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Seventy_third Annual Report of the Public Health Services of British Columbia HEALTH BRANCH DEPARTMENT… British Columbia. Legislative Assembly 1970

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Full Text

 PROVINCE OF BRITISH COLUMBIA
Seventy-third Annual Report of the
Public Health Services
of British Columbia
HEALTH BRANCH
Department of Health Services and Hospital Insurance
YEAR ENDED DECEMBER 31
1969
Printed by A. Sutton, Printer to the Queen's Most Excellent Majesty
in right of the Province of British Columbia
1970
  Office of the Minister of Health Services
and Hospital Insurance,
Victoria, British Columbia, January 26, 1970.
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-third Annual Report of the
Public Health Services of British Columbia for the year ended December 31, 1969.
RALPH R. LOFFMARK,
Minister of Health Services and Hospital Insurance.
 Department of Health Services and Hospital Insurance
(Health Branch),
Victoria, British Columbia, January 26, 1970.
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-third Annual Report of the
Public Health Services of British Columbia for the year ended December 31, 1969.
J. A. TAYLOR, B.A., M.D., D.P.H.,
Deputy Minister of Health.
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 The Health Branch is one of the three branches of the Department of Health
Services and Hospital Insurance, together with the branches of Mental Health Services and the British Columbia Hospital Insurance Service. Each is headed by a
Deputy Minister under the 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 functions and responsibilities of these divisions are outlined
on the preceding page.
Direct services to the people in their communities, homes, schools, and places
of business are provided by personnel of local health departments. Greater Vancouver and Greater Victoria have their own metropolitan organizations, which,
though not under jurisdiction of the Health Branch, co-operate closely and receive
special services and financial assistance from the Provincial and Federal Governments. The remainder of the Province is covered by 18 health departments, known
as health units, which are under the jurisdiction of the Health Branch. Each unit is
complete in itself and serves one or more population centres and the rural areas
adjacent to it.
 TABLE OF CONTENTS
Introduction	
Communicable and Reportable Disease..
Health and Our Environment	
Community and Family Health	
Maternal and Child Health	
Immunization	
School Health	
Home Care	
Health Education-
Extended Care	
Vital Statistics	
Dental Care	
Rehabilitation	
Laboratory Services..
Occupational Health.
Poison Control	
Emergency Health Service....
Council of Practical Nurses..
Publications, 1969	
Tables—
Page
_ 9
. 11
_ 15
. 21
. 24
. 27
. 28
. 30
. 32
. 34
. 35
. 37
. 40
. 43
. 46
. 49
. 50
.. 52
. 53
I.—Approximate Numbers of Health Branch Employees by Major
Categories at the End of 1969  54
II.—Organization and Staff of Health Branch (Location and Approximate Numbers of Persons Employed at End of 1969)  54
III.—Comparison of Public Health Services Gross Expenditures for the
Fiscal Years 1966/67 to 1968/69  56
IV.—Per Diem Rates for In-patient Care during the Fiscal Year April 1,
1968, to March 31, 1969  56
V.—Training of Health Branch Staff Proceeding toward a Diploma or
Degree in a Public Health Specialty  57
VI.—Training of Health Branch Staff by Means of Short Courses  58
VII.—Reported Communicable Diseases in British Columbia, 1965-69
(Including Indians)  5 8
VIII.—Reported Infectious Syphilis and Gonorrhoea, British Columbia,
1946, 1951, 1956, 1961, 1964-69	
IX.—Statistical Summary of Selected Activities of Public Health Nurses,
September to August, Inclusive	
X.—Number of Pupils with Basic Immunization Prior to Entering
Grade I, September, 1968	
59
60
60
60
60
61
XL—Referral of Pupils to School Health Services...	
XII.—Pupils Referred by Public Health Nurses for Further Care.	
XIII.—Registrations Accepted under Various Acts	
XIV.—Case Load of the Division of Rehabilitation, January 1 to December 31, 1969  62
XV.—Statistical Report of Examinations and Work Load in 1968 and
1969, Main Laboratory  63
XVI.—Statistical Report of Examinations  and Work Load in  1969,
Branch Laboratories  64
XVII.—Licensing of Practical Nurses  64
  Seventy-third Annual Report
of the Public Health Services of British Columbia
HEALTH BRANCH
Department of Health Services and Hospital Insurance
YEAR ENDED DECEMBER 31, 1969
The Health Branch of the Department of Health Services and Hospital Insurance
has as its objective the conservation and betterment of community health through
the systematic development and delivery of adequate preventive health services.
This is a goal toward which this Department has striven for a considerable number
of years. To accomplish this as efficiently as possible, there has been a constant
endeavour to encourage the development of adequate local health services in the
form of health units, that is, local health departments, capable of examining the
health needs and the health problems on a community basis, then organizing programmes, services, and such other measures as may be required to cope with them.
The Health Branch provides the direction, supervision, consultation, and assistance
to the staffs employed within those local health agencies. This requires that the
Health Branch exercise a continuous surveillance of all the factors and facilities that
may have a bearing on the health of the people throughout the Province. This
report enumerates various measures undertaken toward accomplishing that task.
Tables I and II show the numbers and kinds of persons employed and their places
of employment. Tables III and IV show the costs of the services for the last
fiscal year.
THE PROVINCE AND ITS PEOPLE
Scattered throughout the 366,000 square miles of the Province are the
2,067,000 people who make up the mid-year population of 1969. This is an increase of 60,000 persons in the period of one year, maintaining the phenomenal
growth of about 3 per cent per year, common to the last couple of years. In the
period since 1965, population growth in British Columbia has exceeded the total
for all other provinces, excluding Ontario and Quebec. If the population were
distributed uniformly throughout the Province there would be a population density
of 5.6 persons per square mile, but the topography of the country militates against
such an even distribution. While population growth is occurring in all areas of the
Province, there still seems to be a disposition on the part of many persons to take
up residence in the south-western corner of the Province, where almost one-half
dwell in the metropolitan areas of Greater Vancouver and Greater Victoria. With
more than 72 per cent resident in urban areas, British Columbia is established as
second only to Ontario among the provinces with the highest portion of urban
dwellers. The age distribution has changed little, since nearly 40 per cent of the
people of British Columbia are under the age of 20 years, while approximately 13
per cent are beyond 60 years of age.
Preliminary data compiled from the Vital Statistics records processed during
the year reveal certain features of the population for the year. For the first time
in 10 years the downward trend in the birth rate was reversed, as the number of
births was 5 per cent higher than that for last year. The rate recorded was 17.0
per 1,000 population as against last year's figure of 16.8, still considerably below
the peak rate of 26.1 recorded in 1967. The lowest rate was that of 13.4, established in 1933.
 S 10 PUBLIC HEALTH SERVICES REPORT, 1969
The general death rate recorded in the Province for the year was 8.5 per 1,000
population, slightly above the 8.4 figure of last year. Higher mortality from pneumonia and influenza played a part in this increased death rate.
Mortality from three of the four leading causes of death (heart disease, cancer,
and accidents) showed no marked variation this year from that of 1968, but that
for cerebrovascular disease (strokes) declined. The rates recorded in 1969 (per
100,000) were 303 for heart disease, 144 for cancer, 80 for strokes, and 68 for
accidents.   In 1968 the comparable rates were 304, 150, 93, and 71 respectively.
There was an improvement in the mortality figure for motor-vehicle accidents
in 1969 and as a result these caused only 36 per cent of all accidental deaths,
compared with 40 per cent in 1968. Deaths from poisoning showed an increase
during 1969, accounting for 12 per cent of all accidental deaths, compared with 10
per cent in the previous year. Falls and burns, the next most important cause of
accidental death, accounted for substantially the same number of people dying
accidentally this year as last year but drowning mortality, the next most important
cause in the accidental death column, showed a reduced toll this year. The number
of suicides in 1969 dropped slightly from last year's high rate of 15 per 100,000
population to 14.
For the third successive year there has been an improvement in the infant
mortality rate per 1,000 live births, which for this year recorded a new record low
rate of 18. This is particularly significant since it is indicative of the desirable
trend toward reducing a death rate classified as one of the major indices of health
care. The rate of stillbirths remained unchanged at 13 per 1,000 live births, demonstrating an area in which improvement is to be desired. The maternal mortality rate
has remained fairly consistent over the years at 0.3 per 1,000 live births, which was
the rate prevailing again for the present year.
In so far as disease incidence is concerned, the health of the Province, while
not ideal, was maintained at a satisfactory level. There are certain disease conditions
which are entirely preventable and, therefore, justify intensified efforts toward their
eradication. Immunization procedures were maintained at a high level. Another
biological in the form of measles vaccine was added to the roster of immunizing
procedures administered through health services programmes.
From the point of view of the people of the Province, there is an evident desire
to have greater efforts devoted toward the field of pollution control as there is
mounting public concern about the ecological effects that man-made wastes are
creating for future generations. In keeping with the needs to find solutions to these
important problems, there will be greater concentration on activities to control
water, air, and land pollution.
This Department has taken positive steps to have a minimum of primary treatment for all sewage discharges where new sewage works are proposed relating to
the development of unoccupied land. Where land is being developed using individual
septic-tank systems of sewage disposal, stringent regulations are enforced. Water-
quality Standards have been issued to secure and maintain such water-quality levels
in the Province, both for drinking-waters and surface waters, as will give adequate
protection for human health and safety. Air-quality Standards have also been
issued and used as the basis of safe levels of air quality for a number of communities throughout the Province where studies have been conducted.
Statements and statistics in this Report dealing with various aspects of the
public health nursing service, for example, home visits, expectant parent classes,
immunizations, etc., concern only the services of the public health nurses under the
jurisdiction of the Provincial Health Branch and, except where otherwise stated,
do not include services provided in Greater Vancouver, Victoria, Esquimalt, Oak
Bay, and New Westminster.
 COMMUNICABLE AND REPORTABLE DISEASE
S 11
COMMUNICABLE AND REPORTABLE DISEASE
No major outbreak of communicable disease occurred in the Province during
1969, but there were a number of interesting developments. Some of these are
reported below and others under " Immunization."
British Columbia has been free of EQUINE ENCEPHALITIS, commonly
called sleeping sickness, for many years. In the past year, however, six horses, two
of which died, contracted this viral disease in the Okanagan region. Careful examination failed to reveal any human cases among persons looking after these horses.
This disease has been epidemic in Saskatchewan on several occasions in recent years,
and has resulted in many humans contracting encephalitis with numerous fatalities.
There were 12 cases of BOTULISM among the native Indian population along
the west coast of Vancouver Island, all following the consumption of salmon eggs
that had been allowed to " ripen " at room temperature before being eaten. This
salmon " caviar " is considered to be a great delicacy, so much so that the fear of
contracting the illness, the danger of which is very well known to the natives, is
subordinate to their keen enjoyment of its taste.
Although there has never been a case of human RABIES reported in British
Columbia, the disease has been regularly found in bats over much of the southern
part of the Province for much of the past 10 years. In 1969, four rabid bats were
identified and in each instance they had bitten or scratched a human contact, making
anti-rabies treatment necessary. For the first time in British Columbia rabies was
also reported in another animal species, a cat, in Port Alberni. Three people were
bitten by the cat before it died, and they, too, had to be treated to prevent their
developing rabies. Despite investigation, the source of the cat's infection remains
unidentified.
INFECTIOUS HEPATITIS continued to increase, with 2,160 cases reported,
up from just over 2,000 in 1968. The Health Branch has continued to provide preventive injections of immune globulin to the immediate household contacts of these
cases. The close link between inadequate or improperly functioning sewage-disposal
systems and outbreaks of hepatitis is frequently apparent.
Fourteen cases of DIPHTHERIA, with two deaths, occurred this year and 14
carriers of virulent diphtheria organisms were identified in the examination of the
contacts to these cases. This is the largest number of cases reported since 1950,
when 63 cases were notified.
Outbreaks of diphtheria can be avoided by adequate immunization, and this
year's experience serves to emphasize again the value of this preventive measure.
As usual, the two people who died and the other children who were seriously ill
were un-immunized.
There has been little change in incidence and need for treatment of active
cases of TUBERCULOSIS over the past few years. Tuberculosis is still a serious
health problem, with more than 500 active cases being found each year. During
the past year several new drugs such as Ethambutol, Capreomycin, and Rifampin
have been introduced as they became available for patient care and are producing
excellent results in those who have organisms resistant to existing drugs. It has
been possible to obtain these new drugs for investigation purposes from the Federal
Food and Drug Directorate, although they have not yet been released for general
distribution. It is significant, however, that with the development and use of these
drugs, more complex methods of treatment are needed. One result of the introduction of new drugs has been the successful retreatment of reactivated cases of
 S 12
PUBLIC HEALTH SERVICES REPORT,  1969
tuberculosis, in itself a major achievement. This brightens prospects for previous
treatment failures, as well as removing a serious health hazard from the community.
