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Seventy-sixth Annual Report of the Public Health Services of British Columbia HEALTH BRANCH DEPARTMENT… British Columbia. Legislative Assembly 1973

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 PROVINCE OF BRITISH COLUMBIA
Seventy-sixth Annual Report of the
Public Health Services
of British Columbia
HEALTH BRANCH
Department of Health Services and Hospital Insurance
YEAR ENDED DECEMBER 31
1972
Printed by K. M. MacDonald, Printer to the Queen's Most Excellent Majesty
in right of the Province of British Columbia.
1973
 DEPARTMENT OF HEALTH SERVICES AND HOSPITAL INSURANCE
(HEALTH BRANCH)
The Honourable Dennis Cocke
Minister of Health Services and Hospital Insurance
SENIOR PUBLIC HEALTH ADMINISTRATIVE STAFF
G. R. F. Elliot
Deputy Minister of Health and Provincial Health Officer
and
Director, Bureau of Special Health Services
A. H. Cameron
Director, Bureau of Administration
K. I. G. Benson
Director, Bureau of Local Health Services
W. Bailey
Director, Division of Environmental Engineering
E. J. Bowmer
Director, Division of Laboratories
C. E. Bradbury
Director, Division for Aid to Handicapped
E. M. Derbyshire
Pharmaceutical Consultant
J. H. Doughty
Director, Division of Vital Statistics
Mrs. M. Green
Director, Division of Public Health Nursing
H. K. Kennedy
Director, Division of Venereal Disease Control
M. A. Kirk
Senior Consultant, Division of Public Health Education
A. A. Larsen
Director, Division of Epidemiology
F. McCombie
Director, Division of Preventive Dentistry
D. Mowat
Director, Division of Tuberculosis Control
H. J. Price
Departmental Comptroller
R. G. Scott
Director, Division of Public Health Inspection
J. H. Smith
Director, Division of Occupational Health
G. Wakefield
Director, Division of In-patient Care
Miss P. Wolczuk
Consultant, Public Health Nutrition
G. D. Zink
Director, Speech and Hearing Services
 Office of the Minister of Health Services
and Hospital Insurance,
Victoria, B.C., January 15, 1973.
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-sixth Annual Report of the
Public Health Services of British Columbia for the year ended December 31, 1972.
DENNIS COCKE
Minister of Health Services and Hospital Insurance
Hon. Dennis Cocke
Minister of Health Services and
Hospital Insurance
 Department of Health Services and Hospital
Insurance (Health Branch),
Victoria, B.C., January 8, 1973.
The Honourable Dennis Cocke,
Minister of Health Services and Hospital Insurance,
Victoria, B.C.
Sir: I have the honour to submit the Seventy-sixth Annual Report of the
Public Health Services of British Columbia for the year ended December 31, 1972.
G. R. F. ELLIOT, M.D.C.M., D.P.H.
Deputy Minister of Health
G. R. F. Elliot
Deputy Minister of Health
and Provincial Health Officer
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 The Health Branch is one of the four branches of the Department of Health Services and Hospital Insurance, together with the branches of Mental Health Services,
the British Columbia Hospital Insurance Service, and the Medical Services Commission.
In the Health Branch, the Deputy Minister of Health and the Directors of the
three bureaux form the planning and policy-making group. Under them the
divisions provide consultative and special services to all public health agencies
throughout the Province.   The chart on the previous page shows the organization.
Direct services to the people in their communities, homes, schools, and places
of business are provided by personnel of local health departments. Greater Vancouver and Greater Victoria have their own metropolitan organization 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 adjacent rural areas.
 TABLE OF CONTENTS
Page
Introduction     9
Communicable and Reportable Disease  13
Health and Our Environment  18
Specialized Community Health Programmes  22
Community Health Nursing  27
Home Care  28
Maternal and Child Health  32
School Health  33
Preventive Dentistry  35
Nutrition Service  3 9
Public Health Education  42
Vital Statistics  44
In-patient Care  46
Aid to Handicapped  48
Laboratory Services  50
Emergency Health Service  52
Pharmaceutical Consultant Service  53
Council of Practical Nurses  54
Publications, 1972  55
Tables—
I—Approximate Numbers of Health Branch Employees by Major Categories at the End of 1972  56
II—Organization and Staff of Health Branch (Location and Approximate
Numbers of Persons Employed at End of 1972)  56
III—Comparison of Public Health Services Gross Expenditures for the
Fiscal Years 1969/70 to 1971/72  58
IV—Training of Health Branch Staff Proceeding Toward a Diploma or
Degree in a Public Health Specialty  58
V—Training of Health Branch Staff by Means of Short Courses  59
VI—Reported Communicable Diseases in British Columbia,  1968-72
(Including Indians)  60
VII—Reported  Infectious  Syphilis  and  Gonorrhoea,  British  Columbia,
1946, 1951, 1956, 1961, 1965-72  61
VIII—Statistical Summary of Selected Activities of Public Health Nurses,
September 1971 to August 1972, Inclusive  61
LX—Statistical Summary of Public Health Inspectors' Activities, 1969-72,
for 17 Provincial Health Units  63
X—Summary of Services Provided by Speech and Hearing Services, 1972 63
XI—Report of Direct Service by Auxiliary Workers to Public Health Nursing Programme, September 1971 to August 1972  64
XII—Number of Pupils Receiving Basic Immunization Prior to Entering
Grade I, September 1971  64
XIII—Number of Pupils With Immunization Up to Date at End of Grade I,
June 1972  64
XIV—Rubella Immunization Status of Grade V Girls, June 1972  64
 Tables—Continued
XV—Enrolment in Public and Private Schools in British Columbia, June
1972	
XVI—Pupils Referred for Health Services	
XVII—Registrations Accepted Under Various Acts	
XVIII—Case Load of the Division of Rehabilitation, January 1 to December
31, 1972	
XIX—Statistical Report of Tests Performed in 1971 and 1972, Main Laboratory, Nelson Branch Laboratory, and Victoria Branch Laboratory
XX—Emergency Health Service Medical Units Pre-positioned Throughout
British Columbia	
XXI—Licensing of Practical Nurses	
65
65
65
66
67
68
68
 Seventy-sixth Annual Report
of the Public Health Services of British Columbia
HEALTH BRANCH
Department of Health Services and Hospital Insurance
YEAR ENDED DECEMBER 31, 1972
Public health services throughout the world have almost invariably had their
origins in the need to control communicable diseases. The official bodies providing
these services have carried names such as "Health Departments" and "Boards of
Health," depending upon the wishes of the legislators of the day.
In British Columbia, the first legislation to authorize a Provincial Board of
Health was passed in the late 1860's, but such a Board did not actually function until
almost 30 years later! Beginning in the 1890's, however, the Board exercised its
authority in administering the Province's public health services and continued to
do so for some 50 years. Then, in 1946, the services were given full departmental
rank when the Department of Health and Welfare was created. In 1959 this was
changed to the Department of Health Services and Hospital Insurance, comprised
of three parts, each with its own Deputy Minister—the Public Health Branch, the
Mental Health Branch, and the Hospital Insurance Service. Late in 1972 the Medical Services Commission was included (on transfer from the Department of the
Provincial Secretary) to make a "four-branch" department.
Over the years, most public health services throughout the world have extended
their programmes and activities well beyond communicable disease control. British
Columbia has been no exception. Since World War II the public health services
provided by the Health Branch have expanded to include formal programmes in
nutrition, public health education, and aid to handicapped persons. At the time
of the poliomyelitis epidemic in 1953 the Government established, under the
jurisdiction of the Health Branch, a facility for the continuing care of post-
poliomyelitis cases. Parts of the Health Branch's Pearson Hospital in Vancouver,
built in 1951 for the care and treatment of tuberculosis patients, have been gradually
converted for the long-term care of other types of patients who do not have communicable diseases. In 1957 the first "home care" programme was established in a
health unit (local health department). By the end of 1972, 114 centres throughout
the Province had home care programmes. (As the name implies, they are intended
to provide health services in the patients' own homes and so reduce the need for
high-cost hospital care.) In 1971 the responsibility for administering the Community Care Facilities Licensing Act was transferred to the Health Branch. (Under
this Act the main objective is to ensure that proper supervision is given to boarding-
homes, kindergartens, and other facilities giving care to persons who, although not
ill, are not able to care for themselves.) More recently still, the Health Branch was
given the major responsibility in designing, constructing, and probably operating
several "personal care" homes. (According to present planning, these will provide
beds for ambulatory persons who do not require services in an extended-care hospital but who need more care than can be provided in a rest home.)
With these changes in the role and the responsibilities of the Health Branch,
the time has come to re-examine the objectives and to include in the re-examination
the relationships among the services offered by the Health Branch and those offered
by the other branches of the Department.   With this end in view, the Provincial
 H 10
PUBLIC HEALTH SERVICES REPORT,  1972
Government commissioned Dr. R. Foulkes, late in 1972, to undertake a study
entitled the "Health Security Research Project." It is anticipated that Dr. Foulkes
will submit a report to the Minister of Health Services and Hospital Insurance in
approximately one year's time.
This Seventy-sixth Annual Report describes the events and trends in the public
health services during 1972 and the state of affairs at the end of the year. Details of
the various programmes are set forth in the narrative which follows this introduction
and the tables which appear at the end of the Report.
THE PROVINCE AND ITS PEOPLE
There was a population of 2,247,000 in the Province in 1972, which is 62,000
more than in 1971. In the Province's area of 366,000 square miles, this is about
6.1 persons per square mile compared with 4.5 of 10 years ago. While the central
area of the Province has shown notable growth during this period, the heaviest concentrations of population continue to be in the southwestern corner of the Province.
Some of the more significant developments recorded among the population during the year are revealed by the following preliminary statistics:
• The birthrate per 1,000 population declined in 1972 to 15.5. The final
figure was 16.0 in 1971.
• For the second year, a drop of some magnitude occurred in the proportion of
births which are illegitimate. A high of 13.8 per cent was reached in 1969.
The following year the percentage dropped very slightly to 13.7. However,
in 1971 there was a more pronounced decline to 12.2 and in 1972 this
reversal was continued, the proportion declining to 11.2 per cent. This is
the same as the percentage seven years ago.
• Again, in 1972, there was little change in the marriage rate, there having
been 9.2 marriages per 1,000 population. The 1971 rate was 9.3.
• Likewise, the deathrate showed little change in 1972, being 8.0 per 1,000
population, the same as the record low rate first recorded in 1970.
• Heart disease took a somewhat greater number of lives in 1972 than in the
previous year. The rate of deaths was 270 per 100,000 population, compared with the 1971 rate of 266. In view of the almost continuous, and
considerable, decline in heart-disease deaths since 1965, this year's slightly
higher figure is not surprising.
• Cancer showed no change in the rate of deaths this year, the rate recorded
being 154 per 100,000 population. This was lower than the rates for 1969
and 1970, however.
• The rate of deaths for cerebrovascular lesions in 1972 was 89 per 100,000,
somewhat higher than the rate of 85 for 1971.
• Accidents resulted in 74 deaths per 100,000 population, a slight reduction
from the last year's high figure of 75. The proportion of accidental deaths
resulting from motor-vehicle accidents was 41, slightly above the level in
1971. The proportion of accidental deaths which resulted from falls increased again this year, being over 16 per cent.
• The suicide rate for 1972 was at about the same high level recorded in 1971,
17 per 100,000 population. This is considerably above the rate of about 10,
registered 10 years ago.
• An encouraging improvement was noted this year in the infant mortality
rate, one of the important indices of the level of community health services.
The rate recorded in 1972 was at a record low of 16.0 per 1,000 live births.
 INTRODUCTION
H 11
Again this year, as in 1971, there were no serious outbreaks of communicable
disease in British Columbia.
For the second time in the history of the Province, reports were received of
Western equine encephalomyelitis among humans. As yet there is no commercially available vaccine for prevention of this disease and control measures are expensive and not very effective.
Trichinosis from infected bear meat was also reported a number of times.
The amount of trichinosis infection in game animals is not known and studies
are under way to determine the extent of the problem.
The epidemic of gonorrhoea, which started in 1969, continued through 1972.
However, as a result of the decline in the number of transient youths and
the increase in the numbers of unemployed youths living independently and
no longer under parental control, there has been a change in the epidemic
pattern. The disease now continues at a high rate throughout the year,
whereas formerly it was a summer epidemic.
A further increase this year in reported active tuberculosis cases seems to
confirm that the decline which occurred in the number of reports for 1970
was an unusual fluctuation. It appears that the large number of immigrants
into the Province is contributing to the maintenance of the number of active
cases.
^s^td
In this, my first report as Deputy Minister of Health and Provincial
Health Officer, I wish to note another significant event which occurred in
1972. This was the retirement, early in the year, of Dr. James A. Taylor,
my predecessor in office. Dr. Taylor began his career in the public health
services in 1938 when he became a Medical Health Officer in the Abbotsford
area. He became second-in-command of the Provincial service in 1949 and,
in 1962, was appointed Deputy Minister of Health and Provincial Health
Officer. During most of the years of his service I had the privilege of working closely with him. I have first-hand knowledge of the great contributions
which he made.
G. R. F. Elliot
Q^K)
 H 12
PUBLIC HEALTH SERVICES REPORT,  1972
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VI
 COMMUNICABLE AND REPORTABLE DISEASE
H 13
COMMUNICABLE AND  REPORTABLE  DISEASE
Although there were no serious outbreaks of communicable disease in the Province this year (see Table VI), 7 human cases of a disease, Western equine encephalomyelitis (WEE), new to British Columbia, were reported from the southern part of
the Okanagan Valley. WEE is primarily a disease of wild birds which is transmitted
to man and horses by mosquitoes. There is, as yet, no commercially available
vaccine that can be used to protect against this disease and the main preventive
measure is through expensive and somewhat ineffective mosquito-control procedures.
Seventeen human cases of trichinosis, another disease of animals, occurred as a
result of eating smoked sausage adulterated with infected bear meat. It is known
that many bears are infected with this condition, and studies are under way to determine how serious and widespread this problem is among game animals.
DIPHTHERIA
Diphtheria continued to be a problem in the Greater Vancouver area. Throughout the Province there were 11 cases reported and 33 carriers were identified. There
is no doubt that, if the present level of immunity against diphtheria is not maintained,
there would be many more cases in all parts of the Province.
INFECTIOUS HEPATITIS
Infectious hepatitis continues to be a problem with 1,894 cases reported. This
last year saw some progress made in the development of laboratory methods which
could lead to better control of this disease. A number of laboratories are now able
to carry out tests which can differentiate between hepatitis A and B, which appear to
be spread in different ways. Permanent active immunization is still not possible and
some serious questions are being asked about the real value of the temporary passive
immunization provided by immune serum globulin.
RUBELLA VACCINATION PROGRAMME, 1971/72
Only 84 cases of rubella were reported this year, compared with 1,168 cases
in 1971. Rubella occurs in marked cycles and it will not be possible to determine
the real value of the mass-immunization programme undertaken in 1970 for another
seven or eight years. About 85 per cent of the Grade V girls in the Province are now
protected and every health unit is trying to ensure that no girl enters her child-
bearing years without protection against rubella.
RHEUMATIC FEVER PROPHYLAXIS PROGRAMME
A careful review of this programme during the year showed that several hundred
children were taking their medication very irregularly or not at all. These were
dropped and there are now about 1,000 children regularly taking oral penicillin to
prevent recurrence of rheumatic fever.
TUBERCULOSIS
In 1970 a substantial decrease to 453 in the number of active cases was
reported, but it was not possible to state whether this was a trend or simply repre-
 H 14
PUBLIC HEALTH SERVICES REPORT, 1972
sented an abnormal fluctuation. In 1971 there was an increase to 515 and substantially the same number was reported for 1972. This would suggest that the
decline in 1970 was simply a fluctuation, so that, contrary to the 1960's, a continuing
drop in the incidence of tuberculosis is not being experienced. In part, at least,
maintenance of the number of active cases can be attributed to the large number of
immigrants involved, particularly from southeast Asia.
The latter point gives rise to concern about immigration policies. Individuals,
particularly from southeast Asia areas, come to Canada on a visitor's permit and
immediately apply for immigrant status. Even if active disease is found, there is no
alternative but to admit them. Since they have not utilized routine channels, there
is no sponsor's bond and, therefore, the disease is frequently treated at the expense
of Canadian citizens. There are six examples of admissions of such visitors in a
two-month period late in 1972.
The time involved in the treatment of tuberculosis has not changed, but the
programme in British Columbia continues to treat many infected persons wholly as
out-patients, the out-patient figure for 1971 being slightly less than 50 per cent of
all persons treated. Of those admitted to hospital, 66 per cent are discharged within
four months and only 3 per cent remain in hospital a year or longer. In most
instances, this latter group represent custodial care where it has been impossible
to arrange adequate placement. This length of hospitalization is one of the lowest
in Canada.
As stated in last year's Report, the relatively poor yield of discovery from
community surveys has led to a change in the manner in which these are conducted.
The concept of "Operation Doorstep" has been abandoned and the surveys are now
programmed to offer miniature X-ray facilities to those communities which do not
have such service available either in their local health unit or hospital. It is becoming
apparent that there is little value in attempting a skin-testing programme in conjunction with these surveys. Previously, a physician travelled with the team and read
the miniatures immediately so that the individual was induced to return. He would
receive his X-ray report when he had the skin test interpreted. Now, the physician
is stationed in Vancouver and the reports of the X-ray are mailed to the patient. As
a consequence, only about one-third of patients return to have their skin test read.
The skin-testing in schools has also been abandoned as a routine because the
yield of positive reactions was so low, being less than 1 per cent. It is intended,
however, to continue periodic testing in schools in high-incidence areas.
The type of solution (PPD) has been changed and a new product is now used.
This contains Tween 80, a detergent which prevents adherence of the PPD to the
syringe and, thus, a more accurate dose is administered. Its use has produced
somewhat larger reactions, but most doubts about tests which previously produced
problems, particularly where the interpretation of a positive resulted in prophylactic
treatment, have been eliminated.
