PROVINCE OF BRITISH COLUMBIA Seventy-fourth Annual Report of the Public Health Services of British Columbia HEALTH BRANCH Department of Health Services and Hospital Insurance YEAR ENDED DECEMBER 31 1970 Printed by K. M. MacDonald. Printer to the Queen's Most Excellent Majesty in right of the Province of British Columbia. 1971 DEPARTMENT OF HEALTH SERVICES AND HOSPITAL INSURANCE (HEALTH BRANCH) The Honourable Ralph R. Loffmark, Q.C. Minister of Health Services and Hospital Insurance SENIOR PUBLIC HEALTH ADMINISTRATIVE STAFF J. A. Taylor Deputy Minister of Health and Provincial Health Officer G. R. F. Elliot Director, Bureau of Special Health Services A. H. Cameron Director, Bureau of Administration K. I. G. Benson Director, Bureau of Local Health Services G. F. Kincade Director, Division of Tuberculosis Control E. J. Bowmer Director, Division of Laboratories H. K. Kennedy Director, Division of Venereal Disease Control J. H. Smith Director, Division of Occupational Health C E. Bradbury Director, Division of Rehabilitation J. H. Doughty Director, Division of Vital Statistics A. A. Larsen Director, Division of Epidemiology Mrs. M. Green Director, Division of Public Health Nursing F. McCombie Director, Division of Preventive Dentistry W. Bailey Director, Division of Environmental Engineering R. G. Scott Director, Division of Public Health Inspection M. A. Kirk Senior Consultant, Division of Public Health Education Miss P. Wolczuk Consultant, Public Health Nutrition H. J. Price Departmental Comptroller The Hon. Ralph R. Loffmark, Q.C. Minister of Health Services and Hospital Insurance J. A. Taylor, Deputy Minister of Health and Provincial Health Officer Office of the Minister of Health Services and Hospital Insurance, Victoria, British Columbia, January 26, 1971. To Colonel the Honourable John R. Nicholson, P.C., O.B.E., Q.C, LL.D., Lieutenant-Governor of the Province of British Columbia. May it please Your Honour: The undersigned respectfully submits the Seventy-fourth Annual Report of the Public Health Services of British Columbia for the year ended December 31, 1970. RALPH R. LOFFMARK, Minister of Health Services and Hospital Insurance. Department of Health Services and Hospital Insurance (Health Branch), Victoria, British Columbia, January 26, 1971. The Honourable Ralph R. Loffmark, Q.C, Minister of Health Services and Hospital Insurance, Victoria, British Columbia. Sir,—I have the honour to submit the Seventy-fourth Annual Report of the Public Health Services of British Columbia for the year ended December 31, 1970. A. TAYLOR, B.A., M.D., D.P.H., Deputy Minister of Health. ~— UJ o ? < DC __ cn ?. -1 _c <r o H H 0. «. en N O 7 I < u f) ._. oi < O « a UJ () u sr > < tr OS CQ UJ CO a H < a I 1- -1 < UJ I LL O tr LU h- t/> _» _E o a_ H . Z t.O oo Zto Ocn 550 Eo w ca o sd Z o Ob 5.2 >° 3^ cd S u oi O H «. oi O < tJ, > 3 r E_ &.X oz tnO P QOh Z tx.2 §S a. X sea £< ax cd oi > oi < oi cd X H > oi 99 < Cd a u en ej z o cd u En en H CJ O Cd > en J H > 6.3 og Zx H ■< OH 23 S. / H en to O >cd 3= Z Z CJ o J __ Q C/3 a __ «. 3 a. 0 O Z 3 0 0 -j 0 z 0 Cd CJ z 00 oi Id -J z 0 Cd Cd CJ oi Cd Si zS za £ cd a C_.cn OZ Oh P ai Cd en X H _J Oj 2< ow CL. Cd Z C/.H 63 £■ cnJ O X c_cd au as Eg O z S2 2 H Z j* u z Cd O oi 3 CO 3 z 0 al > oi 0 5. 3 Qm > z w a* 3 5 a. Cd s Cd 1 1 1 1 1 1 The Health Branch is one of the three branches of the Department of Health Services and Hospital Insurance, together with the branches of Mental Health Services and the British Columbia Hospital Insurance Service. Each is headed by a Deputy Minister under the direction of the Minister of Health Services and Hospital Insurance. In the Health Branch, the Deputy Minister of Health and the Directors of the three bureaux form the planning and policy-making group. Under them the divisions provide consultative and special services to all public health agencies throughout the Province. The chart on the previous page shows the organization. Direct services to the people in their communities, homes, schools, and places of business are provided by personnel of local health departments. Greater Vancouver and Greater Victoria have their own metropolitan organizations, which, though not under jurisdiction of the Health Branch, co-operate closely and receive special services and financial assistance from the Provincial and Federal Governments. The remainder of the Province is covered by 18 health departments, known as health units, which are under the jurisdiction of the Health Branch. Each unit is complete in itself and serves one or more population centres and the rural areas adjacent to it. TABLE OF CONTENTS Page Introduction 9 Communicable and Reportable Disease 13 Health and Our Environment 16 Community and Family Health 19 Maternal and Child Health 24 Immunization 25 School Health 26 Home Care 28 Preventive Dentistry 30 Nutrition Service 33 Public Health Education 34 Vital Statistics 35 Extended Care 37 Rehabilitation 38 Kidney Failure Correction Programme 40 Laboratory Services 41 Poison Control 44 Emergency Health Service 45 Council of Practical Nurses 47 Publications, 1970 48 Tables— I.—Approximate Numbers of Health Branch Employees by Major Categories at the End of 1970 49 II.—Organization and Staff of Health Branch (Location and Approximate Numbers of Persons Employed at End of 1970) 49 III.—Comparison of Public Health Services Gross Expenditures for the Fiscal Years 1967/68 to 1969/70 51 IV.—Per Diem Rates for In-patient Care during the Fiscal Year April 1, 1969, to March 31, 1970 51 V.—Training of Health Branch Staff Proceeding toward a Diploma or Degree in a Public Health Specialty 52 VI.—Training of Health Branch Staff by Means of Short Courses 52 VII.—Reported Communicable Diseases in British Columbia, 1966-70 (Including Indians) 54 VIII.—Reported Infectious Syphilis and Gonorrhoea, British Columbia, 1946, 1951, 1956, 1961, 1964-70 54 IX.—Statistical Summary of Public Health Inspectors' Activities, 1968— 70, for 17 Provincial Health Units 55 X.—Public Health Inspectors' Time-study 56 XI.—Statistical Summary of Selected Activities of Public Health Nurses, September, 1969, to August, 1970, Inclusive 56 Page XII.—Summary of Service Provided in Three Areas by Employees' Health Services Staff, 1970 57 XIII.—Enrolment in Public and Private Schools in British Columbia, June, 1970 58 XIV.—Number of Pupils Receiving Basic Immunization Prior to Entering Grade I, September, 1969 58 XV.—Pupils Referred for Health Services 58 XVI.—Registrations Accepted under Various Acts 59 XVII.—Case Load of the Division of Rehabilitation, January 1 to December 31, 1970 60 XVIII.—Statistical Report of Examinations and Work Load in 1969 and 1970, Main Laboratory 61 XIX.—Statistical Report of Examinations and Work Load during the Year 1970, Branch Laboratories 62 XX.—Emergency Health Service Medical Units Pre-positioned Throughout British Columbia 62 XXI.—Licensing of Practical Nurses 63 Seventy-fourth Annual Report of the Public Health Services of British Columbia HEALTH BRANCH Department of Health Services and Hospital Insurance YEAR ENDED DECEMBER 31, 1970 This Seventy-fourth Annual Report of the Public Health Services of British Columbia presents an outline of the measures undertaken in the field of preventive medicine to promote and safeguard the health of the people of the Province. These preventive services constitute only a small segment of the total volume of health care now available through Government which also provides many therapeutic services which are much more extensive and costly. Nonetheless, the effect of the preventive services is significant when measured in terms of reduction of need for therapeutic care, in prevention of individual suffering, in a decrease in human mortality, and in a financial saving in total health costs. There is little doubt that in specific fields the preventive measures of the public health service have proven their worth. The introduction of mass immunization clinics, while lowering biological disease incidence almost to zero, also led to the disappearance of isolation hospitals, a decrease in the need for hospital beds (at least in specific fields), and added to longevity, health, and happiness while contributing to the Provincial economy. Funds spent in preventive services represent an investment in the most important of all the Province's natural resources—people. As scientific medical research continues, other diseases are added to those identified as being conquerable through biological immunization. Each discovery promotes its individual and collective rewards within each community. Immunization is not the only field in which concentration upon preventive medicine has promoted human well-being. Each of the tasks performed by the separate divisions within the Department is designed with health promotion in mind, encouraging techniques to minimize disease development and encourage healthful communities. These call up the skills of a group of trained personnel and appeal to people to have regard for those things that will help them to maintain ideal individual health and thereby community health. This report recounts the things that have been done with that objective in mind. In dealing with the field of human health there is always a need for a critical review of accomplishments by the services and programmes administered through the Health Branch, becoming all the more necessary with the rising costs of providing total health services. There will continue to be real concern about those costs. Inflationary trends in the economy will increase the costs without adding benefits to existing programmes or services. Nor are escalating costs entirely the result of a changing economy. Many factors warrant a searching analysis of every facet of delivery of health services, an analysis that will promote greater stability of costs without infringing on quality of service. This topic was the subject of much discussion during the Federal-Provincial Conference of Ministers of Health in 1969. As a result, a decision was made to organize a study into the costs of health services. Not only monetary costs, but efficiency of services was to be taken under consideration. This study was to cover J J 10 PUBLIC HEALTH SERVICES REPORT, 1970 three major areas—hospital services, medical care, and public health services. A Steering Committee comprising seven task forces was established to undertake the requisite examination of all the factors that might be involved. That task force made its report to the Conference of Health Ministers in November, 1969, following which it was decided that a continuing study to implement the recommendations should be maintained. During the year the various reports of the Task Force on Costs of Health Services in Canada have been reviewed. It is interesting to note the changing role forecast for public health as contained in the statement of the group assigned to deal with costs of public health services. The following view is expressed:— " That the practice of public health involves three components— • Prevention to include health promotion and maintenance: • Concern with the organization and delivery of health care at the community level to include the assessment of resources in relation to actual and anticipated health needs: • The early identification and bringing under adequate care of individuals in need of health care." Such views have been discussed with Medical Health Officers practising in British Columbia and have been generally accepted as goals toward which health services and programmes should be directed in the interests of promoting a unified community health service. THE PROVINCE AND ITS PEOPLE An increase in the number of people, more marriages, a practically constant birth rate, and a record low death rate were the statistical factors revealed in a study of the health features affecting the people of British Columbia in 1970. The population in the Province at the mid-year was estimated as 2,137,000, representing an addition of some 70,000 people over the previous year. With the estimated number of births totalling 36,900, a major portion of the population increase is attributable to the 50,000 people who have immigrated to the Province. This increase in the population approaches a 3V_i per cent annual growth rate, an extremely high factor and one which, if continued, would result in a tripling of the population by the year 2001. Within that population, preliminary figures would indicate marriages totalled 19,900, providing a rate of 9.3 per 1,000 population, somewhat higher than last year's rate of 8.8. The preliminary estimate of 36,900 births produces a birth rate of 17.3 per 1,000 population, slightly above last year's rate of 17.1 and also above the 1968 low of 16.8. Among those births, the proportion of illegitimate births was substantially the same as in 1969, 13.9 per cent, the first sign of a halt in the steadily increasing trend commencing in 1960. There was a record low death rate estimated to be 7.8 per 1,000 population. Last year the rate was 8.4. A substantial contribution to this lowered mortality was evident in the sharply reduced number of deaths from heart disease. The rate recorded for the conditions in this category was 270 per 100,000 population, a reduction of over 9 per cent from the 1969 figure and about 23 per cent below the rate recorded as recently as 1964. The 1970 rate marks a continuation in the almost unbroken record of improvement in heart disease mortality rates since that latter date. It may be a reflection of the improved medical techniques that are being developed in the field of cardiac disease. INTRODUCTION J 11 This same trend toward a lower mortality attributable to afflictions of the arterial system of the body was paralleled in the rate of deaths from cerebral vascular lesions affecting the central nervous system. During 1970 the rate of 82 per 100,000 population was below the previous year's rate of 86 per 100,000 population. Regrettably, a similar favourable trend could not be observed in deaths classified as being due to cancer. This cause of mortality remains fairly constant at a rate of 156 per 100,000 population, almost the same as recorded in 1969. Accidents continue to take their toll with a rate of 75 per 100,000 population, an increase over the rate of 70 recorded in the previous year. Among these, fatalities caused by motor-vehicles retained a major significance in accounting for 36 per cent of the total accident mortality, slightly below the figure prevailing for the year 1968. Deaths from poisoning caused 15 per cent of all accidental deaths, an increase in number of almost a quarter, making poisoning second in the list of leading causes of accidental deaths. Fatalities due to falls accounted for 12 per cent of the deaths due to accidents, slightly less than in the previous year. Deaths due to drowning were the highest for many years, increasing by almost 60 per cent in 1970 as compared with 1969. The rate of deaths from suicide at 15 per 100,000 population this year was down slightly from the 1969 figure. The infant mortality rate has declined each year since 1966 when it was 24 infant deaths per 1,000 live births. In 1969 the rate was 17.8 and, in 1970, it was 16.4. In so far as mortality is concerned as an index of health, there is room for considerable improvement. Certainly, the increasing numbers of accidental deaths