The need for treatment beds for tuberculosis has not increased during the
year, and there are indications that we have reached a plateau in incidence of new
and reactivated tuberculosis cases. The Division of Tuberculosis Control with
headquarters at Vancouver, has been able to operate a treatment programme with
only 172 sanatorium beds (located in Vancouver) for both non-Indian and Indian
members of the population. The main reason for this is that, whenever feasible,
patients are treated on an ambulatory basis under supervision of health units and
Division clinics. Reduction in sanatoria population has been gradual over the past
five years, but 1969 showed practically no change from 1968. The older age-group
still predominates and the males outnumber females by almost three to one. The
causes for this have perhaps more of a sociological than a health background, in a
situation which sometimes sees tuberculosis referred to as an old man's disease. The
reverse is seen in the native Indian population, where almost 60 per cent of the
tuberculosis admissions are females in the younger age-groups. Here again sociological reasons can be seen, for it is frequently the young females in the family
setting who are more likely to be in contact with sources of tuberculosis.
The travelling clinics of the Division of Tuberculosis Control now serve 66
British Columbia communities outside metropolitan Vancouver and Victoria. The
over-all volume of work remains high, and there has been some increase in service
demands in those areas showing greater population growth. The successful operation of the travelling clinics is undoubtedly due to the happy working relationship
that exists between the clinic staff and personnel of health units throughout the
Province.
Testing of blood samples received at the Provincial Laboratory.
 COMMUNICABLE AND REPORTABLE DISEASE
S 13
Mobile surveys, known throughout the Province as " Operation Doorstep,"
have screened approximately 91,000 persons during 1969. In this important phase
of tuberculosis control activity we have seen emphasis shift from detection of active
cases to prevention. In all there were 78,383 free tuberculin skin tests and 49,464
X-rays taken during the surveys. Most areas of the Province are covered by mobile
survey once every eight or nine years, although a reduction to between five and six
years would be desirable. An outstanding exception is the eastern section of downtown Vancouver, which is now surveyed annually; the tuberculosis rate here is
many times the Provincial average. Other surveys were conducted at many institutions, such as the British Columbia Penitentiary, Riverview Hospital, Haney Correctional Institution, University of British Columbia, Simon Fraser University,
British Columbia Institute of Technology, Columbia College, the Pacific National
Exhibition, and some rest homes. Special attention is given to school children in
the surveys, and up to 95 per cent of them received the tuberculin test.
In the field of research it is found that, because of the large number of people
contacted, the mobile surveys for tuberculosis are ideal for certain other projects.
In 1968 a pilot study of sputum tests for early detection of cancer of the lung was
carried out in co-operation with the British Columbia Cancer Institute. The operation was found to be feasible and an extensive programme offering cancer tests to
high-risk groups (men 45-50 who are heavy smokers) was begun during 1969. So
far, 1,179 men have been screened, and four whose smears suggested cancer are
being followed up.
In VENEREAL DISEASE CONTROL, the number of infectious syphilis
cases continues to show improvement, there being a significant decrease from the
previous year. On the other hand, gonorrhoea cases have increased from approximately 4,200 to 4,800. The two main reasons for the latter involve our unfortunate
inability to pursue effective control measures in the young transient population to
a satisfactory standard and, secondly, the application of an effective educational
programme with physicians, which has resulted in an increase in reporting. Other
incidental features of the venereal disease programme have been an increase in
the number of non-gonococcal urethritis cases appearing for treatment, and the
family planning council, which is offered at the Vancouver clinic for the many
promiscuous young women who seek this advice.
Although it is satisfying to know that infectious syphilis is well controlled in
British Columbia, there is the constant possibility of traveUers from abroad having
acquired this infection, and this includes single homosexual males who visit cities
to the south. Fortunately, control measures continue to be effective. All public
laboratories doing blood tests for syphilis are operated by the Health Branch and
inform the Division of Venereal Disease Control about positive findings. Another
significant factor is that physicians throughout the Province feel very strongly that
syphilis should be eradicated and their co-operation in reporting is very satisfying.
One of the most important weapons in the control of syphilis is the blood test;
one-third of patients who contract the disease have no way of knowing that they
are infected except by this test. In addition to the Provincial laboratories, the
Canadian Red Cross Society and the Provincial Mental Hospital process blood
tests for syphilis. Pregnant women, too, form another large group that is routinely
blood tested; this ensures that a syphilis infection is not spread to the baby during
pregnancy.
There are three programmes in effect for the control of GONORRHOEA.
The first is known as " speed-zone epidemiology," which is the rapid tracing of
female contacts and offering them treatment. The second procedure is that in any
area where an epidemic is occurring, or might occur, the promiscuous females have
 S 14 PUBLIC HEALTH SERVICES REPORT, 1969
already been identified and the Medical Health Officer can arrange for their treatment on a quarterly basis in order to reduce the infection present in the area. The
third method is to trace and treat male contacts; some of them have such minor
symptoms that they do not readily seek medical treatment.
A long-standing problem in the control of gonorrhoea has been that only about
one-third of the cases seen by private physicians are reported to the Division of
Venereal Disease Control. As a result, the contacts are not followed up. Commencing two years ago, a concerted effort was made to obtain physician co-operation. A public health nurse was employed full-time to visit all the physicians in the
Vancouver area. In addition, a series of cards was made up and printed by~the
Division of Public Health Education. These embodied a simple sketch (embodying
a touch of humour) and a message requesting the co-operation of the physician
in reporting. At the end of 1969, it can be said that the policy of sending these
cards and the interviewing of the physicians has contributed to a significant increase
in the reporting of gonorrhoea cases.
It has become obvious that if control of gonorrhoea among the young transient
group in Vancouver is to accomplish desired results, more persuasion is necessary
to promote their co-operation. A public health nurse is receiving special training
and it is hoped that she will soon be working in the young transient community and
in a position to make effective contact with them.
As venereal diseases are constantly being introduced into British Columbia,
it is necessary to maintain an intensive programme of control in order to keep them
at a reduced level. The effectiveness of our control programme is becoming widely
known, and many inquiries are received from outside the Province regarding various
phases of its operation.
DISEASE CONTROL in general is traditionally a responsibility of foremost
concern to the public health nurse. Among the many important aspects of prevention is her supervision of tuberculosis patients and their contacts; during the year,
9,662 visits were made for this purpose, and 14,904 turberculin tests were done.
Other tests for communicable disease made by the nurse totalled 3,043. Public
health nurses rendered 3,283 services in connection with the control of venereal
disease, and regularly supervised the more than 1,100 children who are presently
on rheumatic fever prophylaxis. An additional 9,327 services were provided
in disease control; these included epidemiological investigations, and injections
for infectious hepatitis, rubella, and other conditions.
For further information on diseases see Table VII.
 HEALTH AND OUR ENVIRONMENT
S 15
HEALTH AND OUR ENVIRONMENT
The words ENVIRONMENTAL HEALTH are becoming synonymous in the
people's mind with POLLUTION CONTROL. There are few features of life in
modern society which receive such close public attention and scrutiny. The citizen
is much better informed on this subject than he was a few years ago and is apt to
demonstrate impatience at apparent lack of action. This calls for increased emphasis
on the necessity of keeping open the channels of communication, to inform the people
of action being taken for their welfare. On the other hand, the informed citizen can
be an advantage, as when public approval is desirable for the acceptance of newly
introduced legislation.
There was much evidence in 1969 of the people's increasing concern with the
preservation and restoration of their environment. The policy statement made in
September regarding minimum sewage-treatment requirements resulted in a marked
upsurge in inquiries and requests for information. A notable feature, too, was the
marked increase in the number of requests for information on pollution of water,
air, and land received from school children.
Other major developments in the Province were the publishing and distribution of the Water-quality Standards and Air-quality Standards, and the commencement of construction on the first tertiary treatment plant in British Columbia at
Kelowna. This plant has been designed to remove a high percentage of phosphates
before sewage effluent is discharged into Okanagan Lake. Another important feature of the year's operations has been a substantial growth in the number of plans
and specifications for public water and sewage works submitted to the Division of
Environmental Engineering for approval by the Deputy Minister. The number of
submissions and approvals was 312 for water works and 281 for sewage works, an
increase of approximately 100 per cent over the past two years. A policy involving
sewage disposal was established wherein the Division was able to negotiate with a
significant number of municipalities toward a construction schedule for treatment
plants to be operational in the next few years; this would allow time for engineering
reports, design plans and specifications, land acquisition, financing, and a period
for construction.
The Division worked in co-operation with the Pollution Control Branch in
reviewing permit applications received by that Branch for effluent or waste disposal.
In all recommendations pertaining to these reviews forwarded to the Pollution
Control Branch, the primary consideration has been the possible effect on public
health of the new or amended project concerned.
All areas of the Province are visited by engineers of the Division of Environmental Engineering and the consultant in public health inspection. In this way,
and also by mail and telephone, consultative service is given to the health units.
Technical information and guidance were offered on such topics as fluoridation and
chlorination of small water supplies, sterilization of plastic pipe, alternative methods
of waste disposal, water purifiers, and solid-wastes disposal by sanitary landfill.
During the field visits to health units, a policy is followed of visiting the appropriate officials of municipalities, where consultative engineering services on subjects
relating to environmental control are offered. Water and sewage works are inspected
to ensure safety to public health. Many of these services are of a routine nature, but
one development was a changing of the method of reporting fluoride analyses for
water-works systems which fluoridate their supplies. Under the new system, each
operation is classified primarily in terms of the control of fluoride level in the water.
In addition to this change, an added feature is that all Medical Health Officers con-
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A mobile air-quality laboratory is located at the edge of downtown Vancouver.
 HEALTH AND OUR ENVIRONMENT
S 17
cerned are advised of the fluoridation status of any fluoridated water supplies in
their area.
Considerable importance is attached to the discussions that the engineers have
with municipal officials and their staffs on matters of public health. This is carried
one step further in that members of the staff of the Division are active in many types
of speaking engagements. These include talks to such groups as contractors' associations, prospective engineering candidates in schools, Y.M.C.A.s, and gun clubs.
Technical surveys in the various aspects of environmental health were somewhat
limited because of the high volume of activity in other fields of interest. Two projects, however, were initiated. A sewage-lagoon study was made, with field visits
for observation supported by tests in the field and in the laboratory. The purpose
of this study was to determine the suitability of the design criteria used for lagoons
built in various climatic areas of British Columbia. The second study was done on
the efficacy of a new type of diatomaceous-earth filter used by the swimming-pool
construction industry. This filter offers a new concept in operation in which the
earth is reused a number of times before being discharged to waste.
A role of growing importance in the Division of Environmental Engineering
is the participation of staff members on committees where environmental engineering is of concern. Health Branch representatives sat on the following: Public
Health Technology Advisory Committee to the British Columbia Institute of Technology, Pacific Northwest Pollution Control Council and Awards Committee, National Advisory Committee on Public Health Engineering, Canadian Drinking Water
Standards Committee, and the Federal-Provincial Okanagan Watershed Study
Committee.
A bank of modern sophisticated equipment occupies the main unit of the mobile air-quality
laboratory.   It is operated by staff of the Provincial Laboratory in Vancouver.
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Public health inspectors conduct a percolation test to determine suitability of a location
for septic-tank disposal field.
 HEALTH AND OUR ENVIRONMENT
S 19
Enforcement of the CAMP-SITE REGULATIONS by publ'c health inspectors
with the co-operation of Tourist Accommodation Counsellors of the Department of
Travel Industry has resulted in 494 commercial camp-sites being approved for
licensing; these provided 13,847 camping-spaces. New camp-sites with improved
facilities have been encouraged, and 22 of the poorer camps were closed down.
There are 389 MOBILE-HOME PARKS in the Province, and these include
6,857 spaces for trailers. The majority of mobile-home parks have been surveyed
by public health inspection staff to assure compliance with the regulations. In this
particular field the Consultant in Public Health Inspection has maintained liaison
with the British Columbia Motels and Resorts Association and other representatives of the industry.
In connection with the SEWAGE-DISPOSAL REGULATIONS it is observed
that the use of various pre-fabricated septic tanks is growing. Contact is maintained
with the manufacturers of these tanks to ensure that the latter meet the requirements of the regulations. Strict enforcement of these regulations has had and will
continue to have benefits that are difficult to measure. This work by the public
health inspectors has done much to alleviate such undesirable conditions as the
pollution of roadside ditches and recreational waters and has led to the improvement of many sub-standard installations.
In enforcement of the PUBLIC SWIMMING-POOL REGULATIONS it has
been observed that the standard of pool construction has shown a marked improve
ment and considerable progress has been achieved in water quality and safety.
Several pools not meeting the requirements have ceased operation.
Shawnigan Lake, on Vancouver Island, was surveyed to determine standards of water quality.
 S 20
PUBLIC HEALTH SERVICES REPORT,  1969
The Province is beginning to reap the benefits, too, from the regulations governing SUMMER CAMPS. These established minimum standards for buildings,
recreational water safety, sewage and garbage disposal, washroom facilities, and safe
drinking-water. Public health inspectors checked and approved 118 of these camps,
which catered to 45,788 children in 1969.
Under the COMMUNITY CARE FACILITIES LICENSING ACT (enacted
at the 1969 Session of the Legislature), public health inspectors gave approval for
licensing to 365 kindergartens with an enrolment of 11,208 children. Three hundred
and forty-six rest homes, with accommodation for 9,157 persons, were approved.
Licences were granted also to 15 hostels for unemployed adults, accommodating
10,533 persons.