In reviewing case-finding, it must be stressed that the most productive source is
the general hospital, which contributed about 45 per cent of the total number
of cases found in the Province. It is therefore imperative that all adult patients
admitted to hospital have a routine chest X-ray. With the removal of miniature
X-ray equipment from hospitals, this is not being done.
It is also of interest to note that the rate of new active tuberculosis is almost
double in the non-Canadian-born as compared with the Canadian-born, and the
incidence in Chinese almost equals that in the native Indian population.
Through the Registry, the contact tracing continues to be successful. Thirty-six
active cases were found by these means.    In all instances, contact had occurred
 COMMUNICABLE AND REPORTABLE DISEASE
H 15
where the source case had positive sputum. In only two instances was there positive
culture only.
The Province continues to enjoy a low mortality rate from tuberculosis. The
over-all rate was 1.2/100,000 and, if Indians and Orientals are excluded, the rate
was 0.9/100,000.   Of the 27 deaths, 13 occurred in persons over 70 years of age.
Work has commenced on the conversion of the fourth floor of the north-south
wing of Willow Chest Centre for the cardiac-surgical unit. This has necessitated
opening a third ward at Pearson Hospital for tuberculosis patients, with only 31
beds being presently available at Willow Chest Centre.
VENEREAL DISEASE
Venereal diseases are usually contracted through sexual intercourse. Of the
five diseases classified as venereal, only gonorrhoea and syphilis occur in this Province. Several other infections, often spread by venereal contact, may also be spread
by other means.
The present epidemic of gonorrhoea first started in 1969. The numbers of
transient young people have since declined, but the numbers of alienated young
people who are living independently and not under parental control have increased.
The pattern of the gonorrhoea epidemic has changed from a summer epidemic to a
high year-round incidence (see Table VII).
There have been several changes in control practices during the year:
• A transport medium has been made for use by physicians, to take routine
cultures from females in the sexually active age-groups. This is necessary
because many females do not know they are infected. It is difficult to establish a diagnosis on females from a smear only, so the newer culture techniques
will greatly increase the ability of physicians to diagnose gonorrhoea.
• In addition to the Darkfield test for syphilis, the direct fluorescent test for
treponema pallidum (DFA/TP) has been introduced. This test eliminates
the need to transport a live organism so that the diagnosis of syphilis can be
made from skin lesions by dead bacteria. All physicians in the Province
can now test for the diagnosis of syphilis from skin lesions.
Many young people do not understand that venereal disease is controlled by
identifying, locating, and treating sexual contacts. They tend to protect their sexual
contacts and so encourage the spread of the disease. Consideration is being given
to the addition of a health educator to the staff of the Division to develop educational
programmes in order to facilitate the control of venereal disease.
An additional male nurse was employed to provide an alternate clinic for the
male homosexual population and to establish co-operation with them.
Syphilis remains under good control with only minor outbreaks in this Province.
It is, however, being constantly introduced from the outside by sick mariners, male
homosexuals visiting cities to the south, single men visiting Mexico and Europe, and
transient youths visiting from the United States. The control programme involves
identifying the sexual contacts of cases and in turn identifying the sexual contacts of
the contacts. They are all treated as though they were infected with syphilis, and so
the epidemic is eliminated. By repeating this each time a case of syphilis is diagnosed, it is possible to keep this disease under good control.
Latent Syphilis
Perhaps a third of the persons who acquire syphilis have no outward manifestations of this disease. The disease is then termed "latent," and can only be diagnosed
 H 16
PUBLIC HEALTH SERVICES REPORT, 1972
by a blood test. A VDRL test is used as a screening procedure and the Fluorescent
Treponemal Antibody Absorption Test is used for the confirmatory test. Each
working-day the Provincial laboratory examines over 600 blood tests submitted by
private physicians and venereal disease clinics. In addition, routine blood tests are
taken on all persons donating blood to the Red Cross Society and on patients
admitted to the veterans' hospitals and the mental hospitals. It is necessary to
uncover these patients who do not know they have syphilis and provide them with
treatment to prevent the serious late manifestations of heart disease, paralysis, and
mental illness.
Gonorrhoea
Gonorrhoea is caused by a specific bacterial infection usually limited to the
genital tract. There is a short incubation period of two to nine days, following which
the male will have a burning pain on micturation and a urethral discharge. Perhaps
four out of five females have no symptoms whatsoever and only one out of five will
have a vaginal discharge or a burning pain on micturation. The major problem is
that females may not know they are infected and will unknowingly continue to spread
this infection until they are identified and brought to treatment. Gonorrhoea is a
disease which occurs primarily in single young people. The average age for the
male is 22 and for the female it is 20. They are usually not living at home but are
living independently away from parental influence.
Although most people are willing to attend a venereal disease clinic, not all are
prepared to do so. Further, there are still people who will not attend their private
physician for either venereal infections or family planning because they consider
them to be social and not medical problems. In order to reach these people and
provide facilities for them, several different types of clinics are maintained. In 1970
a nurse was employed to work with young people and since then two nurses have
been added under a Federal grant for this purpose. As there has been a decrease
in transient youth and an increase in nontransient youth, there has been a trend to
less street work and the operation of more clinics to serve this clientele. In the
summers of 1971 and 1972, public health nurses throughout the Province extended
a medical service to hostels for the medical care of transient youth. Arrangements
were made with local physicians to volunteer their services to provide treatment for
those medical conditions referred by the public health nurse.
The Vancouver City Gaol has discontinued the practice of incarcerating women
charged with soliciting. It was no longer possible to examine them before a gaol
appearance the following morning. Arrangements were made with the city police
to issue a requirement that a woman charged with soliciting be examined by a
venereal disease clinic or physician prior to her Court appearance. This procedure
is working well.
A recent report has indicated that some of the penicillins that are being used
in treating gonorrhoea have less penicillin available for absorption by the body. This,
coupled with the fact that gonococcus strains are showing increasing resistance to
antibiotic therapy, has necessitated an increase in the dosage of penicillin and the
addition of another drug, probenecid, to delay the excretion of the penicillin. Tro-
.bicin has been introduced and found to be an effective drug, but it is still very
expensive and has some undesirable side effects.
 COMMUNICABLE AND REPORTABLE DISEASE
H 17
NONGONOCCAL URETHRITIS
Nongonococcal urethritis, or nonspecific urethritis, is an infection of the male
which produces a watery or mucous discharge and a pain on micturation. Different
viruses have been thought to have been involved with this infection, but none has
been proven to be the cause. Examples of these are mycoplasma and conjunctivitis
inclusion virus. As with gonorrhoea, very few females show signs of this infection,
and yet it is necessary to treat steady female partners at the same time as the male
in order to prevent recurrence of this infection in the male. The incidence of this
infection in the male parallels that of gonorrhoea. This infection does not respond
to treatment with penicillin but does respond to treatment with seven days of sulpha
or tetracycline therapy.
GENERAL
Diagnostic and treatment clinics are maintained in Vancouver, New Westminster, Victoria, Prince Rupert, Dawson Creek, Prince George, and Kamloops. In
Vancouver, clinics are operated at the City Gaol, Willingdon School for Girls,
Oakalla Prison Farm, Vancouver Health Units 1 and 5, the Cool-Aid Free Clinic,
the Pine Street Free Clinic, and the Downtown Community Health Clinic. A clinic
is operated at Gordon Neighbourhood House, which is primarily used as an alternate
clinic for male homosexuals or "gays."
THE PUBLIC HEALTH NURSE AND DISEASE CONTROL
Disease control is a traditional area of concern of public health nurses and,
therefore, they are involved in the prevention and control of a number of diseases.
• Tuberculosis control is an important part of this programme, and 8,905
home visits made this year represented a 14-per-cent increase over last year.
• 16,101 tuberculin tests were administered by public health nurses to determine sensitivity to tuberculosis. Most tests were given to contacts of new
cases and to selected grades of school children in regions known to have a
high incidence of tuberculosis. There were 28 per cent more tuberculin tests
done this year than in the previous year.
• Venereal disease visits by the public health nurses were much the same in
number as last year and amounted to 4,779 visits.
• Public health nurses supervised 929 children on rheumatic fever prophylaxis
treatment.
• In addition, 6,707 visits were made for the epidemiological investigation of
diseases and to give prophylactic injections for infectious hepatitis.
• Public health nurses gave 466,034 individual immunizations and 12,964
tests at special clinics and at child-health conferences held at neighbourhood
health centres. (See Table VIII for the contribution of public health nurses
in immunizations.) The number of immunizations is down from last year as
the extensive rubella campaign has now been completed. Rubella vaccine
is now available as part of the routine immunization schedule and is given to
children when they are 15 months old.
• Immunizations done by the public health nurses provided a minimum saving
to the British Columbia Medical Services Plan of about $934,000. These
immunizations might otherwise have been charged to the Plan at a rate of
$2 per dose.
 H U
PUBLIC HEALTH SERVICES REPORT, 1972
HEALTH  AND OUR  ENVIRONMENT
Work under this main heading is carried out by the Division of Environmental
Engineering, the Division of Public Health Inspection, and the Division of Occupational Health.  The reports of the three divisions are given separately as follows:
ENVIRONMENTAL ENGINEERING
This has been another interesting and challenging year for the Division of
Environmental Engineering. Each member of the staff has generously contributed
to the achievements made. A sincere effort has been made to give more time to the
health units, especially by way of field visits. The programme to update the records
for the public waterworks systems got off to a good start, but was hampered somewhat because of staff resignations.
It was apparent from numerous discussions with the Medical Health Officers
throughout the Province that they shared the concern of this Division regarding
the need for "preventive" measures to be taken in our struggle with environmental
control and management. While regulations may be unpopular with many people,
they do assist to preserve the environment. The members of this Division have cooperated with the health unit staffs in applying the regulations in a sensible and
reasonable manner. As our environment becomes more hazardous for living, it will
mean that more of people's activities must be regulated.
In accordance with the Health A ct, approval of plans and specifications for all
public waterworks systems proposed for construction in British Columbia is the
primary divisional function. A secondary function is that of consultant to the field
staff on subjects which include private water supplies and treatment, sewage and
solid-wastes disposal, swimming-pool design review and operation, subdivision approvals, and water-quality studies.
Although there were only 104 official visits to the health units throughout the
Province this year, this continues to be one of the most important roles for the engineers, since it affords them the opportunity to gain field experience which makes
them useful as consultants. Records of various kinds are kept in the files of this
Division, and include water chemical analysis, master plans for waterworks systems,
fluoridation, public swimming-pools, and pollution control permits.
Before any part of a public waterworks system proceeds to construction, a Final
Certificate of Approval from the Health Branch must be issued to the owner. This
year the number of approvals issued was 538, an increase of 158 over last year. The
publication of a waterworks design manual has not yet reached the printing stage,
but work is proceeding on it.
Water quality for municipal water supplies continues to be a concern to this
Division. While treatment with chlorination is often sufficient to make the water
potable, many supplies are being affected by various activities in the watershed which
contribute to the turbidity, colour, and other aesthetic features. It is hoped that the
"Task Force on Multiple Use of Watersheds of Community Water Supplies," set up
by the Ministers' Environment and Land Use Committee, will be effective in its
efforts to maintain good aesthetic water qualities for many of the British Columbia
communities.
Another major role of the Division is to offer constructive advice to municipal
engineers and waterworks superintendents regarding the operation of their water
 HEALTH AND OUR ENVIRONMENT
H 19
systems to ensure safety to public health. This year 137 official visits of this kind
were recorded.
Swimming-pool plans have been reviewed on behalf of the Medical Health
Officers who are responsible for issuing approval for all public swimming-pools in
accordance with the Swimming-pool Regulations. It is estimated that 74 public
swimming-pools have been reviewed by the Division this year.
Another way in which the Engineering staff is able to keep in touch with current practices and new equipment is through attendance at conferences and short
courses, as well as being involved in projects which require background reading from
professional literature. In this regard, members of the staff were very busy this year,
two of them appeared on a television series which dealt with the environment. Two
members of the staff also took part in an open-line radio programme which discussed
sewage treatment. On 12 other occasions members of the staff spoke to various
groups such as schools and community service groups on subjects relating to public
health engineering.
During the year, consultant services were given to a district municipality in
solving a swimming-pool operation problem. On another occasion one staff member
visited 19 fish hatcheries in the western United States in connection with a project in
which he acted as consultant to the Department of Public Works on a proposed
$5,000,000 fish hatchery.
The Ministers' Environment and Land Use Committee has requested various
Government departments to study and report on different problems affecting environmental control. This Division has been represented on three different task forces,
namely, watershed control, harbour water-quality studies, and indiscriminate dumping of garbage. In addition to these studies, members of this Division were included
in the committee which drafted Provincial Building Codes (cross connection control),
and a committee dealing with sewage-sludge utilization (Iona Sewage Treatment
Plant). The Division has continued with its activity in the water and waste operators
training course at UBC. Four members of the staff gave lectures at the short course
and the Assistant Director of the Division acted as co-ordinator for the school.
Areas in which staff members gained further training included a short course
on incineration, another on solid-waste recycling, and a third on well (groundwater)
design and theory.
PUBLIC HEALTH INSPECTION
This Division's role is to assist the local health departments to provide a comprehensive environmental health programme for the people of British Columbia.
The preventive health aspect of the Public Health Inspector's job has been reinforced
by the following activities (see Table IX):
• New Food Premises Regulations became effective April 1, 1972, providing
an up-to-date code for the food trade in British Columbia. One of its main
features is the introduction of the permit system for restaurants and catering
businesses. The permits will be issued annually by the Medical Health
Officer when he is satisfied that the applicant has sufficient knowledge of
modern food-handling practices and adequate equipment to enable him to
operate in a safe and sanitary manner. The first permits will be issued April
1, 1973, thereby giving operators ample opportunity to bring their premises
up to the required standard.
• The Camp-sites Regulations were amended in October of 1971, making it
mandatory for the operator to have an annual permit from the Medical
 H 20 PUBLIC HEALTH SERVICES REPORT, 1972
Health Officer.  The permit system has assisted with the upgrading of campsites for the travelling public.
• A major revision of the procedure manual for public health inspectors was
completed this year.
• Site inspections by the public health inspectors prior to the development of
new subdivisions, and the requirement under the Sewage-disposal Regulations
calling for a permit from the Medical Health Officer for the installation of a
private sewage-disposal system, has reduced the number of health hazards
resulting from poor installations.
Educational Activities
The Division of Public Health Inspection organized a one-week course for 42
public health inspectors in February, with the main emphasis on food control. The
course also dealt with a number of other subjects, including community care facilities,
noise control, pesticide control, and the use of the mass media in education.
Fifteen students from the public health inspectors' course at the British Columbia Institute of Technology were given field-training in various health units
during June, July, and August.
Public health inspectors have worked with the food-service industry and the
Department of Education to educate food-service workers in safe food-handling
techniques.
The Director of the Division has worked with the Canadian Restaurant Association, Provincial and municipal health officials, and the Department of National
Health and Welfare in the preparation of a National Sanitation Code for Canada's
food-service industry. He was invited to attend a seminar in Ottawa to assist with
the completion of the code.
As well as serving on the Advisory Committee for the public health inspectors'
course at the British Columbia Institute of Technology, the Director of this Division
served as a supervising examiner for the Board of Certification of Public Health
Inspectors, established by the Canadian Public Health Association. The examinations in western Canada were held in June and September in Vancouver. A total of
23 candidates passed the examinations.
OCCUPATIONAL HEALTH
Radiation Protection
This year, with the establishment of requirements for accreditation of radiology
facilities under the Provincial Medical Services Act, it became necessary for the
owner to produce a current radiation survey report indicating that his X-ray equipment met the necessary safety codes for radiation protection. As there is no other
body in the Province equipped to provide this service, the Radiation Protection Section of the Occupational Health Division was asked to assist with this task.
In acute general hospitals there are 350 medical X-ray units which are being
surveyed regularly as part of the Division's safety programme. It is estimated that,
under the regulations of the Medical Services Act, an additional 200 units will be
added to the list. This is equivalent to more than a 50-per-cent increase in the Division's annual inspection programme for the medical profession. In order to survey
the new units a major reorganization of priorities and manpower will be required.
 HEALTH AND OUR ENVIRONMENT
H 21
In addition to the above, approximately 950 X-ray units are surveyed for the
dental, chiropractic, and veterinarian professions, and for research and industry.
The continuing proliferation of microwave ovens throughout the Province has
necessitated a stepped-up programme that could ultimately involve the public health
inspectors as surveyors. A pilot project was carried out in the Victoria-Saanich area.
Preliminary results of this survey indicate that almost 50 per cent of microwave ovens
are leaking excessive radiation and are a potential health hazard. More survey instruments are to be acquired in 1973, and these will be used by the various health
units throughout the Province.
During the past five years, United States nuclear submarines visited Esquimalt
and Nanoose Bay of Vancouver Island. Assistance has been given to the Canadian
Navy in the monitoring of air and sea water to ensure that there was no release of
radioactive material during the time the submarines were in port. The visits have
become more frequent and, as tentative dates only are known in advance, the Division's regular survey programme has been disrupted. Four visits out of eight scheduled were carried out in 1972, with 301 air and 70 sea-water samples being checked.
In January 1972, the Department of National Health and Welfare, Ottawa,
issued a warning concerning radiation hazards from ionizing radiation-producing
devices used in high schools as educational aids. In view of this, visits have been
made by inspectors to a number of high schools throughout the Province. The
opportunity was taken to survey school equipment and to discuss any hazards with
the teachers concerned. Sixteen secondary schools have been visited in Victoria,
Duncan, Nanaimo, Trail, Rossland, Castlegar, Vancouver, and Cranbrook. A number of old X-ray tubes have been located, together with other devices which have
been found to emit excessive amounts of radiation. The teachers have co-operated
in most instances by removing the terminals of the X-ray tubes so that they cannot
be activated. Other devices which emit excessive amounts of radiation have been
withdrawn from use or are being operated at lower voltages to reduce the field. In
some instances they have been installed in shielded boxes.