are to a large degree preventable and, therefore, justify intensified effort to promote improvement. The fact that so many deaths are due to accidents involving motor- vehicles is particularly significant. There is also little doubt that many other deaths occurring as a result of poisoning, falls, and drownings could have been prevented by the judicious exercise of caution and attention to safety measures. In the field of communicable disease, efforts have been continued through a vigorous immunization programme to eradicate biologically preventable disease. For the most part, a high level of community immunity has been maintained sufficient to prevent epidemic outbreaks. Nonetheless, the occurrence of seven cases of diphtheria among unimmunized children is an indication that eradication is not complete as yet. The measles immunization programme introduced a year ago continues. Continuous educational programmes will be offered to illustrate the advantages of immunization as a preventive of this childhood infection. To the armamentarium of immunizable diseases the introduction of rubella vaccine this year appears to have provided a valuable addition. Approximately 240,000 children were immunized in the latter half of the year. Rubella vaccination will become a member of those routine immuninological procedures offered annually, and there is every prospect that cyclic epidemics of this disease will no longer significantly affect the health of the people of this Province. Despite concentrated efforts on the part of the health team to educate food- handlers to the importance of sanitary food-handling in eating establishments, outbreaks caused by improper food-handling continue to occur. This year there were 532 cases of Salmonella food poisoning reported, a marked increase over that for the year previous. This infection, under proper control, is preventable. The incidence of tuberculosis, which is generally regarded as no longer of serious importance, nevertheless remains a matter of some concern. Over 500 active cases are identified annually within the Province. In spite of intensive I 12 PUBLIC HEALTH SERVICES REPORT, 1970 efforts, limited progress is being made in further reduction of the incidence of infection. This indicates the need for maintaining an active case-finding programme throughout the Province. In the field of venereal disease control, continuous progress is being made in the treatment of syphilis. This is the fifth successive year in which there have been less than 80 cases of infectious syphilis reported. On the other hand, gonorrhoea has shown a marked increase in incidence for the second successive year. This year there were an estimated 5,900 cases, seemingly attributable to the sociological development within our society referred to as " transient youth." During the three summer months, 60 per cent of the patients attending the Vancouver Clinic were transient youths, half of whom were from other provinces of Canada, and half from the United States. In general, the people of British Columbia enjoyed a year free from any major epidemics, with advancements in the control of preventable diseases and with a significant lowering of the over-all mortality rate. Based on those factors there is reason for some satisfaction with the health services designed in the public interest. However, there are a number of areas where improvement is yet to be realized wherein further human benefits can be attained. There is a continuing need for intensification of public health services throughout all the communities of the Province. COMMUNICABLE AND REPORTABLE DISEASE J 13 COMMUNICABLE AND REPORTABLE DISEASE There were no serious outbreaks of communicable disease this year, but a few localized incidents emphasized the need for constant vigilance. DIPHTHERIA Nine cases of diphtheria were reported, a decrease of five from the previous year. Most of these cases occurred in two small communities in the northern part of the Province, and several were in children whose parents, for personal reasons, had chosen not to have them immunized. FOOD POISONING Reported Salmonella food-poisoning cases numbered 532, a sharp increase over 1969. Improper food-handling or inadequate facilities are generally responsible. Frequent and regular surveillance of all food-handling establishments by public health inspectors usually results in keeping this type of condition under control. INFECTIOUS HEPATITIS Infectious hepatitis cases were down to 1,910 from 2,139 in 1969. This infection remains a constant threat, particularly among groups of young people living under communal conditions. TUBERCULOSIS Tuberculosis continues to be a source of infection, with over 500 active cases occurring annually in British Columbia. There has been no appreciable reduction in the incidence of the disease during the past six years. It is evident that the problem is deep-rooted because the most intensive efforts in tuberculosis control create only a gradual reduction in the incidence of the disease. It is probable that most people who now develop tuberculosis were infected decades ago. However, satisfactory progress is being made in protecting the present growing generation. The infection rates in this group, as shown by the tuberculin test, have been markedly reduced. Small epidemics of tuberculosis continue to occur. In one recent outbreak, active cases of tuberculosis developed among contacts of a man who had spread the disease under confined working conditions. The following points summarize the current tuberculosis situation in the Province:— • Undiagnosed cases of tuberculosis with positive sputum are a potent factor in the spread of disease and warrant special emphasis on intensive contact tracing once discovered. Results of contact examinations in British Columbia show that 3.6 per cent of those in close contact with cases having positive sputum develop active disease. • Twenty years ago there were 292 deaths from tuberculosis in British Columbia and the death rate was 25.1 per 100,000. Last year this was reduced to 29 deaths from tuberculosis and the death rate was 1.4 per 100,000. • Death rates from tuberculosis are probably no longer a useful yardstick in measuring progress but do indicate the effectiveness of treatment with present-day methods. The need for admissions to the hospitals operated by the Division of Tuberculosis Control has been gradually lessening and, as a result, it is now possible to serve the Province with 172 sanatorium beds, equally divided between Pearson Hospital and Willow Chest Centre. I 14 PUBLIC HEALTH SERVICES REPORT, 1970 • Most active cases of tuberculosis are treated initially outside hospital. • Cases of tuberculosis are only admitted to hospital if they cannot be treated at home; when special problems arise with their drug therapy; when they do not progress favourably on treatment at home; or when they are unable to co-operate because of alcoholism or recalcitrance. Native Indians pose a special problem in treatment because many live on remote reserves where treatment facilities are not available. Among them there is need for intensive education in personal hygiene, and for these reasons a higher proportion of them enter a sanatorium for initial therapy and require a longer stay in hospital. Treatment programmes have resulted in lowering the number of sanatorium beds. About 80 per cent of all new active cases under treatment are outside a sanatorium and these represent over 1,000 cases of tuberculosis on a home-treatment basis, with many patients continuing to work. This is but one example of the benefits to society derived from a public health service that includes home care among the programmes administered by professional public health nurses. The Diagnostic Clinics of the Division of Tuberculosis Control are responsible for case-finding and for the follow-up of about 20,000 known cases of tuberculosis and suspects throughout the Province. The effect of the work of these clinics may be summarized as follows:— • It has been possible to decrease dramatically the number of sanatorium beds. • The travelling clinics visit 66 centres which are responsible for about 1,000 cases of tuberculosis on antimicrobial therapy on an out-patient basis. Successful treatment is dependent on adequate supervision and constant review. A Public Health Inspector checks the temperature of broiled chicken at an up-to-date kitchen. Temperature levels in cooking chicken are of prime importance in the fight against food poisoning. COMMUNICABLE AND REPORTABLE DISEASE J 15 • Case-finding continues to be carried out by community tuberculosis surveys and by local health units, where miniature X-ray facilities have been established in 24 centres. However, there is still a great need for X-ray service in the smaller and outlying communities and the future emphasis should be directed toward these centres. In Community Tuberculosis Surveys, combined tuberculin testing and X-raying have been carried on for over 10 years. For the future it is planned to do these diagnostic procedures separately because the point has now been reached where many persons covered by these surveys might receive tuberculin tests needlessly. Therefore, • tuberculin testing will not usually be done on the X-ray buses, • tuberculin tests will periodically be administered to young people (including pre-school groups and those in school) and adults on request. The collection of sputum for cytological examination has been added to the survey procedure and a significant number of cases of respiratory cancer have been detected. VENEREAL DISEASE CONTROL Gonorrhoea has shown a marked increase in incidence for two successive years. In 1968 there were 4,179 reported cases. In 1969 the number has risen to 4,780, and in 1970 to 5,900. (See Table VIII.) This increase is attributable to the sociological development referred to as " transient youth." This group has caused a substantial increase in the number of persons visiting the Vancouver Clinic, where the average attendance of males has increased from 30 to 40 a day and the average attendance of females from 12 to 15 per day. During the three summer months, 60 per cent of the Vancouver Clinic patients were transient youth. Half were from other parts of Canada and half from the United States. In order to prevent the spread of gonorrhoea in this transient population a public health nurse was employed to promote treatment and preventive measures among identified groups. This procedure has been very effective, although the nurse is called on to provide many medical services in addition to gonorrhceal control. Requests for help include birth-control information, lice control, scabies control, and advice regarding respiratory infections. The outlook is brighter, so far as syphilis is concerned. The disease continues to exhibit the gains to be derived from control endeavours with this, the fifth year, in which less than 80 infectious cases have been reported. The laboratory has introduced a new procedure of fluorescent technique of staining for syphilis organisms in eye fluid, making it possible to positively identify syphilis lesions of the eye. THE PUBLIC HEALTH NURSE AND DISEASE CONTROL Disease control is a traditional area of concern to the public health nurse. Among the important aspects of prevention and control is supervision of tuberculosis patients and contacts. A total of 437 patients and families were under health supervision, and this year 8,723 home visits were made on their behalf. In addition, public health nurses conducted 15,316 tuberculin tests, while tests for other communicable diseases amounted to 5,388, a 78 per cent increase over last year. Public health nurses performed 3,562 services in connection with control of venereal disease, and regularly supervised the health of 1,135 children on rheumatic fever prophylaxis. In addition, 8,723 services were provided in disease control and included epidemiological investigations and injections for infectious hepatitis. J 16 PUBLIC HEALTH SERVICES REPORT, 1970 HEALTH AND OUR ENVIRONMENT Health and environment are of vital interest to three divisions of the Health Branch within the Bureau of Local Health Services—Environmental Engineering, Occupational Health, and Public Health Inspection. The main functions of the Environmental Engineering Division are • to serve as a consultative agency in analysis of engineering procedures that may be adopted to protect the public health; • to review engineering plans and specifications for approval of all proposed public waterworks systems within the Province; • to provide consultative services to Medical Health Officers and public health inspectors in matters relating to water supplies and treatment, sewage- disposal systems, solid-waste disposal, public swimming-pools, and subdivision developments; • to consult with the Pollution Control Board and to advise on public health hazards likely to be created from waste-disposal sources; • to keep records and statistics on Provincial waterworks systems and to provide technical information to public health inspectors; • to draft informative articles on technical subjects related to waterworks and waste disposal. Special projects during the year included reporting on fluoridation installations, writing waterworks-design standards for the Province, and designing a data and record card for waterworks systems. POLLUTION CONTROL All pollution control permit applications are reviewed jointly by the Division of Environmental Engineering and the Medical Health Officer affected. Departmental policy requiring at least primary sewage treatment to produce a water quality acceptable within the Recommended Standards continued to provide the principal guidelines for recommendations to the Pollution Control Branch concerning these applications. There has been a shift to the Director of Pollution Control of responsibility in matters relating to regulations and enforcement of environmental management. The Health Department has become more directly concerned with surveillance and advice, an approach which will prove effective in the long term. Emphasis will be on research and study of new methods and materials used in the field of waste treatment and disposal. The Director of the Division of Occupational Health was appointed to the advisory panel for the public inquiry held in August to investigate pollution caused by the forest products industry. The hearing continued over a two-week period and a considerable amount of time was spent afterward preparing the report for the Director of the Pollution Control Branch. Individual problems have arisen during the year, the most notable being the lead pollution of a small area of Richmond municipality in close proximity to a lead-smelting plant. As the Pollution Control Branch of the Department of Lands, Forests, and Water Resources assumes responsibility for the control of air pollution on January 1, 1971, the Health Branch air pollution advisory committee is being phased out. The Director of Occupational Health and members of the Provincial Laboratory HEALTH AND OUR ENVIRONMENT J 17 and Public Health Engineering staff will continue to act as advisers to the Health Branch and to the Pollution Control Branch. RADIATION The Director of the Division of Occupational Health is a member of the safety advisory committee for the TRIUMF (Tri-University