The two FLOOD DISASTERS that occurred in the Province during the year
both happened in the West Kootenay Health Unit area. The flood that struck the
City of Trail on April 23rd without warning caused damage running into millions
of dollars and placed a heavy work load on the staff of the health unit. As the
flood waters were heavily contaminated with raw sewage, public health inspectors
supervised and advised on the disinfection of premises. Particular attention was
given to the inspection of restaurants and food stores. A large quantity of food
was condemned for human consumption. Greenwood, a mining town near the
southern border of the Province, was also struck in September when a local mill-
tailing pond developed a major leak and flooded a large area of the community.
There was considerable contamination from septic tanks, and the appropriate precautions were taken by the public health inspection staff.
In many of the more important aspects of environmental health control, the
Division of Laboratories, the Division of Environmental Engineering, and the Public
Health Inspection Service work closely together. Mention of the work of the
laboratories in this particular sphere is made in that section of this Report.
 COMMUNITY AND FAMILY HEALTH
S 21
COMMUNITY AND FAMILY HEALTH
Despite the rapidly changing face of public health, the PUBLIC HEALTH
NURSE remains in the forefront of many health activities in the public service.
In British Columbia, the Division of Public Health Nursing of the Health Branch
assists the health units in evaluating programmes being conducted by nurses in
order that new technical information and methods may be introduced as quickly
and efficiently as possible. The Director of the Division is assisted by a staff of
consultants who visit the health units at regular intervals. Each consultant is competent to provide assistance and advice on the general public health nursing service,
and in addition, she has training and knowledge about certain specialties, such as
school health, mental health, home care, and communicable disease. These consultant services aid the local staffs in adapting new methods, materials, and procedures to local conditions, so that residents of small rural communities have the
same oportunity to benefit from high-quality service as do the inhabitants of larger
cities. The consultants, in addition, are associated with many interdisciplinary
interagency committees, and work with various voluntary health agencies, such as
the St. John Ambulance Association, Canadian Arthritis and Rheumatism Society,
Cerebral Palsy Association, etc.
Public health nursing in local health services is professional nursing done in
a community setting involving health promotion, illness prevention, and the provision of certain treatment services. It is not limited to any special segment of society
or age-group, and is provided in a variety of situations, such as the home, schools,
certain institutions, and health centres. A service is rendered within the framework
of policies of the local health unit and the Health Branch. The nurse is assisted in
her work by health unit aides, who provide limited non-professional service; by
registered nurses who assist with the home nursing service; and by numerous volunteers who give many hours of free time, assisting with various types of clinics; and
child health conferences.
While the responsibility for attending to the MENTAL HEALTH needs of
the people of our Province lies primarily with the Mental Health Services Branch,
this important area of public health responsibility occupies much of the public
health nurse's attention through her involvement in both preventive and treatment
areas of service. The decentralization of services of the Mental Health Services
Branch during the past several years has seen 14 mental health centres opened
throughout the Province. Most are located in the main offices of the health units,
and this facilitates close co-operation between the two Branches on both administrative and operational levels. The public health nurse finds herself involved in
primary prevention as she goes about her daily duties. She is frequently able to
prevent serious situations developing through anticipatory guidance, health counselling, and referral to appropriate resources. She is able to identify potential emotional problems at child health conferences, prenatal classes, schools, special group
meetings, and in home visits. In the South Okanagan Health Unit a pilot study
on the identification and selection of pre-school children who need help with motor,
social, and learning development was carried out; it is expected that the study will
demonstrate what can be accomplished in primary prevention by public health nurses
at child health conferences. In the area of secondary prevention or treatment, the
public health nurse provides health supervision in the home to persons on active
treatment for emotional disorders. A total of 17,310 home visits was made for
this purpose.   A notable benefit of this policy is that patients are frequently able
 S 22 PUBLIC HEALTH SERVICES REPORT,  1969
to leave hospitals or other treatment centres early and receive the needed care at
home. Scarce hospital and other psychiatric-treatment beds are thus released for
further use. Approximately 4.7 per cent of the public health nurse's time is spent
giving direct service in secondary prevention. Forty-nine per cent of these visits
concern school children, 6 per cent are for pre-school children, while the remaining
45 per cent involve adults.
Much attention has been given to SPEECH-THERAPY SERVICES. A wider
understanding of speech and hearing (communication) disorders, and the functions
and roles of personnel trained in this field has been encouraged. It is becoming
apparent that the present term of " speech-therapy services " is outdated, as it permits little understanding of the relationship between the reception (hearing) and
use (speech) of human communication and indicates only the services which speech
pathologists and audiologists are able to perform.
Regular meetings of senior Health Branch staff, including from time to time
representatives of the speech and hearing professions and special education facilities,
have offered opportunities for discussion of various aspects of service. These have
included development of training programmes, the responsibilities of speech and
hearing staff in health education activities, methods of recruitment, interpretations
of various levels of qualification, the need for short courses in communication disorders, and ways to further the professional growth of field staff. The commencement of a two-year graduate course in speech pathology and audiology in the Faculty
of Medicine at the University of British Columbia marked an important stage in
the growth of these services.
A continuous demand has been observed for information relative to the nature
of speech and hearing problems, and relative to plans for their assessment and
solution. Inquiries have been received not only from the general public and from
the public health staff, but from such organizations as Union Boards of Health,
school administrators, parent-sponsored speech and hearing associations, and primary-school teachers' groups. Many health units have been visited by the senior
speech-therapy consultant for the purpose of attending meetings and workshops on
this subject. The field staff, too, has been increasingly busy in the speech and
hearing programme, focusing attention on the pre-school and early school-age child,
where parent involvement in the programme is encouraged.
Many services of the public health nurse are family-centred, and VISITS TO
THE HOME were up 4 per cent over the previous year for a total of 172,062
visits. All types of services increased, including telephone consultations and visits
to adults for general health supervision; the latter were generally for health appraisal, and usually resulted in the person obtaining early diagnosis, treatment, or
care. The nurse's call could include advice on mental health or emotional problems, nutrition, and general health teaching. In the West Kootenay Health Unit
a genetic counselling study was introduced into the nursing visits to determine
whether such a service might assist parents to avoid a genetic deformity in future
children.
In 1969 the Welfare Institutions Licensing Act was superseded by the COMMUNITY CARE FACILITIES LICENSING ACT. The effect of this new
legislation was to place the supervision of those facilities in the community providing any form of care into the hands of a departmental board composed of members
of the Departments of Health, Social Welfare, and Education. Regulations are
now being prepared which will set minimum standards of accommodation, staffing,
and supervision. The facilities controlled by this Act and supervised by the departments concerned in most instances provide care to the very young or the very old
and who, in general, are not able to look after their own interests properly.
 COMMUNITY AND FAMILY HEALTH
S 23
In addition to the work done through the rehabilitation committees, CONSULTANT PUBLIC HEALTH PHYSIOTHERAPISTS are employed on a part-
time basis in nine health units. Their main function is to assist with home care,
which often involves rehabilitation nursing. Physiotherapists supervise the progress
of selected patients so that suitable rehabilitation plans can be developed. In some
cases homes are assessed and alterations and adaptations suggested prior to a patient's discharge from rehabilitation facilities to his home. They help to extend the
benefits of rehabilitation by the provision of in-service training to the public health
nurses. In addition, they provide help to some operators of personal-care institutions and private nursing homes in the development of rehabilitation nursing and
recreational programmes for patients in these institutions. They also assist the
teachers in schools for retarded children and teachers in other schools that have
special classes for the retarded.
Certain INDIAN RESERVES, by arrangement with the Medical Services
Directorate of the Department of National Health and Welfare, receive health services from the public health nurses of the local health unit. This past year, 81
reserves, with a resident population of 11,844 Indians, were included in the health
service. Also, 9,017 Indian children attended local schools and received regular
school health service from the public health unit. It is interesting to note that 28
per cent of the total Indian population of 46,929 Indians now live permanently off
reserve.
Table IX presents detailed information concerning the activities of public
health nurses.
 S 24
PUBLIC HEALTH SERVICES REPORT, 1969
MATERNAL AND CHILD HEALTH
As they prepare for an addition to their family, expectant parents are particularly receptive to health teaching and are prepared to follow through with it.
Such teaching is the basis of PRENATAL CLASSES conducted by public
health nurses; many potential health problems are prevented by talks and discussions about pregnancy, normal infant development, family relationships, and like
subjects. For the mothers, too, there is instruction in prenatal and postnatal exercises. The year saw 329 series of group discussions and classes held at health
centres, frequently in the evening so that both parents could attend. During the
year, 3,782 mothers and 1,347 fathers took part in 18,220 group sessions; this
attendance represents an increase in parents attending of 17 per cent over the previous year. Plans are underway for a television series on prenatal instruction so
that expectant parents who do not avail themselves of the service can be reached.
In addition to the organized activity in the health centres, public health nurses made
3,875 prenatal calls and 18,920 postnatal home visits; the former was slightly less
than the 1968 total of 3,999, while the postnatal visits increased from 18,371.
INFANT AND PRE-SCHOOL children need special attention to prevent
possible permanent damage from disabilities which show up in the early years of life.
Public health nurses assess the child for defects such as vision, speech, hearing loss,
mental retardation, and abnormal physical or emotional development. Assessments
may be made at the time of visits to the home or at one of the approximately 1,300
child health conferences regularly scheduled at health centres; the latter is a convenient method, for the child in many cases is routinely brought there for his immunization procedures.
wm
A play area set up at the health centre enables the public health nurse to discuss with parents
any social, emotional, and physical problems observed in the pre-school children.
 MATERNAL AND CHILD HEALTH
S 25
Hearing-testing of the child is done at the pre-school age with up-to-date equipment
designed to hold the attention of the youngster.
A new avenue of assessing the young child's health and welfare, and thereby
bringing about some desirable improvement, has been the subject of an interesting
experiment at Kelowna. It has long been recognized that the child health conferences at health centres, where sizeable groups of parents with their children
assemble in the waiting area, provide the one meeting place where pre-school children can be observed as a group. So often this was a scene where rows of harried
mothers held crying babies and tried to restrain rambunctious toddlers. In this
general atmosphere of tension and anxiety it occurred to observers that here was a
receptive group for education in child growth and development. The waiting area
was rearranged and chairs for parents were grouped around a large play area,
divided according to the types of toys available into three smaller areas, suitable for
the various types of play in which youngsters might engage. There was opportunity
for observation of the children's play by parents and the public health nurse. The
nurses would afterwards discuss the children's play behaviour with the parents.
Toward the end of the year the following impressions were gained: the child health
conference waiting area was transformed from a climate of tension and confusion
to a happy place where constructive activities occurred; the area served as an
excellent observation place; public health nurses were able to assist parents in understanding their children's play; and the experiment provided opportunity for detection of social, emotional, and physical problems not apparent to the nurse during
her office interview, such as in the child's relationship with his parents, siblings,
and peers.
 S 26 PUBLIC HEALTH SERVICES REPORT,  1969
In addition to regular child health conferences, special clinics were held in
some districts for 3- and 4-year-olds, in an effort to reach more pre-school children
and arrest any defects or abnormalities as early in life as possible. In all, public
health nurses made 35,000 visits concerning the health of infants and over 32,000
visits involving the health of pre-school children.
 IMMUNIZATION
S 27
IMMUNIZATION
In any programme for the control of communicable disease a progressive
policy of immunization is paramount in protecting the public health. Immunizations
are available at the school and at health centres, where they are usually given when
children with their parents attend the child health conferences. Close on half a
million immunizations were done during the year; this included protection against
smallpox, poliomyelitis, diphtheria, whooping-cough, and tetanus. In addition, protection for measles was included in the routine schedule, which started
in the school-year in September. It is estimated that savings to the British Columbia
Medical Plan amounted to around $750,000 through administration of these antigens
by the public health nursing staff. This cost estimate, incidentally, does not include
the more than 3,000 tests made for communicable disease.
It was in August that the Health Branch initiated the service to protect susceptible infants and young children against " red " MEASLES (rubeola) through
the use of a live virus vaccine. Initially the vaccine is being offered to all susceptible
children up to the end of the elementary-school grades. Eventually it will be given
routinely to all infants when they reach age 1. Undoubtedly, the saving in the cost
of medical and hospital care will more than compensate for the cost of the vaccine.
A vaccine for GERMAN MEASLES (rubella) is presently under consideration by the Federal authorities for licensing for sale in Canada. While rubella in
itself does not present any great danger, its most serious aspect is that many
pregnant women who may contract the disease give birth to babies with severe
congenital defects.
 S 28 PUBLIC HEALTH SERVICES REPORT,  1969
SCHOOL HEALTH
Services in the schools of the Province have traditionally been an important
part of the work of the public health nurse.   She is, in effect, the school health nurse.
The number of children receiving health supervision in schools has increased
by 41,757 over the previous year to approximately 350,000. To provide health
services to these rapidly increasing numbers of children it has been necessary to
adopt a policy of selectivity based on the child's need. The public health nurse,
therefore, spends most of her time with children who have particular problems.
Selection of children for special follow-up is accomplished in a variety of ways—
by teacher referral, self-referral, review of individual and family histories, teacher-
nurse conferences, liaison committees with school personnel, and routine screening.
