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Seventy-eighth Annual Report of the Public Health Services of British Columbia HEALTH BRANCH DEPARMENT… British Columbia. Legislative Assembly 1975

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 PROVINCE OF BRITISH COLUMBIA
Seventy-eighth Annual Report of the
Public Health Services
of British Columbia
HEALTH BRANCH
Department of Health
YEAR ENDED DECEMBER 31
1974
Printed by K. M. MacDonald, Printer to the Queen's Most Excellent Majesty
in right of the Province of British Columbia.
1974
 DEPARTMENT OF HEALTH
(Health Branch)
The Honourable Dennis Cocke
Minister of Health
SENIOR PUBLIC HEALTH ADMINISTRATIVE STAFF
G. R. F. Elliot
Deputy Minister of Health and Provincial Health Officer
A. H. Cameron
Director, Bureau of Administration
K. I. G. Benson
Director, Bureau of Local Health Services
J. H. Smith
Director, Bureau of Special 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
L. D. Kornder
Director, Division of Occupational Health
A. A. Larsen
Director, Division of Epidemiology
F. McCombie
Director, Division of Preventive Dentistry
G. G. MacDonald
Director, Division of Public Health Education
D. Mowat
Director, Division of Tuberculosis Control
H. J. Price
Departmental Comptroller
R. G. Scott
Director, Division of Public Health Inspection
G. Wakefield
Director, Division of In-patient Care
P. Wolczuk
Consultant, Public Health Nutrition
G. D. Zink
Director, Division of Speech and Hearing
 Office of the Minister of Health,
Victoria, B.C., January 14, 1975
To the Honourable Walter S. Owen, Q.C, LL.D.,
Lieutenant-Governor oj the Province oj British Columbia
May it please Your Honour:
The undersigned respectfully submits the Seventy-eighth Annual Report of
the Public Health Services of British Columbia for the year ended December 31,
1974.
DENNIS COCKE
Minister oj Health
Hon. Dennis Cocke
Minister of Health
 Department of Health (Health Branch)
Victoria, B.C., January 11,1975.
The Honourable Dennis Cocke,
Minister oj Health, Victoria, B.C.
Sir: I have the honour to submit the Seventy-eighth Annual Report of the
Public Health Services of British Columbia for the year ended December 31, 1974.
G. R. F. ELLIOT, M.D.C.M., D.P.H.,
Deputy Minister oj Health
G. R. F. Elliot
Deputy Minister of Health and
Provincial Health Officer
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 The Health Branch is one oj the jour branches oj the Department oj Health.
The other three are Mental Health Services, the British Columbia Hospital Insurance
Service, and the Medical Services Commission.
In the Health Branch, the Deputy Minister oj Health and the Directors oj the
three bureaux jorm 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
oj business are provided by personnel oj local health departments. Greater Vancouver and Greater Victoria have their own metropolitan organizations which,
though not under jurisdiction oj the Health Branch, co-operate closely and receive
special services and financial assistance jrom the Provincial and Federal Governments. The remainder oj the Province is covered by 18 health departments, known
as health units, which are under the jurisdiction oj the Health Branch. Each unit
is complete in itselj 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  16
Specialized Community Health Programmes  20
Community Health Services  26
School Health  28
Mental Health  29
Home Care Programmes  3 0
Preventive Dentistry  31
Nutrition Service  35
Public Health Education  37
Vital Statistics  38
In-patient Care  40
Aid to Handicapped  42
Laboratory Services  43
Emergency Health Service  46
Council of Practical Nurses  47
Publications, 1974  48
Tables-
I—Approximate Numbers of Health Branch Employees by Major
Categories at the End of 1974  49
II—Organization and Staff of Health Branch (Location and Approximate Numbers of Persons Employed at End of 1974)  49
III—Comparison of Public Health Services Gross Expenditures for the
Fiscal Years 1971/72 to 1973/74  51
IV—Training of Health Branch Staff Proceeding Toward a Diploma or
Degree in a Public Health Specialty  51
V—Training of Health Branch Staff by Means of Short Courses  52
VI—Reported Communicable Diseases in British Columbia, 1970-74  55
VII—Reported Infectious Syphilis and Gonorrhoea, British Columbia,
1946, 1951, 1956, 1961, and 1966-74  55
VIII—Statistical Summary of Selected Activities of Public Health Nurses,
September 1972 to August 1974, Inclusive  56
IX—Statistical Summary of Public Health Inspectors' Activities, 1971-
74, for 17 Provincial Health Units  57
 Tables—Continued
X—Number and per Cent of Children Receiving Basic Immunization
Prior to Entry to Kindergarten (September 1973)  58
XI—Number and per Cent of Pupils Immunized at End of Grade V
(June 1974)  58
XII—Number and per Cent of Girls Immunized for Rubella at End of
Grade V (June 1974) .  58
XIII—Pupils Referred for Health Services  59
XIV—Registrations Accepted Under Various Acts and Materials Issued  59
XV—Case Load of the Division for Aid to Handicapped, January 1 to
December 31, 1974  60
XVI—Statistical Report of Tests Performed in 1973 and 1974, Main
Laboratory, Nelson Branch Laboratory, and Victoria Branch
Laboratory.  61
XVII—Licensing of Practical Nurses  62
 Seventy-eighth Annual Report
of the Public Health Services of British Columbia
HEALTH BRANCH
Department of Health
YEAR ENDED DECEMBER 31, 1974
The provision of a full range of health services to all British Columbians on an
equitable, efficient basis is a major concern and commitment of the Government of
British Columbia. One of its first acts after assuming office in 1972 was to commission Dr. R. G. Foulkes to carry out a comprehensive study of all aspects of the
delivery of health care in the Province and to make recommendations for improving
the system. Dr. Foulkes submitted his report in December of 1973 and steps were
taken immediately to examine the many far-reaching proposals put forward, with
a view to upgrading health services as rapidly as possible. To this end the Minister
of Health established three committees, namely, a Management Committee, a Reorganization Committee, and a Legislative Review Committee. These committees,
and the working groups established under them, worked throughout the year developing the broad policies, legislative measures, and organizational structure
deemed necessary as the framework for a modern health care system responsive to
the needs of the people.
Considerable progress was made toward the foregoing objective during the
year. The general direction the health programme is to take was determined and
the main elements of the administrative organization developed. Key features of
the planning and management of Health Services will be consumer participation,
regionalization, and decentralization. The development of standards is recognized
as an important need which will be pursued vigorously, and high priority will be
given to the extension of modern data processing facilities to cover all aspects of
the Department's activities.