The Radiation Protection Section was involved in a number of unusual investigations, some of which are briefly described below:
• The radioactive source storage room at HMC Dockyard, Esquimalt, containing several cesium and radium sources, was flooded when a water main broke.
• A road transport company in Burnaby received a trailer from eastern Canada
which carried two shipping flasks containing 170,230 curies of cobalt-60,
with a thermal decay heatload of over 2.5 kilowatts. An inspection revealed
that the shipping flasks had been completely surrounded by a shipment of
cardboard cartons containing flight bags, and intense heat resulted. The
Atomic Energy Control Board advises that new transport regulations, to be
published soon, will prevent such situations occurring. In addition, Atomic
Energy of Canada, supplier of this cobalt-60, will print warnings in future
not to overload a trailer in which sources generating significant quantities
of heat are being carried.
• "Coin amusement" firms in Vancouver have been importing a "laser game"
which is installed in billiard halls and restaurants. On learning of the presence of these machines, and the possible hazards from lasers, an inquiry was
made. The sale of laser machines will eventually be controlled by regulations under the Radiation Emitting Devices Act.
The Radiation Protection Section has acquired a $12,000 nuclear data, multichannel analysing system capable of examining and determining the radioactive
 H 22
PUBLIC HEALTH SERVICES REPORT, 1972
elements present in a sample, e.g., air, water. It is also useful in environmental surveillance programmes. In case of accidents, it will provide the necessary information so that the proper protective measures can be instituted. The analyser can
determine the radioactive build-up from fallout in soil and plant life, and it will be
useful for monitoring TRIUMF (Tri University Meson Facility).
The reconstituted Radiological Advisory Council, and its several committees,
have been meeting regularly under new terms of reference which require it "to
develop and maintain an over-all plan for radiological services in British Columbia
hospital facilities, to establish priorities, and to develop methods of review to control
over-utilization." Three permanent committees have been established—the Equipment and Planning Committee, the Functional Programme Review Committee, and
the Radiation Safety Committee. In addition, four ad hoc committees to establish
guidelines for angiography, tomography, mammography, and ultrasound have been
set up.
Since its reactivation in April of this year, the Radiological Advisory Council
has had six meetings, the Equipment and Planning Committee 12 meetings, and the
Functional Programme Review Committee four meetings.
At the request of the British Columbia Hospital Insurance Service, the Radiological Advisory Council has reviewed and recommended acceptance of 50 applications for grant from Provincial hospitals toward capital cost of radiological equipment with a gross value of $518,192. The Director of Occupational Health and two
members of the Radiation Protection Section are members of the Council and several
of the committees.
Other Activities
Apart from radiation protection services, environmental activities mainly involve the Director of the Division. The Committees on Pesticide Control have been
very active this year and requests for medical assessments from the Pollution Control
Branch with regard to air-emission applications have increased manyfold.
With the TRIUMF (Tri University Meson Facility) project nearing completion,
the Division is still very much involved with the development of a proper disposal
site for radioactive waste. A committee from the Atomic Energy Control Board,
Ottawa, made a preliminary inspection of a proposed site in the Province in May
1972.
The Division, as in previous years, continued to provide consultative services
on environmental and industrial hygiene problems to local health departments, other
departments of Government, and private industry.
SPECIALIZED COMMUNITY HEALTH  PROGRAMMES
The Health Branch is responsible for the maintenance of a number of specialized programmes designed to help various sections of the community. These include people afflicted with a specific and sometimes rare disease, and elderly people
and very young children requiring special care for a variety of reasons. Motor-
vehicle and poisoning accidents are also covered by special programmes.
A summary of these is as follows:
 SPECIALIZED COMMUNITY HEALTH PROGRAMMES
H 23
KIDNEY FAILURE CORRECTION PROGRAMME
This programme was established to provide equipment, drugs, and supplies to
patients who were trained to operate an artificial kidney in their own home. The
procedures and equipment are improving, and a major change has been made to
reduce blood-clotting problems. Some patients have a problem with a catheter
when the latter is placed in an artery and vein. By surgically connecting an artery
and a vein and using needles to draw off the blood and return it after cleansing in
the artificial kidney, complications have been markedly reduced. This has meant a
modification in equipment, and retraining of patients, so that fewer patients have
been prepared for the home service.
There are now 68 patients at home on hemodialysis, and this is roughly the
same number as a year ago. It costs an average of $236.00 a month to maintain
the patients on hemodialysis. There are three training centres to train patients for
hemodialysis—two in Vancouver and one in Victoria. In addition, there are two
support centres located at Kamloops and Trail.
Not all patients are suitable for hemodialysis and it is possible to maintain
some of these on peritoneal dialysis. Because machines and concentrate have not
been developed, the procedure is time-consuming and laborious. It does serve as a
method of allowing the patient the freedom of being at home. However, improved
methods will soon be available, and peritoneal dialysis is probably a temporary
method. There are currently 15 patients at home on peritoneal dialysis, and the
average cost of maintaining a patient at home is $607 a month.
Patients deprived of all kidney function often have generalized disease, and
their life expectancy is diminished. This is a general statement that explains the loss
of nearly one patient a month. On the other hand, those patients who are relatively
healthy are able to lead quite normal productive lives. One patient no longer had
need of the service because, after a very prolonged period of time, his own kidneys
regained adequate function.
Not all patients can be trained for dialysis in the home. It has been necessary
to supply some patients who are treated in hospital with drug subsidies amounting to
$3,150, and transportation subsidies of $6,130.
Some patients are suitable to receive a kidney transplant. Fresh transplantable
kidneys are not readily donated, so that the opportunity to receive a kidney transplant with a kidney that has blood and tissue matching does not occur frequently.
There are several patients who are functioning on transplanted kidneys, and it is
necessary to supply some of them with immuno-suppressive drugs.
This service is being gradually expanded to provide supplies for other patients
who can be cared for at home. For example, there is one patient with Crohn's
disease who must receive most feeding intravenously. The maintenance cost is $287
a month. Although it may seem costly to maintain these patients, it is much less than
the $1,500 or more that it would cost to occupy a hospital bed for a month. It also
allows the patient the freedom of living at home.
The Service has been improved during the year. In order to get started,
arrangements were made with the hospitals to supply drugs and other supplies to
the patients. These are charged to the Service. Last year a stockman was employed,
and this year a warehouse was rented and stocked. It started to function as a supply
centre for artificial kidney machines, concentrate, and supplies. A clerk was added
to the staff to maintain the records. The training centres are still supplying the staff
to evaluate homes, start patients at home, and provide the support services for the
home patients, with this Service providing their travelling expenses.
 H 24 PUBLIC HEALTH SERVICES REPORT,  1972
This Service operates with the assistance of two committees. A committee of
physicians appointed by the Medical Association is a consultant committee to recommend policy to the Minister of Health. Another committee of nurses and technicians
make recommendations concerning the equipment and supplies to be used.
POISON CONTROL PROGRAMME
There are now 57 hospitals participating in the British Columbia Poison Control Programme. More than 8,000 cases of poisoning, either accidental or intentional, were reported during the year. From the reports received, the information
cards produced by the Faculty of Pharmaceutical Sciences for the Health Branch
were a great help in determining the treatment required. The Provincial reference
centre planned for the Vancouver General Hospital is still not in operation due to
lack of space and staff-time to operate it on a full-time basis.
HYPOGAMMAGLOBULINEMIA PROGRAMME
At the end of the year, 11 people with this uncommon medical condition were
receiving regular monthly injections of immune serum globulin at no cost to themselves. The Health Branch is fortunate in having the services of specialists from
the Faculty of Medicine and the Red Cross Blood Transfusion Service to act as
consultants to this programme and to advise on individual applications where there
may be some question as to whether immune serum globulin will be an effective
remedy.
SPEECH AND HEARING SERVICES
During the past year the concepts of the services offered under the title "Speech
Therapy" have undergone revision. This is in keeping with the development of new
training programmes in Canadian universities for the disciplines of speech pathology
and audiology. These programmes prepare personnel to undertake diagnosis, treatment, and management of the population with disorders of communication, and
require that graduates have knowledge of the normal development of speech, language, and hearing, and the processes which disrupt communication and the techniques of habilitation and rehabilitation.
Within the British Columbia Health Branch these trends are reflected primarily
in the appointment of an audiologist as Director of Speech and Hearing Services.
In addition, further placement of speech pathologists in local health units has continued with the concurrent expansion of programmes. The role and function of
speech pathologists in a public health setting is emerging and evolving as the needs
of the population become known. The primary aim at present is to develop programmes for the identification, management, and prevention of communication
disorders in children during the pre-school years with ongoing diagnostic and
rehabilitation services for other age-groups in the population, whenever and wherever possible. A major portion of the time of the speech therapy staff is spent in
developing and carrying out in-service training programmes for public health nurses
and primary teachers so that they may develop skills in identifying and referring
those children who exhibit handicapping problems in speech and (or) hearing.
Highlights of the service in 1972 were as follows (see Table X):
• A pilot project was carried out in five health units with selected groups of
public health nurses from all areas of the Province during the past year to
 SPECIALIZED COMMUNITY HEALTH PROGRAMMES
H 25
assist them in gaining additional skills in screening the hearing of young
children.
• The Provincial Speech and Hearing Planning Committee has continued to
discuss the necessary speech and hearing services as required in British Columbia. A Hearing-aid Regulation Act was passed in 1971. It provides for
the licensing of hearing-aid dealers and consultants. A Board was established to administer regulations under the Act.
Hearing Conservation, Planning Considerations
In recent years, advances in otology, audiology, and education have emphasized
the importance of early detection, rehabilitation, habilitation, and education for the
acoustically handicapped. These advances have resulted in the establishment of
hearing conservation programmes throughout the nation and the world. Current
planning includes provision for the development of a comprehensive concept in
hearing conservation. A location will be selected in the near future for a pilot project
encompassing the following public health planning principles and considerations:
• Prevention.
• Mass screening.
• Assessment, to establish the type, severity, and cause of the disorder.
• Medical consultation and treatment.
• Rehabilitation, including selection and fitting of prosthetic devices; speech,
hearing, and language therapy and education.
Particular attention will be given to establishing the feasibility of developing
programmes utilizing mobile units and (or) permanent facilities within health unit
areas.   Included within the general planning principles will be specific provision for
• mass identification audiometry procedures, including extended in-service
training for nurses, speech therapists, and volunteers;
• comprehensive diagnostic audiologic assessment;
• establishment of a differential diagnostic, treatment, and management concept, including audiologic, medical, nursing, social, speech, and hearing rehabilitation and education;
• provision for continuing professional management and supervision of clinical
cases.
Under present planning the programme will utilize controlled, sound-tested environments which will overcome the frequently encountered problem of environmental ambient noise, which invalidates hearing measurements. Modern electronic
instrumentation will provide comprehensive diagnosis and assessment of hearing disorders. The instrumentation will be used in a variety of applications. It is used to
maintain calibration standards for audiometers and auditory trainers. It can be used
to conduct sound studies which will identify excessive noise levels which are potentially detrimental to the hearing mechanism and (or) instructional programme. Instrumentation will provide a basis for scientific hearing-aid evaluation and fitting
procedures. The programme will provide for comprehensive assessment of infants
and pre-school children, including selection and fitting of prosthetic devices, when
indicated, and home training programming, when recommended. Also provided will
be hearing conservation programming for noise-induced hearing problems. The
programme will include a comprehensive data collection and retrieval system which
will lend itself to programme accountability, research, and statistical data.
 H 26
PUBLIC HEALTH SERVICES REPORT,  1972
MOTOR-VEHICLE ACCIDENT PREVENTION
Health Branch staff, working with the British Columbia Medical Association,
continued to provide a consultative service to the Motor-vehicle Branch in the field
of medical fitness to drive. The booklet Guide to Physicians in Determining Fitness
to Drive a Motor-vehicle was completed and has been approved by the British Columbia Medical Association. The Canadian Medical Association has also accepted
the British Columbia guide as the basis for Canada-wide standards.
COMMUNITY CARE FACILITIES
This is the first full year that the Health Branch has been responsible for the
supervision of community care facilities. During the year many changes were made
in order to improve the efficiency of this section of the Health Branch's operations
and the level of care provided in these licensed facilities.
Amendments to the Community Care Facilities Licensing Act were made which
more clearly define a community care facility and set out the responsibilities of local
authorities in supervising them.
In recognition of the increasingly important role of education as it relates to
facilities providing services to children, an amendment to the Act permits an additional member of the licensing board appointed from the Department of Education.
It is planned to decentralize the control of community care facilities over the
next few years. As an initial step, the licensing board's administrative staff, who
have until now functioned as inspectors, have become specialist consultants, and the
field staff of the Health Branch have been given the task of inspecting licensed
facilities and facilities for which applications for new licences have been received.
Many requests are received for listings of licensed facilities from persons who
are looking for accommodation and from groups who are undertaking studies in this
field. In order that these requests can be met promptly, all of the information available on licensed facilities has been placed on punched cards, and very shortly it will
be possible to provide up-to-date information on request.
Throughout the year, there was a steady development of new and larger facilities for aged persons through grants under the Elderly Citizens' Housing Aid Act
and private enterprise. Facilities for mentally disabled persons continued their
steady development. However, the greatest increase occurred in day care services
for children.
EMPLOYEES' HEALTH SERVICE
In a recent study on "Quality in General Practice" reported in the Journal of
the Royal College of General Practitioners, it is pointed out that Canadian women
live five and one-half years longer than men. This gap in life expectancy is increasing, and the article suggests that men may be neglecting their health at the prime of
life so that they suffer more severe illness after the age of 45 and die sooner. The
article further states "we cannot be sure but the data available strongly suggest the
need for an industrial (occupational) medical service to give men easier access to
medical care."
The Division of Occupational Health has been able to obtain the services of
another full-time physician, and it is hoped to introduce, in the near future, a programme of periodic medical examinations for senior male Civil Service personnel.
Later, it is hoped to extend the programme to other staff on a voluntary basis.
Efforts have been made to employ a full-time counsellor to implement the
Government programme on alcoholism. This is an urgent problem as the direct and
 COMMNITY HEALTH NURSING
H 27
indirect loss due to absenteeism, accidents, bad decisions, discharges, dissention,
early retirement, lowered work efficiency and morale, overtime payments, and
unfavourable public relations in the community account for approximately $l1/2
million for a work force the size of the British Columbia Civil Service.
Numerous services were offered to employees in the Vancouver, Victoria, and
Essondale areas. For example, in Vancouver the occupational health nurse attended
seven locations on a regular basis and dealt with 4,226 visits by employees during
the year (October 1971 to September 1972). The services rendered included such
items as treatment of illness or injury, counselling, medical examinations, and
immunizations.
In Victoria, the Occupational Health Unit was visited 4,657 times by employees
to receive services of one kind or another.
The programme at Essondale and Woodlands is somewhat different from the
above because most patients are seen mainly on a referral basis. The usual reasons
for referral are
• pre-employment health interview;
• return to work after illness or injury;
• frequent health problems;
• health problems which interfere with ability to work.
Approximately 2,340 employees were seen during the year. Many treatments for
minor illness or injury are carried out at the first aid stations scattered throughout
the mental hospitals.
In addition to the above, Occupational Health staff visit Government departments on a regular basis in order to study the type of work performed and the
possible hazards involved. It is necessary to carry out special inspections in areas
where industrial hygiene problems or hazards are occurring.
The Civil Service Commission Screening Committee, which meets from time to
time, is concerned with the placement of disabled employees. The Director of
Occupational Health is the chairman of this committee, and other members are
Chiefs of Classification and Recruitment (Civil Service Commission) and the Administrative Assistant to the Chairman of the Civil Service Commission.
COMMUNITY HEALTH  NURSING
The public health nurse is a member of one of the professional groups working
in the broad field of public or community health. She has dual preparation, which
includes the knowledge and skills essential for basic nursing and the special skills of
public health practice. Her activities (see Table VIII) are concerned with the
promotion and maintenance of health, prevention of disease and disability, and
provision for comprehensive care of the sick and disabled.
Prevention in public health may be categorized as follows:
• Primary—which involves preventive procedures  such  as immunizations
against certain communicable diseases, as well as such matters as anticipatory guidance to mothers of young children.
* Services provided by public health nurses under the jurisdiction of the Provincial Health Branch. This
report does not include services provided by Greater Vancouver, Victoria, Esquimalt, Oak Bay, and New
Westminster, except in the school health programmes.
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PUBLIC HEALTH SERVICES REPORT, 1972
• Secondary—which involves case-finding, and early diagnosis and treatment
through individual assessment and screening programmes to enable corrections of defects such as hearing, vision, emotional illness.
• Tertiary—which involves the reduction of disabilities through treatment and
care, as in the home nursing programme. Through this service the public
health nurse provides care for persons with physical and emotional problems.
She assists in arranging for the rehabilitation of persons with certain disorders, thus permitting many individuals to be maintained in their home
settings at their maximum level of "wellness."
The public health nurse's participation in the public health programme may be
described as follows:
She is competent in assessing the family and particularly in relating the cause
and effect of individual health problems to the total family situation. However,
service is not limited to any segment of society or age-group but is provided on a
uniform basis throughout the Province.
The public health nurse contributes to the assessment of community health
needs, and to the planning and organizing of services to meet these needs.
She is able to extend her professional skills to more people by utilizing assistants
such as registered nurses, health unit aides, volunteers, and incentive trainees for
routine activities.
Public health nursing service is provided within the established policies of the
Health Branch so that a similar public health nursing service is available to all
residents in the Province.
In the central office, the Division of Public Health Nursing provides:
• Nursing consultant service to assist health units in evaluating their programmes so that services can be provided efficiently and economically with
the available personnel.
• Planning and arranging for the continuing professional training of public
health nursing staff.
