
protozoan parasites were identified in specimens of feces:   Entamoeba coli (233),
Giardia lamblia (180), Endolimax nana (170), Entamceba histolytica (62), Ioda-
:   mceba biitschlii (46), and Chilomastix mesnili (14).   The following helminth eggs
:  were identified in feces: Trichuris trichiura (74), Clonorchis sinensis (25), Ascaris
lumbricoides (18), hookworm (13), Oxyuris vermicularis (12), Tenia spp. (8),
Diphyllobothrium latum (3), and Hymenolepis nana (1).    The following adult
worms were also seen: Ascaris lumbricoides (13), Tenia spp. (4), and Enterobius
vermicularis (1).   Out of 1,954 National Institute of Health swabs examined, 325
revealed eggs of Enterobius vermicularis.   Two ectoparasites, both Phthirus pubis,
were also identified.
VIRAL INFECTIONS
Specimens from 140 patients were examined for enteroviruses, using tissue
culture techniques or animal or serum neutralization tests. The following viral
agents were isolated: Poliovirus Type I (5), Poliovirus Type n (4), Poliovirus
Type III (4) (these figures include the isolation of Types I, II, and III, probably
Sabin vaccine strains, from four patients), Coxsackie A9 (2), Coxsackie A23 (2),
Coxsackie A (1), Coxsackie B (2), and not yet identified (9). One case of Rickettsialpox was identified by serological methods.
Three epidemics were investigated during 1964:—
(a) Specimens from cases of influenza-like illness were examined; no virus
was isolated. Influenza A2 virus was responsible for similar infections in
Washington State.
(b) An outbreak of Erythema infectiosum was investigated, but no viral agent
was isolated.
(c) In an outbreak of illness characterized by gastrointestinal and respiratory
symptoms, two deaths occurred. Influenza C virus was isolated from two
other patients with similar symptoms.
To illustrate the complexity of virological procedures, some of the techniques
employed in the virology laboratory during 1964 are listed: 11,500 tubes of tissue
culture were prepared; 20 enteroviruses were standardized by titration with homologous antisera and ampouled for subsequent use; 78 families of suckling mice were
inoculated; and 253 laboratory mice were examined for infection.   Because of the
 q 82 PUBLIC HEALTH SERVICES REPORT, 1
complexity and diversity of these procedures,
to assess work load in the Virology Section ir
PUBLIC HEALTH CHEMISTRY
During 1964 the amalgamated Chemistry and Water Bacteriology Section
operated in close harmony. Merging of these two laboratories proved satisfactory
both administratively and technically. The work load in connection with chemical
analysis increased from 13,400 units in 1963 to 24,800 units in 1964; this increase
of 85 per cent was largely due to chemical surveys of water samples collected from
the Fraser, Thompson, and Nechako Rivers, and from Kootenay Lake. The following new tests were calibrated and made available: Determination of sodium, potassium, manganese, arsenic, sulphide, organic nitrogen, oil and grease. Field kits
were also calibrated and issued to the field staff.
Water Bacteriology
The number of samples submitted for bacteriological examination increased
from 14,400 in 1963 to 14,900 in 1964, largely because the coliform test was performed on all water samples submitted for chemical analysis. On January 1, 1964
a six-month study was started to determine the relationship between the results of
completed tests and confirmed tests on drinking-water samples. During this period
3,325 (82 per cent) of the 4,054 drinking-waters examined by the coliform test
were negative either in the presumptive test or the confirmed test. The remaining
729 drinking-waters were examined by the completed test: 407 (56 per cent) were
positive, 322 (44 per cent) were negative. When these findings were reported to
the Health Officers' Council in September, 1964, it was decided to continue indefinitely carrying out the completed test on all drinking-water samples that yielded
positive confirmed tests. Over 1,900 completed tests were performed during the
year.
A second study was also started in 1964 to compare the results of testing water
samples by the coliform (multiple-tube fermentation) test and by the membrane
filter technique.
BRANCH LABORATORIES
The Kootenay Lake General Hospital continued to provide part-time technical
and cleaning assistance in the Nelson branch laboratory. Vacation relief was provided by the main laboratories. The work load, which was 28,700 units in 1962
and 31,000 units in 1963, increased to 33,000 units in 1964 (Table H).
The Royal Jubilee Hospital laboratory continued to provide public health
laboratory services for the Greater Victoria Metropolitai
work load, which was 106,200 units in 1963, decreased
(Table II).