Meson Facility) project at the University of British Columbia. Plans are being made for a comprehensive radiation survey in order to obtain background data before the cyclotron goes into operation. The radium-leak testing procedures developed for mass surveying proved so successful and accurate that the Radiation Protection Division of the Department of National Health and Welfare adopted the method and, from September, 1970, instituted a similar programme on a national basis for all radium users. On May 13, 1970, the Federal Government received royal assent for the Radiation-Emitting Devices Act. Salient features of the Act and its significance for the Provincial Radiation Protection Section may be summarized as follows:— • The Act deals with the importation and sale of X-ray and radiation-emitting devices to ensure that they conform to national and international standards of radiation safety. • The widespread use of microwave devices, particularly microwave ovens and laser generators, has given rise to much concern, and these will now be covered by the Act so far as their sale in Canada is concerned. • The Act specifically states that it is the responsibility of each Province to ensure that radiation-emitting devices are maintained in a safe and working condition and free of radiation hazards. During the visit of an American nuclear submarine to Canadian waters, the mobile field laboratory was called out for radiation surveillance. There was no recorded release of radioactivity during its stay. There were several incidents during the year involving alleged improper use of radioactive sources that required investigation by inspectors. None turned out to be a health hazard. To eliminate the possibility of leakage of radioactive material which might contaminate food and drink being processed in the Province on bottling-lines, six radioisotope gauges have been installed and a strict programme of inspection and leak testing continues to be carried out. SEWERAGE PLAN REVIEW The responsibility of sewerage plan review was transferred from the Division to the Pollution Control Branch during the year. A co-ordinated arrangement with the latter branch has been evolved whereby engineers supervising plans of sewerage systems will analyze them from both aspects. Thus, a permit from the Pollution Control Branch implies acceptance from a public health point of view. The Division of Public Health Inspection has an administrative as well as consultative function. Continued in-service training courses have been provided for public health inspectors to assure a high quality of service. Greater efficiency is encouraged through consultation, programme planning, and evaluation studies. There are 59 public health inspectors employed in 18 health units. The Division co-operates with other governmental agencies and health departments, including Metropolitan Health Departments and the Medical Services Directorate within the National Department of Health and Welfare. I 18 PUBLIC HEALTH SERVICES REPORT, 1970 SURVEYS Barbecued Chicken.—A survey of barbecued-chicken operations in British Columbia in 1967 indicated several potentially dangerous food-handling practices which prompted a further survey in December, 1969, and January, 1970. Inspectors visited a total of 90 food stores, 46 of which were in the City of Vancouver and North Vancouver. It was noted that 77 per cent of the barbecue operations showed a holding temperature of less than 140° F. Such insufficient holding temperatures serve to incubate bacterial production, thus creating potential food infection. Two incidents of staphylococcal food infection, related to barbecued chicken during the past year in British Columbia, demonstrate the careful precautions required in retail outlets selling such produce. Public health inspectors have been required to impress operators about the potential health dangers inherent in the procedure. Mobile Homes.—The Health Branch, in co-operation with the Department of Industrial Development, Trade, and Commerce, completed a survey of mobile- home parks with the assistance of Provincial health units and the two Metropolitan Health Departments of Greater Victoria and Vancouver. The total number of mobile-home parks in British Columbia is 515. The total number of spaces is 12,376. The total number of spaces occupied is 9,984 (based on 74 per cent of returns from a survey). FOOD-HANDLER CLASSES A total of 778 food-handlers employed by the British Columbia Ferries Division attended courses on " Safe Food Handling." Four health units were involved in conducting the classes. Those in attendance were given certificates signed by the Medical Health Officer and Senior Public Health Inspector. A number of 35-mm. slides showing the preparation of a turkey dinner, the most popular ferry meal, were taken by the Health Education Division with the co-operation of the Catering Superintendent of the British Columbia Ferries and the Boundary Health Unit. These were used on food-handling courses with marked success. FOOD POISONING Outbreaks of food poisoning from various food establishments indicate a need for frequent inspections and continuing education of food-handlers. A food- premises regulation has been prepared with the objective of placing greater emphasis on improved food-handling. A comparison of food poisoning cases notified is given below:—• 1970 1969 Salmonella 560 400 Staphylococcal intoxication 8 29 Botulism 2 8 Foodpoisoning type unspecified 6 19 Totals 576 456 PUBLIC HEALTH INSPECTORS' ACTIVITIES Public health inspectors in 17 health units took part in a two-week time-study in the spring and the information obtained is set out in Table X. A statistical summary of public health inspectors' activities is shown in Table IX. COMMUNITY AND FAMILY HEALTH I 19 COMMUNITY AND FAMILY HEALTH The public health nurse continues to hold a high place in Provincial public health programmes and her duties are the direct concern of the Public Health Nursing Division.* This division • assists health units in evaluating programmes being carried out by public health nurses in order that services may be provided as efficiently and economically as possible; • plans and arranges for educational and technical training to enable the upgrading of public health nursing services. To facilitate these aims, four nursing consultants visit health units at regular intervals to provide consultations and advice on general public health nursing, as well as in certain specialties such as school health, mental health, home care, and communicable diseases. In addition, the Division is concerned with co-ordinating services with various other health agencies such as the Red Cross, Medical Services, Division of the Department of National Health and Welfare, the University of British Columbia, the Registered Nurses' Association of British Columbia, and Canada-wide organizations including the Canadian Public Health Association. FAMILY HEALTH SERVICE Public health nursing is a family health service given in the community setting and involves health promotion, illness prevention, and the provision of certain treatment services. It is available to all persons whether healthy, sick, or disabled. In summary:— • Service is not limited to any segment of society or age-group and is therefore given in a variety of settings such as homes, schools, certain institutions, and health centres. • Service is provided within the established policies of the health unit and the Health Branch. • In the performance of her duties, the public health nurse is assisted by health unit aides, by registered nurses who assist with the home nursing service, and by volunteers who assist with clinics and other activities. In this way the public health nurse extends her skills to serve more people. • Certain programmes and services are directed to selected age-groups and situations where there is a " risk " factor which provides a focal point for health promotion. • Public health nurses made 175,069 visits to homes during the year (a 2 per cent increase over 1969) and provided 199,123 individual services by telephone. (See Table XI for detailed statistics.) The special programmes and services rendered by public health nurses in health units during the year were many and varied. MENTAL HEALTH In this, as in so many of the assignments performed by public health nurses, prevention of mental illness is the prime objective. Toward such an achievement, efforts were made to identify potential problems at child health conferences, pre- * A statistical summary of selected activities of public health nurses is shown in Table XI. J 20 PUBLIC HEALTH SERVICES REPORT, 1970 natal classes, schools, and in home visits. School children received 43 per cent and adults 50 per cent of the visits, with pre-school children making up the balance. Nevertheless, some members of the public do develop mental illness and are referred to the Mental Health Branch for care. Changing trends in treatment encourage the patient to maintain community residence where possible. This poses a need for frequent home visits to foster individual patient improvement. As a key community health worker, the public health nurse is involved in this. There were 11,820 visits to persons receiving treatment because of an emotional disturbance, and half of these were to school-children. REHABILITATION NURSING Consultant public health physiotherapists assisted in nine health units with home care and rehabilitation nursing. During the year they participated in 142 group meetings and lectures in addition to 491 consultations with public health nurses regarding patients under care. Hospital liaison is necessary to ensure that rehabilitation nursing programmes initiated in hospital are continued when patients are discharged. Public health physiotherapists made 468 hospital liaison visits, 1,267 home visits, 521 individual patient assessments, and 566 re-assessments of patients and their environment. Other activities include assistance in developing rehabilitation and recreational programmes for patients in private nursing homes and similar institutions and advice to schools in relation to children with physical handicaps in special classes and in schools for the retarded. ADULT AND GERIATRIC SERVICES Services to adults for general health supervision (in addition to those for mental health, tuberculosis, venereal disease, prenatal or nursing care) form an important part of the public health nurse's work. During the year, 57,226 services were rendered for general health appraisal and resulted in persons obtaining early diagnosis, treatment, and care for medical conditions, nutrition counselling, health counselling, or referral to another agency. SERVICE TO INDIANS Certain Indian reserves receive public health nursing services from the health units through a special arrangement with the Medical Services Directorate of the Department of National Health and Welfare. This year, 10,174 Indians on 71 reserves were included in the general health service. It is interesting to note that 14,082 of 46,911 Indians resident in British Columbia now live permanently off the reserve and receive general health service in the communities in which they are resident. Also, most Indian children now attend community schools and receive the general school health service. SPEECH-THERAPY SERVICES Attention has continued to be given to this service and, as a result, there is a wider understanding of the problems of speech-and-hearing handicapped people. Health Branch staff met with representatives from the Department of Education; the Department of Rehabilitation and Social Improvement; Metropolitan Health Services; the British Columbia Oto-Ophthalmological Society; the Department of Paediatrics and Division of Audiology and Speech Sciences, University of British Columbia; the Western Institute for the Deaf; and the British Columbia COMMUNITY AND FAMILY HEALTH J 21 Speech and Hearing Association during the spring and summer. In the fall, a Provincial Speech and Hearing Planning Committee was established to advise these Government departments and community agencies on planning and co-ordination of services for the people with communication problems. Since it is important for staff to have the opportunity of participating in continuing-education programmes, the Health Branch sponsored a workshop in Audiology and the Needs of the Hearing Handicapped Population in British Columbia, in co-operation with the Western Institute for the Deaf. This workshop was attended by teachers of the deaf and hard-of-hearing, audiologists, otologists, hearing-aid dealers, speech therapists, psychologists, and consultants in special education from all areas of the Province. In the health units in which speech therapists are located, the emphasis on services to the pre-school and early school-age child has been maintained. Consultation with parents, teachers, and hospital nurses in relation to the older child and adult with severe disorders of communication have also been undertaken on specific request. MOTOR-VEHICLE ACCIDENT PREVENTION The Health Branch continued to provide a consultative service to the Driver Licensing Division of the Motor-vehicle Branch and to give advice on the ability of persons with medical defects to drive safely. A revision of The Guide to Physicians in Determining Fitness to Drive a Motor-vehicle, produced some years ago, has been started. It is hoped that it will be ready for distribution to all practising physicians soon. Public health nurse checks child's hearing prior to school entry. J 22 PUBLIC HEALTH SERVICES REPORT, 1970 COMMUNITY CARE FACILITIES The Director of the Division of Epidemiology has continued to act as chairman of the Interdepartmental Community Care Facilities Licensing Board, which investigated a number of complaints and directed the operators of the institutions involved to correct deficiencies. There has been a substantial increase in the number of individuals and agencies wishing to provide some form of day care for children of working mothers. The quality of care offered by some of these facilities was found to be only marginal, and this led to a considerable increase in the work load of the Board and its Inspectors. An increase in the construction of highrise accommodation for elderly people who require some form of supervision or help in order to carry out the task of daily living has required careful supervision to assure that the needs of elderly citizens are not subordinate to the accommodation of the maximum number of people in the minimum of space. RHEUMATIC FEVER The number of children on the British Columbia Rheumatic Fever Prophylaxis Programme, as of October 1, 1970, was 1,332. This approximates the number one year ago. Although the programme has continued unchanged during 1970, an Advisory Committee is assessing the situation to determine if the number can be decreased by approximately one third. It is now felt that children who do not develop evidence of cardiac damage following their first attack of rheumatic fever within five years of such an attack are far less likely to develop such damage at a later date. For this reason it is considered that some revision of the criteria, which would phase out children after a five-year period if there was no evidence of cardiac damage, might be possible without sacrificing the purpose of the