HOME  CARE
The quality, quantity, and cost of health care is of increasing concern to all. It
is, therefore, most important that provisions be made for high-quality care at levels
most appropriate to meet the total health needs of people requiring it. Home care
programmes are designed for persons who require active medical, nursing, and rehabilitative services, but do not need the expensive facilities of an acute hospital or
other institutions. They are co-ordinated community-oriented programmes available
to selected patients in their own homes in order to shorten the length of their hospital
stay and to prevent unnecessary hospitalization. They thereby preserve the home
and family unit and meet the health and social needs of a segment of the population
whose health care in the community would otherwise be inadequate. Under the
direction of his private physician and the co-ordination of the public health nurse,
the patient is provided with nursing, social work, physiotherapy, homemaker, meals-
 HOME CARE
H 29
on-wheels, and other ancillary services according to his needs and to the resources
of the area.
• Home care is available in 114 communities to over 80 per cent of the population in Provincial health units in British Columbia. Service in the Kamloops
area was extended during the year to include Brocklehurst.
• Those sections of the Province not receiving service are, in the main, isolated
areas with a scattered young, active population.
• Nursing and social work services are provided at no cost to the patient.
Other services, if available, are provided through insurance plans or are paid
for by the patient according to his means.
• Health unit nursing staff made 88,903 home nursing visits during the year, 78
per cent of these were to patients 65 years of age and over. This was a 7-percent increase over 1971.*
• In addition, there were 11,178 nursing visits on behalf of patients on treatment at home for recognized psychiatric or emotional problems, a 3-per-cent
increase over the previous year. *
PUBLIC HEALTH PHYSIOTHERAPISTS
Five part-time public health consultant physiotherapists, serving in eight health
units, made 1,466 visits, assessed 516 patients, and carried out 841 reassessments
in connection with home care services. In addition they served as consultants to
public health staff, physicians, the staff of personal care homes, and acted as liaison
with other rehabilitation facilities.
SPECIAL HOME CARE PROJECTS
A special home care project to serve persons discharged early from the acute
general hospitals in the Coquitlam-New Westminster area completed its first year of
operation. All services, including nursing, physiotherapy, homemaker, meals-on-
wheels, medication, and supplies were paid for by Provincial Health Branch funds.
In this programme, 429 patients received 4,419 days of care at an average cost per
patient-day of $11.83. This cost of replacement days is approximately one-quarter
the cost had the patient remained in an acute hospital. Sixty-three per cent of these
patients were between the ages of 20 to 64 years, and 32 per cent were 65 years or
over. They were almost equally divided among surgical, orthopedic, and medical
diagnoses.
In May, two further home care projects were initiated to serve three general
hospitals in Victoria and the one acute hospital in Kamloops, and although the cost
per patient-day is slightly higher in the early stages of the operations, the success of
the programmes in providing alternative, less costly, and yet a high-quality type of
care is quite apparent. The physicians, the home care staff, and particularly the
patient and his family have been extremely pleased with the new programme.
MENTAL HEALTH
While the Mental Health Branch has prime responsibility for the provision of
mental health service in the Province, mental health is recognized as an integral part
of a generalized public health nursing programme. Close co-operation is maintained between the personnel of the two branches.
* The above visits to persons requiring nursing service for physical or emotional reasons represent a cost
saving to Medicare of more than $100,000.
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PUBLIC HEALTH SERVICES REPORT, 1972
In this part of the programme the primary objective of the public health nurse
is to prevent the development of mental illness by identifying individuals who show
early signs of potential illness so that assistance can be made available at an early
stage. During their routine work, public health nurses find families and individuals
in crisis situations so that the nurses are in a particularly strategic position to provide
help where there is a high risk factor for mental breakdown. Special efforts are
made to identify potential problems at the time of home visits, at child health conferences, prenatal classes and school, youth and geriatric clinics. Activity is summarized as follows:
• 7,369 visits were made for primary prevention, of which 46 per cent were
for adults, 45 per cent for school-age, and 8 per cent for pre-school children.
• In addition, 11,178 visits were made for secondary prevention to patients
under care for emotional disorders. Pre-school children received 6 per
cent of the visits, school-age children 30 per cent, and adults accounted for
the 64 per cent of the visits which were made for therapeutic reasons. These
visits represent a saving of around $20,000 to the medical care plan.
• In all, mental health visits, both primary and secondary, totalled 11,178 for
an over-all increase of 4 per cent over last year.
• A total of 184,179 visits was made to homes which provided the public
health nurses with opportunities for case-finding and for mental health counselling, which is an integral part of health care service.
YOUTH SERVICE
This year an influx of youth into the Province during the summer months again
appeared imminent. As this could lead to an increase in communicable diseases,
particularly venereal disease, arrangements were made once again with the assistance
of the Division of Venereal Disease Control to prepare for such an eventuality. Special kits of literature and medical supplies were made available to all health centres,
and records were kept of the services rendered during the period June through
August.
During this period, 535 young people sought assistance. This represented a
30-per-cent reduction from last year. Slightly more than half (282) presented
themselves at health centres, while 263 were seen at hostels and other similar settings.
This contrasts with the situation a year ago when only one-third came to health
unit centres. Fifty-two per cent were over the age of 19 years, while only 7.6 per
cent were below the age of 16 years. There were 9 per cent more males than females
seeking attention.
Of the total number of young people requesting help, 237 had minor illnesses,
injuries, intestinal disorders, skin infections and rashes, 90 suspected venereal disease,
and 55 needed health or financial information.
Minor problems were treated, health counselling given, and referrals made to
social workers, physicians, and out-patient departments as indicated. It is believed
that this special programme prevented more serious problems from developing.
The Central Vancouver Island Health Unit and the Northern Interior Health
Unit provided most of the service to transient youth this year.
ADULT AND GERIATRIC SERVICES
Another important part of the work done by public health nurses is with adults
and elderly citizens. During 1972 a total of 47,543 home visits was made to adults
for general health appraisal, advice, and referral for medical and other types of care.
These visits resulted in many persons obtaining early diagnosis, care, and treatment,
 HOME CARE
H 31
thereby preventing the need for extensive medical and institutional care at a later
date. The number of visits increased one-third over the past year. Adults receive
special attention under special programmes as noted elsewhere in this Report, particularly in relation to communicable disease control, home care, maternal care, and
in general family health service.
A few health centres have been able to establish geriatric clinics where elderly
people come for general health appraisal by the public health nurse and have hearing,
vision, urine, blood pressure, glaucoma, and other screening tests. They also receive
nutrition counselling and general health advice. Many persons seen are referred to
appropriate agencies or physicians for further care. More geriatric services need to
be developed as additional public health nursing staff become available to organize
clinics in appropriate centres.
Patients over the age of 65 received 68,747 home visits for home nursing service, 1,285 mental health therapeutic visits, as well as 11,215 visits for general health
supervision. In all they received 81,247 home visits, and this figure represents the
largest number of home visits to a specific age-group.
Professional public health nursing services were provided by telephone to
adults, as illustrated by the 207,968 calls made during the year.
SERVICE TO INDIANS
Certain Indian reserves receive public health nursing service from health units
through a special arrangement made with the Medical Services Directorate of the
Department of National Health and Welfare.
• Public health nurses now serve 72 reserves with a population of 9,020
Indians, or approximately one-third of those on reserves.
• 16,455, or just about one-third of the total Indian population of 49,022
living in British Columbia, now live off the reserves and receive the same
public health services as the non-Indian population. In all then, Provincial
public health nursing service is given to approximately 50 per cent of all
Indians in the Province, the remainder being provided for by the Medical
Services Division of the Department of National Health and Welfare.
• Almost all Indian children living on reserves now attend local schools and
receive school health service from the health unit public health nurse.
• Medical Services are beginning to provide auxiliary Indian health workers,
such as community health workers and aides, to assist public health nurses
in their work with the Indian people. It is believed that supplementary
assistance will help the Indian people gradually to raise their health status.
AUXILIARY WORKERS FOR PUBLIC HEALTH NURSING
PROGRAMMES
In spite of a general population increase and resultant high and continually
rising case loads, it has been possible for public health nurses to continue to provide
a good quality of nursing service by utilizing auxiliary workers trained on the job to
do work of a technical nature. In this way public health nurses can find more time
for professional activities.
• During the yeai, volunteers donated 10,930 hours of their time to the health
services. This represents about 1,500 working-days and 10,494 direct services to individuals.
• Auxiliary workers, health unit aides, volunteers, and incentive programme
trainees together gave a total of 65,187 direct services to individuals. These
services are primarily screening procedures such as vision and hearing
screening for pre-school and school children (see Table XI for details).
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PUBLIC HEALTH SERVICES REPORT, 1972
MATERNAL AND CHILD  HEALTH
Classes for expectant parents continue to be popular as evidenced by increased
attendance of both prospective mothers and fathers. The classes consist of a series
of discussion groups in which the public health nurses centre teaching around the
physical and emotional changes during pregnancy, normal development of the foetus
and infant, nutrition, and changing family relationship to promote positive mental
health. Recommended relaxation exercises are discussed and practised. In summary:
• Classes were held at 74 health centres where 417 series of classes were presented to 5,188 mothers, representing an 11-per-cent increase of participants
over last year. The number of fathers participating was up 24 per cent, with
2,504 attending the series.   The over-all class attendance was 27,692.
• The interest and importance of family health education in relation to the
birth of a new baby are well illustrated by the fact that three-quarters of the
series had both parents enrolled. It is estimated that well over 60 per cent
of all new mothers attend classes prior to the birth of their first baby.
• In addition, public health nurses made 3,672 prenatal and 19,796 postnatal
visits to mothers to assess the babies' progress and discuss maternal and
child care.   The figures are somewhat lower than those for 1971.
INFANT AND PRE-SCHOOL
Many potential health problems can be recognized in infancy and early childhood and prompt attention will often prevent these from becoming serious at a later
date. The public health nurses, therefore, place a great deal of emphasis on early
case-finding and arranging for treatment and care. Public health nurses are involved
in a number of programmes where they have the opportunity of assessing the health
status of young children—in special clinics, child health conferences, kindergartens
and play groups, as well as in the home situation. Screening programmes include
testing for hearing loss, vision, retardation, and deviation from the normal growth
and development patterns. Most health units are now using the standardized Denver Development Screening Test which was designed for use in assessing motor, language, and social development. More special screening clinics are being set up for
the 3- and 4-year-old child. A great deal of social and physical damage can be
prevented by early treatment, and counselling of parents by specialists and by the
public health nurse.
• 80 per cent of newborn infants received one visit from a public health nurse
during the important first six weeks of life, about the same proportion as for
1971. Additional visits were made to children at "risk" for conditions such
as suspected health abnormalities and to give advice on child care.
• Public health nurses made 34,260 visits to homes of infants for general health
assessment and counselling.   This was a slight increase over the 1971 figure.
• 16,785 infants attended child health conferences where public health nurses
provided 52,657 individual services and counselling sessions. This was
slightly below the figure for 1971.
• 7,590 pre-school children attended child health conferences for assessment,
health counselling, and immunizations for a total of 85,411 individual ser-
 SCHOOL HEALTH
H 33
A public health nurse instructs a prenatal class in the stages of pregnancy and birth.
Prenatal classes are held regularly throughout the Province.
vices.   While the number of pre-school children attending child health conferences increased this year, individual services were somewhat fewer.
• 28,930 home visits were made by public health nurses on behalf of pre-school
children for reasons of physical or emotional health, about the same number
as last year.
SCHOOL  HEALTH
The focus of the school health programme is primarily preventive—the provision of health education, a healthful environment, and personal health services—all
designed to promote knowledge, attitudes, and abilities for healthful living and to
prevent or seek early treatment for conditions which might prevent the child from
reaching his potential.
The school setting gives a unique opportunity for preventive health measures
because of the large numbers of children in their formative years who are readily
available for health education and care. At 5 years of age approximately 70 per
cent of children attend kindergarten, and by 6 years of age virtually 100 per cent are
under the care and supervision of the school health team.
 H 34
PUBLIC HEALTH SERVICES REPORT, 1972
The public health nurse is the health professional most accessible to the schools
and has the primary responsibility for bringing to the pupils the services of a health
unit. Through her concurrent involvement in the community she also brings an
awareness of its needs and resources, has ready access to homes, and knows many
of the families.
Other members of the health unit staff contribute to the programme—the health
unit director, the public health inspector, the preventive dentistry team, and in
some areas the speech therapist. Through the public health nurse services are made
available from the community mental health team and from many local and Provincial health and welfare agencies. Public health nursing auxiliaries play an increasing
role in assisting the nurse with routine screening procedures.
In keeping with the concept of prevention and early remedial treatment, the
emphasis on pre-school screening has continued this year. Health assessment of
4-year-old children has given an opportunity for remedial work with the child and
parents before school entry. When the child enters school, either Kindergarten or
Grade I, the nurse discusses with the school principal any factors which may influence
the child's adjustment to school. Through the "pre-school round-up" she makes a
special effort to see children who are about to enter Grade I and to have immunizations brought up to date. Table XII shows that a high percentage have basic immunization before entering school.
Reinforcing immunization is provided in Grades I, V, and X. Table XIII gives
the immunization status at the end of Grade I and shows that a high level of protec-
A public health nurse conducts a hearing screening test on a student attending
a junior secondary school on Vancouver Island.
 PREVENTIVE DENTISTRY
H 35
tion is being maintained, particularly for the major diseases of smallpox, diphtheria,
tetanus, and poliomyelitis.
This year a special report gives the percentage of Grade V girls who are protected against rubella (see Table XIV). The immunization of pre-pubertal girls is
of particular concern because of the need to prevent rubella in women in their child-
bearing years and the possible birth of infants with congenital defects. It is gratifying
to note that 85.4 per cent of Grade V girls have had this protection and it is anticipated that the percentage will be even higher in future years as the programme
becomes firmly established.
Table XV shows an increase in school enrolment of 6,577 for the Province.
Enrolment decreased by 1928 in the Greater Vancouver area and by 202 in the
Greater Victoria area. In the remainder of the Province there was an increase of
8,707. Although enrolment in public kindergartens increased, this was more than
offset by the decrease of 1,073 in private kindergartens. The over-all enrolment in
private schools continues to decrease in all areas of the Province.
During the year, public health nurses in areas served by the Health Branch
provided 268,049 individual services to pupils in schools and auxiliary workers
provided 53,614. Public health nurses held 5,466 formal conferences with classroom teachers to review the health status of children and in addition held 64,203
unscheduled conferences with teachers. They also made 40,978 visits to homes on
behalf of school-children (see Table VIII).
In order to make good use of the nurse's time in the school, routine activities are
under constant scrutiny. Those which can be performed by an auxiliary worker are
delegated to her (see Table XI), and those which are not productive are replaced
by other services. Rather than making routine inspections of large numbers of
healthy children, the nurse places emphasis on children who have special needs.
The teacher is a valuable ally in selecting these children. In the past school-year,
16.4 per cent of school-children were selected for the special attention of the public
health nurse and 7.4 per cent were referred by her for further care (see Table XVI).
PREVENTIVE  DENTISTRY
The goal of the Division of Preventive Dentistry is a state of optimum oral
health for the people of British Columbia of all ages, irrespective of racial origin or
socio-economic status. Ideal oral health is the complete absence of disease and
dento-facial deformities of the oral cavity. At this time there is as yet no proven
panacea for the total prevention of oral disease, whether this is dental caries or
periodontal (gum) disease, and still less for the prevention of gross handicapping
maxillo-facial malformations. Nevertheless, a very great deal of prevention leading
to the minimization of these disorders can today be effected. Successful prevention
very significantly reduces the needs for and costs of dental treatment. Such results
have been demonstrated through programmes initiated by this Division of Preventive
Dentistry and with the co-operation of the dental profession of British Columbia.
As an indicator, each year in this Province a dental health survey is carried out
in at least one of seven regions. Such surveys commenced in 1956 and each survey
comprises results for a statistically chosen random sample of the school-children of
 H 36
PUBLIC HEALTH SERVICES REPORT, 1972
the region. Two series of Province-wide surveys were completed during the periods
1958-60 and 1961-67. A third series commenced in 1968 and will be completed
in 1974. Between the first and second series of surveys an improvement of the
dental health status of the children was demonstrated. Similarly, in regions where a
third survey has been completed, further improvements have been noted. Early in
1972 such a survey was carried out in the schools of the Fraser Valley. Comparing
results of this survey with those of surveys in 1959 and 1965, various improvements
in the dental health of the children of this region are observed, and especially in a
lower dental caries attack rate of the deciduous (baby) teeth. Nevertheless, it is of
very considerable concern that for all school-aged children (7-15 years) no less
than 22 per cent had received no treatment for dental caries other than extractions.
This survey also showed that in this region 15-year-old children, on the average, had
11 of their 28 permanent teeth already attacked by dental decay, and while six of
these teeth had been satisfactorily restored (filled), four teeth were untreated and
one permanent tooth had already been extracted or would likely be extracted in the
near future. Furthermore, among these 15-year-olds, 32 per cent showed evidence
of periodontal (gum) disease and 38 per cent had a handicapping malocclusion
(severely crooked teeth). Very obviously a great deal more needs to be done and
can be done by the communities and by the families to reduce the need and thereby
the costs for treatment of dental caries, periodontal disease, and malocclusion.
In Greater Vancouver, dental health programmes are sponsored by the City
of Vancouver, the North Shore Union Board of Health, and School District No. 41
A public school child is shown undergoing a dental examination as part of the Province-
wide surveys which are carried out each year to assess the level of dental health of children
throughout the Province.
 PREVENTIVE DENTISTRY
H 37
(Burnaby). School District No. 61 provides preventive dental services to the pupils
of Greater Victoria. During 1972 these services were extended to School Districts
No. 62 (Sooke), No. 63 (Saanich), and No. 64 (Gulf Islands). The Government
of British Columbia provides grants-in-aid to the annual operating costs of these
services in both the Greater Vancouver and Greater Victoria metropolitan areas.
In the remainder of the Province, as part of the total public health services provided by the 17 health units of the Health Branch, five Regional Dental Consultants
are employed. These dentists, each with graduate training in community health
practices, organize and supervise the dental health programmes operating in these
rural areas.