GENERAL COMMENTS
During the year the Virology Section established techniques for the isolation
and identification of enteroviruses. The continued co-operation and advice of
Dr. D. M. McLean, Hospital for Sick Children, Toronto; Drs. J. C. Wilt and
W. L. Parker, Department of Bacteriology, University of Manitoba; and Dr. F. P.
Nagler, Laboratory of Hygiene, Ottawa, are gratefully acknowledged.
The Public Health Chemistry Section widened the scope of its facilities for
chemical analysis of water and laid a solid foundation for future work in connection
with air-pollution control and occupational health. A second analyst was appointed
to the staff.
 LABORATORIES Q 83
The senior analyst attended a three-week course on air-pollution survey
methods held at the United States Public Health Service Sanitary Engineering Center
I in Cincinnati, Ohio.   The senior serologist attended a two-week course on syphilis
[ serology at the Laboratory of Hygiene.
New movable laboratory benches were installed in the chemistry laboratory
I to permit more efficient use of the available space and to accommodate new equip-
[ ment.   Two new safety cabinets were installed in the tuberculosis laboratory to
ensure maximum protection for staff.
In the academic sphere six members of the staff lectured or instructed at the
University of British Columbia in the Departments of Bacteriology and Nursing or
in the Faculty of Medicine. Four of the staff lectured at the short refresher course
for public health inspectors. Members of the Serology Section presented a one-
week course on serological techniques for trainee technologists at the Vancouver
General Hospital. In May and in November two trainee technicians were enrolled
for the first and second Medical Laboratory Technology Courses at the new British
Columbia Institute of Technology.
In August the Director presented a paper at the 19th annual meeting of the
International Northwest Conference on Diseases in Nature Communicable to Man,
i at Ashland, Ore. In November the Director presented a paper at the 32nd
annual Christmas meeting of the Laboratory Section, Canadian Public Health Association, in Quebec, and in December attended the 20th annual meeting of the Technical Advisory Committee on Public Health Laboratory Services, held in Ottawa.
At the end of a busy and successful year of consolidation, it is a pleasure to
mpliment members of the staff on maintaining the high standard of laboratory
performance in the widening fields of public health laboratory service.
 1
Q g4 PUBLIC HEALTH SERVICES REPORT, 1964
Table I.-^Statistical Report of Examinations and Work Load in 1963 and 1964,
Main Laboratory
-_SSff*S-—*mm
Blood-
^mpiement-fixationCauan
IraasiSS.
 LABORATORIES                                                    Q 85
1   Table II.—Statistical Report of Examinations and Work Load during the Year 1964,
Branch Laboratories
B
Nelson
Victoria
PeS^ed
WorMoad
Pe_SSed
Workload
EH=Sr"e„a
H
_i|
"l
.E
ll
p=E^EEEEE
s^S^.^z:
I         CC-_n~.ement fixation
[      Tuberculosis laboratory—
WSgjp
10,701
32,941
32,832
104,076
Table III.—Pathogenic Enteric Bacteria—New Patients with Positive
Laboratory Results
Year
Saltnonell*
S,_6el_.
Pattosenic
Total
1957
|
J
1
I
 PUBLIC HEALTH SERVICES REPORT, 1964
 OCCUPATIONAL HEALTH Q 87
REPORT OF THE DIVISION OF OCCUPATIONAL HEALTH
During 1964 the activities of the Division of Occupational Health have been
increasing, especially in the area of the employees' health programme.
As a member of the Advisory Committee on the Sale and Distribution of
Poisons, Drugs, and Medicines in Agriculture and the Committee on Safe Use of
Chemicals in Agriculture, the Director assisted in preparing a report for the Minister of Agriculture on methods to control pesticide hazards.
The chemistry laboratory has been used to a limited extent by the Division of
Occupational Health, but this is expected to increase if the public health inspectors
become more involved in factory inspection. Also, as we hope to do more research
in air pollution in the near future, this will require a considerable amount of laboratory assistance.
Excellent relations have been maintained with the Factories Branch of the
Department of Labour, Department of Mines and Petroleum Resources, Department
of Agriculture, Federal Food and Drug Directorate, and the Workmen's Compensation Board. This is very much appreciated by the Director of the Division, as in
many areas, services overlap and consultation with these other departments is necessary and useful in order to avoid duplication.
As in previous years, the demands for radiation protection services continued
to increase. In addition to radiation inspection and surveys, courses were again
arranged for industrial and medical technicians at the Institute of Technology.