programme. Until this year, children accepted on the programme in their late 'teens were allowed to continue for five years, even though they had passed the age of 21. The provision of free penicillin has now been entirely discontinued at the age of 21. In 1968 a study was conducted to develop an accurate method of detecting children who were not taking their penicillin regularly. The study was completed in 1969 and the results published in the July-August edition of the Canadian Public Health Association Journal. AGAMMAGLOBULINEMIA The Canadian Red Cross Blood Transfusion Service has for many years provided immune serum globulin free of charge to people suffering from a relatively uncommon but life-threatening disease called " agammaglobulinemia." The Red Cross organization discontinued this service early in the year. The product is expensive, and many people who must have monthly injections of immune serum globulin in order to live a normal life found themselves unable to pay the retail price for this serum. The Health Branch, by purchasing larger quantities of this product through competitive tender, has been able to obtain immune serum globulin at a much reduced price and is now providing it free of charge to those who require it to sustain life. An advisory committee with representation from the Departments of Pediatrics and Pathology of the University of British Columbia and the Transfusion Service of the Canadian Red Cross is assisting the Health Branch in evaluating each COMMUNITY AND FAMILY HEALTH J 23 application. By the end of the year six people were accepted on the programme and fourteen rejected for lack of proper medical indication of their need for routine injections. OCCUPATIONAL HEALTH Occupational health physicians and nurses traditionally have been concerned with the health consequences of the interaction between the employed person, his supervisors, and his work environment. This concern, which has been narrowly defined, should now be expanded and related to the total health care system. For the employed person, the medical department of the work place represents a natural point of first contact and a door to the health care system. It can serve this purpose only if it is an integral part of the total community resource and not an isolated entity. With this end in view, the Division of Occupational Health operates a Provincial Government Employees' Health Service. The staff consists of three public health nurses who serve the employees in the Victoria, Vancouver, and Essondale areas. Supervision and special consultations are provided by a physician. The staff of the service work closely with the employees' supervisors, departmental personnel officers, and the Civil Service Commission. Where indicated, discussions are held with the family doctor or the Workmen's Compensation Board. Table XII summarizes the work of this service. I 24 PUBLIC HEALTH SERVICES REPORT, 1970 MATERNAL AND CHILD HEALTH Attendance at prenatal classes held throughout the Province by public health nurses is increasing. This is particularly true of prospective fathers who attended classes in 1970 at a rate 30 per cent higher than in 1969. It is noted that prospective parents show readiness to accept health education. Teaching centres around problems of pregnancy, normal development, family relationships, and meal planning. Included are recommended relaxation exercises. Group classes are held at most of the 80 health centres in the health units. Attendance of mothers and fathers was 20,840, or an increase of 14 per cent over 1969. In 1970, 21 per cent of all expectant mothers attended classes. Some health units participated in television education to reach expectant mothers who have not attended classes. Public health nurses made 4,240 prenatal and 19,746 postnatal visits. The latter indicates that approximately 95 per cent of all new mothers have at least one visit from the public health nurse to assess the health needs of the mother and new baby. INFANT AND PRE-SCHOOL CHILDREN Special attention to infants and pre-school children will assist in disclosing many potential health problems, enabling timely corrections to be made. PubUc health nurses are involved in programmes to determine the status of the child's physical and emotional health. The work includes screening programmes for hearing loss, vision, and retardation. Assessments are made at special clinics, conferences, and in the home situation. During the year:— • Public health nurses made 36,114 visits to homes of infants for the purpose of general health assessment and counselling. • Newborn infants, numbering 16,946, attended the local regular child health conferences held in local communities. This indicates that approximately 75 per cent of all infants received continuing public health nursing health supervision. • Attendance was up 4 per cent for infants and 8 per cent for pre-school children over 1969, with an attendance of 60,435 infants and 89,423 preschool children. • Public health nurses made 33,612 visits to homes on behalf of pre-school children, of which 7 per cent were for primary or secondary prevention in mental health. SPECIAL STUDIES In 1970 more emphasis was directed toward special pre-school clinics for 3- and 4-year-old children. Three health units were involved in special studies to determine the best screening methods for detecting deviations from normal health. The South Okanagan Health Unit is testing the validity of the Denver Developmental Screening Test designed to test motor, language, and the personal-social development of pre-school children. In the Boundary Health Unit a study to detect visual problems in infant and pre-school children was completed. The Central Vancouver Island Health Unit is involved in another study to document the results of screening programmes for hearing, vision, and general development. It is felt that emphasis on prevention and early correction of defects will contribute a great deal to future progress and eliminate costly treatment at a later date. IMMUNIZATION J 25 IMMUNIZATION Immunizations form an important part of the communicable disease control programme for those diseases where some measure of control is possible by this procedure. During 1970:— • 480,610 doses of biologicals were given for protection against diphtheria, pertussis, smallpox, rubeola (measles), and poliomyelitis. This was an increase of approximately 60,000 doses over 1969 (see Table XIV on page 58). • In addition to the conservation of human health, immunizations, as completed by public health nurses, provided a great measure of saving to the British Columbia Medical Plan, which might otherwise be charged at a rate of $2 per injection or dose. The over-all saving is estimated to be $960,000. Of particular interest were the following:— Rubella.—A major programme of immunization against rubella (German measles) was undertaken in late summer. Funds were provided jointly by the Health Branch, a number of philanthropic foundations, and local municipalities, and made possible a project in which 240,000 doses of vaccine were purchased and given to children between the ages of 1 and 11. This programme is expected to lead to a major decrease in the number of infants born with congenital defects due to this infection. Rubeola.—The rubeola (measles) immunization programme initiated in 1969 was continued through 1970 with disappointing public acceptance. There is no doubt that the cost of medical and hospital care for the victims of measles far exceeds the cost of immunizing every newborn infant. Immunizations are available at health centres, child health conferences, special clinics, and schools. This young girl is one of many who received rubella vaccine from the public health nurse. J 26 PUBLIC HEALTH SERVICES REPORT, 1970 SCHOOL HEALTH The health of school children was under constant care by public health nurses in 1970, which saw an enrolment increase of approximately 15,000 children in areas served by the Health Branch. This figure includes an increase of about 1,600 kindergarten pupils to whom public health nursing service is made available as a follow-up of the supervision given in the child's pre-school years. Main features of the programme are:— • In the pre-school and kindergarten services, vision and hearing screening, combined with health education and general observation, help to ensure that a child will enter Grade I with a positive attitude to health and with known defects under adequate care. It will be noted from Table XIV that a high percentage of pupils have basic immunization prior to entering Grade I. • Ideally, the school health programme beyond Grade I should be mainly concerned with maintaining an existing high standard of health and conducting intensive follow-up of emergent problems. • To provide health services to the increasing number of children, it is necessary for the public health nurse to be selective. She therefore spends most of her time with children with special problems and arranges needed services. Selection of children for special follow-up is accomplished by Public health nurse preparing child for vision test. SCHOOL HEALTH I 27 teacher referral, review of the individual and family health history, teacher- nurse conferences, school liaison committees, and routine screening. In Provincial health units, public health nurses held 64,784 conferences and 2,769 meetings with teachers. The number of individual services to pupils increased 32 per cent to 406,790, and 4 per cent of these services were given by health unit aides under direction of the public health nurse. In an effort to help families meet health needs of their school children, 45,852 home visits were made by public health nurses. An active programme of referral and follow-up is shown in Table XV, and it will be noted that approximately 15 per cent of pupils were referred to the public health nurse and 9 per cent were referred by her for further care. These figures show a continuing close involvement of the public health nurse in helping to meet the physical and emotional needs of children. For further information on School Health Services, see Table XIII. Public health nurse visits a patient in hospital before discharge and admission to the home-care programme. J 28 PUBLIC HEALTH SERVICES REPORT, 1970 HOME CARE Home care is an important aspect of community health care as it represents an efficient and economical way of caring for patients who can remain at home but need part-time nursing and related health services. Home care is provided by the public health nurses as part of their general programme of nursing. Auxiliary services which may be available from local agencies or groups are arranged by the public health nurse as required for the patient's care. These services might include homemakers, medical supplies, meals-on-wheels, visiting volunteers, occupational therapy, and physiotherapy. If the home care service were not available, many of the patients would be occupying acute, extended, or other types of institutional beds at a much greater cost to the taxpayer. Because of many variables it is impossible to place a value on the increased social well-being of patients being cared for in their own home environment. Home care service is available in 113 communities to almost 80 per cent of the population in the health unit areas. Important features of the programme were:— • During the year there were 77,766 home nursing visits for care of physical conditions, an increase of 2 per cent over 1969. • In addition, 5,449 additional visits were made to patients under psychiatric treatment. In this way some remissions are prevented and many patients can be rehabilitated to community life. • 83,255 visits were made for tertiary prevention concerned with improving, rehabilitating, or maintaining patients with both mental and physical conditions at home. • It is possible that savings to the British Columbia Medical Plan amounted to over $166,000, as comparisons with nursing visits made by a voluntary nursing organization indicate this would be an acceptable charge to the plan at $2 per visit. An elderly citizen relaxes while the public health nurse changes a dressing in the home-care programme. HOME CARE J 29 ^^^MfcwJasSaaf- I 30 PUBLIC HEALTH SERVICES REPORT, 1970 PREVENTIVE DENTISTRY During the past two decades British Columbia's preventive dental services have given maximum attention to infants, pre-school, and elementary school-children, and to young parents, endeavouring to develop a new generation with greatly improved dental health. Programmes, so far, have concentrated on the provision of early and regular dental treatment, commencing at 3 years of age, and on the prevention of dental caries. As a result, there has been • some reduction in prevalence of dental caries; • a very considerable improvement in the provision of early and regular dental care by dental practitioners and in the acceptance of the necessity for such treatment by young parents. In the future, attention must be given to the prevention of malocclusion (crooked teeth) and of periodontal (gum) disease. This latter condition, at present, is the major cause of tooth-loss in adults. Furthermore, malocclusion is a predisposing cause to periodontal disease. The Health Branch continues to provide annual grants-in-aid to the dental health division of the Greater Vancouver Metropolitan Health Service and to the dental department of the Greater Victoria school district. In these metropolitan areas, children of elementary grades receive annual classroom dental inspections, with parents being notified of the findings. Assistance is provided to schools for the better teaching of dental health in the regular curricula. For the remainder of the Province, five regional dental consultants work with three to five, usually adjacent, health units. They assist health unit directors and public health nurses in planning and administering local dental health programmes. In addition, the consultants endeavour to improve dental health knowledge, attitudes, and habits of the people in the communities they serve. In most communities of health unit areas there are now 3-year-old birthday card dental programmes. As children reach their third birthday, the health unit mails a birthday card with enclosure. The card entitles the child to visit the family dentist and, at no direct cost to the parents, to receive the following services:— • Examination (with X-rays, if necessary). • Counselling as to diet and oral hygiene. • A topical application (painting) of the teeth with a decay-preventing solution. If further treatment is necessary, costs are borne by the parents. Currently programmes are operating in 38 school districts and are being organized in a further six districts. There remain 11 districts where there are one or more resident dentists, but programmes have not commenced. It is hoped that programmes may be started in these districts when the acute shortage of dentists' time has been alleviated. In communities where programmes do operate at maximum efficiency, more than 80 per cent of all 3-year-olds visit the family dentist. During the period August, 1969, and September, 1970, more than 7,000 such children benefited by this service, an increase of about 12.5 per cent compared with the same period 12 months earlier. Remote areas of the Province without a resident dentist