At the Provincial level, a Health Advisory Council comprised of a cross-section
of professional and lay persons will be established to advise the Minister, and a
Senior Deputy Minister will oversee the operation of the entire Health Department.
The Department will be divided into two main branches, one encompassing medical
and hospital programmes, the other community health programmes, with a Deputy
Minister in charge of each.
At the second session of the Legislative Assembly an amendment was made
to the Department oj Health Act which enabled the planned restructuring of the
Department to proceed.
In the field of dental health, another milestone was reached in February when
the Province concluded an agreement with the College of Dental Surgeons of British
Columbia to establish a joint study to develop a comprehensive dental programme
for children. The expanding programme of the Division of Preventive Dentistry
was further evidenced by the appointment of an Assistant Director during the year.
Although there were no major communicable disease outbreaks in 1974, there
were disturbing increases in reported cases of diphtheria and of rubella. Increased
emphasis is being placed on the importance of immunization against these diseases
 I 10 PUBLIC HEALTH SERVICES REPORT, 1974
and in 1974 the Department extended its free rubella vaccine programme to include
women and girls of all ages. A gratifying reduction of 16 per cent occurred from
1972 to 1973 in the number of new cases of tuberculosis reported, while the death
rate from this disease in 1973 was the lowest on record.
Gonorrhoea continues to be of major concern, but the rapid increase of recent
years abated to only 4 per cent during 1974. A conference on venereal disease was
convened in Vancouver to bring together representatives of the medical profession
and the community. Recommendations made by this conference are being actively
pursued.
The staff and facilities of the Division of Occupational Health were considerably
expanded during the year, underlining the Department's conviction that a readily
accessible employee health service is mutually advantageous to both employer and
employee. The Radiation Protection Service, which this Division operates, was
also augmented to provide better monitoring of possible sources of damaging radiation and to give increased consultative service relating to radiation hazards.
Improvements were made in the kidney dialysis service, permitting a larger
number of patients to be dialyzed at home and thus allowing the hospital renal units
to service other acute cases more effectively.
Additional measures were taken to ensure the well-being of children and adults
being cared for in boarding-homes and similar types of accommodations. The
activities of the several Government departments involved will henceforth be coordinated through two separate licensing boards overseeing facilities on child and
adult care respectively.
Special attention was directed at improving the nutritional status of the population through nutrition workshops, field consultations, research projects, and the
appointment of additional professional staff.
A major expansion of home care programmes into many of the larger centres
in the Province was effected during the year. Physicians are making increased use
of this service for their patients, thus freeing valuable hospital beds for more acute
cases.
Effective June 1, 1974, the Department of Health assumed financial responsibility for the Victorian Order of Nurses in British Columbia, thereby eliminating
any charges to the patients for this service.
When seriously ill or injured persons require transportation by air to a hospital
or other treatment centre, "mercy flights" were made, as in previous years, by aircraft of the Canadian Armed Forces, the Provincial Government, the Royal Canadian
Mounted Police, the Canadian Coast Guard, and, in some cases, by the United
States Coast Guard. In each case a medical assessment of the need was made by
a senior medical officer of the Health Branch who, through telephone conferences
with the patient's physician, the providers of the aircraft, and the receiving hospital,
played a prominent co-ordinating role.
From July 73 to June 1974 the numbers of such "mercy flights" undertaken by
several agencies were: Canadian Armed Forces, 148; Provincial Government, 17;
Canadian Coast Guard, 3; voluntary aircraft, 2. The co-operation displayed by each
of these agencies was of a very high order. Officials of the Health Branch wish to
record their deep appreciation.
THE PROVINCE AND ITS PEOPLE
The second largest population increase on record occurred in British Columbia
from 1973 to 1974. Eighty thousand people were added to the Province's total,
only slightly fewer than the 83,000 increase from 1956 to 1957.   The proportionate
 introduction
I 11
increase in population was 3.5, more than double the figure for Canada as a whole,
and well above the percentage recorded in all but a few countries of the world.
Birth rates in the Province continued their downward trend this year, leaving immigration, the other component of population growth, to make the most substantial
contribution. The special topographic, climatic, and economic characteristics of the
Province, which have been mentioned in previous reports, combined to encourage
heavy concentrations of people to reside in the southwest corner of the Province.
Then there have been the attendant problems of providing service to the scattered
population in the remaining areas.
Following are some comments on the vital statistics of the population based
on preliminary data for 1974:
• The birthrate continued to decline this year, reaching a figure of 14.5 per
1,000 population compared to the rate of 14.8 for 1973. These rates are
at the low level of the mid-thirties. For the first time in a decade, illegitimate
births during the year made up less than 11 per cent of all births in the
Province.
• The rate of marriages per 1,000 population in 1974 was 8.8. This was
somewhat below the 1973 figure of 9.2. Although well below the high
rates of the 1940's, the 1974 figure remained at a fairly high level and
represented a considerable advance over the rates in the early part of the
1960's.
• There was an increase in the deathrate in 1974 over 1973, the figure this
year being 8.2 per 1,000 population, compared with 7.8 in 1973. Each of
the four leading causes of death contributed to the over-all mortality rate
increase.
• The deathrate per 100,000 population for heart disease in 1974 was 270.
While this was an increase over the level of the rates for recent years, it was
still substantially less than the rates recorded during the 1960's and earlier.
• Over the last few years the cancer deathrate has shown little variation.
Except for one year in the last nine, this has been between 150 and 155 per
100,000 population. The exception was a rate of 158 recorded in 1969.
The 1974 figure was 155.
• Cerebrovascular disease caused a higher number of deaths per 100,000
population in 1974 than in the previous year—83 compared to 79. However, as was the case for heart disease, this is still well below the level of the
rates in the 1960's.
• The accident rate this year attained its highest point since 1943, 90 per
100,000 population. The rate showed a considerable increase over the
1973 figure of 80 which, in turn, was above the 1972 rate of 76. There
were proportionately fewer accidental deaths in 1974 caused by automobiles
—40 per cent compared to 44 per cent in 1973. Falls caused about 16
per cent of accidental deaths, about the same proportion as reported in
1973. Poisonings caused 10 per cent of accidental deaths, this being down
from the 1973 figure of 13 per cent. In 1972, poisonings represented a
high 16 per cent of accidental deaths, so that this year's figure disclosed a
considerable improvement, even though the level of the number of such
deaths was still excessive.