An important event during the year was the visit of Dr. Robert Kehoe, Professor of Industrial Medicine at the University of Cincinnati and Director of the
Kettering Institute. He addressed the annual meeting of the British Columbia
Branch of the Canadian Public Health Association, his subject being " Occupational
Health in the Public Health Programme."
EMPLOYEES' OCCUPATIONAL HEALTH SERVICE
The operation of this service is running smoothly, and the medical director
spent a considerable amount of time seeing employees referred by the various departments for health reasons. During the year more than 200 employees were seen on
this basis. Many other referrals were adequately dealt with by the occupational
health nurse concerned.
An occupational health unit has recently been established at the Provincial
Mental Hospital, Essondale, and staffed by a full-time public health nurse. As
mentioned in the 1963 report, her function will be to give service to Mental Health
Services employees located at Essondale, Valleyview, and The Woodlands School.
There was a change of nursing personnel at the Victoria unit, as the incumbent
nurse resigned in May in order to get married. Her permanent replacement took
over the position in August.
A total of over 7,700 services was rendered to Government employees by the
occupational health nurses located at the Victoria and Vancouver offices.
Two special immunization programmes were organized for employees during
the fall of 1964 for influenza and oral poliomyelitis vaccines. Immunization against
influenza required the giving of over 5,500 inoculations. The administration of oral
polio vaccine was proceeding at the end of the year. More than 1,500 employees
indicated that they wished to have the vaccine.
The morbidity information, as received by use of the revised C.S.C. 5 form,
is proving very useful to the Service in dealing with many health and related problems that occur in this large working population.
 q gg PUBLIC HEALTH SERVICES REPORT, 1964
EDUCATION
During the year the Director of the Occupational Health Division participated
in the Public Health Inspectors' Refresher Course and the two sessions of the Health
Officers' Council, presenting papers or commenting on such topics as " Pesticide
Hazards and Their Control," " Factory Inspection," and "Air Pollution."
Several lectures on occupational health were given to nurses at the University
of British Columbia School of Nursing.
As well as the above, the Director spoke at different times to supervisory and
employee groups in the various Government departments on the functions of the
Occupational Health Service.
RADIATION PROTECTION SECTION
The Radiation Protection Section of the Division of Occupational Health has
found it necessary to curtail and modify some of its programmes because of more
demands for consultations and surveys of X-ray and radioisotope installations. In
the field of refresher courses particularly, the only one being continued by this
Department is for X-ray technicians employed in hospitals.
The refresher courses for medical X-ray technicians, conducted this spring,
were the most successful held to date, with a total of 84 students from all parts of
the Province registered for both courses. The advanced course in particular was
of a very high calibre. Speakers were provided by the United States Public Health
Service, an X-ray supply house in Cleveland, and the Radiation Protection Division
of the Department of National Health and Welfare. The refresher courses for 1965
are being organized with the co-operation of the British Columbia Division of the
Canadian Society of Radiological Technicians, who will take charge of the development of the technical programme. The courses will be held at the British Columbia
Institute of Technology in Burnaby.
The demand for the work of the survey team continues to grow, with 285
surveys and 820 consultations completed to November of this year. Because of the
very large concentration of X-ray equipment in the two major centres of Vancouver
and Victoria, there has been very little coverage given these areas as, once the
programme is started, it will take a surveyor one full year to make the first preliminary surveys; an increase of staff would be required to meet this responsibility.
How this programme is continuing to grow is indicated by the following
1962....... ...     217
During 1964 the two inspectors covered mainly the East Kootenay, Okanagan,
North Thompson, and mid-Fraser River areas.
The service is being used by hospital administrators, architects, X-ray supply
houses, and the various Government departments at an increasing rate as consultants on their planning and radiation problems. We have held some 200 consultations and approved 85 sets of sketch-plans and working drawings in this period.
The work of the Radiological Advisory Council to the Department of Health
Services and Hospital Insurance has continued to increase, with several requests
being received for it to study and recommend standards for equipment and
protection.
 OCCUPATIONAL HEALTH Q 89
The full Council will now meet on a quarterly basis, and the Equipment and
Planning Committee of the Council will meet at least once a month. To December 1st, this Committee had reviewed and approved 70 applications for grants
toward X-ray equipment from the British Columbia Hospital Insurance Service
amounting to a total expenditure of $678,535.
In 1959 this service did a research study into means of providing better and
cheaper communication between hospitals in a region. It was initially to be designed
to speed up the reading and reporting of X-ray film by a regional radiologist and
reduce the need for this professional specialist wasting so much of his valuable time
in travelling.
The original concept called for a television network, using high-resolution
industrial cameras and with voice transmission. The concept and equipment were
available, but the cost of transmission proved prohibitive.