are visited annually by a dental public health extern. (Each year several young fully qualified dentists are so engaged for a 10- or 12-month period.) Each dentist is provided with highly PREVENTIVE DENTISTRY J 31 specialized and modern portable dental equipment, and work in this field may be summarized as follows:— • In most communities visited, dental care is provided to pre-school and Grade I children, with parents paying a nominal registration fee. • In most cases the local Board of School Trustees assists the Health Branch in meeting the cost. • During the 1969/70 school-year, 1,100 children benefited from the services. Many native Indian children are included in these programmes. Older children and adults are also treated, but on a fee-for-service basis. Currently being served are some 35 communities. During 1970, 20 communities were deleted from this programme because they are reasonably close to adequate resident dental services. Methods will be explored to ascertain if dental service to remaining communities can be continued on a nearly self-sustaining basis. It is hoped moneys released may be utilized for the inauguration of more dental hygiene programmes throughout the Province. In the Okanagan region and in the Alberni Valley, dental hygienists have carried out most effective dental health educational programmes. These include classroom dental inspections, counselling, and group instruction in the elementary grades. Use is also made of radio, television, and newspapers for further dental health education. In Kelowna, a community dental health centre was inaugurated in the fall of 1970, and the value of its services will be most carefully evaluated. There will be developed, with the co-operation of the local dental practitioners, a new concept in the total delivery of dental care. Patients will be referred to the centre for special preventive and educational services, to be given either singly or when appropriate, in groups. Instruction and services for the prevention of periodontal disease will be available for people of all ages; for young persons, preventive services for dental caries and malocclusion; and, for the elderly, early diagnosis of oral lesions for the possibility of cancer. Funds for extra staff to provide these additional services have been made available through a National Health Research Grant. All dentists newly registering to practise in British Columbia are provided with kits for the taking of a small section or a smear for the accurate diagnosis of a suspected pre-cancerous or other suspicious lesion of the oral cavity. Kits are made up by the office of the College of Dental Surgeons of British Columbia. Cytological diagnosis of oral smears and pathological diagnosis of biopsy sections are carried out by the British Columbia Cancer Institute. This service is providing a certain stimulus to the early diagnosis and, thereby, more successful treatment of oral cancer. Surveys to evaluate the dental health status of the total child population (7-15 years) of the Province were first carried out in the period 1958-60 by the examination of a random sample of 9,300 children. A second series was completed during the years 1961-67, when 9,500 children were examined. Many improvements in dental health status of the children were demonstrated. The third series commenced in 1968 and will be concluded in 1974. In each region surveyed a third time, further consistent and significant trends toward better dental health are evident. Current methods available for the prevention of dental caries, periodontal disease, and malocclusion are either unacceptable to large segments of the population or are entirely inadequate. Further field research projects are necessary to discover more effective methods for dental health improvement. During 1970 the following research projects were completed:— J 32 PUBLIC HEALTH SERVICES REPORT, 1970 • Dental-treatment needs measured by a simplified epidemiological method. • The incidence of staining of permanent teeth by the tetracyclines. • Evaluation of dental caries in subjects chewing a gum containing dicalcium phosphate dihydrate. • Motivation of parents to provide their children with urgently needed dental treatment, using messages containing different methods of persuasion. Research projects currently being planned include • evaluation of decay-preventing properties of two mouth rinses; • value and practicality of daily supervised classroom tooth-brushing in early grades; • supervised distribution of fluoride supplements; • conceptual model of a children's dental care programme on a prepayment basis, with subsidized premiums for low-income families. In summary, much has been accomplished, programmes have been changed to meet altered circumstances and will continue to change, but much remains to be done to improve further the dental health of the people of British Columbia. NUTRITION SERVICE J 33 NUTRITION SERVICE Community nutrition services in British Columbia are made effective by the teaching and support of the public health nurse and other public health staff working in co-operation with the medical profession, hospitals, schools, and social service agencies in the community. Consultant services are provided by the public health nutritionist on the headquarters staff of the Health Branch to ensure that the community is well informed on nutrition matters. This position of Nutrition Consultant was filled in the spring after it had been vacant for some months. The new Consultant visited the majority of the health units at least once during the remainder of the year. Discussion focused on individual community problems within the broad subject areas of normal nutrition education, therapeutic diet counselling and institutional food services. Emphasis in nutrition education was placed on food budgeting and on weight control. Educational kits were developed for both these topics. Additional teaching tools were devised for certain aspects of meal service in supervised boarding homes licensed by the Community Care Facilities Licensing Board and for therapeutic diet counselling. Co-ordination of community nutrition resources was maintained by liaison with related professionals in the academic and business community and in other Government departments. These included the British Columbia Nutrition Co-ordinating Committee, the British Columbia Dietetic Association, the British Columbia Home Economics Association, and the Departments of Education, Agriculture, and Rehabilitation and Social Improvement. The following activities are planned for 1971/72:— • Participation of British Columbians in the first phase of a Canadian National Nutrition Survey in the summer of 1971. • Emphasis on prenatal and child nutrition in education materials. • Increased use of mass media in nutrition education. J 34 PUBLIC HEALTH SERVICES REPORT, 1970 PUBLIC HEALTH EDUCATION Health education in its broadest sense encompasses every effort by Health Branch staff to create awareness, influence attitudes, and stimulate desirable behavioural change as these efforts relate to the solution of community and individual health problems. All public health workers are, therefore, " health educators " and, throughout this Annual Report of the Health Branch, there are many examples of the educational activities of the health officers, public health nurses, dental officers, public health inspectors, nutritionists, physiotherapists, speech therapists, radiation inspectors, and other Health Branch staff. All of these are given professional and technical assistance by the Division of Public Health Education. This Division, which is located at Health Branch headquarters, has on its staff several consultants who are specially qualified in health education. During the year, these consultants co-ordinated the development and preparation of educational materials for use by the other staff members of the Health Branch and for distribution to the public. These materials included illustrative slides for use with projectors, tapes of recorded commentaries, filmstrips, film-loops, pamphlets, posters, and leaflets. Important publications in 1970 were a pamphlet Drug Abuse and You, of which 150,000 were printed and distributed throughout the Province and a brochure How to Be a Good Loser, which was prepared by the Consultant in Nutrition and published in the late fall. Five Provincial health units prepared and developed half-hour television programmes as part of a series of 13 on " The Child in the Family," which were presented on the Jean Cannem Show during February, March, April, and May. The purpose of these programmes was to stimulate interest in specific areas of health and to make the viewers aware of available public health services. These programmes were presented by a variety of public health workers from the Provincial health units, Metropolitan Health Service of Greater Vancouver, and other community agencies. The activities of the staff of the Provincial health units in this television series were co-ordinated by the Division of Public Health Education. VITAL STATISTICS J 35 VITAL STATISTICS The work of the Division of Vital Statistics covered a wide variety of data collection, processing, and comparison. The large volume of information which arrived at the Division's headquarters was carefully collated and correlated with other data to produce statistical information for a large number of users. The Division continued to carry out its statutory functions connected with the administration of the Vital Statistics Act, the Marriage Act, the Change of Name Act, and the operation of a Registry of Wills Notices under the Wills Act. (Services are provided to the public through the main office in Victoria and 109 district offices and sub-offices situated throughout the Province.) Table XVI indicates the volume of registrations accepted under the above- mentioned Acts in 1969 and 1970. The work of the Division may be summarized as follows:— • The total volume of registrations accepted showed increases over the preceding year for all items except deaths and stillbirths. • Divorce registrations continued to rise steeply, following the introduction of the Federal Divorce Act in 1968. • Under the Marriage Act, the number of marriage licences issued and the number of civil marriages performed increased by approximately 7 per cent. • Under the Wills Act, a steady increase of notices filed during 1969, when 17,331 entries were made, continued in 1970 when entries totalled 18,137. • An increase from 714 in 1969 to 800 in 1970 occurred in the number of registrations for changes of name under the Change of Name Act. • A considerable amount of statistical work in connection with cancer was carried out by the Division, which provided services to the central Cytology Laboratory in connection with the screening programme for cancer of the cervix. Approximately 340,000 forms, representing that number of cervical smears, was submitted to the Division for mechanical tabulation in 1970. (A research officer served as a member of the committee of the International Collaborative Study on Uterine Cancer and provided statistical data for a follow-up study on women who were screened and found to have preclinical carcinoma of the cervix.) A committee established during the year for the review of cancer care in British Columbia also received statistical advice and assistance. • Intensified efforts to secure the co-operation of all pathologists in the Province have resulted in an increase in the total number of new notifications during 1970, which were recorded on the Cancer Register. • The Registry for Handicapped Children and Adults maintained a high level of registration of handicapping conditions, and approximately 250 registrations per month were recorded. • During the year the genetic and pediatric consultants to the Registry introduced a genetic counselling programme for advice to families of affected children through the co-operation of several local health units and the family physicians in those health unit areas. • In the field of dental studies, assistance was given to the Division of Preventive Dentistry by providing analytical and mechanical tabulation services in connection with the projects which are outlined in the report of that Division. J 36 PUBLIC HEALTH SERVICES REPORT, 1970 • The Division also continued to provide biostatistical services to other divisions, other departments of Government, and voluntary agencies. • For several years, detailed information relating to newborn infants has been collected in four Vancouver hospitals by means of an obstetrical discharge summary form. During 1970 the second report on the data for 1963-70 was released- This report dealt principally with the incidence of stillbirth and early neo-natal deaths in relation to other relevant factors, and has been made available to health units. A large volume of case records is maintained in Vancouver by the Registry for Handicapped Children and Adults. EXTENDED CARE J 37 EXTENDED CARE Pearson Hospital serves two broad categories of patients—those with tuberculosis or other respiratory problems and those who are in need of extended care, including those suffering from the effects of poliomyelitis. Among staff changes, the most significant was the retirement during the early summer of Dr. H. S. Stalker, who had been with the Public Health Service since 1937 and has served as Pearson Medical Superintendent since 1952. Prominent among hospital activities were the following:— • Many items of furniture and equipment were added or modernized. • Extensive renovations were made in the main kitchen and staff lunchroom and in the administration building. • The clinical laboratory section of the hospital continued to function well, and the total work load of the laboratory showed a 9 per cent increase (over an 11-month period). • The physiotherapy and occupational therapy departments have been very active and the occupational therapist continued to work closely with the rehabilitation nurse in devising and providing specialized equipment such as braces and feeding-aids. • For the first time, students from the School of Rehabilitation Medicine at the University of British Columbia were assigned to the Physiotherapy Department, so that both occupational and physiotherapy aspects are part of the educational programme. • The Social Service Department has been actively reviewing its function and has established closer working relationships with other professional disciplines. WOMEN'S AUXILIARY Assistance from the Auxiliary continued to be a welcome facet of hospital life. The efforts of the members has made it possible to maintain a high degree of programme activity. This artist, working at the Pearson Hospital, produces beautiful work on a commercial basis. J 38 PUBLIC HEALTH SERVICES REPORT, 1970 REHABILITATION Rehabilitation is the restoration of the handicapped to the fullest physical, mental, social, economic, and vocational usefulness of which they are capable. This idealistic concept of a total rehabilitation programme was developed in a conference in Washington, D.C., in 1942. In North America, most rehabilitation programmes are administered or financed by government agencies. In British Columbia, rehabilitation of handicapped persons has been a responsibility of the Health Branch since the first rehabilitation programme was