The public health nurse is an essential link between the school and the family,
and helps both the teacher and the family to understand the child with special difficulties, so that he can remain in the school system and benefit from it. In these,
health guidance was given to teachers and pupils in 50 schools or classrooms with
an enrolment of 1,008 retarded children. Nurses were similarly involved in 67
classrooms with 2,249 children who were receiving special education because of
problems such as learning disabilities, dyslexia, brain damage, cerebral palsy, and
emotional disturbances. Special attention is also directed toward the 7,227 children
in kindergartens. In two health units where volunteer aides have been used to
conduct initial hearing and vision screening examinations, a total of 18,645 direct
services was rendered for school children and 2,133 services for pre-school children.
By using these various methods the available time of the public health nurse
in the school has been extended so that she can use her training and skills solely for
professional activities.
The percentage of children who have basic immunization prior to entering
Grade I remains high, and the aim of many health units is to increase this percentage
to the point where it will no longer be necessary to give the basic series in school.
Indeed, some health units have already been able to reduce immunization in the
schools to reinforcing doses only, and to offer immunization at child health conferences or the health unit office for the few school children who require additional
doses. This change is a welcome one, as it keeps the child's first year at school
relatively free from injections.
For further information on school health see Tables X, XI, and XII.
 All aspects of the school environment, including its drinking-water, are checked
by the public health inspector.
 S 30
PUBLIC HEALTH SERVICES REPORT,  1969
HOME CARE
HOME NURSING CARE is provided by the public health nurse in 113
districts to approximately 80 per cent of the people of British Columbia outside the
two major metropolitan areas. Such professional nursing service in the home may
in some cases obviate necessity for admission to hospital, or in others may allow
for early hospital discharge; this service, therefore, promoted more efficient use of
hospital beds to the community at large. That hospital admissions of such patients
are obviated is evident from the fact that 73.9 per cent of the patients are admitted
directly to home care from the community. The remaining patients are discharged
from hospital directly to home care service. In addition to the public health staff,
the home care programme includes close working arrangements with local welfare
and other agencies so that other needed services may be channelled into the home.
Auxiliary services include homemakers, medical supply cupboards, "meals-on-
wheels," and visiting social services. Public health staffs are active in the community in promoting needed community resources to assist with care and rehabilitation. During 1969, 76,193 home visits were made for nursing service, an increase
of 7 per cent over the previous year.
It is some years now since geriatrics became a significant part of the public
health nurse's work, and this trend is becoming more marked. This is evidenced
by the fact that 52 per cent of all home visits are to persons over 65 years of age.
The majority of patients on the home care programme are over 65 years of age,
w**
The home care programme sees the public health nurse using her training and skills
in the patient's home.
 HOME CARE
S 31
and more services are being added to assist this age-group to maintain good health.
At a number of centres, " 60 and Up Clinics " have been held to provide screening
for disabilities such as vision, hearing, high blood-pressure, and to provide counselling and health supervision to persons who would not otherwise seek attention. The
nutrition teaching seems to be particularly needed, and is well received. Personal-
care institutions are a frequent place of call for geriatrics counselling; nurses made
almost 1,000 visits to 131 of these institutions to give assistance to the operators,
who provide custodial care to elderly persons.
 S 32 PUBLIC HEALTH SERVICES REPORT,  1969
HEALTH EDUCATION
The major problems of DRUG ABUSE, pollution, smoking, family fife education, and venereal disease concerned the staff of the Division of Public Health
Education, over and above a steady volume in the routine administrative work
performed by the Division.
In connection with the drug-abuse problem among young people, meetings
were held between senior staff of the Health Branch and the Department of
Education. A recommendation resulting from these meetings was that the health
unit offices should be established as resource centres for drug information. As an
interim measure, a chart of symptoms designed for parents and a corresponding
technical chart for physicians are being prepared and will be distributed through the
local health units. These will be most useful to our field staff in endeavouring to
deal with one of the major problems of our society. The pamphlet written two
years ago on LSD is being updated and two new films on drug abuse were added
to the film library, out of seven previewed during the period. As these films on
drug abuse are intended for teen-agers, it was decided to get the reaction of a
representative cross-section of teen-agers at the previewing sessions. In this, excellent co-operation was received from the medical consultant in family life education
of the Greater Victoria School Board, who arranged suitable audiences for this
purpose. The Division again assisted in the planning and co-ordination of several
STAFF TRAINING activities.
The traditional Public Health Institute, attended by staff from the whole
Province, was held in May at the University of British Columbia. The monthly
staff bulletin, containing a wide selection of educational and informative material,
was published regularly. In the fall, 28 public health inspectors commenced correspondence courses arranged by the Division. There were two groups, one
organized with the co-operation of the Ryerson Polytechnical Institute in Toronto
and the other with the National Communicable Disease Center in Atlanta, Georgia.
A detailed statement concerning staff training is given in Tables V and VI at the
end of this Report.
The CONSULTATIVE SERVICE offered by the Division was in five main
areas—
to other divisions in the Department,
to the staff of local health units,
to the Department of Education,
to the University of Victoria,
to the British Columbia Institute of Technology.
The level and amount of service significantly increased during the year.    There
were numerous field trips to various health units, a series of lectures on health
teaching was given to student teachers at the University of Victoria and another
series on educational techniques to the public health inspector students at the
British Columbia Institute of Technology in Burnaby.    Plans are under way to
have a consultant in health education speak to the students attending the diploma
in public health nursing course at the University of British Columbia.   One of the
consultants continued to act in an advisory capacity to the Department of Education's Elementary Curriculum Committee.
The Division arranged the co-operation of members of the Department of
Education in the previewing of films and filmstrips suitable for use in schools. Their
continued assistance is highly appreciated by members of this Division.
 HEALTH EDUCATION S 33
In other areas of educational service, 78 films and filmstrips were previewed;
32 films and filmstrips were purchased; 238 books were added to the central
library; 27 pamphlets, posters, and other educational aids were developed for use
by local health unit personnel; 23 pamphlets and other educational aids were
developed for use by other divisions in the Health Branch; 117 photographs were
taken, processed and printed; and 173 colour transparencies were taken to make
up various series of slides for instructional use and public showing.
 S 34 PUBLIC HEALTH SERVICES REPORT,  1969
EXTENDED CARE
This programme of the Health Branch is centred at Pearson Hospital in Vancouver, originally designed and built for the accommodation of tuberculosis patients.
With the continuing decline in the need for institutional care for tuberculosis, more
beds became vacant and it became possible five years ago to plan for the allocation
of separate sections of Pearson Hospital for the treatment of patients requiring extended care for other conditions. Many patients, too, have severe conditions complicated by respiratory problems which can benefit from the special facilities of the
Poliomyelitis Pavilion at Pearson. After the programme began in 1964, the number of beds for extended-care patients gradually increased to 170, but during the
past year it was not possible to convert any additional beds to extended care. One
of the main reasons for this is the extremely heavy physical work load imposed on
nursing staff by this class of patient. Many extended-care patients require considerable lifting, and even with the use of a hoist wherever possible, the constant lifting
and general heavy nursing work results in staff members becoming exhausted at the
end of their shift, and this in turn brings about a high rate of absenteeism due to
illness. This situation compounds itself, and staff willing to work hard for a limited
period are unable to do so when the situation continues. To cope with this, it has
regrettably been necessary to temporarily discontinue the admission of quadra-
plegics and other new patients so as to ease the strain on the nursing load.
A bright aspect of the extended-care programme has been the provision of a
bus which can accommodate 16 patients in wheelchairs. This means transportation provides many of the patients with welcome and beneficial outings.
Outfitting the bus was one of the many activities of the Women's Auxiliary to
Pearson Hospital. The Auxiliary continued its valuable service, which is a significant feature in brightening the daily lives of the patients. In addition to outfitting
the bus, it gave five colour television sets, three portable washer-dryers, two alternating-pressure mattresses, and an electric typewriter during the year. Members
arrange Hallowe'en, Christmas, Valentine, and summer garden parties for the keen
pleasure of patients, and give birthday and Christmas presents to each patient. The
Auxiliary, with other volunteers, also provides regular movies and organizes such
activities as an indoor sports club, a live talent show, card games, bingo, and singsongs. Few things are more important in the care of these patients than high morale;
toward this, the Women's Auxiliary makes an effective and selfless contribution.
 VITAL STATISTICS
S 35
VITAL STATISTICS
The REGISTRATION OF BIRTHS, MARRIAGES, AND DEATHS has
traditionally been a responsibility of the Division of Vital Statistics since the last
century. With the introduction of the Vital Statistics Act and amendments throughout succeeding years, stillbirths, adoptions, and divorces, together with issue of information and certificates based on these registrations, have been added. Services
are provided to the public through the main office in Victoria and 109 district offices
and sub-offices situated throughout the Province.
The growth in volume of registrations in 1969* was particularly notable
in divorce registrations, which increased almost 100 per cent. The new Federal
Divorce Act liberalizing the grounds for divorce, which was passed in 1968, is undoubtedly an important factor in this regard.
The recent upward trend in numbers of marriages was maintained in 1969.
There were approximately 18,400 marriages, an increase of 10 per cent over the
previous year.   The Marriage Act is administered by the Division of Vital Statistics.
The two other pieces of legislation administered by this Division are the Change
of Name Act and certain sections of the Wills Act. Under the Wills Act, the main
provision of interest is that notice of a testator's will (not the will itself) may be
filed with the Division, and certificates of such notices may be issued on request.
The steady rise in number of notices filed in recent years continued in 1969, with
17,330 entries being made.
An important section of the Division's activities is the provision of BIO-
STATISTICAL SERVICES to other divisions of the Health Branch. These divisions included Epidemiology, Venereal Disease Control, Tuberculosis Control, Public Health Dentistry, and Public Health Nursing.
A considerable amount of work is done also in conjunction and co-operation
with other departments and agencies. In the field of cancer notification, for instance,
efforts have been made in recent years to secure complete and timely reporting of
cancer cases; these efforts were intensified in 1969 after the pathology section of
the British Columbia Medical Association had taken steps to ensure the full cooperation of pathologists in the project. This is now beginning to show results in
the form of more complete reporting of live cases, a trend which we can hope will
promote better and earlier diagnosis of future cancer cases. Another major task
in operations pertaining to cancer was the checking and statistical processing of
approximately 300,000 reports representing smears examined by the Central Cytology Laboratory for British Columbia at Vancouver. A member of the Division of
Vital Statistics attended an international collaborative study on cancer of the uterus
in Toronto in September. Considerable attention was focused on the British Columbia programme for detection of cancer of the cervix uteri, and on the statistical
methods employed.
The research section collaborated in a number of projects in the field of preventive dentistry during the year. These are described in more detail in the section
on Dental Health.
Infant morbidity and mortality continue to be the subject of close observation.
A report was completed covering an analysis of some 42,000 births in four British
Columbia hospitals over the period 1963-67. The report was based on a special
study of obstetrical discharges from these hospitals, and it dealt principally with the
incidence of toxaemia and respiratory complications among mothers.    A number
* See Table XIII.
 S 36
PUBLIC HEALTH SERVICES REPORT, 1969
of favourable comments have been received from members of the medical profession on this report.
There was a major development in the operation of the REGISTRY FOR
HANDICAPPED CHILDREN AND ADULTS. The entire case load of the
Registry was recoded under the Eighth Revision of the International Classification
of Diseases, which was adopted throughout Canada in 1969. This procedure, a
monumental task, provided an opportunity for re-examination of diagnostic data
for each individual case, and for inserting etiology codes where possible for inclusion in the new file of punch cards. While this was a time-consuming operation
it resulted in much deadwood being discarded and the knowledge that information
on all current cards was completely up to date. A report has been published on
the results of two years of follow-up of children included in the Registry at ages
7 and 14 years.
To assist him in evaluating the programme of rheumatic fever prophylaxis,
statistics relating to this service were prepared for the Director of Epidemiology.
Another service for the Division of Epidemiology was the processing of statistics
for the POISON-CONTROL CENTRES. Records are being processed currently
and results for 1969 should be available early in 1970.
The adoption of the Eighth Revision of the International Classification of
Diseases in British Columbia involved intensive amendment of medical coding procedures and other consequent adjustments within the research and mechanical
tabulation sections, as well as in the Registry for Handicapped Children and Adults.
A summary of the main implications of the new classification was prepared for the
guidance of health officers and others concerned in the certification of deaths.
In Victoria, the new District Registrar's office of the Division of Vital Statistics serves the
population of the whole southern tip of Vancouver Island.
 DENTAL CARE
S 37
DENTAL CARE
When the Division of Preventive Dentistry was formed in 1949, the general
plan was to concentrate efforts on the dental health of school children and preschool children down to the age of 3 years. After the early years of pioneering and
organizational activities, it was recognized that a ready means must be available to
measure the progress being made in improving the dental health of young people.
In the 1950's a series of surveys of school children was begun, and these studies
have continued on a broad front up to the present day. Some of results of these
preventive activities are now being seen in clear perspective.
Dental caries experience of children of all ages between 7 and 15 years has
decreased by 23 per cent. In 1959, the average number of permanent teeth
attacked by decay was 6.2, and is now 4.8 teeth per child. In the past 10 years the
proportion of children with no untreated carious teeth has more than doubled, from
15.5 per cent to 35.6 per cent. For 15-year-olds, the ratio with no untreated carious
teeth more than trebled, from 16.4 per cent to 52.8 per cent. These results are
gratifying, and are a tribute to the work done by members of the Division of
Preventive Dentistry with the co-operation of professional private practitioners in
communities throughout the Province.