• The suicide rate per 100,000 population in 1974 was 18, this being down
slightly from the high rate of 19 for 1973.
• Deaths of infants under 1 year of age this year numbered 19 per 1,000 live
births, an increase over the 1973 figure of 17.
 I 12 PUBLIC HEALTH SERVICES REPORT, 1974
• There was a continuation of the increase in diphtheria in the Province which
was remarked on last year. This parallels the unexplained similar increases
noted in other areas.
• Rubella also increased and as this was noted mainly among older children
and young adults, the free immunization programme was extended to cover
girls and women, as well as younger children of both sexes.
• Active cases of tuberculosis were reduced in number in 1973 as compared
to 1972.   General hospitals continue to be the chief reporting source.
• While reportings of gonorrhoea again recorded an increase in 1974, this was
proportionately less than the level in recent years. In the past the change
was a reflection of the lesser number of visitors to the Province, but in
addition, the greater general awareness of the presence of the disease in
epidemic form has made efforts to control it more effective.
 COMMUNICABLE AND REPORTABLE DISEASE
I 13
COMMUNICABLE  AND  REPORTABLE  DISEASE
DIPHTHERIA
The marked increase in the incidence of diphtheria reported last year has continued. Sixty-nine cases of clinical disease were reported this year and 228 healthy
carriers were identified. Most of these cases occurred in Vancouver, Victoria, and
around Nanaimo, with only an occasional case being identified in other parts of the
Province. There were three deaths from this disease reported.
The increase in diphtheria in the Province parallels the experience of several
other provinces and a number of American states. As yet there is no satisfactory
explanation for the return of this disease after an almost total absence for more
than a decade.
Immunization in infancy, followed by reinforcing immunization during school
life, provides good personal protection against the toxin produced by the diphtheria
bacillus but does not prevent the carrier state and the spread of this disease in the
community. Although the Health Department is taking aggressive steps to contain
any outbreak that occurs, protection through immunization is still the best weapon
against diphtheria.
RUBELLA VACCINATION PROGRAMME
There was a notable increase in the number of cases of rubella in 1974 despite
the fact that an effective vaccine has been available, free of charge, for the nast two
years. A total of 342 cases of rubella was reported, compared to 77 cases in 1973.
In direct contrast to other years, however, most persons infected with rubella this
year were older school-aged children and young adults. This would aopear to
indicate that the infant immunization programme has been effective and that more
emphasis should now be placed on the protection of girls and young women in
their child-bearing years. Early in the year the Health Department extended the
immunization programme and now provides vaccine without cost to all girls and
women, as well as to young children of both sexes. A free diagnostic blood test
to determine susceptibility (the NI test) is also available to physicians.
BOTULISM
Two cases of botulism were reported this year, both of which were fatal. The
major problem in this Province is consumption of contaminated fish eggs by native
population. Prepared in the traditional way, these eggs are considered a great
delicacy but present a very real hazard to anyone eating them. Warnings and an
ongoing educational programme have helped a great deal, but cases of this frequently
fatal disease continue to occur.
RHEUMATIC FEVER PROPHYLAXIS
The number of children receiving free antibiotics from the Health Department
to prevent recurrences of rheumatic fever now stands at 885. Studies elsewhere
have shown that injected penicillin, although many times more expensive, is more
* See Table VI.
 I 14 PUBLIC HEALTH SERVICES REPORT, 1974
effective than the oral antibiotics that have been provided in this Province over the
past 15 years. It is hoped that it will be possible to offer patients and physicians
a choice of oral or injected antibiotics in 1975, if a source of supply at a reasonable
cost can be found.
TUBERCULOSIS CONTROL
During 1973 there was a satisfactory reduction in the number of active cases
of tuberculosis. This went from 566 in 1972 to 473 in 1973. The chief reporting
source of these cases continued to be the general hospital, which indicated that the
routine chest X-ray of those admitted to general hospitals continued to be desirable.
The number of tuberculosis patients in hospital has also reduced, the present
number being 85 to 90. A year ago the figure stood at 120 to 125. This reduction
reflects the smaller number of active cases occurring and the effect of the discharge
policy under which a responsible patient can now be discharged once his sputum
smears are negative rather than waiting until negative cultures are obtained.
There was no change in the manner in which the clinics operated during the
year. The arrangement for having the X-rays for the travelling clinics taken at
local hospitals functioned satisfactorily and provided higher quality X-rays.
In keeping with the practice elsewhere in Canada and the United States, the
criteria used in the interpretation of the tuberculin skin test has been changed.
The current readings are: Less than 5 mm. in diameter is considered negative,
from 5-9 mm. is classified as doubtful, and 10 mm. or larger is positive. Formerly,
any reaction of 6 mm. or greater was called oositive.
During 1973, 14 deaths were attributed to active tuberculosis and this is the
lowest number on record.
VENEREAL DISEASE CONTROL*
There are several diseases which are commonly transmitted by sexual intercourse and which are referred to as sexually transmitted diseases. Of these, five
are almost exclusively transmitted by sexual intercourse and by no other means.
In British Columbia the most common venereal disease is gonorrhoea, but there are
some cases of syphilis and the occasional case of lymphogranuloma venereum.
Granuloma inguinale and chancroid are extremely rare. With 5,000 cases of
gonorrhoea reported and studies indicating that this is 20 per cent of the actual
number of cases, 25,000 cases are estimated to have occurred. In addition, 5,000
cases were seen in the clinic, bringing the total estimated incidence to 30,000 cases.
In order to assess the problem of the control of gonorrhoea, a Venereal Disease
Conference was held in Vancouver. Ninety representatives of the professions and
community involved with this problem attended. The delegates to the conference
made 76 recommendations and the joint sponsoring committee of the Medical
Association and Provincial Government narrowed this list to 10 high-priority items.
These items included
• public information;
• laboratory services;
• improved contact tracing;
• more extensive clinic facilities;
• a screening examination by physicians.
The incidence of gonorrhoea has increased between 15 and 20 per cent each year
from 1969 to 1973, inclusive, but the increase in 1974 was only 4 per cent. One
of the reasons for this is that the poor weather early in the summer discouraged
* See Table VII.