A basic programme in 45 school districts in these areas, in which one or more
resident dentists are located, encourages families to have their 3-year-old children
attend their family dentist. These children receive from their health unit an attractive birthday card. An insert informs the parents that the card should be presented
to their dentist of choice while the child is 3 years of age. The child receives a dental
examination, X-rays if considered necessary, and counselling in respect to oral
hygiene and dietary practices. In addition, usually their teeth are painted with a
decay-preventing fluoride solution, all at no direct cost to the parent. During the
period September 1971 to August 1972, approximately 9,000 3-year-olds so benefited. A study reported in 1969 showed that, when at the Grade I level, those
children who had attended their dentist as 3-year-olds had 50 per cent fewer premature extractions and 50 per cent more were caries free compared with children
who had not visited their dentist at that age. Of considerable interest is the percentage of all 3-year-olds in each community who participated in this programme.
Before such programmes were initiated, in 1964, it was estimated that only 20 per
cent of 3-year-olds visited a dentist. In 1972, in Vernon, over 90 per cent of 3-
year-olds who received their birthday card from their health unit visited a dentist.
However, such a high level of participation is only achieved when dental health
auxiliary staff are available to telephone parents whose children's cards are not
returned via the dentists to the health unit, and to encourage these parents to avail
themselves of this service.
The use of dental health auxiliary personnel was first pioneered in 1964 in the
Okanagan region with the employment of a dental hygienist. Since then, that region
and others have demonstrated how additional auxiliaries such as dental hygienists,
dental assistants (latterly certified dental assistants), and also registered nurses and
clerks with in-service training can all add their contributions to an effective dental
health educational programme. By December 1972 there were so employed, in the
rural health units, five dental hygienists, nine dental assistants (six of whom were
certified), three dental health educators, and two dental health aides. However, of
these 19 persons, only nine were employed full-time. Nevertheless, with these numbers and with the anticipated future expansion of dental health auxiliary programmes,
there was appointed a Consultant, Dental Hygiene, to serve the Division on a
Province-wide basis. This appointee was a dental hygienist who has served as Dental
Hygiene Supervisor to the Okanagan region for the past six years. However, it is to
be recorded that until this time all the above personnel have been employed on a
local basis by their respective Union Boards of Health, with funds being provided by
the Health Branch from the appropriation entitled "Preventive Dental Programmes."
During the past year an innovation of note was the additional employment of
dental auxiliary personnel through the local initiative programme of the Government
of Canada. Thereby, increased dental health educational activities were initiated in
Alberni, Kamloops, and Salmon Arm.  With the additional assistance of the teams
 H 38
PUBLIC HEALTH SERVICES REPORT, 1972
recruited in the latter two centres, it was possible to provide dental health education
in every elementary school in the three health units of the Okanagan region. Never
before has such coverage been achieved. These two teams provided dental health
instruction to close to 26,000 school-children.
The Okanagan Dental Health Centre continues to provide preventive services
which, it is believed, are not replicated in such a setting elsewhere in North America.
Firstly, a "plaque control" programme is offered, primarily for the prevention of
periodontal disease—the major cause of tooth loss in adult life. Over 100 persons
have benefited from such counselling and personalized instruction. An abnormal
manner of swallowing is a most insignificant cause of a serious form of malocclusion.
Seventy-four children have received specific lessons in corrective muscle therapy to
counteract this condition. In only two cases have the patients failed to respond to
this preventive treatment. For families not in receipt of fluoridated water, supplemental fluorides are available at cost from the Kelowna Dental Health Centre, with
a telephone follow-up to encourage continuance of this rather tiresome regimen.
At present close to 800 children benefit from this service, with some 80 per cent of
families continuing on a regular basis.
Commendable as this practice may be, it falls far short in community benefits
compared with enrichment of the community's water supply to the optimum fluoride
content. A dramatically lower level of dental decay is clearly evident in the two
largest communities in this this Province which have had fluoridated water for the
longest periods—Prince George since 1955 and Kelowna since 1956. Nevertheless,
only 11 per cent of the population of British Columbia, for wherever fluordiation is
engineeringly possible, so benefit. This is the lowest percentage of any province in
Canada. Eight of the twelve Canadian provinces and territories have in excess of
50 per cent of their populations, who could so benefit, in receipt of fluordiated water.
Since 1953, the Division of Preventive Dentistry has arranged for dentists to
visit on as regular a basis as possible those communities which have been and are
without a resident dentist or not regularly visited by a dentist. For several years
past, including 1971 and 1972, five dentists (dental public health externs) have been
especially recruited each year for this purpose, commencing their 12-month tour of
duty early each summer. They are provided on a free loan by the Health Branch
with a set of easily transportable and highly sophisticated dental equipment. Some
40 communities now receive this service each year. It is extremely doubtful if any
of these communities are yet of a sufficient size to support a resident dentist on a
full-time basis throughout the year. Experience has shown during the past few years
that when a community reaches such a size, without fiscal incentave by any level of
government, a dentist, of his own initiative, establishes a practice in such community.
Furthermore, during the same period of time, there has developed an increasing trend
for dentists practising in larger centres, for fiscal reasons, for a change of scene and
pace, or for reasons of social conscience to adopt more and more of the underser-
viced communities, establishing satellite practices, and there visiting on a regular
schedule, e.g., two days a week, one week a month, etc. The dental public health
extern programme each year visits all other communities in need of such a service.
But with a few exceptions, all requests for this service are currently being provided.
In the Okanagan region, such is the climate and topography that a dental clinic trailer
is used for this purpose to optimum advantage.
During the past five years the ratio of population to dentists in British Columbia
has improved significantly. The ratio in 1967 was 2,387 persons per dentist, while
in 1972 each dentist was available to an average of 2,027 persons. Furthermore,
although there remains a considerable disparity between the availability of dentists
 NUTRITION SERVICE
H 39
in the metropolitan areas compared with the rural areas, especially the northern
region, this situation has also improved. In 1966 the ratio of dentists to population
in the northern regions of this Province was 1:4,757. This ratio in 1972 was
1:3,697, which over a five-year period was a most significant improvement. Increased availability of dentists has occurred to a marked degree in all regions of
British Columbia during this period.
In addition to the increased number of dentists, the availability of dental services is being steadily increased by the number of dental hygienists and certified dental assistants, both of whom provide dental services previously only provided by
dentists. At the close of 1972 there were 178 dental hygienists and 317 certified
dental assistants licensed to practise in British Columbia. In 1965 there were only
15 dental hygienists practising in this Province and it was not until 1971 that the
first certified dental assistants were trained and licensed. The University of British
Columbia graduates some 20 dental hygienists each year and certified dental assistants are currently being trained in three vocational schools, with plans being completed for such courses to be made available in two further schools.
This division continues to sponsor scientific clinical field trials for the improvement of techniques for the prevention of oral diseases and abnormalities. Currently
progressing are two large-scale studies, each including some 1,300 children who
started in the studies when in the fourth and fifth grades. One study is being carried
out in the Surrey School District and the other in five northern communities and in
neither instance are the respective local water supplies fluoridated. Each study is
testing a mouth rinse, used once each school-day, which was shown to be highly
effective in preventing dental decay in earlier laboratory and animal studies. The
active ingredient of one rinse is stannous fluoride, and the second has an acidulated
fluoride phosphate base. Initiated in the fall of 1972 in the Okanagan was a third
study in which a similar number of students are involved and which will test the
effectiveness of a special fluoride paste brushed on by the students, followed by a
fluoride rinse. While this technique will be carried out only twice each school-year,
it is hoped it will demonstrate a level of decay prevention equal or superior to the
results of earlier and rather similar Scandivanian trials.
NUTRITION  SERVICE
During the year, every attempt was made to concentrate services on the nutritionally vulnerable groups (pregnant, infant, pre-school, adolescent, aged) and to
stimulate an interest in nutrition in the community through the media.
As senior citizens are confronted with a multitude of problems regarding food,
nutrition, and eating, a major project was undertaken to reach the elderly with
nutrition information. A television series consisting of eight 10-minute shows,
entitled the "Senior Chef," was broadcast over a commercial television station from
January to April. Greater Victoria, Vancouver Island, and the Lower Mainland
were included in the viewing area. In each show, the Chef (page 41) demonstrated
two quick nutritious recipes, gave hints on food-buying, and, using the four food
groups, suggested menu plans. Equipment used was unsophisticated and low-cost
foods were emphasized.   During the 15 weeks in which the show was broadcast,
 H 40 PUBLIC HEALTH SERVICES REPORT,  1972
1,515 requests were received for the booklet which contained all the recipes used
in the show. Many viewers requested additional nutrition information, which
emphasized the need for follow-up services in nutrition for the elderly. The series
itself, evaluated by both senior citizens and professionals working in the community,
was considered to be a success. The series was rebroadcast out of Kamloops covering
the South Central, North Okanagan, and Cariboo regions in October and November.
A second television series was undertaken in co-operation with a Victoria cable-
vision station and other Health Branch divisions from August to November. The
series of 12 half-hour shows, entitled "Health in British Columbia," included six
shows on nutrition. Experts working in British Columbia were invited to participate
in discussion with the nutrition consultant in the following topics: Nutrition for Preschoolers, Food-buying, Weight Control, Food Costs and Food Values, Food for
Senior Citizens, and Health Foods. The series provided general nutrition information
to the community. Unfortunately, it was not possible to provide counselling service
to those requesting further information. The video tapes were retained for use
throughout the Province.
The nutrition consultant also participated in three consumer forums in Kamloops, Williams Lake, and Canim Lake. The forum, organized by the local health
units and the area community college, were open to the general public and representatives of consumer groups. Each one-day forum consisted of lectures, discussion groups, and panels centred on the theme "We Care About Consumers and the
Food They Eat." Questions and attendance indicated the forums were well received
and nutrition was of interest in these communities.
As the majority of complaints received on community care licensing facilities
concern food and nutrition, a dietitian was employed part-time for eight months of
the year to examine existing regulations regarding nutrition and food service in
community care facilities and to make recommendations regarding these regulations.
During this time a manual for the operation of these facilities emphasizing nutrition
for pre-schoolers and the aged was prepared. The public health staff members will
require an intensive in-service education programme to assist them in the interpretation of the new regulations and proper utilization of the accompanying manual.
British Columbians participated in phase two of the national nutrition survey
(Nutrition Canada) from January 10 to April 7. The investigating team examined
over 18,000 residents from 42 areas of the Province. Included in the survey were
native Indians on reserves and a sampling of transient youth from the Vancouver
area. A preliminary report of the results of the survey is expected in the spring of
1973 and should be invaluable in planning nutrition education programmes for the
immediate future.
The in-service education component of the nutrition service was expanded to
include
• introduction of a new daily food guide to professionals working in nutrition
education;
• presentation of a lecture, "Nutrition in Pregnancy," at the public health
nurses' regional conference in Kamloops;
• discussion of "Food Handling From the Nutritionists' Point of View" at
the public health inspectors' meeting at Riverview;
• participation in a home economics teachers' workshop in the Victoria area;
• participation in a seminar at the North West Adult Education Conference
(Vancouver) on educational programmes in foods and nutrition which could
be undertaken by adult education departments;
 NUTRITION SERVICE
H 41
• field work in community nutrition for dietetic interns from Victoria area
hospitals;
• discussion group with home economic students at the University of British
Columbia on careers in community nutrition;
• participation in the University of Victoria continuing education programmes
for nurses.
Consultative services to community-oriented professionals, although limited,
did include
• 24 health unit visits to 15 of the health unit offices in the Provincial and
metropolitan health service (visits to health unit suboffices have been excluded from the Consultant's schedule);
• provision of resource information regarding nutrition education materials
and methods to the Director of Home Economics, Department of Education,
for use in home economics secondary school curriculum throughout the
Province;
• participation with health unit personnel in open-line radio shows, community
panels, television programmes, and newscasts on the subject of nutrition,
food, and food costs throughout the Province;
The "Senior Chef," a programme produced on a Victoria Television station was directed toward older people in the community and people living alone. Simple ways to make
meals were demonstrated and an explanation given by the Senior Chef on the way in which
these meals should be balanced for adequate nutritional intake. Eight programmes were
produced by the joint efforts of the Division of Public Health Education and the Provincial
Nutritionist.
 H 42
PUBLIC HEALTH SERVICES REPORT,  1972
assistance to Camosun College (Victoria) in establishing an evening course
in nutrition;
advice to dental assistants in Nanaimo on establishing a nutrition education
programme at the second-grade level;
production, in co-operation with the Division of Public Health Education,
of the following publications and visual aids: Daily Food Guide, Directory
of Community Nutrition Services, Nutrition Quiz photographic slide series
plus verbal script, Nutrition Tips and Ideas, and the "Senior Chef" recipe
booklet.
PUBLIC  HEALTH   EDUCATION
As one of the most important concerns in the delivery of health care to people
and communities is education in public health, all members of Health Branch staff
throughout the Province of British Columbia are concerned with informing the public
on public health matters and guiding them toward better health.
On the staff of the Health Branch are nurses, doctors, public health inspectors,
speech therapists, dentists, occupational therapists, physiotherapists, rehabilitation
officers, clerical staff, and health educators, all of whom spend a great deal of time
on this most important function. All staff members, therefore, require to have an
understanding of human behaviour, human learning processes, and educational
methods, and it is the first duty of the Division of Public Health Education to give
assistance to staff in these matters.
The Division of Public Health Education also gives assistance to health education matters, on request, to other Government departments and to voluntary health
agencies. An active liaison with voluntary agencies permits the free flow of ideas
on the procedures to be employed in the preparation and circulation of educational
material in the Province.
During 1972 the staff of the Division of Public Health Education consisted of
three consultants and two clerks, who spent most of their time in advising other divisions of the Health Branch on the assessment of health education methods and materials. This includes previewing and evaluating films, film strips, publications, and
posters, and the selection of appropriate educational methods and techniques. The
Division also provides a technical service for the production of printed and audiovisual material and maintains a library service. The activities during 1972 include
• lectures to the Public Health Diploma Nursing Course at the University of
British Columbia;
lectures to the Dental Hygiene class at the University of British Columbia;
work on a multimedia presentation with the staff of the Division of Venereal
Disease Control for the "Infinity Fair" display in Vancouver;
organizing and conducting a workshop for Powell River teachers on Family
Life Education;
organizing and conducting a workshop for teachers in the Peace River district
on the Human Life Sciences curriculum;
assisting Health Unit staffs  at Prince Rupert,  Cranbrook, Kamloops,
Kelowna, Williams Lake, Victoria, Prince George, Langley, Surrey, Courte-
nay, and Coquitlam in the preparation of Health Education materials to
 PUBLIC HEALTH EDUCATION
H 43
support their ongoing health care delivery programmes.   In some cases practical technical help was given, e.g., photographic slide preparation, sound-
tape dubbing, and instructions on the care and operation of audio-visual
equipment.
Experimental work in the use of video-tape recording equipment was carried
out at the South Central Health Unit, Kamloops, and an instructional tape on inspection of food-preparation equipment in a large institution was produced.   The experiments were successful and will undoubtedly lead the way to further productions for
in-service training of staff, not only in the public health inspection service but in all
divisions of the Health Branch.
Methods of placing information concerning health before the public require
careful assessment in order to meet development of specific media. For example,
television, which is regarded as the most powerful information-spreading vehicle today, is being made more available for public education. The Division has taken
steps to keep pace with this trend and, notably, the Division of Public Health Inspection, the Community Care Facilities Licensing Section, and the Nutrition Consultant
have been in close communication, resulting in several specific projects being completed.
Details of these are as follows:
• The "Senior Chef" series: This programme consisted of eight live television
shows directed, for the most part, to older people who, by reason of a failing
interest in meal preparation and the accessibility of canned foods, tend to pay
little or no attention to the body's nutritional requirements. A postproduc-
tion survey indicated that the project was successful. In consequence, the
shows, which were video-taped, were shown in various Provincial centres.
Kamloops district saw the series in September and October, and Prince
George, Cranbrook, and Prince Rupert Health Branch staff have indicated
interest in showing the series in their areas.
• The use of localized cablevision facilities offers tremendous potential in the
field of public information and, in Victoria, 12 half-hour programmes were
arranged with programme time being allocated as follows:
Nutrition 6 half-hour presentations.
Public Health Inspection Service 3 half-hour presentations.
Community Care Licensing Facilities 3 half-hour presentations.
Health Branch staff are continually reviewing the educational objectives criteria
and standards of their programmes so that health, both personal and community, can
become a real and motivating factor in the lives of the people of British Columbia.
VITAL STATISTICS
The Division of Vital Statistics continued to undertake the wide variety of duties
involved in administering the Vital Statistics Act, Marriage Act, Change of Name
Act, and part of the Wills Act; and to provide centralized statistical services to the
Health Branch and to other Government departments and voluntary health agencies.
Services are provided to the public through the main office in Victoria, a branch
office in Vancouver, and 103 district offices and suboffices throughout the Province.
 H 44
PUBLIC HEALTH SERVICES REPORT,  1972
Table XVII indicates the volume of documents processed under the above-
mentioned Acts in 1971 and 1972.
Items of importance in the work of the Division during 1972 were:
The total volume of registrations accepted continued to increase, despite a
slight decline in the number of birth registrations.
The number of registrations of wills notices under the Wills Act, which has
risen steadily in recent years, revealed a further substantial increase in the utilization
of this service.
The Change of Name Act was amended in March this year to broaden its application and to remove certain existing limitations in connection with changes of name
respecting children. The amendment also provides for birth and marriage certificates
to be issued in the name adopted under the Change of Name Act, without revealing
the person's original name.
The Registry for Handicapped Children and Adults continued to receive about
250 registrations monthly in addition to about 200 reports of congenital anomalies,
which are important for medical research and surveillance, though not all of these
are registrable as handicapping conditions. The follow-up programme relating to
children who reached the ages of 7 and 14 years respectively in the current year
continued to receive good co-operation from health unit directors and attracted wide
interest outside the Province.