While it is true that these measures of preventing dental decay have had beneficial results, it is the opinion of the professional staff of the Department that the
most effective method is the fluoridation of community water supplies. In British
Columbia, 17 communities and three Armed Services' stations have this benefit,
and the total population of all these centres represents less than 8 per cent of the
whole Province.
The Director of the Division of Preventive Dentistry administers the various
programmes of dental health through a well-organized field staff in the Province.
Dental health consultants are stationed at five strategic locations and they assist in
the organization and direction of dental health programmes in three to five (usually
adjacent) health units. In two areas there are dental hygienists, and there are
dental assistants to help in the administrative and organizational work of all the
regional consultants.
The dental needs of communities without practising dentists had been recognized for some years, and a programme of providing the services of DENTAL
" EXTERNS " was inaugurated eight years ago. This programme has been broadened during the past year. Eight young graduate dentists visited more than 50
communities, at points such as the Queen Charlotte Islands, northern and western
Vancouver Island, the North Thompson River, the Columbia Valley, and the
Chilcotins. These young dentists use, on a loan basis, lightweight portable equipment (specially designed by the Health Branch) which can be readily transported
by automobile, boat, or aircraft. Close to 2,500 younger children received complete
dental treatment through programmes organized in the communities concerned, the
parents paying a nominal fee for each child so treated. The balance of costs is
shared between the Health Branch and the community. The externs treat older
children and adults also, on a fee-for-service basis. Many native Indian children
also benefit from these services.
In common with the rest of the Province, the dental health of school children
of the metropolitan areas of Greater Vancouver and Greater Victoria has continued
to improve. Grants to the school dental services of the metropolitan health departments were again made to assist in these operations.
 S 38
PUBLIC HEALTH SERVICES REPORT,  1969
Another programme of providing COMMUNITY PREVENTIVE DENTAL
SERVICES to children in rural areas of the Province was begun several years ago.
In each community involved, the programme was organized and encouraged by the
Health Branch, and sponsored by a community organization. The initial and continuing success of these programmes, however, is largely due to the widespread
acceptance of them by the local private practitioners, and their wholehearted
co-operation in making the programme an effective tool in improving the dental
health of our young people. Four years ago these programmes were given a new
look by the introduction of the 3-year-old birthday card. The card, mailed by the
health unit to the child when he attains his third birthday, invites the parents to
take him to the family dentist for a free examination, X-rays, topical fluoride
application, and counselling. For these services the dentist receives a modest fee
through the health unit. So popular have these programmes become that by the
end of 1969 they were operating in 38 school districts in which there were resident
dentists. Acceptance of the service has risen to over 80 per cent in four districts
where it has become well established, and, in all, the number of children visiting
their family dentists through the programme rose to 6,500 from 5,500 in the
previous year; in 1967 it was only 3,500. Unfortunately, the Province is not yet
fully covered by the programmes, and in most instances this is only because the
local dentists are already so busy they cannot undertake the additional work load.
Two important features in the general area of preventive dental health service
are MALOCCLUSION and PERIODONTAL DISEASE. With the arrest and
prevention of dental caries in our young children under a reasonably satisfactory
Dental externs give professional dental care to children in remote areas.   Aircraft is
frequently used to transport personnel and the lightweight portable equipment.
 DENTAL CARE
S 39
measure of control, it is now intended to devote more attention to these areas.
Failure to correct malocclusion in children can have serious effects in the child's
later life—poor mastication, psychological trauma, and periodontal disease. Periodontal disease itself, encountered often in early adult life, almost invariably results
in premature loss of teeth. One of the regional dental consultants, who is presently
doing additional graduate work, is concentrating his studies on the growth and
development of the oral cavity and diseases of the soft tissues of the mouth, areas
of study which cover malocclusion and periodontal disease. On his return to staff
duties in British Columbia, a pilot programme for the prevention of malocclusion
and of periodontal disease will be set in motion. As far as is known at the present
time, British Columbia will be the first Government on this continent to undertake
such an advanced programme in the prevention of these serious oral disorders.
No person is in a better position to observe suspicious lesions in his patient's
oral cavity than the dentist. Recognizing this, the Health Branch, in co-operation
with the British Columbia Cancer Institute, organized the setting up of an ORAL
CANCER DIAGNOSTIC SERVICE. With the active participation of the British
Columbia Dental Association, the service has been in operation since 1966. Special
kits for taking smears, and for sending them and biopsy sections to the Cancer
Institute, are provided by the Division of Preventive Dentistry and distributed to
dentists by the College of Dental Surgeons of British Columbia. Up to the end of
1968, out of a total of 826 smears submitted, a positive diagnosis of malignancy
was confirmed in 35 cases. The majority of these cases undoubtedly benefited by
this early diagnosis.
Taking British Columbia as a whole, the RATIO OF DENTISTS TO POPULATION (1:2,342) ranks with the best in Canada, but the distribution leaves much
to be desired. For all people living north of a line drawn through Lillooet, the ratio
is 1:4,418, which is considerably worse than the Canada average of 1:2,991. The
Faculty of Dentistry at the University of British Columbia will soon be graduating
its first class of dentists and the number will increase in succeeding years. The
summer of 1970 will also see some 20 new graduates from the dental hygienists'
school at the University. It is possible there may be an improvement in the distribution of dental manpower when these graduates enter practice.
By RESEARCH, the Division of Preventive Dentistry constantly strives to find
better ways for improving dental health, especially that of children. One such
research project demonstrated in Greater Victoria that more children visited the
family dentist after the school dentist reported their need to their parents. A study
is continuing in Trail to assess the effects of chewing a sugar-sweetened gum, believed
not to cause dental decay. A rapid screening technique for large groups of children,
developed by World Health Organization, is being evaluated in the Fraser Valley.
Results are also being analysed of a study in Greater Vancouver to determine if
fluoride solutions painted on teeth can arrest existing caries. Results are awaited
on examinations carried out on teen-age children of three racial groups—Anglo-
Saxon, Chinese, and Italian, to determine if there are different degrees or kinds of
malocclusion. Two studies in the Okanagan demonstrated the improved dental
health of children under the regional dental hygienists' programme.
 S 40 PUBLIC HEALTH SERVICES REPORT,  1969
REHABILITATION
Many persons with physical handicaps need the special skills of medicine,
psychology, social work, and vocational training. The function of the Division
of Rehabilitation is to integrate and co-ordinate these skills so as to develop or
restore as much as possible the ability of the person to compete in employment,
and to foster independence and self-determination. To accomplish these purposes
it is necessary to marshal the resources of the individual and many of the resources
of the community.
The rehabilitation needs of handicapped people in the whole Province are
now served through LOCAL REHABILITATION COMMITTEES, which are
located in 28 areas. Each committee has a membership consisting of the local
medical health officer, the district supervisor of social welfare or his representative,
and a senior representative from the appropriate Canada Manpower Centre. Other
members may be added from time to time as the circumstances of the community
demand; such is the case in Greater Victoria, where the local committee is based
at the headquarters of a rehabilitation agency, Goodwill Enterprises.
Work of the committees is co-ordinated and guided by rehabilitation consultants, who operate in the five regions of the Province. The presence of welfare and
Manpower representatives on the committee is instrumental in bringing rapidly to
the committee's attention those disabled persons in need of service toward rehabilitation. The needs of the patient are assessed by the committee, which makes recommendations to the Division of Rehabilitation, so that the appropriate services
can be supplied or arranged. They may include medical, social, and vocational
assessments, followed by physical restoration, social and vocational counselling,
vocational training, and job placement. The general aim of the Division is to work
toward the provision of those services that will lead to vocational rehabilitation.
In working toward its goal of job placement, staff of the Division have become
aware of the growing demand by employers for more highly trained personnel and
greater attention is, therefore, being given to the placement for appropriate TRAINING of each individual. Consequently, there has been a marked increase in the
number of patients attending such post-secondary educational facilities as universities, colleges, and technological institutes. Currently, 34 disabled persons are
thus registered, ten are blind and six are deaf. In all, 365 patients were in training
during the year; this consisted of new enrolment of 253, plus those persons who
were carried over from the previous year. Those graduating from training numbered 141.   These figures show an increase over previous years.
An important feature of the Rehabilitation Service is the support given to
certain REHABILITATION AGENCIES to improve their contribution to the
vocational rehabilitation of the disabled. These agencies receive financial assistance
to the extent of approximately 80 per cent of salaries and fees-for-service of the
professional personnel involved. The three most notable agencies are: The Goodwill Enterprises of Victoria; the Western Institute for the Deaf, located in Vancouver; and the Opportunity Rehabilitation Workshop, formerly known as the Vancouver Training Workshop for the Handicapped.
In recent years, excellent relationships have been established between the Division and the Goodwill Enterprises of Victoria, to the extent that the facilities and
staff of Goodwill make a substantial contribution to the rehabilitation programme
for the whole Vancouver Island region. Important in another aspect is the Western
Institute for the Deaf.   The deaf person encounters special problems as he struggles
 REHABILITATION
S 41
toward a satisfying personal and social life, and these problems require special services for their solution. The Western Institute for the Deaf is particularly well fitted
for this task. The Opportunity Rehabilitation Workshop, recently reorganized, has
made progress in the acquisition of suitable physical facilities, but unfortunately it
has not been possible to develop the full complement of the necessary professional
staff.
Since 1965, the Division has offered a RENAL DIALYSIS service to patients
who suffer from chronic renal (kidney) failure. This was initiated as a humanitarian relief to patients who needed to undergo peritoneal dialysis, with appropriate
drugs and medication, in order to stay alive. The cost of this treatment was so
high that, with few exceptions, patients needed financial or professional assistance
to carry on. When the programme was first put into operation the patients assisted
by the Division were maintained in their own homes on peritoneal dialysis. In
recent years a more sophisticated and efficient method of dialysis has become available—hemodialysis, which involves the use of a special machine which removes
toxic substances from the blood and returns it to the patient. Due to the sophisticated nature of this equipment and the skilled procedures necessary, patients visited
hospitals on an out-patient basis for hemodialysis. Since early 1968, planning has
proceeded which envisaged most patients being trained to operate their own hemodialysis equipment (which has been carefully selected and tested) in any one of
the three major hospitals which presently are participating in the programme.
Training of the handicapped is an essential feature of the services rendered by Goodwill Enterprises of Victoria, a voluntary organization which co-operates closely with the
Division of Rehabilitation.
 S 42
PUBLIC HEALTH SERVICES REPORT, 1969
The Division gives assistance to 33 of these people toward the purchase of
drugs and other medication necessary for the control of infection and blood electrolytes. Training the patients was a long and painstaking process, particularly as
it was first necessary to give special training to groups of technical hospital personnel, who in turn were to teach the patients to use then own equipment. Also it was
necessary for technicians to assess the home of each selected patient to ensure that
conditions were suitable for installation of the equipment. So successful has been
the programme that there are now 14 patients who have been trained to dialyse
themselves in their own homes.
Of the 56 persons who have received assistance through the renal dialysis
service, 26 are now in regular employment and 15 are going about their daily occupation as housewives. As far as is known, British Columbia has the largest government-supported renal dialysis programme in North America.
Of the 10 children born in this Province with known THALIDOMIDE
DEFORMITIES, four are still receiving aid. They are supported regularly by
Government funds, directed toward their rehabilitation.
For further information on rehabilitation see Table XIV.
 LABORATORY SERVICES
S 43
LABORATORY SERVICES
The year saw the Division of Laboratories continuing to provide increased
services in microbiology (including bacteriology), virology, and public health
chemistry. New and varied techniques were introduced to improve the quality of
the laboratory services for the Province, especially with regard to the controlling
of man's environment and public health.
The VOLUME OF WORK performed by the main laboratory at Vancouver
and the two branch laboratories stationed at Victoria and Nelson is measured in
Dominion Bureau of Statistics (D.B.S.) units. As thus recorded, the work load
increased by approximately 6 per cent.* Other areas of laboratory activity, such
as shellfish surveillance, air-quality control, and virology, which do not lend themselves to recording by the D.B.S. units, are not included in this computation of
work load but their contribution to the over-all volume of work was considerable.
Many of the various types of tests and examinations conducted during the
year showed increases; these included tests for syphilis, gonorrhoea, Salmonella,
shigella, whooping-cough, fungal infections, and tuberculosis. Decreases occurred
in tests for febrile (fever) illnesses and intestinal parasites. There were five examinations for diphtheria, compared with six during the previous year. Noteworthy
among the results of examinations were: One type of Salmonella (Salmonella
clifton) was isolated for the first time in Canada; three other types were isolated
for the first time in British Columbia. In food poisoning, the organisms responsible
were recovered from such varied food items as turkey, pork pie, potato salad,
macaroni, chicken stew, sandwich spread, mayonnaise, and lemon slice.
During the year three notable developments took place in the PUBLIC
HEALTH CHEMISTRY SERVICE. Environmental testing facilities were expanded and made available to all departments of the Government. An interdepartmental committee involving the Health Branch and the Water Resources Branch
was set up to assist the Director of the Division of Laboratories in the disposition
and operation of environmental laboratory services. This will aid him in assigning
work-load priorities, preparing estimates of expenses, and in co-ordinating the
laboratory aspects of pollution-control programmes.