 COMMUNICABLE AND REPORTABLE DISEASE
I 15
many visitors. The other reason was that the publicity which attended the epidemic
has made physicians and the public more concerned with controlling it.
The problem in venereal disease control is that only some infected people
develop manifestations of disease while others show no signs or symptoms yet continue to spread infection.
With gonorrhoea, 95 per cent of men develop symptoms, but 5 per cent do not.
The reverse is true with women, with at least 80 per cent not developing any
symptoms of the disease. With this disease so widely prevalent, complications are
frequently seen, particularly pelvic inflammatory disease with its resulting problem
of sterility in a high percentage of those afflicted, and disseminated gonococcal
infection, which is a blood spread of the infection to the joints or skin. Many
patients either do not know who their sexual contacts are or are unwilling to name
them. This inability to control each small epidemic unfortunately leads to the
spread of the diseases.
In order to speed the contact tracing of known cases, an arrangement has been
made with the Department's laboratory in which the Division is immediately notified
each day of all positive tests. These results are telephoned to the local health unit
concerned and the nurse is able to contact the physician promptly so that the patient
can be interviewed and the contacts treated.
The Department's laboratory introduced the Automated Reagin Test (ART)
as a screening test for syphilis on September 1, 1974. This replaces the VDRL
test which has been carried out for many years but which was too time-consuming
in view of the volume of specimens submitted to the laboratory.
The Microhemagglutination Assay for Treponema pallidum (MHA-Tp) test
is performed on all positive screening tests and, if this is negative, the Fluorescent
Treponemal Antibody Absorption (FTA-ABS) test is performed because it is the
test that will remain positive for life.
Infectious Syphilis
Infectious syphilis is a disease that is being brought into the Province primarily
by the male homosexual group who acquire the infection in the cities on the west
coast of the United States. These individuals are single and many are mobile.
This allows them to lead a more permissive life. The number of infections in seamen
and young men returning from abroad is declining. The control of this infection
is best effected by considering that each case is the centre of a small epidemic and
that the group at risk consists of the sexual contacts of the case and the individuals
who have had sexual relationships with these contacts within the incubation period.
This small epidemic is controlled by offering all the members of this group adequate
treatment.
Latent Syphilis
Many people who acquire syphilis infection have no symptoms of the disease.
It is necessary to have a continuing screening programme to find these asymptomatic
carriers. The Provincial Laboratory conducts over 600 tests a day on blood from
pregnant women, and from people undergoing pre-employment examinations and
other routine physical examinations. In addition, the Canadian Red Cross tests
all blood donated. By finding people who do not know they have an infection it is
possible to offer them treatment and thus prevent later complications.
Gonorrhoea
Gonorrhoea is an infection of the genital tract by the neisseria gonococcus.
After an incubation period of two to nine days it produces severe symptoms of pain
 I 16 PUBLIC HEALTH SERVICES REPORT, 1974
and discharge in the male but few, if any, symptoms in the female. Those who do
not have signs or symptoms of disease unknowingly go on spreading the infection.
The disease occurs mainly in young single-status adults with peak incidence at age
20 to 22 years. It is prevalent also in those who lead a permissive sexual life, such
as alcoholic women, prostitutes, male homosexuals, and alienated youth.
General
Diagnostic and treatment clinics are maintained in New Westminster, Victoria,
Prince Rupert, Prince George, and Kamloops. The main clinic is located at 828
West 10th Avenue and is open each week-day. The Vancouver Health Department
operates the Pine Street Clinic at 2333 Pine Street.* During the year the Wednesday
evening clinic at Gordon Neighbourhood House and the Monday evening session
at the East-end clinic were discontinued. The Oakalla Prison Farm clinic was discontinued because patients were seen at the Vancouver City Gaol and the change
in parole policies eliminated the need.
THE PUBLIC HEALTH NURSE AND DISEASE CONTROL
The public health nurse played an active role in the disease control programmes
and provided the following services: f
• 549,989 individual immunizations and 32,844 tests were given at neighbourhood clinics, child health conferences, schools, and kindergartens. This
represents a 13-per-cent increase over 1973 in immunizations, and a minimum saving to the British Columbia Medical Services Plan of more than
$1 million, based on the physician's fee of $2 per injection.!
• 26,098 visits were made to patients and contacts concerning tuberculosis,
venereal disease, and for epidemiological investigation of other communicable diseases. Included are prophylactic injections for infectious hepatitis,
and the supervision of children on rheumatic fever prophylaxis. The number
of tuberculosis visits were down, while venereal disease visits increased 73
per cent over last year.   The over-all services increased by 22 per cent.
HEALTH  AND OUR  ENVIRONMENT
ENVIRONMENTAL ENGINEERING
Engineers in the Health Department are involved in many phases of health-
oriented engineering. The duties of the Division fall into six distinct categories,
the highlights of which are as follows:
• Waterworks—All community waterworks systems serving more than two
dwelling units require approval under the Health Act, and 688 certificates
were issued during 1974 with appropriate notification being made to health
units, Municipal Affairs Department, Highways Department, and the Water
Rights Branch.
• Sewage works—A large portion of the Division's time was spent in reviewing the entire range of pollution control applications for effluent discharges.
Regional Engineers shared this review work with health unit staff.
* The hours of opening are Monday to Friday from 9.30-11.30 a.m. and 1.30-4.30 p.m.; Monday and
Thursday from 7-9 p.m.; and Saturday from 10 a.m.-12 noon.
t See Table VIII for details.
t See Tables X and XI for the immunization status of pre-school and Grade V children. The number of
Grade V girls protected against rubella is shown in Table XII.
 HEALTH AND OUR ENVIRONMENT
I 17
• Solid wastes—The Division's work in this connection was limited to advice
to Medical Health Officers and their staff, consulting engineers, and municipalities. All pollution control applications for refuse permits were reviewed
by the Division. Direct assistance to municipalities and regional districts
was offered throughout the year.
• Swimming-pools—The Division was responsible for the review of all new
pools and communication was maintained with pool designers and consulting engineers. Because pools are technically complicated, some plans required several reviews before final acceptance. Engineers reviewed and
approved 115 swimming-pools during the year.
• Sanitation—Engineering aspects of sanitation are prominent in a technological society. The Division was involved in the review of new toilets for
travel trailers, prefabricated septic-tank designs, materials used in tile fields,
guidelines for individual home package treatment plants, and a number of
other items.