The Registry has proven its usefulness in a number of ways over the years it
has been in existence. It has provided a central index of handicapped persons in
the Province which facilitated surveys of special groups such as older deaf children
and children requiring special dental care. It has aided early ascertainment of
cases, leading to prompter treatment and rehabilitation. As well, it has provided
an extremely useful source of morbidity statistics on the handicapping conditions
included on the Registry.
The staff of the Registry co-operated in the production of two papers based
on Registry statistics, which were published during the year (see list of publications,
page 55).
The Cancer Register, which has been under development during the past few
years, reached a further stage during the year with the completion of records and
punch cards respecting all known live cases. This Register is being set up along
the lines of the well-established Registry for the Handicapped, with due allowance
for the difference in the nature of the conditions being reported.
The Division collaborated with the Central Cytology Laboratory of the British
Columbia Cancer Institute in collecting and processing data for the cytology screening programme for cervical cancer. Data on more than 375,000 screening tests
were transferred to punch cards during 1972, and the results of the 1971 screenings
were analysed.
Assistance was given to the Medical Services Division of the Department of
National Health and Welfare in carrying out a dental survey of native Indian children, which was conducted on the same lines as the annual school dental surveys.
This is the first such survey carried out for these children and it should provide
valuable base-line data. The Division also assisted in planning the 1972 dental
health survey in the Fraser Valley region. The report of the Director of the Division
of Preventive Dentistry provides information on the findings of the survey.
First-year results from the two studies on the caries-inhibiting effect of fluoridated mouth wash in two areas of the Province, which are referred to in the report
of the Director of Preventive Dentistry, were being processed and summary data
prepared.
 VITAL STATISTICS
H 45
The Division's Research Section participated in the preparation of a paper on
the results of the Trail chewing-gum study, which was published in the Journal of
the Canadian Dental Association (see list of publications, page 55). The results
of the study indicated that after two years of chewing there were no statistically
significant differences in mean caries increments for all teeth among the three
experimental groups.
The Research Section continued to give service to the Mental Health Branch
in the processing of statistics relating to patients of residential institutions and those
treated at day-care centres.
The records of the operations of the Division of Venereal Disease Control
were processed, and monthly and annual statistical reports were compiled.
The Division's Research Section maintained detailed statistics on natality and
infant mortality in the Province. Analytical tables relating to births in 1965-70
were prepared from the records of the Physician's Notice of Birth, and were circulated to public health staff and selected medical specialists.
A report on infant mortality in the Province covering the period 1965-69 was
published during the year in the Division's Special Report series.
A report on the level of pregnancy loss among British Columbia mothers in
1965-69, based on information given in the Physician's Notice of Birth, was prepared and accepted for publication by a professional journal. This report is designed to indicate the rate of abortions and stillbirths in the period preceding the
liberalization of abortion which followed the amendment of the Criminal Code in
1969.
This picture shows the Tabulation Section of the Division of Vital Statistics, a section which
produces statistical information for many health agencies in the Province.
 H 46
PUBLIC HEALTH SERVICES REPORT,  1972
The Division maintained punch-card files of all known cases of tuberculosis,
admission and separation records of tuberculosis institutions, out-patient records,
and results of tuberculin testing surveys.
The Division co-operated in the Department of National Health and Welfare's
continuing programme for surveillance of congenital anomalies, and submitted
weekly lists of anomalies gleaned from various sources. These are summarized
by the Federal Department and comparative figures are returned to the provinces
for their information. The data provide a valuable means of monitoring the occurrences of various types of anomalies.
Following the transfer to the Health Branch of responsibility for the licensing
and controlling of community care facilities in 1971, the Division assumed responsibility for mechanical processing of the records of their operations.
The Division collaborated in the preparation of a paper on the results of a preschool health-screening project in the Central Vancouver Island Health Unit, which
was published in the Canadian Journal of Public Health. (See list of publications,
page 55.)
The Mechanical Tabulation Section continued to undertake editing, coding,
punching, and tabulating all records submitted for processing by other divisions and
agencies as weU as all vital statistics documents.
IN-PATIENT CARE
The In-patient Care Programme at Pearson Hospital and the Willow Chest
Centre provides for tuberculosis patients and for persons requiring continuing care
for other conditions listed later in this section. (The out-patient programme for
those with tuberculosis has been described in this volume.)
At the present time, three wards in Pearson Hospital are providing care to 130
patients with tuberculosis. Normally two wards are used at Pearson Hospital and
the increase is a temporary measure while renovations are being carried out at the
Willow Chest Centre. The latter is providing care in two wards for 21 patients at
present. The increase of patients with tuberculosis at Pearson Hospital has increased the work load of some departments in the hospital, especially the X-ray and
laboratory services. There has been a concurrent increase in the number of patients
attending the hospital's dental, ophthalmology, and otorbinolaryngology clinics, accentuated by the need to transport Willow Chest Centre patients to Pearson for these
consultation services. When the Willow Chest Centre renovations are completed,
advantage can be taken of these specialty treatments at the Vancouver General
Hospital.
As well as the care for tuberculosis patients at Pearson Hospital, which has
already been described, a number of beds are set aside for the extended care of
patients with other respiratory conditions, and for those with multiple sclerosis,
muscular dystrophy, the residual effects of poliomyelitis, and other such conditions.
This is another aspect of the In-patient Care Programme.
Several senior staff changes have occurred due to retirement, resignations to
seek other employment, or reorganization of departments. The two services of
Occupational Therapy and Physiotherapy were combined to form a new Department
of Activation Services.    The director of this department was formerly the senior
 IN-PATIENT CARE
H 47
physiotherapist. A recreational therapist position was established in the Activation
Services and this has resulted in co-ordination of the many and varied recreational
activities for both Pearson Hospital and Willow Chest Centre patients and also
increased emphasis toward the diversional programme for patients with tuberculosis.
A number of resignations of members of the Physiotherapy and Occupational
Therapy staff occurred, but recruitment of new staff has been encouraging.
The Department of Nursing at Pearson Hospital and that at Willow Chest
Centre are now combined into one department. The new director was previously
in charge at the Willow Chest Centre. Replacement of senior nursing personnel
who have retired was somewhat improved over the previous year, although recruitment difficulties continue. Central Supply Services for both institutions were part
of their respective nursing services and have now been integrated at Pearson, the
unit there requiring minimal increase of personnel.
The amalgamation of other in-patient services of Willow Chest Centre with
those of Pearson Hospital continues. The centralization of stores at Pearson Hospital has now been completed. Both Dietary Services are now combined under the
supervision of the hospital's Chief Dietitian. The Social Service Department has
continued to be active in its efforts to rehabilitate patients in Willow Chest Centre
and Pearson Hospital. A new programme was started at the latter institution to
encourage severely disabled patients to accept increased responsibility in meeting
some of their physical limitations. There has been evidence of some benefit to
those who are participating.
Considerable constructional work has been done, involving new roofing of one
ward and of the administration building. Interior painting of six of the seven wards
has been completed, with that of the last under way at the year's end. The services
of a colour consultant from the Department of Public Works resulted in a new,
cheerful appearance to the wards, appreciated by patients, staff, and visitors. Replacement of the ceiling and painting of the main kitchen are in progress. The
flooring of the patients' rooms in the extended-care wards was replaced.
The laboratory at Pearson Hospital has obtained new microscopes, and these
improved models are of great assistance to the staff in processing the increased
number of sputum examinations resulting from there now being in operation a third
ward for patients with tuberculosis. More accurate enzyme tests for the follow-up
treatment of these patients with the newer antimicrobial drugs is now possible because of the acquisition of additional equipment.
In-service education courses are being assessed for their effectiveness and being
altered as required. The use of health education films for patients with tuberculosis
has been initiated. Participation in certain areas of health education in the community has been requested by some outside agencies. The topics include patient
bed-care in the Homemakers programme and tuberculosis nursing for student nurses,
in addition to already established practical experience for students from the School
of Rehabilitation Medicine at the University of British Columbia and from the
Vancouver Vocational Institute.
Other significant events included Pearson Hospital again being granted full
accreditation by the Canadian Council on Hospital Accreditation. Thus the hospital
has maintained its accredited status since it was first surveyed in 1954. The occasion of the 20th anniversary of the official opening of the hospital on May 14,
1952, was celebrated with a staff tea party which was well attended. The patients
participated by having a special dinner. Present and former members of the staff
who were employed when the hospital opened were invited as special guests.
The Women's Auxiliary has continued to serve the patients in many ways.
The auxiliary's provision of a number of the amenities of life, including the services
 H 48
PUBLIC HEALTH SERVICES REPORT, 1972
of a hairdresser and a manicurist, are greatly appreciated by the patients. Television sets, special supplies for occupational therapy, parties for and visits to patients
have been of inestimable benefit. Organizations such as the Multiple Sclerosis
Society, the Tuberculous and Chest Disabled Veterans Section of the Royal Canadian Legion, the Canadian Paraplegic Association, and the Kinsmen Rehabilitation
Foundation of British Columbia also contribute to the welfare and happiness of the
patients.
AID TO HANDICAPPED
The Division for Aid to Handicapped can report another year during which
several important gains were made through which more handicapped people in the
Province were provided with services (see Table XVIII).
Late in 1971, arrangements were made to appoint a consultant for the Kootenay
region. His office is located in the Health Centre in Nelson and he serves the East
and West Kootenays. New Aid to Handicapped Committees have been formed in
Castlegar and Creston and are providing services to a developing and increasing
case load of disabled persons in the region. Because of this appointment, the Division is able to extend its services to greater numbers in the Greenwood-Grand Forks
area and it is expected that an Aid to Handicapped Committee in that area will soon
be developed. As a result of these developments, the case load in the region has
increased substantially.
The Okanagan region is showing consistent case-load expansion since the appointment of a full-time replacement consultant in the area last year after a period
of 18 months when consultant services were provided on a one-week-a-month basis
from the Vancouver office.
The Vancouver office carries a case load of approximately 500, which is the
largest of any office in the Province. This case load is a difficult one, requiring precise supervision by the professional and clerical staff, and consists to a great degree
of a shifting population of handicapped persons. They are brought to Vancouver
from all parts of the Province for special procedures or a wide spectrum of special
services not obtainable elsewhere in the Province. These services include sophisticated medical and vocational assessment, special treatment services, psychological
testing and vocational counselling, vocational education, training from the industrial
rehabilitation workshop, and university training at the graduate level.
During the year a Vancouver Aid to Handicapped Committee has been developing a case load at twice the rate of the Victoria Committee. These two committees
carry the responsibility for approximately 35 per cent of the Provincial case load.
During 1973 it is hoped that, with added clerical and professional staff, the
work of the Vancouver Aid to Handicapped Committee can be decentralized and
located more directly within the health and welfare service areas of the Greater Vancouver region.
The Division was able to increase its financial assistance to designated agencies.
Financial assistance takes the form of money specifically alloted for qualified professional personnel and necessary supporting clerical staff. By making funds available for this purpose, the availability of well-qualified professionals to the handicapped of the Province has been considerably enhanced.
 AID TO HANDICAPPED
H 49
The Opportunity Rehabilitation Workshop has made excellent use of its salary
assistance and now has one of the best vocational assessment units and vocational
training programmes for the handicapped in Canada. Its capacity has expanded to
the point where between 60 and 65 handicapped persons are in the assessment or
training process at all times.
Goodwill Enterprises of Victoria have also functioned in a similar manner.
The Western Institute for the Deaf has received assistance toward professional salaries and this has allowed it to make a contribution which otherwise would not have
been possible.
A matter of need which should be a high priority in the development of services
for the handicapped is that of planning for competent vocational assessment services
which should be more widely available than they are. The Division has felt for some
time that considerable effort should be directed toward the development of such services either within or in conjunction with the presently available vocational schools
which are well equipped, competently staffed, and located in every region in the
Province. Advantage should be taken of these circumstances and an effort made
to add what is required in staff and equipment to make the assessment services
available.
Accordingly, arrangements were made in the early part of the year with the
Technical and Vocational Services Division of the Department of Education to start
an experimental, joint project in conjunction with Camosun College and the British
Columbia Vocational School, Victoria. The Division for Aid-to-Handicapped contributed the services of a competent rehabilitation evaluator and rehabilitation psychologist and the Technical and Vocational Services Division contributed adequate
quarters and the expertise of the staff of the vocational school.
The Division has received valuable assistance from the staff of other Provincial
Government departments, notably the Department of Education and the Department
of Rehabilitation and Social Improvement, the regional and local offices of Canada
Manpower, and the many voluntary agencies who have helped with the re-establishment of the disabled into a life with meaning and purpose.
LABORATORY SERVICES
PUBLIC HEALTH LABORATORY SERVICES
Despite the noise, dirt, and disorganization inevitably created by renovations
to the four floors of the Provincial Health Building in Vancouver, the Provincial
Laboratories continued to provide uninterrupted services in bacteriology, mycology,
parasitology, and virology. In Table XIX the number of tests performed in 1972
in the Main Laboratory and the Branch Laboratories at Nelson and Victoria are
compared with the corresponding figures for 1971. Work load increased from
498,000 tests in 1971 to 504,500 tests in 1972. There were increases in virus
isolation, 40 per cent; smears and cultures for Neisseria gonorrhcece, 34 per cent;
examination for intestinal parasites, 29 per cent; smears and cultures for miscellaneous bacteria, 19 per cent. Decreases noted were fungal examinations, 31 per
cent; water bacteriology, 8 per cent; syphilis serology, 6 per cent; agglutination
tests for febrile diseases, 5 per cent; enteric bacteriology, 4 per cent.
 H 50
PUBLIC HEALTH SERVICES REPORT, 1972
REFERENCE SERVICES
To meet the growing need for advice on exotic diseases, a Tropical and Parasitic
Diseases Reference Service has been established at the Provincial Laboratory, Vancouver, B.C. An exotic disease is defined as one which is normally acquired outside
the area in which the doctor works.
With the increasing speed and volume of world travel, more physicians are
likely to be consulted by patients with or without symptoms who may have acquired
exotic infections in the tropics. In taking the medical history of such patients,
answers will determine the investigation essential to rapid differential diagnosis and
appropriate early treatment. Lack of clinical awareness of such exotic diseases as
malaria may lead to the tragedy of delayed or missed diagnosis and unnecessary
death. The reference service has provided advice on these matters and has distributed selected drugs for their treatment.
The Botulism Reference Service for Canada, established in the laboratories
by the Department of National Health and Welfare and the Provincial Department
of Health Services and Hospital Insurance, continued to provide consultative and
practical assistance on the diagnosis and treatment of botulism, although there have
been very few cases reported.
The Service also participated in the investigation of six food-poisoning incidents caused by other agents.
VIROLOGY
In 1971 and 1972, outbreaks of Western equine encephalitis (WEE) were
reported from the Okanagan Valley. For the first time in British Columbia, WEE
infection of patients and of horses was proven by laboratory tests.
COMMUNICABLE DISEASE NEWS
At the request of the Editorial Board of the British Columbia Medical Journal,
brief communicable disease news items were submitted for publication each month
in the section devoted to public health and mental health news. This is a new
activity for Laboratory staff and represents an important step forward in the dissemination of information on communicable disease.
The Director and the Virologist made updating visits to discuss current development in microbiology with consultants in Canada and the United States.
CLINICAL LABORATORY SERVICES
The work load in clinical laboratories in British Columbia hospitals continued
to increase due to greater usage of diagnostic procedures and a variety of new tests.
This situation created a change in pattern, particularly in the larger hospitals, and
new equipment was required in order to utilize available space and staff. Requests
for more sophisticated equipment were referred to the Laboratory Advisory Council
through the office of the Consultant of Clinical Laboratories. This necessitated a
great deal of research in order to give advice to British Columbia Hospital Insurance
Service regarding grants.
The Laboratory Advisory Council has, for several years, advised the British
Columbia Hospital Insurance Service before grants are awarded to hospitals for the
purchase of diagnostic and laboratory equipment. The Council consists of representatives from the British Columbia Medical Association, the Health Branch, the Department of Pathology of the Faculty of Medicine at the University of British Columbia, and the British Columbia Hospital Insurance Service.
 LABORATORY SERVICES
H 51
In British Columbia, clinical laboratory services have been regionalized and
there are now eight in existence throughout the Province. These laboratories offer
many diagnostic tests to in-patients and out-patients of hospitals. It is interesting
to note that the organization now in existence in British Columbia has become a
prototype for other Canadian provinces.
The additional equipment, totalling approximately half a million dollars, made
it possible for the supply of technologists to meet the demands in most hospitals.
The graduation of 80 technologists in British Columbia last year filled the staffing
needs, except in some rural areas. The addition of training-schools in Nanaimo and
Kelowna should assist the staff problems in the smaller hospitals in these areas.
The students received their initial training at the British Columbia Institute of
Technology and, as the demand for technologists will increase, the Advisory Committee to the School of Medical Technology at the institute was asked to project the
number of trainees required in 1975-80. A subcommittee was appointed to study
this problem. A vast amount of data were accumulated and a detailed report was
presented to the principal of the institute.
Postgraduate training was provided by the Fifteenth Annual Postgraduate
Course in Kamloops and a course in hcematology which was given one evening a
week for 15 weeks. This was offered by the Extension Division of the British Columbia Institute of Technology in co-operation with the British Columbia Society
of Medical Technologists, and 60 technologists attended. A similar course in microbiology is scheduled in January 1973.
British Columbia Hospital Insurance Service construction department continued
to consult the Laboratory Advisory Council. Functional programmes, preliminary
plans, and working drawings for expansion or new laboratory facilities were reviewed
and recommendations made.
The plans for the new laboratory in the Dawson Creek hospital allowed space
for expansion to provide regional pathology services. Two pathologists showed
interest in setting up a programme in this area and commenced preliminary discussions with the British Columbia Hospital Insurance Service and the Laboratory
Advisory Council. When this becomes a reality, the majority of hospital laboratories in the Province will be included in a regional pathology service.
EMERGENCY  HEALTH  SERVICE
The objective of the British Columbia Emergency Health Service is to develop
a capability to provide mass-casualty care and emergency public health service to
the people of the Province. The co-ordination of the service is carried out by a
consultant who also functions as Pharmaceutical Consultant (see separate report,
page 53).