The main programmes undertaken in 1969 included water and waste-water
chemistry and air chemistry. The work load for chemical analysis of water and
waste water increased by about 65 per cent from the previous year. To meet this
growing volume, plans were made for automation of this particular section; a step
in this direction was accomplished with the purchase of two automatic analysers
for the determination of heavy metals and phosphates in water.
In air chemistry, considerable testing was necessary in keeping with the AIR-
SAMPLING PROGRAMMES which continued at Prince George, Nelson, Castle-
gar, and Marysville. A study to determine the concentration of lead in air in Trail
began in 1969. The Lower Mainland Air-quality Study, financed by a National
Public Health Research Grant, continued; a continuous air-monitoring station was
established in Vancouver, supported by a mobile air-quality laboratory and 15 fixed
stations in the Lower Mainland. The continuous air-monitoring station was designed to measure carbon monoxide, total hydrocarbons, oxides of nitrogen, total
oxidants, sulphur dioxide, and wind speed and wind direction.
In water microbiology the number of water samples examined again increased.
Included in these were laboratory tests for the limnological study of Skaha Lake,
which was in its second year.
* See Tables XV and XVI.
 S 44
PUBLIC HEALTH SERVICES REPORT,  1969
In the VIROLOGY SERVICE there was a steady growth in the diagnostic
assistance provided to physicians and hospitals. Specimens examined included
viruses from such diseases as encephalitis, influenza, rubella, meningitis, pericarditis,
myocarditis, pneumonia, gastro-enteritis, and febrile (fever) rashes. The number
of specimens from patients that were examined during the year increased approximately 30 per cent over 1968. A new strain of influenza virus, type A 2 Hong
Kong, was isolated during the investigation of an epidemic affecting adults which
lasted from November, 1968, to February, 1969. As the influenza A 2 epidemic
declined, a second wave, due to influenza type B-infected people, was detected in
metropolitan Vancouver and the Lower Mainland of British Columbia.
In the case of rubella (German measles), more and more concern is being
seen in the potential danger to pregnant women of this otherwise bland infection.
The demand for hemoglutination-inhibition tests for rubella antibodies, especially
in pregnant women, showed a marked increase of over 100 per cent during 1969.
Work on the arbovirus project, supported by a National Health Grant, continued. Some 2,000 residents of rural British Columbia were tested for arboviral
antibodies, and these were demonstrated in some persons residing in the Southern
Interior of the Province.
The LABORATORY ADVISORY COUNCIL has now been in existence for
several years, and continues to advise the British Columbia Hospital Insurance
Service before grants are awarded to hospitals for the purchase of diagnostic laboratory equipment.   The Council is composed of members from the British Columbia
Operation of air-sampling stations adds to the responsibilities of the Provincial Laboratory.
Chemical analysis of dustfall samples is being done here.
 LABORATORY SERVICES
S 45
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.
Clinical laboratories in the hospitals throughout the Province offer a battery
of diagnostic tests to both in-patients and out-patients. Each year, new methods
and tests are evolved and those which were formerly considered esoteric have now
become routine procedures. As a result, most pathologist-controlled laboratories
have aimed for more and more automation and multi-phasic screening programmes,
whereas the smaller hospitals meet their needs by acquiring only semi-sophisticated
equipment.
The laboratory-planning sub-committee of the Council was involved in frequent consultations with architects and hospital personnel. Major projects during
the year included the regional laboratory in the Trail-Tadanac Hospital, completed
in December; laboratories in the Penticton and the Kelowna hospitals, now under
way; and detailed sketch plans for the new laboratory in the Chilliwack hospital.
Another regional pathology service was instituted, bringing to nine the total
of such services throughout the Province. A pathologist based in the new hospital
at Cranbrook has been appointed by the hospital authorities to supervise the laboratories in the Invermere, Kimberley, Fernie, and Creston hospitals.
The increasing use of automated equipment has permitted the handling of a
large number of tests without an increase in technical staff; nevertheless, the increased demand for non-automated tests necessitated additional technologists in the
majority of hospital laboratories. An additional 10-per-cent increase in membership of the Canadian Society of Laboratory Technologists was noted during the
year; approximately 1,000 registered members of the society are employed in
British Columbia.
For the first time in many years no shortage of technologists developed, but
with a large increase in hospital beds expected by 1971, more technologists will be
required. To meet this, the Advisory Committee of the School of Medical Technology at the British Columbia Institute of Technology has recommended the 1969
senior class at the Institute be increased from 100 to 120 students. Another
development at the Institute has been the commencement of a night-school course
in general knowledge for medical laboratory technologists.
The efficiency of a laboratory diagnostic service can have a profound effect on
the standards of health care by quickly providing the physician with scientific
information to assist him in dealing effectively with a diagnostic problem.
 S 46 PUBLIC HEALTH SERVICES REPORT,  1969
OCCUPATIONAL HEALTH
It is generally acknowledged that the constantly rising tempo of modern technological change in our society, and the increasing complexity of man's working
environment, pose many problems relating to his health and well-being, problems
unknown a generation ago. To meet these, the services of the Division of Occupational Health are being broadened.
The Division is involved in five main areas of activity:—
1. Employees' health services in government and industry.
2. Radiation protection.
3. Problems related to poisoning.
4. Air pollution-control studies.
5. Control of pesticide hazards.
At present the two main areas of activity are the PROVINCIAL GOVERNMENT
EMPLOYEES' HEALTH SERVICE and RADIATION PROTECTION.
The benefits of the Health Service operated for the Provincial Government
employees have become more widely recognized by senior and supervisory staff
during recent years. This has led to a broader acceptance of the programme, especially in areas that can lead to prevention of illness and disability or shortening its
duration. As well as the average incidence of injuries and illnesses which occur
on the job, it is the more complex, and sometimes more deep-seated problems which
senior personnel are recognizing more readily. These can be due to such factors
as wrong job placement, personality incompatibilities, emotional or mental ill health,
domestic stresses which interfere with the employee's productivity, feeling of insecurity aggravated by increasing technology, and many other situations, each of
which can be of a very individual nature. The staff of the Division of Occupational
Health are in a unique position to deal with these problems; they can interview
the employee, the supervisor (usually at the latter's office so that the working environment can be observed), the personnel officer, and sometimes the family doctor
or the Workmen's Compensation Board. Many of these investigations are time-
consuming, but they can be of incalculable benefit to the employee and to the Government Service. It is the policy of the Employees' Health Service to try and keep
the employee on the job as long as possible, providing this is not detrimental to his
health. Every effort is made to assist the employee to work at his maximum level
of efficiency, and our success along these lines is, to a large extent, due to the degree
of co-operation received from the various departments of Government. The main
activities of the service continue to be centred at Victoria, Vancouver, and at the
Riverview Mental Hospital. At each of these centres there is a full-time occupational health nurse; a physician is available on specified dates at Victoria and River-
view, and at Vancouver he is available on request.
A growing number of the technological advances made in the fields of medicine, science, and industry involve the use of radium. It is not surprising therefore,
that the operations of the RADIATION PROTECTION SECTION of the Division of Occupational Health are increasing steadily each year.
The radium leak-testing programme begun last year was brought to a conclusion. The method used consisted of dioxane immersion and liquid scintillation
counting. It is understood this is the first time this technique has been used on
a Province-wide basis, and it is already evident that significant results have been
obtained. The majority of radium users in the Province are in the medical field,
and all sources except those used by the British Columbia Cancer Institute were
 OCCUPATIONAL HEALTH
S 47
leak-tested by the Radiation Section staff. It was found that of 141 sources tested,
68 (48 per cent) were leaking or contaminated to some degree. The Cancer Institute staff have carried out their own leak-testing procedures.
As a result of the leak-testing programme, five licensed medical users have
disposed of their radium supplies, involving a total of 379.1 milligrams. A much
more satisfactory and safer situation now exists in the Province; the only medical
radium now used is stored at the British Columbia Cancer Institute in Vancouver,
the Royal Jubilee Hospital in Victoria, or the Royal Columbian Hospital in New
Westminster, all of which have proper storage facilities. The remaining radium
users are non-medical and account for a total of only 172.6 milligrams.
The Radiation Protection Service of the Department of National Health and
Welfare has shown a great deal of interest in the results of our testing, which have
clearly demonstrated the inadequacy of previous testing methods. It is possible
the British Columbia testing procedures will become the nationally recommended
procedure for the future.
Building of the largest radiation installation in British Columbia began during
the year when construction was started at the University of British Columbia on
the Tri-University Meson Facility. Some preliminary work has been completed,
and the tender for the cyclotron is expected to be let early in 1970. In a project
of this dimension, there will, of course, be internal monitoring facilities operated
by the staff. The responsibility for an environmental monitoring programme, however, will fall upon the Radiation Protection Section, to ensure that radioactivity is
not released to the atmosphere and ground water. There will also be the necessity
of providing a radioactive-disposal area for all manner of radioactive waste that
will originate at this site. Discussions and investigations are going on with other
Government departments to arrange for the acquisition of a suitable disposal-site.
The first reports of emission of X-rays from certain colour television sets
occurred three years ago, and the Radiation Protection Section has done a considerable amount of work on the basis of reports and complaints received. It is indicated
that of the sets produced in 1969 a very much smaller percentage than those produced in earlier years exceeded the standard emission as recommended by the
International Commission on Radiological Protection. In British Columbia, most
of the sets checked out by the Radiation Protection Section have been found to be
operating within safe limits.
The Radiation Protection Section, in certain aspects of radiation control, represents the Federal Government and works closely with the Radiation Protection
Division of the Department of National Health and Welfare. An announcement
has recently been made that the Federal Division is to become concerned with all
forms of radiant energy and it is expected from this that the British Columbia
Radiation Protection Section will be taking an active interest in studies on:—
1. Radiation-energy pollution of the environment.
2. Microwave and radio-frequency radiation measurement and control.
3. Laser and ultra-violet radiation.
Because of the intensive inspection activities and the educational aspects of
inspection work in previous years, the routine radiation surveys in the healing arts,
industry, and research, although continuing in some volume, were not as numerous
this year.
The British Columbia Hospital Insurance Service, which has responsibility
for authorizing grants for the purchase of X-ray equipment in hospitals, requested
the assistance of the Radiological Advisory Council in the reviewing of some 79
applications for acquisition of equipment. The head of the Radiation Protection
Section is the technical adviser to the Council.
 S 48 PUBLIC HEALTH SERVICES REPORT,  1969
The Mobile Field Radiation Laboratory, introduced in 1968, has again
seen much activity during the year. In discussions and consultations with the
Provincial Department of Mines and Petroleum Resources, the possibility has been
explored that uranium oxide could form part of an orebody that was being mined
for other minerals. As certain mining developments in the Province indicated that
this possibility should be thoroughly explored, the mobile laboratory is being used
on behalf of the Department of Mines and Petroleum Resources in an operation
designed to ensure the safety of workmen both below ground and in the concentrator
plants. Several mine-sites throughout the Province will be checked for airborne and
solids radioactivity.
The Director of the Division of Occupational Health is chairman of the
Occupational Health Committee of the British Columbia Medical Association and
is a member of the Health Branch Air Pollution Advisory Committee, the Advisory
Committee on Agricultural Pesticides and Veterinary Drugs, the Federal Advisory
Committee on Radiation Protection, and the TRIUMF (Tri-University Meson
Facility) Safety Committee at the University of British Columbia.
 POISON CONTROL
S 49
POISON CONTROL
The Health Branch, in collaboration with the Faculty of Pharmaceutical
Sciences at the University of British Columbia, completed the establishment of
43 POISON CONTROL INFORMATION CENTRES in acute general hospitals
throughout the Province. These provide an immediate source of information to
physicians treating cases of poisoning at the hospital, and to members of the public
who may telephone for advice in emergency. The British Columbia Telephone
Company has now included the telephone number of all these centres among the
emergency numbers in the local telephone directories. An important and welcome
development has been the participation in poison-control work by the Department
of Pediatrics of the University of British Columbia's Faculty of Medicine. That
Department, with co-operation from the Health Branch, is developing a Provincial
POISON INFORMATION CENTRE in Vancouver, where physicians may obtain
information that will help them care for the more complicated cases. Over 4,000
instances of accidental poisoning were reported this year, which shows that there
is a need for services of this kind.
 S 50
PUBLIC HEALTH SERVICES REPORT, 1969
EMERGENCY HEALTH SERVICE
The objective of British Columbia's Emergency Health Service can be defined
as the development and sustaining of a capability to provide mass casualty care
and emergency public health service in the event of major natural or wartime
disaster. It is tied in closely with the Emergency Health Services of the Federal
Government and of other Provinces.
Two public health disaster institutes were held during the year, one at Abbotsford and one at Nanaimo. These institutes are designed to acquaint the public
health staff with their duties and responsibilities in the event of a major disaster.
They were well attended, and representatives included persons from other community agencies and other departments which would be working with the public
health staff in the event of need.