• Operator training—The engineers were responsible for the training of water
and sewerage works operators in British Columbia, with one of the staff
acting as co-ordinator of operator training. Environmental Engineers were
directly involved with the co-ordination of the annual British Columbia
Water and Wastes School.
The Division concluded another successful training programme for swimming-
pool operators at seven centres throughout the Province in 1974. Three members
of the Division were involved in preparing and presenting lectures to about 300
persons attending the schools.
Service to Health Units
A prime consideration of the Environmental Engineering Division is to offer
technical and professional advice to the Medical Health Officers and staff. This
year the engineers made 105 visits to the health units, about the same number as in
the previous two years. During these visits and at other times, engineers examined
10 subdivisions, 44 swimming-pools, 75 waterworks systems, eight solid-waste
disposal areas, 23 sewage-treatment plants, and seven fluoride installations. In
addition, 70 miscellaneous visits, such as private sewage-disposal systems, manufacturing plants, etc., were made.
The engineers in Victoria made 48 visits to municipalities and 12 visits to
consulting engineers' offices. These visits did not include meetings with municipal
officials or consulting engineers at other locations or the visits made by the Regional
Engineers.
The placement of four Regional Engineers at Vernon, Surrey, Nanaimo, and
Cranbrook did much to provide immediate engineering assistance to Medical Health
Officers and staff. The activities of these Regional Engineers was mainly directed
toward collection of data relating to waterworks systems, and the inspection of
works. Each Regional Engineer is responsible for three or four adjoining health
units.
PUBLIC HEALTH INSPECTION
The 86 Provincially employed Public Health Inspectors provide a variety of
services which are described in more detail in Table IX. An examination of this
table reveals an increasing activity in the areas of food premises, community care,
sewage disposal, and land use.
 I 18 PUBLIC HEALTH SERVICES REPORT,  1974
Food Premises
In March the regulations governing the sanitation and operation of food
premises were amended to control the quality of food served by voluntary caterers
to public functions or gatherings. It is not the intention of the Department to apply
those regulations to the small gatherings of service organizations in which the
general public is not involved.
Activities With Other Departments
To ensure a consistent and comprehensive approach to environmental control,
the Division of Public Health Inspection has continued liaison with
• The Department of Travel Industry regarding camp-sites.
• The Departments of Housing, Municipal Affairs,  and Highways on the
subject of mobile home living.
• The Environment and Land Use Committee.
• The Pollution Control Branch.
• The Department of Agriculture in regard to the farm vacation programme.
Educational Activities
As a member of the Environmental Technology Advisory Committee, the
Director of the Division of Public Health Inspection maintains communication with
the British Columbia Institute of Technology. The Health Branch provided field
training for 17 student public health inspectors and members of the Health Branch
have acted as examiners for the certification of Public Health Inspectors. Fifteen
Public Health Inspectors were sponsored for correspondence courses leading to the
certificate in advanced environmental health administration through Ryerson Poly-
technical Institute. Twenty-three Public Health Inspectors attended a course in
communications at the British Columbia Institute of Technology. This is the first
of a series of courses planned to extend over a three-year period.
The Director, Consultant, and Public Health Inspectors meet, on frequent
occasions, with members of Provincial and community organizations such as the
Canadian Restaurant Association; the Motels, Resort and Trailer Parks Association;
and ratepayers' associations to obtain the views of the industries and the consumer
regarding environmental health matters.
OCCUPATIONAL HEALTH
The Division of Occupational Health experienced a major increase in staff in
1974 and consequently expanded its service function to both the Provincial employees and to other departments of Government. During the year new staff were
recruited—one occupational health nurse, one physician, one health physicist, one
radiation protection inspector, and one employee counsellor specializing in the
field of alcoholism.
An employee health unit has been established in Kamloops during the year
and this will serve an increasing population of public servants in the Kamloops
geographic area. Health services to public servants in Riverview, Woodlands
School, Metropolitan Vancouver, and Metropolitan Victoria are provided through
occupational health units in those centres with physician service made available
from the main office of the Occupational Health Division. This Division, working
in close co-operation with the British Columbia Government Employees' Union and
the Public Service Commission, established a policy directed toward employees
troubled with alcoholism.
 HEALTH AND OUR ENVIRONMENT
I 19
To date, routine medical examination of new public service employees has not
been instituted. Selective health questionnaire screening was carried out on some
new employees. Particular attention was directed to food-handlers in the major
Governmental institutions at Woodlands, Glendale Hospital, and Riverview Hospital.
Occupational health representatives provided consultation service to many
other departments of Government and served on many interdepartmental committees. This activity included close liaison with the Pollution Control Branch, the
Water Investigations Branch, and the Interdepartmental Pesticide Committee
through the Department of Agriculture. The Division also worked closely with the
British Columbia Hospital Insurance Services through the Radiological Advisory
Council and the Public Service Commission.
A regular monthly meeting is held with Commission representatives to deal
with public employees whose job performance has been compromised by medical
difficulties. There is every indication that this committee will become increasingly
active in the coming years, resulting in improved service to public employees.
Radiation Protection Service
Man is becoming more concerned with the environment in which he must live.
Problems are arising with this environment as the population and standard of living
increases, and this requires a vastly expanded technology to discover and utilize
natural resources to meet the demands of society. Part of this demand has required
the increasing use of radiant energy in its several forms, both ionizing and nonionizing, which carries with its development a certain health hazard to man and his
environment.
The Radiation Protection Service is aware of this potential radiation hazard
and is working to develop an expanded Provincial programme of control, surveillance, and public information.
In 1974 the Radiation Protection Service added a health physicist to the staff.
He will lead the development of this expanded programme. A good start has been
made in the establishment of an Environmental Radiation Laboratory, ERL, in the
Provincial Health Building in Vancouver.
The objectives of the Environmental Radiation Laboratory are
• to improve the surveillance technique for X-ray equipment used in hospitals,
clinics, dental offices, and industry;
• to monitor and give advice on the use and production of radioisotopes; for
example, the production of radionuclides in the vicinity of particle accelerators or the monitoring of radionuclides released by an accidental spill from
a nuclear submarine;
• to evaluate the health hazard associated with nonionizing radiation, such as
microwaves and lasers;
• to monitor the presence of background radiation in the geosphere and
establish a baseline in the Province; and
• to provide calibration facilities for meters and gauges used in radiation
detection.