The need for communication between hospitals of a region is still necessary,
and later development showed some system of communication between hospitals
could be used by all hospital departments.
With the advent of teletypewriter exchange services, which utilize a machine
combining a typewriter and a dial system that can transmit messages directly by
wire to any institution having a receiving unit, communication can now be provided
quite cheaply.
Approval in principle has been granted for a trial run of this equipment in a
Lower Mainland region; it will be used by radiologists, pathologists, and other
hospital personnel.
The dental X-ray survey programme has been greatly accelerated this year,
with 172 installations checked for radiation safety. This programme has been well
received, and requests are coming in faster than the present staff can handle.
The British Columbia Institute of Technology's X-ray training programme has
been operating since September, and from first reports is fulfilling all the requirements and hopes of the Radiological Advisory Council.
The consultative work in the field of radioisotopes has continued to expand
as both the medical and industrial uses of isotopes increase. This is particularly
true in medical research and the pulp and paper industry. There were approximately 100 industrial radioisotope surveys done this year.
The personal Film Badge Monitoring Service reports from Ottawa indicate
there is still unnecessary radiation being received by some of the users of this service.
In several incidents the wearer of this film badge has been unable to give a satisfactory explanation for the high exposure.
 PUBLIC HEALTH SERVICES REPORT, 1964
REPORT OF THE REGISTRY AND REHABILITATION
SERVICES
THE REGISTRY FOR HANDICAPPED CHILDREN AND ADULTS
The number of handicapped persons registered now exceeds 26,500. Approximately one-quarter of these have so far been reviewed in an effort to establish the
number of family relationships existing between those with congenital anomalies.
Thus far 16 per cent appear to have at least one relative on the handicapped register.
Case records have been reviewed also, with the object of trying to incorporate
an etiological code on the Registry case records. This would add considerably to
the value of information available for future statistical study.
Measures have been taken to encourage more complete registration of persons
suffering from diabetes in the Province in order to make available more data for
the study of this disease. In this connection the Registry is co-operating with the
Clinic for Juvenile Diabetics at the Health Centre for Children and with the family-
tree research project, which is sponsored by the Canadian Diabetic Association.
A study has been completed on 259 infants with anencephaly, the first so far
carried out in Canada.   The results of this study will shortly be published.
During the year a manual of Registry procedures and of the historical development of the Registry was prepared. This manual was drafted initially for the
information of a national committee studying methods of obtaining reliable data on
ongenital anomalies.   However, it has been in demand for use
 REGISTRY AND REHABILITATION SERVICES Q 91
in other Provinces and countries where the establishment of similar registries is
[  under consideration.
The Registry staff and consultants spent considerable time during the year in
I  reviewing a code that they had devised in 1963 for the classification of congenital
!  anomalies and in comparing it with other proposed classifications which had been
[ circulated by the World Health Organization preparatory to the Eighth Revision of
the International Statistical Classification of Diseases, Injuries, and Causes of Death.
The revised Registry code was submitted to the Canadian Advisory Committee
on the Eighth Revision of the International Statistical Classification, and many
features of it were incorporated into the Canadian submission to the World Health
Organization.
Two publications were produced during the year from the Registry. The first,
prepared by Miss A. E. Scott, appeared in Canada's Health and Welfare in April,
1964, entitled " First the Facts." The other was published in the Canadian Medical
Association's journal in August, 1964. This was prepared by Mr. G. Renwick,
Dr. J. R. Miller, and Dr. D. Paterson, and was entitled " Estimates of Incidence and
Prevalence of Mongolism and of Congenital Heart Disease in British Columbia."
In addition, Dr. J. Miller gave a paper on " Human Genetics in Public Health
Research and Programming " in a Symposium on Human Genetics in Public Health
at the University of Minnesota in August, 1964.
The Registry continues to receive visitors and requests for information and
advice from many parts of the world, while medical students at the University of
British Columbia also receive instruction in its operation.
REHABILITATION SERVICES
The policy of developing rehabilitation resources in local communities has now
been fully accepted and advocated by the Rehabilitation Services. This has required
a close working relationship among physicians, Public and Mental Health Services,
Social Welfare Service, National Employment Service, the Department of Education,
local community agencies, and " Employment." Besides assisting in the establishment of this working relationship locally, it has been necessary to develop a closer
liaison between many of these services centrally.