launched in 1946. In the main, programmes have been developed to provide vocational rehabilitation services which are concerned with those processes of assessment, physical restoration, counselling, and training which will enable a disabled person to overcome a handicap to employment. The historical background to rehabilitation in British Columbia is interesting, and a comparison of 1970 with 1947 amply illustrates progress in work among handicapped people. At the end of 1947 the vocational rehabilitation staff consisted of one person, the budget for the year was $2,050, and the case load was 37 inpatients and 29 out-patients—all suffering from pulmonary tuberculosis. Services such as psychological testing and vocational training, elemental in a vocational rehabilitation programme, were almost unknown. At the end of 1970 the administration of the programme attained divisional status and numbered among its staff This man is one of many men and women who are actively engaged in work under the Provincial rehabilitation programme. This photograph was taken at a Vancouver rehabilitation centre. REHABILITATION J 39 a director, assistant director, four highly qualified rehabilitation consultants located in regions of the Province, and appropriate clerical and support staff. The case load at the end of the year was approximately 1,070, in which nearly every degree and category of physical, mental, or social disability was represented. The work in 1970 was carried out on a budget of $500,000, through Rehabilitation Committees located in 28 Provincial centres. In only the extreme northwest area are vocational rehabilitation services not available. Rehabilitation begins with a medical evaluation of the problem presented to the client by his disabilities. The first requirement is a medical assessment through which the d'sability is described, the treatment prescribed, and the resultant handicap estimated. In addition to the medical problem, the nature and extent of social and vocational and other problems are explored so that a course through the rehabilitation process can be charted. Some of the services and aids provided by the Health Branch:— • Diagnostic and treatment services not covered under plans such as the British Columbia Medical Plan and the British Columbia Hospital Insurance Service, which may be deemed necessary to correct or alleviate a disability. • Provision of prostheses, braces, hearing-aids, and such other medical services or items that may be required to further a vocational rehabilitation plan. • Psychological and vocational testing and counselling services. • Specific vocational training or retraining where necessary. (The Health Branch, therefore, underwrites the cost of job-training at almost any level from industrial workshops through vocational schools, schools of technology, junior colleges, and universities, when such training will result in employment. In addition to tuition, maintenance allowances, textbooks, supplies, and transportation may be paid for.) A close liaison with the Federal Division of Manpower has been maintained, so that at the completion of the rehabilitation process employment may be sought. It is often a matter of years before the problems of disability, psychological preparation, vocational counselling, and job-training can be overcome. The matter of job placement is most important, and every resource is utilized. The Division of Rehabilitation seeks to utilize many professional skills and acknowledges help from many quarters and assists with major subsidization of the professional staff of several voluntary agencies designated as part of the rehabilitation programme- Foremost among these are the Goodwill Enterprises for the Handicapped in Victoria, the Opportunity Rehabilitation Workshop in Vancouver, and the Western Institute for the Deaf. For further information on rehabilitation, see Table XVII. I 40 PUBLIC HEALTH SERVICES REPORT, 1970 KIDNEY FAILURE CORRECTION PROGRAMME In British Columbia, most persons who suffer kidney failure are now maintained by haemodialysis, which involves the use of a special machine to remove toxic substances from the patient. As a result of improvements in equipment and techniques during the last several years, it has become possible for the procedure to be performed by the patient in his own home, in which an artificial-kidney machine has been placed. This is much less costly than providing the service in a hospital, although it is still necessary to train the patient in the hospital before he is sent home. There are three hospitals now training patients to operate artificial-kidney machines at home—the Vancouver General and St. Paul's in Vancouver, and the Royal Jubilee in Victoria. In addition, the hospitals at Kamloops and Trail have artificial-kidney machines, but are not engaged in training patients for home haemodialysis. When a patient has been trained to operate the equipment, a machine is supplied to him and necessary alterations to the water and electrical supplies in his home are carried out. It costs an average of $6,000 to establish a patient in his home in this way. In addition, it costs an average of $2,150 a year for supplies and materials. (This form of treatment in hospital costs an average of $14,000 a year per patient.) While maintained on this service, the patient is able to work and live a nearly normal life for many years. The first 16 patients were placed on this service in 1969 and a further 35 during 1970. It is anticipated that there will be a need to give similar help to an additional 35 patients each year. In addition, financial assistance is provided to 46 patients who are still receiving dialysis in hospital but who cannot afford the cost of the necessary drugs. This cost averages $375 annually for each patient. There are also eight patients who have received kidney transplants and who are provided with the necessary drugs at an annual cost of $115 per patient. A laboratory technician examines cultures at the Health Branch laboratory in Vancouver. (See next page.) LABORATORY SERVICES J 41 LABORATORY SERVICES PUBLIC HEALTH LABORATORY SERVICES The Health Branch's Division of Laboratories continued to provide services in the field of microbiology, virology, and chemistry during 1970. In Table XVIII, the number of tests and the work load in Dominion Bureau of Statistics units performed at the main laboratory in 1970 are compared with the figures for 1969- The work load increased by 19 per cent, from 1,081,700 units in 1969 to 1,289,550 units in 1970. (These figures do not include the tests performed in virology, because D.B.S. units have not as yet been established for such work.) The main increases in work load in bacteriology were in tests and examinations for diphtheria, gonorrhoea, intestinal parasites, and tuberculosis. Table XIX shows that the number of tests and work load in units performed at the branch laboratories in Nelson and Victoria increased approximately 20 per cent in 1970. The routine work load of the division in 1970 comprised the following:— D.B.S. Units Main laboratory 1,289,548 Nelson branch laboratory 33,518 Victoria branch laboratory 151,590 Total 1,474,656 PUBLIC HEALTH CHEMISTRY SERVICE The past year brought many changes to the Chemistry Service, with the expansion of some programmes and the suspension of others. In co-operation with the Fire Marshal, physical changes were made because of potential fire hazards in the main water and air chemistry laboratories. To provide necessary additional space for the chemistry section, arrangements were made in September to accommodate some of the staff and equipment in the facilities of the British Columbia Research Council located on the grounds of the University of British Columbia. At the year's end, these arrangements were being assessed to determine what further changes should be made. WATER MICROBIOLOGY Table XVIII shows that the labour load in the Division's main laboratory in Vancouver increased by approximately 20 per cent in water samples submitted for the coliform test, the number of coliform tests completed, and the number of standard plate counts. There was a large increase in the number of fecal coliform tests performed (3,770 in 1970) because of the surveys of bathing-beaches. WATER AND WASTEWATER CHEMISTRY The water and wastewater chemistry work load increased in 1970 to 184,500 units from 109,200 units in 1969 (69 per cent). This increase was made possible by utilization of automated analytical testing equipment. Three additional automatic analyzers were obtained in 1970. The members of the staff participated in the Federal-Provincial Okanagan Lake study by performing chemical analyses of outfall and stream samples. I 42 PUBLIC HEALTH SERVICES REPORT, 1970 AIR CHEMISTRY The Lower Mainland air-quality study to determine the relationship of air quality and meteorology was continued. The final report is scheduled for completion in September, 1971. Financing the Lower Mainland study was shared by Health Branch, the Pollution Control Branch of the Water Resources Service, and the Data Processing Centre. A study of lead contamination in one area of Richmond was completed for the Richmond Health Department. VIROLOGY SERVICE The Virology Service recorded a substantially increased demand for diagnostic procedures from physicians and hospitals. An epidemic of influenza due to type A2 influenza virus occurred in the early weeks of the year and was followed by a sharp outbreak of rubella (German measles). Virological studies tended to indicate an upswing in the incidence of rubella in the first quarter of the year, which seemed to be continued at a rate much higher than would normally be expected throughout the summer. While rubella is usually a mild disease of childhood, it can cause severe developmental abnormalities in unborn babies when non-immune pregnant women contract the disease during pregnancy. Laboratory tests can determine whether a pregnant patient has had rubella as a child and is thus immune for life, or whether she is non-immune and therefore susceptible to infection. i Laboratory workers check readings on the atomic absorption spectrophotometer. This piece of equipment provides an analytical method for the determination of the concentration of metals and semimetals in solution. It is used mainly for water sampling—testing drinking-water for lead, mercury, and copper to make sure they are not more than the toxic limit. LABORATORY SERVICES J 43 Expansion of the Virology Service was authorized so that rubella tests could be available to all pregnant women in British Columbia. Other viral infections were identified in patients with encephalitis, meningitis, pericarditis, myocarditis, pneumonia, and gastro-enteritis. CLINICAL LABORATORY SERVICES For a number of years the Laboratory Advisory Council has continued to advise the British Columbia Hospital Insurance Service before grants are awarded to hospitals for the purchase of diagnostic and laboratory equipment. (During the year the Council assessed approximately $700,000 worth of equipment). The Council consists of representatives from the British Columbia Medical Association, the Health Branch, the Department of Pathology of the Faculty of Medicine at the University of British Columbia, and the British Columbia Hospital Insurance Service. In British Columbia, clinical laboratory services have been regionalized and there are now nine in existence throughout the Province. These laboratories offer many dianostic tests to in-patients and out-patients of hospitals. It is interesting to note that the organization now in existence in British Columbia has become a prototype for other Canadian provinces. The Council prepared outlines of information required for assessing plans to assist architects and the Hospital Construction and Planning Division of the British Columbia Hospital Insurance Service. Plans for 20 laboratories were either under review or at the working-drawing stage in 1970. Diagnostic centres housing X-ray and laboratory facilities were proposed for new communities. A joint committee of the British Columbia Association of Pathologists and the Laboratory Advisory Council was formed to advise the British Columbia Hospital Insurance Service on laboratory facilities in Diagnostic and Treatment Centres. Comprehensive reports were given for proposed facilities at Clearwater and Houston and deliberations were under way for similar facilities at Port Hardy and Rumble Beach. The British Columbia Hospital Insurance Service asked for studies to be conducted on the feasibility of a new regional pathology service to include Dawson Creek, Fort St. John, Fort Nelson, and Chetwynd. L J J 44 PUBLIC HEALTH SERVICES REPORT, 1970 POISON CONTROL The Health Branch, in collaboration with the Faculty of Pharmaceutical Sciences at the University of British Columbia, has now established 48 Poison Control Information Centres throughout the Province. They are located in acute general hospitals and are fully operative. In 1970, reports were received on over 6,000 cases of poisoning, and in each case information on diagnosis and treatment was provided from one of the centres. In 1969, over 5,000 instances of accidental poisoning were reported. In addition to providing service to physicians called on to treat the victims of accidental poisoning, a number of lectures and talks stressing prevention were given to physicians and parents during the year. The establishment of a referral centre where physicians can obtain advice on the treatment of difficult cases is nearing completion. All the equipment for the centre has been obtained, and it is expected that it will be operational early in the new year. EMERGENCY HEALTH SERVICE J 45 EMERGENCY HEALTH SERVICE The provision of mass casualty care and emergency public health service in the event of major natural or wartime disaster is the objective of the British Columbia Emergency Health Service. The Provincial service is closely linked with the emergency health services of the Federal Government and of other provinces. There has been considerable progress during 1970 in the pre-positioning of emergency medical units. The pre-positioning programme is approximately 75 per cent complete, and the emphasis should now be on training personnel to be familiar with the equipment which is distributed throughout the Province at strategic points and is valued at $1,500,000. The pre-positioning and maintenance of emergency medical units is an active programme. Tentative storage sites for two 200-bed emergency hospitals have become available in two zones, leaving two emergency hospitals for which storage sites need to be found in another two zones. The latter units will be considered in future planning. Exercising the facilities provided in the Province is an important matter:— • An exercise based on the 200-bed emergency hospital is planned for the annual meeting of the Union of British Columbia Municipalities. • It is planned to hold one exercise a year, using this training unit. • During 1970, Prince George Regional Hospital and St. Joseph's General Hospital in Dawson Creek exercised their disaster plans, based on a simulated local disaster in the community. • The British Columbia Medical Association Disaster Plan was completely revised and an exercise held in October, 1970. • Two well-attended one-day public health disaster institutes were