For its radioactivity studies the laboratory will have the capability of analysing
air, liquids, and solids.
The Service has taken on staff an additional radiation protection officer, who
will work in the area of the X-ray survey. This additional help has been badly
needed, this survey having increased greatly since the Medical Services Commission
began its accreditation programme for all medical X-ray installations in the Province,
two years ago.
 I 20
PUBLIC HEALTH SERVICES REPORT,  1974
There are about 550 medical X-ray machines in 145 institutions and clinics
and about 1,300 dental units in the Province. In addition, there are 250 X-ray
machines being used by chiropractors, veterinarians, industry, and research.
This year the Service completed 232 surveys and gave five lectures on X-radia-
tion hazards.   The Service also provides extensive consultation services.
In British Columbia there are over 450 licensed radioisotopes varying from
small calibration sources to the larger sources used in cancer therapy. In the year
under review, 174 surveys and 155 leak tests were completed and 141 water samples
analysed for radioisotope content. The water samples are collected during visits
of nuclear submarines to the underwater weapons range at Nanoose. There were
seven visits.
The microwave survey programme continued throughout the year. Training
seminars for Health Unit Inspectors were conducted in six areas. Microwave survey
meters were left in the district for Health Inspectors to conduct their own surveys.
Over 100 microwave ovens were checked with very few exceeding the recommended
radiation levels. In nearly all defective ovens the problem was due to faulty or
inadequate servicing after the units had been in use for some time.
Because ultra-sound equipment is proliferating throughout commerce, industry,
research, and medicine, with its yet unknown potential for radiation damage to
biological processes, the service has developed a questionnaire that has been circulated to all hospitals in the Province. The object of the survey is to determine how
many units are being used and for what purpose. The response from the hospitals
has been very good and the service is currently assessing the returns.
Three members of the Radiation Protection Service are members of the Radiological Advisory Council and (or) one of its three subcommittees.
The Council acts as advisers to the Government, particularly the Department
of Health, on all matters concerned with planning, equipping, and utilization of
X-ray equipment in hospitals and diagnostic centres. The Council and its committees met 41 times during the year, this included seven field trips to rural hospitals.
The Council reviewed and made recommendations to the B.C. Hospital Insurance
Service on 140 applications for capital cost grants toward equipment or renovations.
In summary, the Radiation Protection Service has increased its staff and
facilities during 1974 and is providing a better and more informative service to the
people of British Columbia.
SPECIALIZED COMMUNITY  HEALTH  PROGRAMMES
KIDNEY FAILURE CORRECTION PROGRAMME
Hospitals with renal units are located in Vancouver, New Westminster, Victoria, Trail, and Kamloops. In order to accommodate more patients and allow
others the freedom of living at home, a home programme was developed. A warehouse is operated from 632 West 10th Avenue to provide all the necessary supplies,
and a parts department and pharmacy are located at 828 West 10th Avenue to
supply equipment and drugs. Patients receive training in home dialysis at the
Vancouver General Hospital and St. Paul's Hospital in Vancouver and the Royal
Jubilee Hospital in Victoria. There are 83 patients on hemodialysis, an increase
of eight in 1974. Home hemodialysis costs an average of $300 per month per
patient.
 SPECIALIZED COMMUNITY HEALTH PROGRAMMES I 21
There has been an improvement in peritoneal dialysis technique with the
introduction of a collapsible plastic bag which excludes air from the closed system,
markedly reducing the risk of infection. This has resulted in an increase in the
number of patients at home on peritoneal dialysis from 12 in 1973 to 25 this year.
This new technique costs $750 a month to maintain a patient at home. Machines
which have been developed to provide greater convenience for the patient and
reduce supply costs are undergoing hospital trials and one patient is being maintained at home on a study basis. The trials indicate that the machine is successful
and will soon be accepted for placing in patients' homes. Patients are able to live
a relatively normal life on home dialysis, but it is a very time-consuming procedure.
Most patients require three dialysis runs a week, consuming 30 to 35 hours, including the time spent on dialysis and machine preparation. A new disposable type of
dialyser has been developed which will reduce each run from the present eight to
ten hours to a standard period of five hours. This method will cost an additional
$50 a month for each patient, so that it is not possible to abandon the present
equipment at this time.
Many patients have been at home for a prolonged period of time and it is now
necessary to ensure that the equipment is properly maintained. A dialysis technician
has been employed in order to service and rebuild the equipment.
Not all patients are suitable for home dialysis because of inadequate homes or
medical problems, therefore they must continue to dialyse in hospital, and those who
have a financial hardship may be aided by subsidies. During the year, 55 people
received assistance in obtaining drugs worth $3,000 and with transportation subsidies amounting to $6,000.
In order to increase the number of patients who can be discharged from the
hospital unit, a self-care unit consisting of 10 beds is being established outside the
hospital. It is intended for patients who are able to build their own artificial kidney,
who are in good general health, but who are unable to dialyse at home. It will allow
greater freedom in dialysing for these patients and will allow more patients to use
the limited space in the hospital renal units.
This service is operated with the assistance of three committees—the first,
appointed by the British Columbia Medical Association, is a consultant committee
to recommend policy to the Minister of Health; the second is a committee of renal
technicians and nurses to recommend on equipment and supplies; and the third is
a committee of training hospital social workers to advise on the social needs of
patients.
Home visits have been made to the majority of home dialysis patients who live
outside the Lower Mainland. However, it is hoped that now the delivery system
for shipment of supplies and parts for patients in remoter districts is functioning
more independently, a specially trained nurse will be able to make regular visits to
those furthest from renal units.
Another programme added in 1974 was the supply of nutritional supplements
to growing children on dialysis. These high-calorie, low-potassium, and low-sodium
beverages and food products are supplied in the belief that extra calories may
prevent the stunting of growth.
POISON CONTROL PROGRAMME
Two more hospitals were provided with poison control information cards this
year and the service at the Vancouver General Hospital was improved by the establishment of a second centre there so that telephone calls from the public could be
handled more quickly.   A total of 59 centres is now in operation.
 I 22 PUBLIC HEALTH SERVICES REPORT,  1974
The establishment of a combined poison control and drug information centre
at St. Paul's Hospital, to be financed by the Hospital Insurance Service, was approved. Facilities are now being constructed and a search for a qualified director
is under way.
The new Provincial Reference Centre at St. Paul's Hospital will provide
specialized consultative services to physicians who are caring for cases of poisoning.