Tabletop displays, simulating the emergency hospital, advanced-treatment
centre, and casualty-collecting unit, all of which are key components of the emergency health service equipment and supplies, have been in continuous use throughout the year. They have been used frequently at the Vancouver General Hospital
School of Nursing and at meetings of such organizations as the British Columbia
Pharmaceutical Association and the British Columbia Professional Pharmacists
Society, as well as with the graduating classes of the two hospital schools of nursing
in Victoria.
The Director of the Division of Epidemiology and the Pharmaceutical Consultant (who is now responsible for the Emergency Health Services) lectured on
a number of occasions during the year at Civil Defence training courses, public
These are some of the many items included in the Emergency Hospital, of which 13 have
been pre-positioned throughout the Province.
 EMERGENCY HEALTH SERVICE
S 51
health disaster institutes, and at the pharmacy undergraduate course in community
health at the University of British Columbia.
Representatives from British Columbia visited the training headquarters of
the Federal Emergency Health Service at Arnprior on a number of occasions. The
Pharmaceutical Consultant attended a conference concerning the St. John Ambulance Society involvement in emergency health service, two Health Branch staff
members and one hospital administrator attended a course on community health
planning, and a member of the instructional staff of the Faculty of Pharmaceutical
Sciences, University of British Columbia, together with the Pharmaceutical Consultant, attended a pilot course on surgical instruments for health supply officers.
The Emergency Health Service has always been operated in close conjunction
and co-operation with the Provincial Civil Defence Organization. The latter, during
the year, consolidated its Victoria offices in larger accommodation. Basement storage space has been made available for Emergency Health Service equipment and
the training emergency hospital is housed there. It is expected that the lecture and
demonstration facilities of the Provincial Civil Defence Organization will be used
to make courses available in Emergency Health Service.
The pre-positioning of emergency medical units throughout the Province has
been continuing during 1969. Since this programme began, pre-positioning has
placed 13 emergency hospitals, 33 advanced-treatment centres, 47 casualty-collecting units, and 271 hospital disaster-supply units. There are 95 different storage
sites in the Province containing emergency medical units, located in 65 municipalities. The value of the medical equipment contained in the pre-positioned emergency medical units in British Columbia is estimated at $1,200,000, defrayed
entirely from National Emergency Health Service sources.
 S 52 PUBLIC HEALTH SERVICES REPORT, 1969
COUNCIL OF PRACTICAL NURSES
The council consists of 10 members appointed under the Practical Nurses Act
to represent the Minister of Health Services and Hospital Insurance, the Minister
of Education, the Licensed Practical Nurses' Association, the College of Physicians
and Surgeons of British Columbia, the Registered Nurses' Association of British
Columbia, and the British Columbia Hospitals' Association. The chairman of the
council is a senior officer of the Health Branch.
There were seven formal meetings of the council as a whole during 1969. This
brought to 32 the number of such meetings held since the present council was
appointed in 1965.
There were also numerous meetings of several committees. Because the main
responsibility of the council is the licensing of practical nurses, the Committee on
Credentials was most active. This committee assesses applications for licences and
submits recommendations to the council, which makes the final decisions. Table
XVII shows the status of the licensing programme.
In addition to the licensing activities, there were several other matters with
which council concerned itself during the year. Important among these was the
matter of training and upgrading of practical nurses, in which the Department of
Education was seeking council's advice.
 PUBLICATIONS, 1969
S 53
PUBLICATIONS, 1969
Three Year Study of Self-Administration of a Fluoride-Phosphate Solution," J.
Pub. Health Dent. 29:11, winter issue, 1969, by J. M. Conchie, F. McCombie,
and L. W. Hole.
The Okanagan Dental I.Q. Quiz," C.J.P.H. 60:222, May, 1969, by A. S. Gray,
D. S. Gunther, and I. I. Jordan.
Fluorides in Dental Practice," J.C.D.A. 35:255, May, 1969, by J. M. Conchie.
Pilot Dental Programme for Penticton School Children," J.C.D.A. 35:316, by
A. S. Gray, D. R. Hawk, and I. I. Jordan.
Evaluation of a Newspaper Column and Radio Broadcast for Dental Education
of the Public," J.C.D.A. 35:324, June, 1969, by A. S. Richardson.
Group Dynamics in a Dental Public Health Program," J.C.D.A. 35:407, August,
1969, by A. S. Gray, D. M. Gunther, and I. I. Jordan.
Incidence of Cleft Lip and Palate in British Columbia Indians," J. Med. Gen.,
March, 1969, by B. Lowry and D. H. G. Renwick.
Statistical Methods in a Screening Programme for Cancer," C.J.P.H. 60:267,
July, 1969, by D. H. G. Renwick.
Tick Paralysis in British Columbia," C.M.A.J. 100:417, March, 1969, by N.
Schmitt, E. J. Bowmer, and J. D. Gregson.
Atypical Mycobacterial Disease in British Columbia,   1960-1967,"  C.M.A.J.
101:17, July, 1969, by B. L. Robinson, S. Gryzbowski, E. J. Bowmer, J.
McDiarmid, E. I. Whittaker, and K. Tanner.
 S 54 PUBLIC HEALTH SERVICES REPORT,  1969
TABLES
Table I.—Approximate Numbers of Health Branch Employees by Major
Categories at the End of 1969
Physicians in local health services  21
Physicians in institutional and other employment  19
Nurses in local health services  316
Nurses in institutions  90
Public health inspectors  59
Dentists in local health services  5
Bacteriologists  25
Laboratory technicians  36
Public health engineers   6
Statisticians   7
Others    693
Total  1,277
Table II.—Organization and Staff of Health Branch (Location and Approximate
Numbers of Persons Employed at End of 1969)
Health Branch headquarters, Legislative Buildings, Victoria..    45
Health Branch office, 828 West Tenth Avenue, Vancouver....    30
Division of Vital Statistics—
Headquarters and Victoria office, Legislative Buildings,
Victoria      66
Vancouver office, 828 West Tenth Avenue, Vancouver      21
Division of Tuberculosis Control—
Headquarters, 2647 Willow Street, Vancouver  12
Willow Chest Centre, 2647 Willow Street, Vancouver.. Ill
Pearson Hospital, 700 West 57th Avenue, Vancouver  312
Victoria and Island Chest Clinic,   1902 Fort Street,
Victoria   11
New Westminster Chest Clinic, Sixth and Carnarvon,
New Westminster  6
Travelling clinics, 2647 Willow Street, Vancouver  12
Survey programme, 2647 Willow Street, Vancouver  6
Division of Laboratories—
Headquarters  and Vancouver Laboratory,  828  West
Tenth Avenue, Vancouver     98
Nelson Branch Laboratory, Kootenay Lake General
Hospital        1
Victoria Branch Laboratory, Royal Jubilee Hospital1     	
75
87
470
99
1 Services are purchased from the Royal Jubilee Hospital, which uses its own staff to perform the tests.
 TABLES
S 55
Table II.—Organization and Staff of Health Branch (Location and Approximate
Numbers of Persons Employed at End of 1969)—Continued
Division of Venereal Disease Control—Headquarters and Vancouver clinic, 828 West Tenth Avenue, Vancouver        18
Division of Rehabilitation—
Headquarters, 828 West Tenth Avenue, Vancouver       8
Nanaimo
Chilliwack
Vernon 	
Prince George
Local Public Health Services (Health Units)—
East Kootenay, Cranbrook   26
Selkirk, Nelson  14
West Kootenay, Trail  20
North Okanagan, Vernon  25
South Okanagan, Kelowna
South Central, Kamloops	
Upper Fraser Valley, Chilliwack
Central Fraser Valley, Mission _
Boundary, Cloverdale
38
28
27
26
52
31
17
40
Central Vancouver Island, Nanaimo   48
Upper Island, Courtenay  23
Cariboo, Williams Lake  16
Skeena, Prince Rupert  28
Peace River, Dawson Creek  19
Northern Interior, Prince George  34
Simon Fraser, Coquitlam	
Coast-Garibaldi, Powell River 	
Saanich and South Vancouver Island, 780 Vernon Avenue, Victoria	
12
516
Total
1,277
The total number, 1,277, is 13 more than the number on staff at the end of
1968. The increases occurred mainly in the Division of Laboratories and the
health units. There was a decrease in the staff of the Division of Tuberculosis
Control.
There were also part-time employees in many of the places listed. The part-
time employees serving on a continuous basis totalled the equivalent of approximately 70 full-time employees.
 S 56
PUBLIC HEALTH SERVICES REPORT,  1969
Table HI.—Comparison of Public Health Services Gross Expenditures
for the Fiscal Years 1966/67 to 1968/69
Service
Gross Expenditure
Percentage of
Gross Expenditure
Percentage
Increase or
Decrease
1966/67
1967/68
1968/69
1966/67
1967/68
1968/69
Previous
Year
Patient care _	
Local health services 	
Cancer, arthritis, rehabilitation, and research 	
General  administration  and
consultation services-	
$3,091,643
4,333,381
2,015,778
677,539
630,639
445,084
158,080
$3,894,939
4,756,869
1,965,855
767,027
701,064
491,641
162,231
$3,812,840
5,185,137
2,374,247
1,194,669
873,560
521,397
173,225
27.2
38.2
17.7
6.0
5.6
3.9
1.4
30.6
37.3
15.4
6.0
5.5
3.9
1.3
27.0
36.7
16.8
8.4
6.2
3.7
1.2
-2.1
+9.0
+20.8
+55.8
+24.6
+6.1
+6.8
Division of Vital Statistics	
Division of Venereal Disease....
Totals	
$11,352,144
$12,739,626
$14,135,075
100.0
100.0
100.0
+ 11.0
Table IV.—Per Diem Rates for In-patient Care during the Fiscal Year
April 1,1968, to March 31,1969
Operating cost—
Willow Chest Centre
Tuberculosis hospitals
$791,207
Pearson Tuberculosis Unit      565,761
Combined operating cost  $1,356,968
Number of patient-days
Willow Chest Centre       25,394
Pearson Tuberculosis Unit        25,904
Total number of days' care  ...
Per capita cost per diem—
Willow Chest Centre 	
Pearson Tuberculosis Unit	
Combined per capita cost per diem
51,298
$31.16
$21.84
$26.45
Operating cost 	
Number of patient-days
Per capita cost per diem _
Pearson Extended-Care Unit
$1,414,073
60,937
$23.21
Poliomyelitis Pavilion (Pearson Unit)
Operating cost 	
Number of patient-days	
Per capita cost per diem	
$444,266
12,984
$34.22
 TABLES S 57
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—
Diploma in Public Health Nursing (British Columbia)     5
Administration of Hospital Nursing Units (British Columbia)     1
Diploma in Public Health (Toronto)      1
Bachelor of Science in Nursing (Montreal and Halifax)     2
Total     9
Commenced training—
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
National Health Grants were used to defray part of the costs.
The trainees were required to sign agreements to return to employment with
the Health Branch for specified periods following completion of their courses.
Table VI.—Training of Health Branch Staff by Means of Short Courses
(Types of training, universities or other training centres, and numbers trained.)
12th Annual Refresher Course for Medical Health Officers of Hygiene
(University of Toronto)   3
Interviewing and Counselling for Occupational Health Nurses (University of British Columbia)   1
Nutrient Removal and Advanced Waste Treatment (Portland, Oreg.) 2
Conference on Pulmonary Diseases (Cincinnati, Ohio)   1
Short Course for Co-ordinators of Inservice Nursing Education Programmes (Vancouver)   1
Short Term Course on Dental Photography (University of Washington
School of Dentistry, Seattle)   1
Operation of the Technicon Autoanalyzer (New York and Ottawa)  1
Medical X-ray Protection (Las Vegas)   1
American Cleft Palate Association Annual Meeting (Houston, Tex.)__ 1
Correspondence Course in Bio-Statistics (England)   1
International Congress of Nurses (Montreal)   1
Conference of State and Territorial Epidemiologists at the National
Communicable Disease Center (Atlanta, Ga.)   1
American Waterworks Convention (San Diego, Calif.)   2
Nursing, Retarded Children (The Woodlands School Workshop, New
Westminster)     7
Course for Rehabilitation Consultants (Winnipeg, Man.)   2
Visit to Air-quality Laboratories (Ottawa, Toronto, New York) and
Air Pollution Control Association annual meeting (New York)- 1
Television Studio Production  (Ryerson Poly technical Institute, To- v
ronto)  1  1
 S 58
PUBLIC HEALTH SERVICES REPORT,  1969
Table VI.—Training of Health Branch Staff by Means of Short Courses—Continued
Summer Training Programme for Speech Therapists (Stanford University)    1
Training in Alga? Identification (Okanagan Laboratories, Penticton)  1
Graduate Summer Session in Epidemiology (University of Minnesota) 1
Atomic Absorption Spectrophotometer (Norwalk, Conn.)   1
Basic Statistics for Scientists & Engineers (University of Victoria)  2
Basic Principles of Waste Water Treatment Operation  (Corvallis,
Oreg.)    2
Environmental Health Administration (Ryerson Polytechnical Institute, Toronto)   7
The Handicapped Child (University of British Columbia)   3
The Stroke Patient (University of British Columbia)   2
Developmental Screening for Pre-school Children (Denver, Colo.)  1
Nursing Assessment (University of British Columbia)   2
Home Study Course in Physiology (St. Louis College of Pharmacy).— 1
Occupational Health Nurses Refresher Course (New York University
Medical Center)   1
Seminar on Air Pollution Problems (University of Western Ontario).. 1
Short-Term Training Visit (National Institutes of Health, Washington,
D.C., and Provincial Laboratories, Toronto, and Laboratory of
Hygiene, Ottawa)  1
Narcotic Addiction Foundation Seminar (Kitimat)  5
Table VII.—Reported Communicable Diseases in British Columbia, 1965-69
(Including Indians)
(Rate per 100,000 population.)