held in Trail and Penticton during April. These institutes are designed to orientate public health staff with their duties and responsibilities should a major disaster occur. Tabletop displays of the Emergency Hospital Advanced Treatment Centre and Casualty Collecting Units were used successfully in Vancouver, Victoria, and Summerland at a meeting of the Union of British Columbia Municipalities, and at the annual conference of the British Columbia Hospitals' Association. Sections of the 200-bed emergency hospital were displayed to hospital personnel at Canadian Forces Base Esquimalt, to public health personnel at their annual institute, to pharmacists participating in a continuing education course, at the annual meeting of the Pharmaceutical Association of British Columbia held in Kelowna, and at the annual meeting of the Canadian Society of Radiological Technicians held in Vancouver. Other activities of the Emergency Health Service may be summarized as follows:— • Equipment from the Training Advanced Treatment Centre was again made available as part of emergency services at the Abbotsford Air Show. • A three-day indoctrination course was presented for community and hospital pharmacists, 15 of whom attended. • A Casualty Simulation Course was conducted for 16 candidates at the Provincial Civil Defence Headquarters. J 46 PUBLIC HEALTH SERVICES REPORT, 1970 • A meeting was held with the Victoria Group of Hospital Administrators who are interested in a Community Disaster Plan similar to that of the Lower Mainland. • A demonstration and display of the 200-bed emergency hospital, conducted by the Alberta Emergency Health Services in Edson, Alta., was attended by British Columbia's Co-ordinator of Emergency Health Services. • Lectures were given at the Provincial Civil Defence training courses, the Public Health Disaster Institute, the Pharmacy Undergraduate Course in Community Health, and to student nurses during their final year of training at St. Joseph's and Royal Jubilee Hospitals in Victoria. • Arrangements were made for 14 persons from various parts of the Province to attend courses on community emergency health planning, presented by the Federal authorities at the Civil Defence School in Arnprior, Ont. A list of locations of emergency medical units is shown in Table XX. COUNCIL OF PRACTICAL NURSES J 47 COUNCIL OF PRACTICAL NURSES British Columbia's licensing programme for practical nurses (the main function of the Council) was implemented late in 1964 and the first licences were issued in 1965. The 10 members of the Council are appointed by Order of the Lieutenant- Governor in Council on the basis of nominations submitted by (a) the Minister of Health Services and Hospital Insurance (two members); (b) the College of Physicians and Surgeons of British Columbia (one member); (c) the Registered Nurses' Association of British Columbia (two members); (d) the Minister of Education (one member); (e) the British Columbia Hospitals' Association (one member); (/) the Licensed Practical Nurses' Association of British Columbia (three members). The Council operates by the authority of the Practical Nurses Act and the regulations made under the Act. During 1970, there were six meetings of the Council as a whole, bringing to 38 the number of meetings held since licensing was implemented. There were also numerous meetings of several committees appointed by the Council. Probably the most important of these committees is the Committee on Credentials, which assesses the qualifications of applicants and submits recommendations to the Council. The final decision concerning the approval or rejection of each application is made by the Council as a whole. Table XXI shows the disposition of applications received since the inception of the programme. Under the Act, the Council has some responsibilities in addition to licensing and it devoted significant attention to these during the year. Most important was the Council's continued close work with the Department of Education in the matter of training of practical nurses. A major feature of this was the development of a pilot training programme to assess the merits of a course of 10 months' duration instead of the present course of 12 months. The Council also undertook a review of a publication entitled Outline of Duties to Be Used as a Guide in the Employment of the Licensed Practical Nurse in British Columbia, which the Council prepared and issued in 1966. In another activity of long-range significance, a committee appointed by the Council began a study of the Act and regulations to determine whether changes should be recommended to the Minister. J 48 PUBLIC HEALTH SERVICES REPORT, 1970 PUBLICATIONS, 1970 Four Year Effect of a Dental Birthday Card Programme for Three Year Old Children, J.C.D.A. 36:192, May, 1970, by A. S. Gray, Donna M. Gunther, and Irene I. Jordan. The Incidence of Staining of Permanent Teeth by the Tetracyclines, C.M.A.J. 105:351, August, 1970, by J. M. Conchie, J. D. Munroe, and D. O. Anderson. A Simplified Method of Determining Dental Treatment Needs of a Population, J. Public Health Dent, (accepted for publication), by J. M. Conchie, K. L. Scott, and J. J. Philion. Flash Flood at Trail, British Columbia, 1969, C.J.P.H. 61:104, March/April, 1970, by N. Schmitt, H. B. Catlin, E. J. Bowmer, and A. A. Larsen. Rheumatic Fever Prophylaxis—A Method for Detecting Lapses from Continuous Oral Medication, C.J.P.H. 61:325, July/August, 1970, by A. A. Larsen, L. D. Kornder, and E. J. Bowmer. Family Life Education in a School District, C.J.P.H., March, 1969, by G. A. Gibson and M. B. Maclean. "Battle of the Buttle" or the Buttle Lake Situation, C.J.P.H., April, 1969, by S. Chamut. Sex Linked Cleft Plate in a British Columbia Indian Family, Pa. diatrics, Vol. 46, No. 6, July, 1970, by R. B. Lowry. Registry for Handicapped Children and Adults, British Columbia, Mental Retardation, Vol. 20, No. 2, April, 1970, by Miss A. E. Scott. TABLES I 49 TABLES Table I.—Approximate Numbers of Health Branch Employees by Major Categories at the End of 1970 Physicians in local health services Physicians in institutional and other employment Nurses in local health services Nurses in institutions Public health inspectors Dentists in local health services Bacteriologists Laboratory technicians Public health engineers Statisticians Others 20 17 310 83 58 5 22 35 5 7 693 Total 1,255 Table II.—Organization and Staff of Health Branch (Location and Approximate Numbers of Persons Employed at End of 1970) Health Branch headquarters, Legislative Buildings, Victoria.. 42 Health Branch office, 828 West Tenth Avenue, Vancouver.... 27 69 Division of Vital Statistics— Headquarters and Victoria office, Legislative Buildings, Victoria 67 Vancouver office, 828 West Tenth Avenue, Vancouver 18 85 Division of Tuberculosis Control— Headquarters, 2647 Willow Street, Vancouver 11 Willow Chest Centre, 2647 Willow Street, Vancouver 114 Pearson Hospital, 700 West 57th Avenue, Vancouver.... 323 Victoria and Island Chest Clinic, 1902 Fort Street, Victoria 11 New Westminster Chest Clinic, Sixth and Carnarvon, New Westminster 4 Travelling clinics, 2647 Willow Street, Vancouver 10 Survey programme, 2647 Willow Street, Vancouver 6 479 Division of Laboratories— Headquarters and Vancouver Laboratory, 828 West Tenth Avenue, Vancouver 95 Nelson Branch Laboratory, Kootenay Lake General Hospital 1 Victoria Branch Laboratory, Royal Jubilee Hospital1 96 i Services are purchased from the Royal Jubilee Hospital, which uses its own staff to perform the tests. J 50 PUBLIC HEALTH SERVICES REPORT, 1970 Table II.—Organization and Staff of Health Branch (Location and Approximate Numbers of Persons Employed at End of 1970)—Continued Division of Venereal Disease Control—Headquarters and Vancouver Clinic, 828 West Tenth Avenue, Vancouver Division of Rehabilitation— Headquarters, 828 West Tenth Avenue, Vancouver Nanaimo Chilliwack Prince George 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 Central Fraser Valley, Mission ... Boundary, Cloverdale Simon Fraser, Coquitlam Coast-Garibaldi, Powell River Saanich and South Vancouver Island, 780 Vernon Avenue, Victoria Central Vancouver Island, Nanaimo Upper Island, Courtenay Cariboo, Williams Lake Skeena, Prince Rupert Peace River, Dawson Creek Northern Interior, Prince George 25 14 22 23 36 27 26 26 50 32 17 39 47 20 16 27 17 34 17 11 498 Total 1,255 There were also part-time employees in many of the places listed. The part- time employees serving on a continuous basis totalled the equivalent of approximately 63 full-time employees. TABLES J 51 Table III.—Comparison of Public Health Services Gross Expenditures for the Fiscal Years 1967/68 to 1969/70 Gross Expenditure Percentage of Gross Expenditure Percentage Increase or Decrease of Current Over Previous Year 1967/68 1968/69 1969/70 1967/68 1968/69 1969/70 $3,830,907 4,941,338 2,025,871 707,011 580,627 491,641 162,231 $3,765,566 5,467,761 2,639,181 929,735 638.210 $4,200,358 5,924,284 2,637,205 899,100 860.196 30.0 38.8 15.9 5.5 4.6 3.9 1.3 26.6 38.7 18.7 6.6 4.5 3.7 1.2 27.5 38.8 17.3 5.9 5.6 3.7 1.2 +11.5 + 8.3 -0.1 —3.3 +34.8 Cancer, arthritis, rehabilitation, and research General administration and consultative services Division of Vital Statistics Division of Venereal Disease- 521,397 1 560,231 173,225 | 176,973 +7.4 +2.2 Totals $12,739,626 |$14,135,075 |$15,258,347 1 100.0 100.0 100.0 +7.9 Table IV.—Per Diem Rates for In-patient Care during the Fiscal Year April 1, 1969, to March 31, 1970 Tuberculosis Hospitals Operating cost— Willow Chest Centre $887,374 Pearson Tuberculosis Unit 701,496 Total $1,588,870 Number of patient-days— Willow Chest Centre 25,405 Pearson Tuberculosis Unit 24,744 Total number of days' care . Per capita cost per diem— Willow Chest Centre Pearson Tuberculosis Unit Combined per capita cost per diem . 50,149 $34.93 $28.35 $31.68 Pearson Extended-care Unit Operating cost Number of patient-days Per capita cost per diem. $1,555,469 59,873 $25.98 Poliomyelitis Pavilion (Pearson Unit) Operating cost Number of patient-days Per capita cost per diem . $410,638 13,632 $30.12 J 52 PUBLIC HEALTH SERVICES REPORT, 1970 Table V.—Training of Health Branch Staff Proceeding toward a Diploma or Degree in a Public Health Specialty (Types of training, universities or other training centres attended, and numbers trained.) Completed training during 1970— Diploma in Public Health Nursing (British Columbia) 9 Administration of Hospital Nursing Units (British Columbia) 1 Diploma in Public Health Dentistry (Toronto) 1 Bachelor of Science in Nursing (Montreal and Halifax) 2 Masters Degree in Dental Biology (Montreal) 1 Total 14 Commenced training during 1970— Canadian Hospitals' Association's Medical Records Clerk Course (correspondence) 2 Masters Degree in Speech Pathology (Oregon) 1 Diploma in Public Health Nursing (British Columbia) 3 Diploma in Public Health Nursing (Ottawa) 1 Diploma in Public Health (Toronto) 2 Diploma in Dental Public Health (Toronto) 1 Bachelor of Science in Nursing (McGill University) 1 Bachelor of Science in Nursing (University of Washington) 1 Total 12 Table VI.—Training of Health Branch Staff by Means of Short Courses (Types of training, universities or other training centres, and numbers trained.) 13th Annual Refresher Course for Medical Health Officers (University of Toronto) 1 Speech and Hearing Clinic for Speech Therapists (University of Washington) 1 The Woodlands School Workshop for Public Health Nurses (New Westminster) 45 Continuing Education Course for Health Officers (University of British Columbia) 17 The Fifth Annual Neuropsychology Workshop (University of Victoria) 2 Introduction to Television Production (University of Victoria) 1 Sixth Annual Seminar of Washington State Society of Hospital Pharmacists (Seattle, Wash.) 1 Nursing Assessment (University of British Columbia) 2 Nursing Care for Maternity Patients (University of British Columbia) 5 Developing Leadership in Supervision of Nursing Services (University of Toronto) 2 Space Management, Functional and Neuromuscular Problems (School of Dentistry, University of Washington) 1 Marriage, the Family, and Human Sexuality (Vancouver) 5 Seminar on the Medical Aspects of Safe Driving (Toronto) 1 TABLES J 53 Table VI.—Training of Health Branch Staff by Means of Short Courses—Continued Implementation of Change in Nursing Service (University of British Columbia) 9 Fluorescent Antibody Techniques (Ottawa) 1 " Obesity " (University of British Columbia) 1 Psychiatric Affiliation for Public Health Nurses (Riverview Hospital, Essondale) 12 Air Pollution Course for Public Health Inspectors (University of British Columbia) 25 Second International Congress of the Radiation Protection Association (Brighton, England) 1 Changing Role of the Manager (University of Victoria) 1 Certificate (Correspondence) Course in Environmental Health Administration (Ryerson Institute) 10 Electronic Circuits and Principles II (British Columbia Institute of Technology, Nanaimo) 1 Conference on Adolescence (University of British Columbia) 4 Joint Convention of the Canadian Speech and Hearing Association and the Speech and Hearing Association of Alberta (Glenrose Hospital, Edmonton) 1 " Environmental Management " (Bayshore Inn, Vancouver) 2 " Therapeutic Use of Self " (University of British Columbia) 1 Air Pollution Control Association (Pacific Northwest International Section) Conference (Spokane, Wash.) 1 Sociology and Psychology (University of Lethbridge) 1 Workshop for Supervisory Nurses, " Expertise in Public Health Nursing " (Grosvenor Hotel, Vancouver) 32 J 54 PUBLIC HEALTH SERVICES REPORT, 1970 Table VII.—Reported Communicable Diseases in British Columbia, 1966-70 (Including Indians) (Rate per 100,000 population.) Reported Disease 1966 1967 1968 1969 1970 Number Number Number Number Number of Rate of Rate of Rate of Rate of Rate Cases Cases Cases Cases Cases 1 1 0.1 2 0.1 8 0.4 2 0.1 1 0.1 1 0.1 Diarrhoea of the newborn (.E. colt) 31 1.7 16 0.8 19 0.9 23 1.1 54 2.5 Diphtheria 1 0.1 8 0.4 14 0.7 9 0.4 2 0.1 4 0.2 12 0.6 4 0.2 203 10.8 138 7.1 276 13.8 64 3.1 166 7.8 367 19.6 489 25.1 165 8.2 209 10.1 143 6.7 Food poisoning— Staphylococcal intoxica- 12 342 0.6 18.2 9 256 0.5 13.1 9 165 0.4 8.2 29 400 1.4 19.3 8 532 0.4 24.9 4 0.2 24 1.2 311 15.5 19 0.9 6 0.3 844 45.0 1,664 85.4 2,032 101.3 2,139 103.3 1,910 89.4 1 0.1 Meningitis, viral or aseptic— Due to Coxsackie virus 9 0.5 1 0.1 1 0.1 1 0.1 , 31 1.7 31 1.6 42 2.1 20 0.9 32 1.5 Meningococcal infections .. . 11 0.6 12 0.6 17 0.8 13 0.6 14 0.6 Pemphigus neonatorum 3 0.1 1 0.1 Pertussis 311 16.6 264 13.5 136 6.8 59 2.8 155 7.2 988 52.7 695 35.6 300 15.0 56 2.7 98 4.6 796 42.5 1,782 91.5 720 35.9 1,180 57.0 546 25.5 Tetanus . ... 3 0.2 2 0.1 1 0.1 3 0.2 10 0.5 3 0.1 3 0.1 4 0.2 1 0.1 4 0.2 2 0.1 2 0.1 1 0.1 Totals 3,944 210.5 5,413 278.0 4,215 210.0 4,256 | 205.6 1 3,685 172.4 Table VIII.—Reported Infectious Syphilis and Gonorrhoea, British Columbia, 1966-70 Infectious Syphilis Gonorrhoea Number Ratel Number Ratel 1966 71 3.8 5,415 7.90 R 1<>67 , 72 3.7 4,706 241.7 1968 68 3.4 4,199 209.2 19fi9 45 2.5 4,797 232.0 1970 772 3.252 6,0912 28032 i Rate per 100,00 0 populat ion. 2 Prelim inary. TABLES J 55 Table IX.