The 59 hospitals in the programme will continue to provide service to the public.
HYPOGAMMAGLOBULINEMIA PROGRAMME
There are now eight children and nine adults receiving free immune serum
globulin under this programme. These patients require regular weekly or monthly
injections of this expensive medication for the rest of their lives in order to stay well.
The purpose of the programme is to take advantage of the cost saving available through bulk purchase of this product and to provide the patients' physicians
with the laboratory service needed to diagnose and treat persons suffering from
hypogammaglobulinemia.
COMMUNITY CARE FACILITIES LICENSING
This has been a busy year for the interdepartmental teams responsible for
licensed community care facilities. There has been an increase of 233 licensed
child care facilities and 66 adult care facilities, all of which have had to be carefully reviewed. During the year, adult care facilities closed because they did not
meet the minimum standards of care required.
Solid progress was made in developing new standards of care for children and
adults. A draft of the proposed standards was sent to every agency known to
have an interest in either of these fields. Two well-attended full-day seminars
sponsored by the Department of Continuing Education, University of British Columbia, were held to discuss the proposed standards with agencies involved. Members of the licensing board also met individually with a number of other agencies,
private operators, and nonprofit societies to seek their views.
A decision was made to form two licensing boards, one dealing with child-care
facilities and the other with adult care. Three ministerial appointments from the
public will be made to each board. The terms of reference of the boards are to be
broadened to permit them to function as a co-ordinating group for the Government
departments involved and a medium through which Government can obtain expressions of public opinion.
The board's staff of consultants visited most parts of the Province during the
year to discuss problems with field staff and operators with a view particularly to
assuring the uniform application of the regulations.
The Community Care Act was amended to permit the Government to specify
the qualifications required of the operators of child and adult care facilities and to
certify those who met the required standards. A further amendment now exempts
private homes providing residential care to small groups of physically active persons
from many of the institutional standards.
PREVENTIVE MEDICINE
This is a new venture developed in the Bureau of Special Health Services, in
close co-operation with the Division of Occupational Health. It deals primarily
with those aspects of preventive medicine that promote health through
• health assessment of asymptomatic individuals (risk factor analysis and early
disease detection);
 SPECIALIZED COMMUNITY HEALTH PROGRAMMES
I 23
• life-style or behaviour modification, such as through physical activity, nutrition, and associated factors, as they relate primarily to chronic noncommuni-
cable diseases.
Some of the described activities were initiated prior to June 1, 1974, but have
become Departmental functions. Much of the activity was stimulated by, and
resulted from, the Department of Health sponsored B.C. Conference on Health
and Physical Activity in November 1973, and two National Health and Welfare
sponsored conferences—Fitness and Health in December 1972, and the Child in
Sport and Physical Activity in May 1973.
ACTION B.C., a nonprofit organization under the Societies Act of British
Columbia, was funded by the Department of Health in early 1974 to "promote
positive health through increased physical activity and good nutrition," by motivating people to communicate with one another, become personally involved, and
participate in community action for health promotion.
The Department of Health also provided initial funding to the Multidisciplinary
Advisory Board on Exercise (MABE), which was created in November 1973 with
encouragement from the College of Physicians and Surgeons of British Columbia.
The MABE Progress Report No. 1 (May 8, 1974) recommended research on a
proposed Physical Activity Readiness questionnaire ("PAR" Q). This was proposed
as an initial screening method to determine the current suitability of adults for
activity programmes requiring significant physical exertion, and help to identify
those individuals who should be recommended to see their physician first.
The Department of Health sponsored an extensive research project in August
1974 in Victoria to validate the "PAR" questionnaire. This was a combined
research and service project called the Health Evaluation Programme. Data
analysis is currently in progress, and follow-up for the 1,000 people who took part
is being initiated. Two additional features of the programme were
• a health hazard appraisal from the Department of National Health and
Welfare, which gives a computerized statistical indication of the risk for
developing selected diseases;
• a 24-hour nutrition recall administered by the nutrition consultant to assist
in specific nutrition counselling.
In August the Department in large part funded the PNE ACTION B.C./
Department of Health Display, the focal points of which were a children's physical
activity obstacle course, and the new Canadian Home Fitness Test for adults being
currently developed by Recreation Canada, for ages 15-69 years. This step test, to
music, was taken by 1,810 men and 1,446 women, and gave them an approximation
of their current cardiopulmonary endurance fitness level ("aerobic" fitness). Research information gleaned will contribute significantly to the final form of this
self-test, to be made available nationally in the spring of 1975.
Other projects included
• assisting MABE in the production and distribution of the booklet Fit Facts;
• continuation of the B.C. Medical Journal series on preventive medicine,
including "Prescription for Fitness", a self-administered fitness programme
for "apparently well" adults;
• presentations to the International Committee on Physical Fitness Research,
Associated Boards of Health, and Pacific Coast College Health Association;
• preparation of a brief to the Prepaid Service Contract Inquiry (Department
of Consumer Services), on behalf of the College of Physicians and Surgeons
of British Columbia and MABE;
 I 24 PUBLIC HEALTH SERVICES REPORT,  1974
• participation in the planning of the December 1974 National Conference on
Employee Physical Fitness.
SPEECH AND HEARING SERVICES
During the past year the Division's objective to meet the needs of the population
suffering from communication disorders demonstrated major progress in several
areas:
• The provision of service throughout the Province has continued to increase.
The divisional field staff has grown in numbers and space requirements are
being satisfactorily met.
• Plans for a Provincial data collection system in speech and hearing are
nearing completion.
• The hearing-aid pilot plan is nearing implementation.
• The staff in-service training programme will continue in 1975/76. Additionally, the Minister of Health's Task Force on Communication Disorders
completed its recommendations.
Provision of Service
Professional positions have now been established in all Provincial health units
in speech pathology and positions in audiology have been increased to five. The
audiology positions are located in designated regional centres. In regional centres
where speech pathology and audiology services are offered, comprehensive diagnostic and therapeutic, interdisciplinary teams are being developed. Additional speech
pathology positions are being considered to meet the needs in the regional areas, and
these will be co-ordinated with other community services to ensure greatest effectiveness consistent with economy.
Data Collection
The data collection system in the Division is in the final planning stages prior
to implementation. For the first time in Canada, it should be possible to obtain
reliable and valid data on hearing programme results. Therefore, these data will
be invaluable in providing programme direction. The aim of the programme will
be the provision of the best possible hearing health care for people suffering from
hearing disorders in the Province. It is expected that a similar system will be introduced in speech pathology.