Local community vocational rehabilitation committees have been established
in 10 Provincial communities, while another five are now in the preliminary planning
stages. Thus vocational rehabilitation services are being provided to the handicapped increasingly throughout the Province, and the local communities are becoming fully involved in this responsibility, with advice and assistance from members
of this central service.
Those areas at present being served include Central Vancouver Island, with
headquarters in Nanaimo; the Lower Fraser Valley, with centres in Chilliwack and
Abbotsford (including Mission and Haney); the northern centres of Prince George
and the Peace River area; Okanagan centres, including Kamloops, Vernon,
Kelowna, and Penticton; and the Kootenay area of Cranbrook.
Since all areas differ little or much, one from another, in the availability of
local facilities, in industries, and in community philosophy, it has been necessary
for members of the Central Rehabilitation Services to visit most of the new areas
where a rehabilitation programme is being put into effect in order to assist in accommodating the basic programme to local requirements and conditions.
Members of the Central Rehabilitation Services have attended local commun-
it committee meetings in outlying areas at frequent intervals to provide
 1
q 92 PUBLIC HEALTH SERVICES REPORT, 1964
ongoing consultative assistance.   Authority has been obtained to employ two field
rehabilitation consultants, who will regularly provide such service to two or more j
committees on a regional basis, thus providing a more continuous service and ulti- 1
mately relieving the Central Rehabilitation Services staff from making such frequent
journeys to the areas served.   As the local services develop, it is planned to employ   ;
additional field consultants for this purpose.
Co-ordination of services which may be used in each local area is an important ;
part of the duties of the field consultant, as well as advising the local rehabilitation ;
committees regarding services that may be used in the metropolitan areas, should ''
such services not be available locally. Some aspects of casework will also be \
handled by them.
Discussions have been held with the medical staffs of many hospitals throughout the Province where hospital rehabilitation programmes are developing, to
explain how these services might be integrated with those of the vocational rehabilitation committee in the local community. Much interest has been generated by
these discussions, and some local action in this direction is now becoming apparent.
Physicians in practice are using increasingly the services provided by the local
vocational rehabilitation committees where these are in operation. Arrangements I
have been made with the Gorge Road Hospital in Victoria to provide a physical
assessment service similar to that provided by the G. F. Strong Rehabilitation Centre j
in Vancouver.
Considerable time has been spent in attempting to stimulate the development
of new facilities for the purpose of work assessment and training of severely handicapped persons. This has necessitated the laying-down of standards of operation,
and of holding consultations with existing agencies in an attempt to see how then-
operations might be adapted to these standards.
Some progress has been made in this field, but such progress is slow. The
Poliomyelitis and Rehabilitation Foundation is providing a limited service in this
field, which has proved invaluable, and has received considerable support from
members of the Provincial Rehabilitation Services, both on a consultative basis as
well as in payment for services to handicapped persons who have been assessed in
their workshop.
In view of the policy of the Department of Education to provide additional
vocational-training schools throughout the Province, it has been possible to place
an increasing number of handicapped persons into training programmes, and to
enable many of these to take such training nearer to their own homes.
Consultation and advice have been given on an individual case basis throughout the Province where special rehabilitation problems have occurred.
Besides serving on vocational rehabilitation committees in outlying areas of
the Province, members of the Rehabilitation Services have served, on a regular basis,
on various committees operated by community agencies in Metropolitan Vancouver,
both on casework as well as in a general advisory capacity.
A manual has been prepared by the Rehabilitation Services outlining the
recommended methods of operation of local vocational rehabilitation committees,
how additional services might be obtained, and the conditions under which payment
may be made for such services under the terms of the Federal Act and the Federal-
Provincial Agreement relating to the vocational rehabilitation of disabled persons.
This manual has been distributed to all health unit directors throughout the Province,
as well as to all social welfare offices, in order to facilitate the operation of their
local rehabilitation committees.
 REGISTRY AND REHABILITATION SERVICE Q 93
The following figures represent a brief summary of the results achieved by the
local rehabilitation committee and in the cases served directly through the central
office of the Rehabilitation Services. Only three local rehabilitation committees were
functioning throughout the whole year—Nanaimo, Prince George, and Chilliwack.
Local Rehabilitation Committees
Total number of cases accepted for consideration or carried over
from 1963 214
Total number of cases closed during the year       73
Number of persons placed in employment     31
Number of cases still under consideration or in training at the end
of the year.     141
Central Office, Rehabilitation Services
Total number of cases accepted for consideration or carried over
from 1963   289
Total number of cases closed during the year     75
Number of persons placed in employment     59
Number of cases still under consideration or in training at the end
of the year.    214
   

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