—Statistical Summary of Public Health Inspectors' Activities, 1968-70, for 17 Provincial Health Units 19681 1969 1970 (Estimate) Food premises— Eating and drinking places. Food processing Food stores.. Other.. Factories Industrial camps.. Hospitals.. Boarding homes.. Schools Summer camps Other institutions- Housing. Mobile-home parks. Camp-sites. Hairdressing places- Farms Fairs Parks and beaches... Swimming-pools— Inspection Sample- Surveys (sanitary and other) . Waste disposal- Private water supplies- Inspection Sample- Public water supplies— Inspection. Sample- Pollution samples— Bacteriological Chemical Field tests Municipal outfalls and plants- Private sewage disposal Plumbing- Subdivisions Site inspections- Nuisances— Sewage.. Garbage and refuse- Other (pests, etc.)— Disease investigation Meetings- Educational activities .. 4,808 320 1,111 184 424 325 79 308 492 289 120 2,079 (2) (2) 667 595 52 775 1,920 1,199 1,128 2,680 2,159 2,675 1,453 6,044 2,401 1,040 (2) 1,056 11,380 277 3,755 8,453 3,855 2,295 2,637 423 2,492 1,145 4,390 765 1,558 410 748 375 119 374 956 179 197 1,721 1,287 779 682 339 37 692 1,505 1,122 876 1,057 2,172 3,353 1,108 5,044 2,379 1,251 682 888 11,130 211 4,195 8,084 3,886 2,536 2,059 310 3,287 1,253 3,934 608 1,086 306 506 390 59 338 514 203 201 1,520 1,309 790 386 425 45 274 1,275 1,602 671 1,053 1,687 3,242 916 4,971 2,263 1,119 279 10,721 152 3,627 7,455 2,927 2,134 2,324 327 2,551 1,081 i These are projected figures for the year. 2 Not classified. Information was only available in part of 1968. Table X.—Public Health Inspectors' Time-study Food premises Industrial camps and factories Hospitals and community care (includes summer camps) Housing Mobile home and camp-sites Barber shops and beauty parlours Offensive trade, farms __ Air pollution Fairs, parks, rest-rooms (other) Sewage Per Cent of Time 3.5 0.6 0.7 1.0 1.6 0.2 0.6 0.2 0.3 6.0 J 56 PUBLIC HEALTH SERVICES REPORT, 1970 Table X.—Public Health Inspectors' Time-study—Continued Per Cent of Time Subdivision and site inspection 7.1 Common carrier and Indian reserves 0.2 Surveys 0.8 Waste disposal 0.7 Schools 0.2 Water supplies 2.1 Swimming-pools 0.5 Water quality (samples) 0.6 Nuisances (refuse, sewage, pests, and others) 4.0 Consultations with Health and allied local personnel 9.1 Meetings (staff, other) 3.2 Supervision (Senior Public Health Inspectors) 1.0 Educational activities 2.0 Other activities 4.2 Travel time 21.3 Community activities 1.0 Office— (a) Professional activities— Letters and reports 7.6 Review of plans 2.5 Telephone consultations 5.3 Public inquiries 6.1 Other 4.5 (b) Non-professional activities (clerical filing and recording) 1.3 Normal duty time 100.0 Table XI.—Statistical Summary of Selected Activities of Public Health Nurses, September, 1969, to August, 1970, Inclusive1 School service— 196g/69 1969'70 Direct by nurse and aide 307,534 406,790 Teacher/Nurse conferences 6,956 6,570 Home visits 40,350 45,852 Conference with staff 62,965 64,784 Meetings 2,398 2,769 Expectant parents— Class attendance by mothers 14,989 16,517 Class attendance by fathers 3,231 4,323 Prenatal home visits 3,875 4,240 Postnatal visits 18,920 19,746 Child health- Infants— Conference attendance 58,169 60,435 Home visits 34,944 36,114 Pre-school— Conference attendance 71,587 89,423 Home visits 32,139 33,612 i Services provided by public health nurses under the jurisdiction of the Health Branch, but does not include service provided by Greater Vancouver, Victoria, Esquimalt, Oak Bay, and New Westminster. TABLES J 57 Table XI.—Statistical Summary of Selected Activities of Public Health Nurses, September, 1969, to August, 1970, Inclusive1—Continued Home Care— 1968/69 1969/70 Nursing care visits 76,193 77,766 Physiotherapist assessments 1,220 1,267 Visits to personal care institutions 979 1,248 Adult health supervision visits 44,119 57,226 Mental health visits 17,310 17,749 Disease control— Tuberculosis visits 9,662 8,723 Venereal disease visits 3,286 3,562 Communicable disease visits 9,327 9,635 Rheumatic fever patients 1,121 1,135 Immunizations— Measles (rubeola) Smallpox Poliomyelitis Basic series Other 92,194 158,621 21,565 149,398 47,648 97,388 157,148 22,877 155,549 Total doses Tests- Tuberculin Other Total visits to homes. 421,778 480,610 14,904 15,316 3,043 5,388 172,062 175,069 Professional services by telephone 176,672 199,123 1 Services provided by public health nurses under the jurisdiction of the Health Branch, but does not include service provided by Greater Vancouver, Victoria, Esquimalt, Oak Bay, and New Westminster. Table XII.—Summary of Service Provided in Three Areas by Employees' Health Services Staff, 1970 Service Rendered Provincial Mental Hospital Vancouver Area Victoria Area Health counselling and (or) examination- Occupational health nursei Physiciani Immunizations administered (includes routine and influenza) Medical and surgical treatment 372 104 766 625 767 183 1,294 594 374 46 1,602 1,569 i An occupational health nurse provides full-time service in each area. A physician is available on request, in the Vancouver area, for two days a month in the Provincial Mental Hospital, and one or two days a month in the Victoria area. J 58 PUBLIC HEALTH SERVICES REPORT, 1970 Table XIII.—Enrolment in Public and Private Schools in British Columbia, June, 1970 Grade Schools Kindergartens Schools for Retarded Children Total Greater Vancouver— Public 143,022 7,713 41,998 2,447 299,120 10,660 7,908 2,856 2,404 712 10,522 6,210 301 83 82 151,231 10,652 44,484 3,159 Greater Victoria— Public. Private Remainder of Province— PubUc Private 532 347 310,174 17,217 Totals- Public. Private 484,140 20,820 20,834 9,778 915 430 505,889 31,028 Grand totals 504,960 30,612 1,345 1 536,917 1 Table XIV.—Number of Pupils Receiving Basic Immunization Prior to Entering Grade I, September, 1969 Greater Vancouver Greater Victoria Remainder of Province Total pupils enrolled.. Smallpox- Diphtheria, pertussis, and tetanus Poliomyelitis 12,708 8,918 (70.2%) 9,755 (76.8%) 7,695 (60.6%) 3,556 2,669 (75.1%) 2,808 (79.0%) 2,045 (57.5%) 27,340 19,564 (71.6%) 21,141 (77.3%) 15,941 (58.3%) Table XV.—Pupils Referred for Health Services Greater Victoria Number referred to public health nurse— By school personnel 3,763 From other sources 3,042 Totals 6,805 Province i 29,548 20,435 49,983 Number referred by public health nurse for further care— To private physician for other than vision defect 1,759 To investigator of vision defects 1,607 To speech therapist 68 To mental health clinic 69 To other clinics 78 Totals 11,323 14,193 616 1,462 1,425 3,581 29,019 i Excluding Greater Vancouver and Greater Victoria. TABLES J 59 Table XVI.—Registrations Accepted under Various Acts Registrations accepted under Vital Statistics Act 1969 (Preliminary) Birth registrations 35,512 36,900 Death registrations 17,597 16,800 Marriage registrations 18,502 19,900 Stillbirth registrations 469 425 Adoption orders 2,736 3,150 Divorce orders 4,279 5,450 Delayed registrations of birth 417 436 Registrations of wills notices accepted under Wills Act 17,331 18,137 Total registrations accepted 96,843 101,198 Legitimations of birth affected under Vital Statistics Act 271 260 Alterations of given name effected under Vital Statistics Act. 175 187 Changes of name under Change of Name Act 714 840 Certificates issued— Birth certificates 60,267 62,255 Death certificates 10,223 8,596 Marriage certificates 6,815 6,959 Baptismal certificates 16 10 Change of name certificates 901 999 Divorce certificates 251 234 Photographic copies 7,344 7,233 Wills notice certification 10,777 10,160 Total certificates issued. 96,594 96,446 Non-revenue searches for Government departments 15,120 12,178 Total revenue $357,060 $347,644 Table XVII.—Case Load of the Division of Rehabilitation, January 1 to December 31,1970 Accepted cases active at January 1, 1970 1,032 New cases referred to local rehabilitation committees 606 New cases referred from other sources 288 Cases reopened 137 Total referrals considered for rehabilitation services, January 1, 1970, to December 31, 1970 1,031 Total 2,063 J 60 PUBLIC HEALTH SERVICES REPORT, 1970 Table XVII.—Case Load of the Division of Rehabilitation, January 1 to December 31, 1970—Continued Analysis of Closed Cases Cases closed, January 1 to December 31, 1970— Employment placements made— Canada Manpower centres 45 Division of Rehabilitation staff 20 Placements on graduation from training 153 218 Resumed former activities 97 Job placement not feasible (physical restoration only).... 43 Deceased 4 Awaiting job placement 25 Other (unable to locate clients, moved from Province, lack of motivation, etc.) 115 502 Cases assessed and rejected as not capable of rehabilitation 589 Cases currently under assessment or receiving rehabilitation services 972 Total 2,063 TABLES J 61 Table XVIII.—Statistical Report of Examinations and Work Load in 1969 and 1970, Main Laboratory Uniti Value 1969 Tests Performed Work-load Units 1970 Tests Performed Work-load Units Bacteriology Service Enteric Laboratory— Cultures— Salmonella-Shigella Pathogenic E. coli.. Food-poisoning examination— Miscellaneous Laboratory— Animal virulence (diphtheria). Cultures— C diphtheria Hemolytic staph.-strep.. Miscellaneous Fungi.. N. gonorrhoea.. Smears for— N. gonorrhcece.. Miscellaneous- Serology Laboratory— Agglut.—Widal, Paul-Bunnell, Brucella Anti-streptolysin test- Blood— V.D.R.L.(qual.) V.D.R.L.(quant.)- F.T.A.-Abs C.S.F.—V.D.R.L Darkfield—T. pallidum.. Tuberculosis Laboratory— Animal inoculation Anti-microbial sensitivity- Atypical mycobacteria.. Cultures for M. tuberculosis— Smears for M. tuberculosis Intestinal parasites Chemistry Service Water microbiology— Algse enumeration Coliform test— Presumptive confirmed test- Completed test.. Fascal coliform test F__cal streptococcal test- Shellfish Standard plate count.. Water/Wastewater Chemistry— Check test Routine test- Extended B.O.D Partial Air-quality investigation- Dust fall—total Lead peroxide candle- Soiling index tape . Suspended particulate matter- Partial Totals. 7 10 15 2 5 1 2 10 2 3 10 25 25 6 2 3 10 5 2 4 5 15 2 19 63 117 30 25 10 20 3 15,260 3,510 97 15 1,037 5,371 3,782 5,828 7,568 46,807 3,314 10,905 8,461 149,648 1,945 2,605 2,986 182 532 1,118 248 28,879 16,715 5,874 18,581 1,973 280 434 8,464 106,820 35,100 1,455 90 5,185 26,855 18,910 29,140 37,840 93,614 6,628 21,810 42,305 149,648 3,890 26,050 5,972 546 5,320 27,950 6,200 173,274 33,430 17,622 92,905 3,946 14,000 34,720 60,468 18,670 3,444 123 53 1,296 4,822 4,222 6,099 9,965 55,057 3,569 12,970 8,884 164,856 2,163 2,747 3,120 137 677 1,059 269 29,592 18,875 7,298 13 22,407 2,222 3,770 120 7 2,337 34 29 354 497 18,919 6 7 8 40 9 352,419 | 1,081,693 410,746 130,690 34,444 1,845 318 6,480 24,110 21,110 30,495 49,825 110,114 7,138 25,940 44,420 164,856 4,326 27,470 6,240 411 6,770 26,475 6,725 177,552 37,750 21,894 130 112,035 4,444 15,080 600 105 4,674 646 1,827 41,418 14,910 125,699 150 70 160 120 86 1,289,548 i One D.B.S. unit=10 minutes of work. J 62 PUBLIC HEALTH SERVICES REPORT, 1970 Table XIX.—Statistical Report of Examinations and Work Load during the Year 1970, Branch Laboratories Uniti Value Nelson Victoria Tests Performed Work-load Units Tests Performed Work-load Units Enteric Laboratory— Cultures— Salmonella-Shigella 7 10 15 6 5 5 5 5 5 2 2 2 5 1 2 2 3 10 6 2 3 5 2 4 2 295 2,065 4,356 1,101 24 1 220 5,463 23 2,177 1,998 2,133 813 966 429 10,198 60 708 3 22 2,113 1,594 1,649 / 2,958 295 349 398 30,492 11,010 360 Miscellaneous Laboratory— 6 Cultures— 105 924 826 525 4,620 4,130 1,068 1,044 704 4,170 22 1,100 27,315 115 10,885 9,990 Smears for— 534 522 352 4,266 1,626 Serology Laboratory— Agglut.—Widal, Paul-Bunnell, 1,932 2,145 Blood— V.D.R.L. (qual.) vn.R T., (quant.) 4,170 11 10,198 120 C.S.F.—V.D.R.L 1,416 Darkfield—T. pallidum 9 Tuberculosis Laboratory— 220 12,678 Smears for M. tuberculosis 102 75 2,901 118 204 225 14,505 236 3,188 4,947 Water Laboratory— 14,790 590 1,396 796 Tntnli 10,935 33,518 40,051 151,590 1 One D.B.S. unit=10 minutes of work. Table XX.—Emergency Health Service Medical Units Pre-positioned Throughout British Columbia Emergency hospitals (operational) Emergency hospitals (training) Advanced treatment centres (training) Casualty collecting units (operational) Casualty collecting units (training) Hospital disaster supply units Blood donor packs 13 1 Advanced treatment centres (operational) 36 1 56 1 . 236 22 TABLES Table XXI.—Licensing of Practical Nurses (Disposition of applications received since inception of programme in 1965 to end of 1970.) J 63 Received Approved— On the basis of formal training 3,494 On the basis of experience only— Full licence 396 Partial licence 874 1,270 6,398 Rejected Deferred pending further training, etc. Deferred pending receipt of further information from applicants Awaiting assessment at end of 1970 126 Total 4,764 888 551 69 6,398 Printed by K. M. MacDonald, Printer to the Queen's Most Excellent Majesty in right of the Province of British Columbia. 1971 780-1270-9405 J
- Library Home /
- Search Collections /
- Open Collections /
- Browse Collections /
- BC Sessional Papers /
- Seventy-fourth Annual Report of the Public Health Services...
Open Collections
BC Sessional Papers
Seventy-fourth Annual Report of the Public Health Services of British Columbia HEALTH BRANCH DEPARTMENT… British Columbia. Legislative Assembly 1971
jpg
Page Metadata
Item Metadata
Title | Seventy-fourth Annual Report of the Public Health Services of British Columbia HEALTH BRANCH DEPARTMENT OF HEALTH SERVICES AND HOSPITAL INSURANCE YEAR ENDED DECEMBER 31 1970 |
Alternate Title | PUBLIC HEALTH SERVICES REPORT, 1970 |
Creator |
British Columbia. Legislative Assembly |
Publisher | Victoria, BC : Government Printer |
Date Issued | 1971 |
Genre |
Legislative proceedings |
Type |
Text |
FileFormat | application/pdf |
Language | English |
Identifier | J110.L5 S7 1971_V01_11_J1_J63 |
Collection |
Sessional Papers of the Province of British Columbia |
Source | Original Format: Legislative Assembly of British Columbia. Library. Sessional Papers of the Province of British Columbia |
Date Available | 2018-10-30 |
Provider | Vancouver: University of British Columbia Library |
Rights | Images provided for research and reference use only. For permission to publish, copy or otherwise distribute these images please contact the Legislative Library of British Columbia |
CatalogueRecord | http://resolve.library.ubc.ca/cgi-bin/catsearch?bid=1198198 |
DOI | 10.14288/1.0373666 |
AggregatedSourceRepository | CONTENTdm |
Download
- Media
- bcsessional-1.0373666.pdf
- Metadata
- JSON: bcsessional-1.0373666.json
- JSON-LD: bcsessional-1.0373666-ld.json
- RDF/XML (Pretty): bcsessional-1.0373666-rdf.xml
- RDF/JSON: bcsessional-1.0373666-rdf.json
- Turtle: bcsessional-1.0373666-turtle.txt
- N-Triples: bcsessional-1.0373666-rdf-ntriples.txt
- Original Record: bcsessional-1.0373666-source.json
- Full Text
- bcsessional-1.0373666-fulltext.txt
- Citation
- bcsessional-1.0373666.ris
Full Text
Cite
Citation Scheme:
Usage Statistics
Share
Embed
Customize your widget with the following options, then copy and paste the code below into the HTML
of your page to embed this item in your website.
<div id="ubcOpenCollectionsWidgetDisplay">
<script id="ubcOpenCollectionsWidget"
src="{[{embed.src}]}"
data-item="{[{embed.item}]}"
data-collection="{[{embed.collection}]}"
data-metadata="{[{embed.showMetadata}]}"
data-width="{[{embed.width}]}"
data-media="{[{embed.selectedMedia}]}"
async >
</script>
</div>

https://iiif.library.ubc.ca/presentation/cdm.bcsessional.1-0373666/manifest