The availability of students for summer employment allowed repacking and
tagging of supplies and equipment for the training 200-bed Emergency Hospital,
training Advanced Treatment Centre, and training Casualty Collections Unit. However, these ready-to-use units will have to remain in storage because of severe
reductions in the Provincial Emergency Health Service Programme.
 H 52
PUBLIC HEALTH SERVICES REPORT,  1972
During the last fiscal year, negotiations were active with a number of hospitals
for pre-positioning of medical supplies and equipment. It was considered this programme should be completed to the extent of available funds.
It is considered desirable for Provincial Emergency Health Service to have
discussions with neighbouring States on the exchange of health manpower and other
items of common interest for the protection of the populations.
The Province of British Columbia was subjected to floods and threats of floods
this year. Along with other emergency services, Emergency Health Services were
placed on a standby basis. Fortunately, the flooding did not result in emergencies
requiring major action of Emergency Health Services.
Heavy rain on the Lower Mainland did result in an inundation of a storage
area containing an Advanced Treatment Centre and a Casualty Collecting Unit.
However, quick action by the Commanding Officer of the establishment in acquiring
additional sump pumps limited damage to eight boxes of stretchers and blankets.
Basic industries in more remote areas are creating demands for back-up health
supplies in a community emergency, and these requests are being followed up.
The majority of Emergency Health Services supplies in British Columbia are
stored in community hospitals.
COMMUNITY EMERGENCY PLANNING
Community Emergency Health planning and exercises are an encouraging
aspect of Emergency Health Services in British Columbia. More communities are
noting the value of the exercises, and the number of yearly exercises has increased.
This is due, in part, to accreditation requirements. In particular, the smaller communities, with primary industries, are very conscious of Emergency Health planning.
Casualty simulation and training supplies provided through Provincial Emergency
Health Services are an integral part of these exercises.
TRAINING
Another encouraging aspect is the reception by community hospitals of in-
service programmes for hospital personnel, consisting of three films and two lectures.
These were presented at nine hospitals this year.
Other activities included the following:
• As part of a Disaster Nursing Education Programme, students from the nursing schools at the Royal Jubilee Hospital and the Victoria General Hospital
in Victoria continue to attend Emergency Health Services courses conducted
by the Emergency Health Service at the Civil Defence Headquarters in
Victoria.
• Provincial Emergency Health Service continues to support a jointly sponsored course entitled "Primary Care for the Emergency Patient." Consideration is being given to lengthening this course beyond two days.
• The British Columbia Hospitals' Association again provided excellent display
space in the exhibitors' section at its annual meeting. The Federal Emergency Health Services was well received by hospital administrators and board
chairmen.
• Because the supplies of the Training Advanced Treatment Centre and the
Training Casualty Collecting Unit had been tagged prior to the Abbotsford
Airshow, both units were made available on a standby basis. The airshow
emphasizes the value of a periodic exercise. It is considered that the Fraser
Valley was well prepared and able to cope with the flood situation.
 PHARMACEUTICAL CONSULTANT SERVICE H 53
PRE-POSITIONING
The following units and supplies were pro-positioned in 1972 (see Table XX).
Emergency hospitals  3
Advanced Treatment Centres  2
Casualty Collecting Units  2
There are now 194 units in 111 storage locations in 75 municipalities.
PHARMACEUTICAL CONSULTANT SERVICE
The Consultant in Pharmacy provides advice to the Minister and Deputy Minister and, upon request, to other departments of Government. The Consultant continued as chairman of the Minister's Drug Advisory Committee during 1972. The
committee was commissioned by the Minister of Health Services and Hospital Insurance, and is composed of representatives of the British Columbia Medical Association, British Columbia Pharmaceutical Association, and faculties of medical and
pharmaceutical sciences of the University of British Columbia.
Subcommittees enabled the Drug Advisory Committee to complete most of its
terms of reference, which included investigation of drug prices, product selection,
labelling of products, advertising of brand-name products and generic equivalents,
and the pharmacists' fees for dispensing prescriptions. Last year the Committee
was requested to make recommendations concerning action that might be taken to
reduce the cost of drugs to the elderly, the poor, and to provide assistance to those
who experience an unequal and generally unpredictable incidence of heavy drug
costs.
COUNCIL OF  PRACTICAL  NURSES
The Council of Practical Nurses has, as its main responsibility, the assessment
of applications from persons who wish to be licensed as practical nurses and the
issuing of licences to those who are qualified. The legislative authority lies in the
Practical Nurses Act and the regulations under this Act.
The Council consists of 10 members appointed by order of the Lieutenant-
Governor in Council on the basis of nominations submitted by
(a) the Minister of Health Services and Hospital Insurance (two members);
(b) the College of Physicians and Surgeons of British Columbia (one
member);
(c) the Registered Nurses' Association of British Columbia (two members);
(d) the Minister of Education (one member);
(e) the British Columbia Hospitals' Association (one member);
(/) the Licensed Practical Nurses' Association of British Columbia
(three members).
 H 54
PUBLIC HEALTH SERVICES REPORT, 1972
The first licences were issued in 1965. Since then, the Council has received
over 8,000 applications.   Table XXI shows the disposition of these.
During 1972 the Council as a whole held seven meetings, each about five
hours in length.  This brought to 53 the number held during the period, 1965-72.
There were also numerous meetings of several committees appointed by the
Chairman with the approval of the Council. One of these, the Committee on
Credentials, serves on a continuing basis. It assesses the qualifications of applicants
and submits to the Council recommendations concerning their acceptability. Another
committee was appointed to study the regulations and make recommendations concerning possible changes.
Until 1972, the Practical Nurses Act made the Council responsible for approving the establishment, maintenance, and conduct of schools or training courses for
practical nurses. At the 1972 Session of the Legislature, the Act was amended to
relieve the Council of this responsibility in respect of those schools or training
courses which are operated under the authority of the Public Schools Act. This
makes it unnecessary for the official educational authorities of British Columbia to
seek approval of the Council in matters relating to schools and training courses.
At the same time, the Act retains the safeguard whereby any other person or organization wishing to operate a school or training course for practical nurses must have
the approval of the Council.
PUBLICATIONS,  1972
Twenty Years Experience With a Handicapped Child Registry, Proceedings of the
International Congress of Pediatrics, August 29 to September 4, 1971, pp.
151-156, by R. B. Lowry, J. R. Miller, A. E. Scott, and D. H. G. Renwick.
Incidence and Genetics of Legg-Perthes Disease in British Columbia, Journal of
Medical Genetics, Vol. 9, 2:197-202, June 1972, by Irene M. Gray, R. B.
Lowry, and D. H. G. Renwick.
Incidence of Phenylketonuria in British Columbia, 1950 to 1971, Canadian Medical
Association Journal, 106:1299-1302, June 24, 1972, by R. S. Lowry, B.
Tischler, W. H. Cockcroft, and D. H. G. Renwick.
Hospital Separations and Cancer Registrations in British Columbia, Canadian Journal of Public Health 63:363-365, July/August 1972, by R. W. Morgan and
A. E. Scott.
A Pre-school Screening Program, Central Vancouver Island Health Unit, 1970—71,
Canadian Journal of Public Health 63:268-271, May/June 1972, by Alistair
Thores and John Philion.
Anticariogenic Effects of Dicalcium Phosphate Dihydrate Chewing Gum: Results
After Two Years, Journal of the Canadian Dental Association, 38:213-218,
June 1972, by A. S. Richardson, L. W. Hole, F. McCombie, and J. Kolt-
hammer.
The Continuing Challenge of Salmonellosis, Canadian Journal of Public Health,
62:473, November/December 1971, editorial by E. J. Bowmer.
 PUBLICATIONS, 1972 H 55
Pentastomiasis in Western Canada: A Case Report, American Journal of Tropical
Medicine and Hygiene, 21:58, January 1972, by Z. Ali-Kahn and E. J.
Bowmer.
Filariasis Imported Into British Columbia, Canadian Journal of Public Health,
63:90, January/February 1972, by E. J. Bowmer.
Canadian Botulism Reference Service, Canadian Journal of Public Health, 63:76,
January/February 1972, by E. J. Bowmer and D. A. Wilkinson.
Typhoid at Sea: Epidemic Aboard an Ocean Liner, Canadian Medical Association
Journal, 106:877, April 22, 1972, by J. W. Davies, K. G. Cox, W. R. Simon,
E. J. Bowmer, and A. Mallory.
Index of Drinking Water Pollution—Total Coliform MPN Tests: Confirmed Test
Versus Completed Test, Canadian Journal of Public Health, 63:355, July/
August 1972, by E. J. Bowmer and J. A. K. Campbell.
Rapid Diagnostic Methods in Medical Microbiology, ed. Charles D. Graber, Canadian Doctor, 38:118, April 1972, review by E. J. Bowmer.
Study of Congenital Rubella in B.C., British Columbia Medical Journal, 14:19,
January 1972, by G. D. M. Kettyls, J. Robert MacLean, and Sydney Segal.
Arbovirus Infections in Man in British Columbia, Canadian Medical Association
Journal, 106:1175, June 1972, by G. D. M. Kettyls, V. M. Verrall, Mrs. Leslie
D. Wilton, J. B. Clapp, D. A. Clarke, and J. D. Rublee.
Trichinosis from Bear Meat and Adulterated Pork Products: A Major Outbreak in
British Columbia, 1971, Canadian Medical Association Journal, 107:1087,
December 9, 1972, by N. Schmitt, E. J. Bowmer, P. C. Simon, A. S. Arneil,
and D. A. Clark.
TABLES
Table I—Approximate Numbers of Health Branch Employees by Major
Categories at the End of 1972
Physicians in local health services  18
Physicians in institutional and other employment  19
Nurses in local health services  322
Nurses in institutions  72
Public health inspectors  71
Dentists in local health services  5
Laboratory scientists   22
Laboratory technicians   26
Public health engineers  5
Statisticians    7
Others    778
Total    1,345
 H 56 PUBLIC HEALTH SERVICES REPORT, 1972
Table II—Organization and Staff of Health Branch (Location and Approximate
Numbers of Persons Employed at End of 1972 )
Health Branch headquarters, Legislative Buildings, Victoria    54
Health Branch office, 828 West 10th Avenue, Vancouver     36
        90
Division of Vital Statistics—
Headquarters and Victoria office, Legislative Buildings,
Victoria      70
Vancouver office, 828 West 10th Avenue, Vancouver ....    19
89
Division of Tuberculosis Control—
Headquarters, 2647 Willow Street, Vancouver     10
Willow Chest Centre, 2647 Willow Street, Vancouver ____ 134
Pearson Hospital, 700 West 57th Avenue, Vancouver ___ 326
Victoria and Island Chest Clinic, 1902 Fort Street, Victoria      11
New Westminster Chest Clinic, Sixth and Carnarvon,
New Westminster       7
Travelling clinics, 2647 Willow Street, Vancouver     17
      505
Division of Laboratories—
Headquarters and Vancouver Laboratory, 828 West
10th Avenue, Vancouver     80
Nelson Branch Laboratory, Kootenay Lake General Hospital        1
Victoria Branch Laboratory, Royal Jubilee Hospital1	
        81
1 Services are purchased from the Royal Jubilee Hospital, which uses its own staff to perform the tests.
 TABLES
H 57
Table II—Organization and Staff of Health Branch (Location and Approximate
Numbers of Persons Employed at End of 1972)—Continued
Division of Venereal Disease Control—Headquarters and Vancouver Clinic, 828 West 10th Avenue, Vancouver	
Division for Aid to Handicapped—
Headquarters, 828 West 10th Avenue, Vancouver     10
Nanaimo	
Vernon	
Prince George 	
Surrey 	
Nelson 	
Local Public Health Services (Health Units)—
East Kootenay, Cranbrook  25
Selkirk, Nelson  13
West Kootenay, Trail  21
North Okanagan, Vernon  26
South Okanagan, Kelowna  39
South Central, Kamloops  31
Upper Fraser Valley, Chilliwack  29
Central Fraser Valley, Mission  28
Boundary, Cloverdale   54
Simon Fraser, Coquitlam  38
Coast-Garibaldi, Powell River  18
Saanich and South Vancouver Island, 780 Vernon Avenue, Victoria   45
Central Vancouver Island, Nanaimo  53
Upper Island, Courtenay  24
Cariboo, Williams Lake  18
Skeena, Prince Rupert  28
Peace River, Dawson Creek  19
Northern Interior, Prince George  37
19
15
546
Total
1,345
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 72 full-time employees.
 H 58 PUBLIC HEALTH SERVICES REPORT, 1972
Table HI—Comparison of Public Health Services Gross Expenditure
for the Fiscal Years 1969/70 to 1971/72
Gross Expenditure
Percentage of
Gross Expenditure
Percentage
Increase or
Decrease
(-)
1969/70
1970/71
1971/72
1969/70
1970/71
1971/72
Previous
Year
S
5,924,284
4,200,358
2,637,205
899,100
860,196
560,231
176,973
$
6,235,726
4,335,945
1,774,510
1,205,622
923,546
599,684
189,188
$
6,689,345
4,711,304
1,973,397
1,460,097
832,178
647,938
209,138
38.8
27.5
17.3
5.9
5.6
3.7
1.2
40.9
28.4
11.6
7.9
6.1
3.9
1.2
40.5
28.5
12.0
8.8
5.0
3.9
1.3
7.3
8.7
Cancer,   arthritis,   rehabilita-
11.2
General administration and
consultative services	
Division of Laboratories	
Division of Vital Statistics	
Division of Venereal Disease
21.11
—9.92
8.0
10.5
15,258,347
15,264,221
16,523,397
100.0
100.0
100.0
8.2
1 Large increase due to a new vote, Development of Alternative Care Facilities.
2 Decrease in Division of Laboratories due to the transfer of the pollution control programme to the Water
Resources Branch.
Table TV—Training of Health Branch Staff Proceeding Toward a Diploma or
Degree in a Public Health Specialty
(Types of training, universities or other training centres attended, and numbers trained)
Completed training during 1972—
Diploma in Public Health Nursing (University of Washington) ___    1
Diploma in Public Health Nursing Supervision (Dalhousie University )      1
Master's Degree in Speech Therapy (Western Washington State
College)     1
Diploma in Public Health Nursing (University of British Columbia)       2
Total      5
Commenced training during 1972—
Master of Science in Speech Pathology and Audilogy (University of Washington) 	
Master of Science in Human Communication (London University/Guy's Hospital Medical School) 	
Master's Degree in Public Health (Johns Hopkins University)	
Master's Degree in Public Health (University of Michigan)	
Diploma in Public Health Nursing (University of British Columbia) 	
Total
 TABLES H 59
Table V—Training of Health Branch Staff by Means of Short Courses
(Types of training, universities or other training centres, and numbers trained)
Workshop for Public Health Nurses (The Woodlands School for Retarded, Vancouver)     8
Dr. Robert Barkley Lecture (Queen Elizabeth Theatre, Vancouver) __    1
Regional Workshops on Hearing Screening (Nanaimo, Pringe George,
and Trail)     3
Food Control and Other Related Topics (Riverview Hospital Educational Centre)   48
Focus on Aging (Christmas Seal Auditorium, Vancouver)     5
Nursing Care of the Patient and Long Term Illness (B.C. Institute of
Technology)      2
Drugs and Alcohol: Their Effect on Industry (Bayshore Inn, Vancouver)      3
An Introduction to the Psychology of Aging (Shaughnessy Hospital,
Vancouver)      1
Fifteenth Annual Refresher Course (University of Toronto)      2
First Annual Regional Institute for Public Health Nurses (Kamloops) 90
Seventh Annual Neuropsychology Workshop (University of Victoria)    1
Public Health Refresher Course (University of Alberta)      1
Accidental Happenings in Childhood—Pediatric Nursing (University
of British Columbia)     2
Institute on Crisis Intervention (Vancouver General Hospital)      1
Developing Human Resources for Improved Nursing Care (University
of Toronto)      2
Crisis Intervention Seminar (University of British Columbia)      1
Environmental Health Administration (Ryerson Polytechnical Institute, Toronto)      5
Seminar/Workshop on Electrical Safety in Hospitals (B.C. Institute
of Technology)      1
B.C. Speech and Hearing Association Workshop (Western Institute
for the Deaf, Vancouver)     1
Recycling—Reclamation of Municipal Solid Wastes (University of
British Columbia)       1
Home Care and Management Seminar (Powell River)     1
Senior Health Branch Staff Training (University of British Columbia) 125
Supervisors Training Course in Accident Prevention (University of
British Columbia)     1
Certificate Programme in Health Care Management (B.C. Institute
of Technology)     1
Electron Microscopy Diagnostic Service (University of Toronto)     1
Conference of the Food Service Industry (Department of Health and
Welfare, Ottawa)      1
Group Skills Development Workshops (Vancouver)   20
National Conference on School Health (Ottawa Inn, Ottawa)     1
 H 60
PUBLIC HEALTH SERVICES REPORT, 1972
Table V—Training of Health Branch Staff by Means of Short Courses—Continued
Environmental Health Administration Correspondence Course (Ryer-
son Institute)      8
The 1972 American Speech and Hearing Association (San Francisco)     1
"Probe"—A Conference on Health and the Industrial Environment
(Hotel Vancouver)      6
Third Annual Conference on Trichinellosis (Miami, Florida) 	
The Battered Child (University of Colorado) 	
Cross Connection Control (University of British Columbia) 	
Conference of Radiological Society of North America  (Chicago,
Illinois)  	
Institute on "New Approaches to Working With Volunteers" (Jewish
Community Centre, Vancouver) 	
Multi Discipline Conference of B.C. Chapter of Canadian Guidance
and Counselling Association (Vancouver City College)	
Table VI—Reported Communicable Diseases in British Columbia, 1968-72
(Including Indians)
(Rate per 100,000 population)
1968
1969
1970
1971
1972
Number
of
Cases
Rate
Number
of
Cases
Rate
Number
of
Cases
Rate
Number
of
Cases
Rate
Number
of
Cases
Rate
4
19
8
165
165
311
9
2
2,032
(*)
17
43
136
__.
(t)
276
1,020
5
0.2
0.9
0.4
8.2
8.2
15.5
0.4
0.1
101.3
C)
12
1
23
14
209
400
19
29
8
2,139
(*)
13
22
59
It)
(t)
64
1,236
2
5
0.6
0.1
1.1
0.7
10.1
19.3
0.9
1.4
0.4
103.3
C)
0.6
1.1
2.9
(t)
(t)
3.1
59.7
0.1
0.2
5
54
9
143
532
6
8
2
1,910
(*)
14
32
155
(t)
(t)
166
644
5
0.2
2.5
0.4
6.7
24.9
0.3
0.4
0.1
89.4
C)
1
0.1
1
60
11
72
415
73
16
5
1,894
26
34
22
102
1
84
97
202
454
13
0 1
Diarrhcea   of   the   newborn
(E. colt)     ---
64
11
126
548
8
6
1,954
(*)
1
17
45
91
1,168
200
241
306
2.9
0.5
5.7
24.9
0.4
0.3
89.0
(•)
0.1
0.8
2.0
4.1
2 7
Diphtheria.	