Reported Disease
1965
Number
of
Cases
Rate
1966
Number
of
Cases
Rate
1967
Number
of
Cases
Rate
1968
Number
of
Cases
Rate
1969
Number
of
Cases
Rate
Botulism-
Brucellosis  	
Diarrhoea  of the newborn
(E.coli)	
Diphtheria.
Dysentery, amcebic.
Bacillary 	
Unspecified-
Food poisoning—
Staphylococcal   intoxication-
Salmonella infection.
Unspecified-
Hepatitis, infectious.
Leprosy-
Meningitis, viral or aseptic—
Due to coxsackie virus	
Other and unspecified	
Meningococcal infections	
Pemphigus neonatorum	
Pertussis	
Scarlet fever.
Streptococcal throat-
Tetanus	
Trichinosis 	
Typhoid fever-
Paratyphoid fever-
Totals	
32
3
114
225
1
348
74
1,237
3
53
15
1
231
848
824
0.3
0.1
1.8
0.2
6.4
12.6
0.1
19.4
4.1
69.1
0.2
3.0
0.8
0.1
12.9
47.4 ]
46.0
0.2
0.4
203
367
12
342
4
844
311
796
1.7
10.8
19.6
0.6
18.2
0.2
45.0
1.7
0.6
16.6
52.7
42.5
0.2
0.1
1
1
16
1
2
138
489
9
256
24
1,664
1
9
31
12
264
695
1,782
3
1
10
4
0.1
0.1
0.8
0.1
0.1
7.1
25.1
0.5
13.1
1.2
85.4
0.1
0.5
1.6
0.6
13.5
35.6
91.5
0.2
0.1
0.5
0.2
19
8
4
276
165
9
165
311
2,032
1
42
17
3
136
300
720
4,027
225.1  |    3,944
210.5
5,413 | 278.0 |    4,215
0.1
0.9
0.4
0.2
13.8
8.2
0.4
8.2
15.5
101.3
0.1
2.1
0.8
0.1
6.8
15.0
35.9
0.1
0.1
210.QT
23
14
12
64
209
29
400
19
2,139
1
21
13
1
59
56
1,180
2
0.4
0.1
1.1
0.7
0.6
3.1
10.1
1.4
19.3
0.9
103.3
0.1
1.0
0.6
0.1
2.8
2.7
57.0
0.1
0.1
0.1
4,256 I 205.6
 TABLES
S 59
Table  VIII.—Reported Infectious Syphilis and Gonorrhoea,  British  Columbia,
1946,1951,1956,1961,1964-69
Year
Infectious Syphilis
Gonorrhoea
Number
Rate!
Number
Rate*
1946	
1
834        |        83.0
36       '          3.1
11        1          0.8
4,618
3,336
3,425
3,670
460.4
1951      .    	
286.4
1956
244.9
1961            	
64
3.9
225.3
1964 	
304
17.5
5,821
344.9
1965	
165
9.2
6,005
335.7
1966  	
71
3.8
5,415
290.8
1967    .     ... 	
72
3.7
4,706
241.7
1968          ...
68
3.4
4,1992
209.22
1969    „                           	
502
2.52
4,7602
240.02
i Rate per 100,000 population.       2 Preliminary.
Table IX.—Statistical Summary of Selected Activities of Public Health Nurses,
September to August, Inclusive
1968/69 1967/68
School service—
Direct by nurse and aide  307,534
Teacher-nurse conferences
Home visits
Conference with staff
Meetings 	
6,956
48,432
62,965
2,598
Expectant parents—
Class attendance by mothers      18,771
Class attendance by fathers        4,578
Prenatal home visits       3,875
Postnatal visits      18,920
Child health-
Infants—
Conference attendance
Home visits	
Pre-school—-
Conference attendance
Home visits	
Home care visits	
Visits to personal-care institutions
Adult health supervision visits	
Mental health visits 	
Disease control—
Tuberculosis visits 	
Venereal disease visits 	
Communicable disease visits
Rheumatic fever patients 	
Immunizations—
Smallpox	
Poliomyelitis 	
Basic series 	
Other 	
Total doses	
58,169
34,944
71,587
32,139
76,193
979
44,119
17,310
9,662
3,286
9,327
1,121
92,194
158,621
21,565
149,398
421,777
301,582
8,106
51,586
59,012
1,973
17,121
4,099
3,999
18,705
57,585
33,835
84,749
33,569
71,053
1,337
39,077
17,793
10,212
4,430
9,855
1,077
93,784
174,324
23,456
154,126
444,690
 S 60
PUBLIC HEALTH SERVICES REPORT,  1969
Table IX.—Statistical Summary of Selected Activities of Public Health Nurses,
September to August, Inclusive—Continued
Tests-
Tuberculin
Other 	
Total visits to homes 	
Professional services by telephone
1968/69
14,904
3,043
172,062
176,672
1967/68
21,950
2,934
165,564
161,729
Table X.—Number of Pupils with Basic Immunization Prior to Entering Grade I,
September, 1968
Greater
Vancouver
Greater
Victoria
Remainder
of Province
Total pupils enrolled.
Smallpox-
Diphtheria, pertussis, and tetanus..
Poliomyelitis	
13,133
9,368 (71.3%)
9,716 (74.0%)
9,306 (70.9%)
3,588
2,603 (72.6%)
2,827 (78.8%)
2,669 (74.3%)
25,912
18,726 (72.3%)
20,315 (78.4%)
21,185 (81.8%)
Table XI.—Referral of Pupils to School Health Services
Greater Vancouver
Greater Victoria
Remainder
of Province
fil
4.001
23,402
Number referred from other sources 	
(1)                               3,606
16,117
Totals             	
	
7,607
39,519
1 Figures not available.
Excluding Greater Vancouver, the total enrolment was 358,297.    Of these,
47,126 or 13 per cent were referred to school health services.
Table XII.—Pupils Referred by Public Health Nurses for Further Care
Person or Clinic to Which Referrals Made
Greater Vancouver      Greater Victoria
Remainder
of Province
Private physicians for other than vision defects..
Investigator of vision defects	
Speech therapist  	
Mental health clinic	
Other clinics	
Totals..
C1)
(l)
(!)
(!)
C1)
1,878
1,652
77
72
62
3,741
9,854
13,512
440
1,154
1,445
26,405
1 Figures not available.
The total of 30,146 referrals by public health nurses for special services reflects
an active programme in bringing pupils under appropriate care. Again this year,
the greatest number of referrals were for investigation of vision defects.
 TABLES
S 61
Table XIII.—Registrations Accepted under Various Acts
Registrations accepted under Vital Statistics Act—
Birth registrations    33,528
Death registrations   16,850
Marriage registrations   16,725
Stillbirth registrations   415
Adoption orders   2,223
Divorce orders   2,268
Delayed registrations of birth  387
Registrations of wills notices accepted under Wills
Act	
Total registrations accepted	
Legitimations of birth affected under Vital Statistics A ct 	
Alterations of given name effected under Vital Statistics Act	
Changes of name under Change of Name Act	
16,850
89,246
286
178
710
Certificates issued—
Birth certificates   54,346
Death certificates   9,879
Marriage certificates  6,049
Baptismal certificates   16
Change of name certificates	
Divorce certificates    286
Photographic copies of registration   6,396
Wills certificates  9,931
Total certificates issued      87,791
Non-revenue searches for Government departments    12,858
Total revenue  $259,970
1969
(Preliminary)
35,440
17,470
18,590
467
2,795
4,335
417
17,331
96,845
288
175
715
60,267
10,223
6,815
16
901
251
7,344
10,777
96,594
12,800
$357,062
 S 62 PUBLIC HEALTH SERVICES REPORT, 1969
Table XIV.—Case Load of the Division of Rehabilitation,
January 1 to December 31, 1969*
Accepted cases active at January 1, 1969  1,006
New cases referred to local rehabilitation committees.  708
Cases referred from other sources  306
Cases reopened   108
Total referrals considered for rehabilitation services, January 1
to December 31, 1969  1,122
Total  2,128
Analysis of Closed Cases
Cases closed, January 1 to December 31, 1969—
Employment placements made—
Canada Manpower      65
Division of Rehabilitation     24
Other placements  178
  267
Resumed former activities  117
Job placement not feasible  (restorative services completed)   125
Deceased       6
      515
Cases assessed and rejected as not capable of rehabilitation...     581
Cases currently under assessment or receiving rehabilitation
services   1,032
Total  2,128
' Preliminary totals.
 TABLES
S 63
Table XV.—Statistical Report of Examinations and Work Load in 1968 and 1969,
Main Laboratory
Unit1
Value
1969
1968
Tests
Performed
Work-load
Units
Tests
Performed
Work-load
Units
Bacteriology Service
Enteric Laboratory—
Cultures—
7
10
15
6
5
5
5
5
5
2
2
2
5
1
2
2
10
2
2
3
10
25
25
6
2
3
2
5
50
80
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
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
14,389
3,028
86
39
3,425
8,209
3,783
5,231
5,876
42,449
3,352
12,299
8,397
140,158
1,835
3,079
1,589
1,080
1,344
281
393
1,105
227
26,451
12,905
6,528
1,814
16,874
139
4,795
310
100,723
30,280
1,290
Miscellaneous Laboratory—
Animal virulence (diphtheria)— 	
Cultures—
234
17,125
41,045
Miscellaneous -	
18,915
26,155
N. gonorrhoece . -
Smears for—
N. gonorrhoea     -
29,380
84,898
6,704
Serology Laboratory—■
Agglut.—Widal, Paul-Bunnell, Brucella
24,598
41,985
Blood—
V.D.R.L. (qual.) 	
V.D.R.L. (quant.)	
140,158
3,670
6,158
F.T.A.-Abs	
C.S.F.—
2,605
26,050
15,890
2,160
V.D.R.L _	
2,986
182
532
1,118
248
28,879
16,715
5,874
1,973
18,581
280
8,464
434
5,972
546
5,320
27,950
6,200
173,274
33,430
17,622
3,946
92,905
14,000
60,468
34,720
2,688
Darkfield—T. pallidum	
Tuberculosis Laboratory—
843
3,930
27,625
5,675
158,706
25,810
19,584
Chemistry Service
Water bacteriology—
3,628
84,370
Water chemistry—
6,950
34,550
B.O.D 	
24,800
Totals	
....
352,419
1,081,693
331,470
990,527
i One D.B.S. unit=10 minutes of work.
 S 64
PUBLIC HEALTH SERVICES REPORT,  1969
Table XVI.—Statistical Report of Examinations and Work Load in 1969,
Branch Laboratories
Uniti
Value
Nelson
Tests
Performed
Work-load
Units
Victoria
Tests
Performed
Work-load
Units
Enteric Laboratory—
Cultures—
Salmonella-Shigella-
Pathogenic E. coli-
Food-poisoning examination	
Miscellaneous Laboratory—
Animal virulence (diphtheria).
Cultures—•
C. diphtheria;..
Htemolytic staph.-strep..
Miscellaneous 	
Fungi  	
N. gonorrhoea;..
Smears f or—
N. gonorrhoea;..
Vincent's	
Miscellaneous.-
Serology Laboratory—
Agglut.—Widal, Paul-Bunnell, Brucella .
Anti-streptolysin test	
Blood—
V.D.R.L. (qual.)_
V.D.R.L. (quant.) _
Darkfield—T. pallidum-—
Tuberculosis Laboratory—
Animal inoculation	
Cultures for M. tuberculosis..
Smears for M. tuberculosis—
Intestinal parasites	
Water Laboratory—■
Standard plate count	
Colif orm test 	
Totals-
7
10
15
5
5
5
5
5
2
2
2
2
5
1
2
3
10
6
2
3
2
5
234
257
2,560
624
548
2
46
321
5,428
33
51
137
3,350
1,638
1,285
12,800
3,120
1,096
4
92
642
5,428
66
102
411
16,750
13,591
43,434
2,534
775
5
587
5,285
32
1,587
1,619
1,746
19
489
939
149
11,037
127
5
7
2,267
1,689
1,347
1,038
2,749
17,738
7,750
75
2,935
26,425
160
7,935
8,095
3,492
38
978
1,878
745
11,037
254
15
70
13,602
3,378
4,041
2,076
13,745
36,032
126,462
i One D.B.S. unit=10 minutes of work.
Table XVII.—Licensing of Practical Nurses
(Applications received and approved from inception of programme
to end of 1969.)
Applications received  5,411
Applications approved—
On the basis of formal training  2,832
On the basis of experience only—
Full licence  395
Partial licence   874
  1,269
Total
4,101
Applications awaiting review at end of year      125
Printed by A. Sutton, Printer to the Queen's Most Excellent Majesty
in right of the Province of British Columbia
1970
730-170-729

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