Dysentery, type unspecified..-
Food infection—
0.5
3.2
18.5
3.2
Food intoxication—
Staphylococcal	
0.7
0.2
Hepatitis-
Infectious...  	
84.3
1.2
Meningitis—
0.8
2.2
6.8
0.6
1.5
7.2
(t)
(t)
7.8
30.1
0.3
1.5
Viral     ......
1.0
4.5
Q. fever 	
Rubella  	
0 1
(t)
(t)
13.8
50.9
0.2
53.2
9.1
11.0
13.9
0.2
3.7
4.3
Shigellosis..	
Streptococcal   throat   infection and scarlet fever
9.0
20.2
Typhoid and paratyphoid
fever 	
5
0.6
Total  	
4,212
209.9
4,255
205.6
3,685
172.4
4,792
218.2
3,582
159.4
* Infectious and serum hepatitis combined.
f Not reportable.
 TABLES
H 61
Table VII—Reported Infectious Syphilis and Gonorrhoea, British Columbia,
1946,1951,1956,1961,1965-72
Year
Infectious Syphilis
Gonorrhoea
Number
Ratel
Number
Ratel
1946	
834
36
11
64
165
71
72
68
45
76
73
99
83.0
3.1
0.8
3.9
9.2
3.8
3.7
3.4
2.2
3.6
3.3
4.42
4,618
3,336
3,425
3,670
6,005
5,415
4,706
4,179
4,780
6,070
7,116
7,924
460.4
1951
286.4
1956                    ..    .
244.9
1961	
225.3
1965          ...	
335.7
1966...     	
290.8
1967              	
1968            	
1969  	
241.7
208.2
231.2
1970	
284.0
1971                     	
1972...  	
324.0
352.62
1 Rate per 100,000 population.        2 Preliminary.
Table VIII—Statistical Summary of Selected Activities of Public Health Nurses,
September 1971 to August 1972, Inclusive1
School service—
Directly by nurse  268,049
Directly by auxiliaries   53,614
Teacher/Nurse conferences  5,466
Home visits   40,978
Group sessions with pupils  5,096
Meetings with staff  1,910
Conferences with staff  64,203
Expectant parents—
Class attendance by mothers  20,992
Class attendance by fathers  2,504
Prenatal home visits  3,672
Postnatal visits  19,796
Child health—
Infants—
Conferences
Home visits
Preschool—
attendance     52,657
     34,260
Conferences attendance     85,411
Home visits      29,746
Home care—-
Nursing care visits
88,921
Physiotherapist assessments  1,357
Physiotherapist home visits  1,466
Adult health supervision visits  47,543
Mental health visits  18,547
i Services provided by public health nurses under the jurisdiction of the Health Branch, but does not include
service provided by Greater Vancouver, Victoria, Esquimalt, Oak Bay, and New Westminster.
 H 62
PUBLIC HEALTH SERVICES REPORT, 1972
Table VIII—Statistical Summary of Selected Activities of Public Health Nurses,
September 1971 to August 1972, Inclusive1—Continued
Disease control—
Tuberculosis visits  8,905
Venereal disease visits  4,840
Communicable disease visits   6,516
Immunizations—
Smallpox 	
Poliomyelitis 	
Basic series of diphtheria, pertussis, and tetanus
Rubella	
Measles (rubeola) 	
Other 	
Total doses
89,883
144,205
20,446
31,304
24,269
155,927
466,034
Tests-
Tuberculin
Other 	
Total visits to home	
Professional services by telephone
16,101
12,964
184,161
207,988
i Services provided by public health nurses under the jurisdiction of the Health Branch, but does not include
service provided by Greater Vancouver, Victoria, Esquimalt, Oak Bay, and New Westminster.
 TABLES
H 63
Table IX—Statistical Summary of Public Health Inspectors' Activities, 1969—72,
for 17 Provincial Health Units
Item
1970
1971
1972
(Estimate)
Food premises—
Eating and drinking places..
Food processing 	
Food stores	
Other  ... 	
Factories-
Industrial camps..
Hospitals.
Community care.
Schools..
Summer camps.	
Other institutions-
Housing
Mobile-home parks-
Camp-sites	
Other housing-
Hairdressing places..
Farms  	
Parks and beaches .
Swimming-pools—
Inspection	
Samples-
Surveys (sanitary and other) .
Waste disposal 	
Public water supplies—
Inspection	
Sample-
Private water supplies—
Inspection  _	
Sample-
Pollution samples—
Bacteriological	
Chemical  	
Field tests..
Private sewage disposal.    	
Municipal outfalls and plants..
Plumbing	
Subdivisions 	
Site inspections	
Nuisances-
Sewage 	
Garbage and refuse-
Other (pests, etc.)....
Disease investigation	
Meetings	
Educational activities...
4,390
765
1,558
410
748
375
119
374
956
179
197
1,721
1,287
779
(*)
682
339
692
1,505
1,122
876
1,057
1,108
5,044
2,172
3,353
2,397
1,251
682
11,130
888
211
4,195
8,084
3,886
2,536
2,059
310
3,287
1,253
4,718
751
1,516
408
714
416
88
397
723
179
251
1,856
1,550
837
262
501
440
915
1,232
1,207
768
1,270
1,150
5,302
2,068
3,422
1,685
864
406
11,808
836
211
4,305
8,833
3,707
2,364
2,338
308
3,502
1,139
3,952
698
1,505
448
561
260
86
690
753
186
336
1,437
1,296
745
291
487
369
797
1,115
907
767
861
1,110
4,637
1,968
2,914
1,603
303
520 J
13,614
552
214
4,881
9,976
3,927
2,138
2,299
310
3,849
1,139
5,304
C1)
1,719
802
416
227
(2)
1,5053
220
275
(2)
1,963
1,496
2,311
510
418
386
397
1,297
1,121
537
795
1,377
5,342
2,053
2,535
1,258
15,956
470
414
5,751
10,958
3,921
2,273
2,750
300
3,495
1,522
1 Included in "other food premises."
2 Included in "community care."
3 Includes boarding-homes, youth hostels, day care centres, hospitals, and other institutions.
* Not available.
Table X—Summary of Services Provided by Speech and Hearing Services, 1972
Number of health units offering services to the speech
and language handicapped population  7
Total number of speech and language assessments      746
Total number of therapy sessions  3,501
Total number of consultative/educational visits made by
speech therapists	
382
Total number of persons discharged from therapy      174
 H 64
PUBLIC HEALTH SERVICES REPORT, 1972
Table XI—Report of Direct Service by Auxiliary Workers to Public Health Nursing
Programme, September 1971 to August 1972
For
Infants,
Number
of
Services
For Pre-school Children
For School-children
Adult Services
Type of
Worker
Number of Tests for
Other
Service
Number of Tests for
Other
Service
Under
65 Years
65 Years
Vision
Hearing
Vision
Hearing
and Over
Health unit aide _
Incentive trainee-
Volunteers	
32
5
220
4,064
104
812
3,868
181
756
195
12
865
32,865
4,400
5,751
6,443
1,263
1,272
351
452
817
190
7
261
1
Totals	
257
4,980
4,805
1,072
43,016
8,978
1,620
197
262
Table XII—Number of Pupils Receiving Basic Immunization Prior to
Entering Grade I, September 1971
Type of Immunization
Greater
Vancouver
Greater
Victoria
Remainder of
Province
Total
10,783
7,782 (72.2%)
8,712 (80.8%)
6,187 (57.4%)
6,839 (63.4%)
3,154
2,227 (70.6%)
2,538 (80.5%)
1,918 (60.8%)
1,749 (55.5%)
25,129
17,507 (69.7%)
19,587 (77.9%)
16,068 (63.9%)
12,642 (50.3%)
39,066
27,516 (70.4%)
Diphtheria, pertussis, and tetanus
30,837 (78.9%)
24,173 (61.9%)
21,230 (54.3%)
Table XIII—Number of Pupils With Immunization Up to Date1 at End of
Grade I, June 1972
Type of Immunization
Greater
Vancouver
Greater
Victoria
Remainder of
Province
Total
10,698
7,784 (72.8%)
8,791 (82.2%)
6,952 (65.0%)
6,995 (65.4%)
7,760 (72.5%)
3,120
2,292 (73.5%)
2,675 (85.7%)
2,122 (68.0%)
1,862 (59.7%)
2,350 (75.3%)
26,244
19,591 (74.6%)
22,541 (85.9%)
19,504 (74.3%)
13,929 (53.1%)
17,302 (65.9%)
40,062
Smallpox   	
29,667(74.1%)
34,007 (84.9%)
28,578 (71.3%)
22,786 (56.9%)
Rubella                -
27,412 (68.4%)
!'Up to date" is defined as:
Smallpox: Number successfully vaccinated within the past five years.
Diphtheria and tetanus: Number who have either completed the primary series or had a reinforcing
immunization during the past five years.
Poliomyelitis: Number who have had three or more doses of Sabin vaccine.
Rubeola: Number who have had one dose of live rubeola vaccine.
Rubella: Number who have had one dose of rubella vaccine.
Table XIV-
-Rubella Immunization Status of Grade V Girls, June 1972
Item
Greater
Vancouver
Greater
Victoria
Remainder of
Province
Total
5,974
5,164 (86.4%)
1,795
1,586 (88.4%)
14,245
12,039 (84.5%)
22,014
18,789 (85.4%)
 TABLES
H 65
Table XV—Enrolment in Public and Private Schools in British Columbia,
June 1972
Area
Grade
Schools
Kindergartens
Schools for
Retarded
Children
Total
Greater Vancouver—•
Public... -	
142,866
7,626
43,337
1,712
325,665
9,207
6,849
(!)
2,268
192
12,540
4,730
325
126
91
1
582
397
150,040
Private .            	
7,752
Greater Victoria—
Public           	
45,696
Private  	
1,905
Remainder of Province—
Public 	
338,787
14,334
Totals—■
Public 	
511,868
18,545
21,657
4,922
998
524
534,523
23,991
530,413
26,579
1,522
558,514
l Figure not available.
Table XVI—Pupils Referred for Health Services
Greater Victoria
Area Served by Health Branch
Reason for Referral
Referred to
Public Health
Nurse
Refered by
Public Health
Nurse for
Further Care
Referred to
Public Health
Nurse
Refered by
Public Health
Nurse for
Further Care
2,204
1,055
150
746
1,146
4,030
1,538
517
89
356
590
1,707
21,484
7,894
1,680
5,145
4,659
15,665
12,793
2,394
711
2,292
1,852
Other
4,959
Totals..     	
9,331                  4,797
56,527
25,001
19.6        1            10.1
16.0
7.1
Of the total enrolment of 400,722 for the two areas shown in the table, 16.4
per cent were referred to the public health nurse and 7.4 per cent were referred by
her for further care.
Table XVII—Registrations Accepted Under Various Acts
Registrations   accepted
Act—
Birth registrations	
Death registrations 	
Marriage registrations
Stillbirth registrations
Adoption orders 	
Divorce orders	
under  Vital  Statistics
Delayed registrations of birth	
Registrations of wills notices accepted under
Wills Act 	
Total registrations accepted 	
1971
35,180
17,829
20,422
427
2,578
5,021
371
19,295
101,123
1972
34,910
18,140
20,800
350
1,980
5,270
320
23,525
105,295
 H 66
PUBLIC HEALTH SERVICES REPORT, 1972
Legitimations of birth affected under Vital Statistics Act	
Alterations of given name effected under Vital
Statistics Act	
Changes of name under Change of Name Act	
Documents issued—
Birth certificates -
Death certificates
Marriage certificates	
Baptismal certificates	
Change of name certificates
Divorce certificates	
Photographic copies	
Wills notice certification	
Total certificates issued
1971
219
185
806
58,915
8,283
7,204
17
1,001
239
7,240
10,610
93,509
Nonrevenue searches for Government departments      13,718
Total revenue $385,282
1972
198
193
1,070
65,658
8,818
7,798
26
1,220
248
8,131
11,148
103,047
12,500
$414,712
 TABLES
H 67
Table XVIII—Division for Aid to Handicapped
Case Load, January 1 to December 31, 1972
Cases currently under assessment or receiving services, January 1, 1972  1,102
New cases referred to Aid to Handicapped Committees
outside Vancouver Metropolitan Region  912
New cases referred to Aid to Handicapped Committees in Vancouver Metropolitan Region:
Vancouver   380
Vancouver General Hospital
Richmond	
Pearson Hospital
14
44
7
Total
New cases referred from other sources
Cases reopened (all regions)	
445
84
227
Total new referrals considered for services, January
1, 1972, to December 31, 1972  1,668
Total cases provided with service in 1972  2,770
Analysis of Closed Cases, January 1 to December 31, 1972
Rehabilitated—
Employment placement made:
Canada Manpower     18
Division for Aid to Handicapped     13
Other   200
Total
231
Job placements not feasible: Restorative services completed
Not rehabilitated—
Severity of disability.
No disability.
Unable to locate clients
No vocational handicap
Other	
41
2
25
25
118
13
Total
Other—
Transferred	
Deceased	
211
26
1
Total
482
793
1,275
Cases remaining in assessment or receiving services  1,495
Grand total  2,770
Cases assessed and found not capable of benefiting from services
Total cases closed in 1972	
 H 68
PUBLIC HEALTH SERVICES REPORT, 1972
Table XIX—Statistical Report of Tests Performed in 1971 and 1972, Main
Laboratory, Nelson Branch Laboratory, and Victoria Branch Laboratory
Item
1971
1972
Main
Nelson
Victoria
Main
Nelson
Victoria
Bacteriology Service
Enteric Section—
Cultures—
Salmonella/Shigella   —  .
Enteropathogenic E. coli 	
16,999
3,938
135
5,666
212
3,936
1,361
53
942
1,105
34
1,087
2,394
2,535
15,591
3,576
145
6,281
262
4,441
1,580
34
48
500
327
Miscellaneous Section—■
Cultures—
C. diphtheria? 	
36
335
496
1,503
100
21
4,534
3,443
12,840
66,663
105
29,663
19,852
932
248
420
8,490
1,516
23,848
2,015
5,127
16
2,416
18
172,055
2,053
2,951
7,347
149
6,480
8,954
2,424
1,107
348
255
22,515
3,185
4,665
3,894
6,916
3,120
14,061
81,395
119
30,107
20,337
1,063
251
554
11,535
1,364
23,406
2,281
4,779
22
2,229
821
3,438
937
7
1,953
1,635
1,444
Tuberculosis Section—
2,089
1,730
Smears, M. tuberculosis    	
46
10
20
1,683
5
2,288
Parasites-
49
49
2,417
262
Water Microbiology Section—
2,687
199
6,721
1,182
1,523
4,600
717
1,377
Pascal streptococcal test  —	
239
149
Other tests (algae, shellfish)    	
Serology Section—
VDRL—
Blood (qualitative)   	
4,188
17
10,475
52
693
159,283
1,865
2,739
6,749
368
5,666
8,932
3,384
1,904
345
192
27,604
1,077
2,126
3,946
5,191
8
11,523
100
775
CSF      	
FTA-ABS 	
Darkfield (includes DFATP) 	
6
640
531
11
356
775
Agglutinations —■ Widal,   Brucella,   Paul-Bunnell,
350
341
ASTO  	
Virology Service
Virus isolation—
Rubella  .
Embryonated egg  	
Hemadsorption 	
Serological identification—■
Haemagglutination inhibition—
Rubella 1	
	
Other viruses 	
—
Complement fixation	
Neutralization   	
Totals  	
447,266
9,436
40,941
455,312
10,859
38,320
497,643
504,491
 TABLES
Table XX—Emergency Health Service Medical Units Pre-positioned
Throughout British Columbia
H 69
Emergency hospitals	
Advanced treatment centres
Casualty collecting units
  15
  44
  65
  236
  21
  74
  110
Number of Emergency Health Service units  185
Hospital disaster supplies kit.
Blood donor pack.
Number of municipalities
Number of storage locations
Table XXI—Licensing of Practical Nurses
(Disposition of applications received since inception of programme in
1965 to December 31, 1972)
Received _
Approved-
8,400
On the basis of formal training  4,881
On the basis of experience only—
Full licence  396
Partial licence  875
  1,271
6,152
1,195
701
96
Awaiting assessment at December 31, 1972      256
Rejected	
Deferred pending further training, etc.	
Deferred pending receipt of further information from applicants 	
Total
8,400
Number of licences issued to December 31, 1972  5,457!
Number of practical nurses holding currently valid licences at
December 31, 1972  4,3362
iThe number of licences issued (5,457) is less than the number of applications approved (6,152) because
some persons whose applications were approved did not take the final action to complete licensing.
2 The number of currently valid licences (4,336) is less than the number of licences issued (5,457) because
some persons who have received licences at some time had not requested the annual renewal.
Printed by K. M. MacDonald, Printer to the Queen's Most Excellent Majesty
in right of the Province of British Columbia.
1973
830-1272-9658
 

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