Hearing-aid Project
A hearing-aid pilot project will be launched in the five regional speech and
hearing centres. The objectives of the project are considered in the following outline:
• The Department of Health will plan and design a comprehensive programme
for the delivery of health services to the acoustically handicapped population
of British Columbia in order to reduce the effect of hearing impairment.
Referrals will be through physicians and ongoing public health programming.
• The project will provide each potential candidate for a hearing-aid with a
complete auditory examination and assessment audiologically and medically.
People in all age-levels in five regions of the Province will be involved. The
proposal includes counselling and rehabilitation, and establishes control over
technical and professional standards.
The cost of hearing-aids delivered under the project is expected to vary from
$25 to $125 per unit, but this is yet to be finally determined.
 SPECIALIZED COMMUNITY HEALTH PROGRAMMES
I 25
VISION SERVICES
With the addition of an orthoptist to the Local Health Services staff, consultative services were provided to over 200 public health nurses, aides, and summer
students. Visits were made to 12 health units and 16 branch offices, with particular
stress placed on the detection and management of visual defects in the young child.
Studies and discussions with various related professionals have confirmed that
a previously stated figure of 4.5 per cent of children suffer from strabismus of varying
degrees.
With this extended educational programme, it is hoped that the detection of
strabismus will be more readily recognized in children at an early age. Earlier
treatment gives a child a chance to develop some degree of normal binocular
function prior to his entering school. A child becomes a visual adult by age 7,
after which a functional cure may not be attained.
Pilot studies have been set up in order to determine the earliest age at which
visual acuity and stereopsis may be recorded, and what other procedures could
be effectively introduced, especially those which would assist in the early detection
of strabismus.
Twelve health units have been provided with stereopsis and visual acuity recording sheets to be used for recording results of eye tests on kindergarten and preschoolers. Copies of these results are being requested for the coming year. Statistics will be gathered and evaluated, and should prove to be useful in an effort to
Wearing special Polaroid lenses, this pre-school child demonstrates the appreciation
of stereopsis or 3-D by trying to "pinch" the wings of the house fly. The stereopsis test
done successfully and combined with an accurate visual acuity, tells us whether the child
is using both eyes together. In the background is the STYCAR vision chart which is often
used for testing pre-school visual acuity.
 I 26 PUBLIC HEALTH SERVICES REPORT,  1974
establish recommendations of the most effective testing equipment for general use,
as well as referral levels for various age-groups.
It is hoped that by next year, with continued visits and demonstrations of
screening methods and equipment by the orthoptist, all health units will be using
the Titmus Stereopsis Test as part of routine vision screening for kindergarten and
pre-school.
COMMUNITY HEALTH SERVICES
The public health nurse is one of the health professionals delivering health care
to the people in her designated community. As a member of an interdisciplinary
health team, she brings her unique skills of therapeutic nursing combined with preventive medicine and health promotion to assist in maintaining health at its maximum level. She also co-ordinates the skills of others for the benefit of the individual,
family, or "at risk" groups which require a close working relationship with others
who have their contribution to make to total health care. Through case-finding
methods, early treatment and care can be arranged for persons who are unaware
of potential physical or emotional problems. Through individual counselling and
group teaching, health problems may be minimized so that both treatment and
prevention are combined for the benefit of the over-all health of the community.
MATERNAL   AND   CHILD HEALTH
Prenatal
The special series of group discussions with expectant mothers and fathers
continues to be an important method of informing receptive groups of young people
who are anxious to learn how to become good parents. They learn about the growth
and development of a new baby, and their responsibilities as parents in the enlarging
family setting. These sessions provide a unique opportunity for the public health
nurse to foster positive mental health attitudes which will have a permanent effect
on total family environment.
• There were 605 series of classes held at 80 health centres during the year.
• 6,686 new mothers and 3,510 new fathers participated with a total attendance of 35,434 at the sessions. More than 50 per cent of the classes had
both parents enrolled.
Infant and Pre-school
At this age, case-finding methods such as screening procedures are utilized to
locate children "at risk" for certain health problems so that the potential problems
may be prevented or cared for, before they become serious and require expensive
treatment or institutional care. The public health nurses work in situations where
they assess the health of young children, at home visits, special clinics, child health
conferences, day care centres, play groups, and kindergartens. Formal screening
includes taking a careful history, testing for retardation, hearing loss, vision abnormalities, and general deviation from the normal growth and development patterns.
The Denver Development Screening Tests are routinely used to assess motor,
language, and social development of infants and pre-school children. Most formal
pre-school clinics are for 3 and 4-year-old children.  The public health nurses assist
 COMMUNITY HEALTH SERVICES
I 27
parents whose children show a development lag, so that they can attain the normal
level. When indicated, children are referred to specialists through their family
physicians.
• 23,241 newborn infants received at least one assessment visit from a public
health nurse during the first six weeks of life. This represents about 97 per
cent of all babies born in the area served.
• Public health nurses made 18,196 additional visits to homes of the infants
for general health assessment, advice, and counselling on child care. Special
attention was directed toward children with suspected abnormalities, "at
risk" due to unfavourable home conditions, genetic inheritance, possible
child abuse, failure to thrive, etc.
• 18,727 infants attended child health conferences where public health nurses
offered 59,572 individual counselling, immunization, assessment, and various
screening procedures.
• 101,004 individual services of a similar nature were provided to pre-school-
aged children in child health conferences.
• 31,431 visits in addition were made on behalf of pre-school children for
similar reasons.
FAMILY, ADULT, AND GERIATRIC SERVICES
Public health nurses provide a family health service for all members of the
family, regardless of their age. Through family counselling and the provision of
health advice, they are in a position to promote attitudinal changes of life-style which
can lead to better general health and reduce health care costs. Examples of this
include discussion of safety, obesity, exercise, smoking, and understanding of disease
and human relationships.
• 239,775 visits of all types were made to homes by public health nurses,
which is an increase of 34,962 over the previous year, or just over 17 per
cent.
• 84,033 visits were made on behalf of adults for health appraisal, advice,
referral, or follow-up health supervision as requested by a physician. This
is a 3 3-percent increase over last year and indicates an increased utilization
of the public health nurses in providing continuity of health care in the
home. Public health nurses have put forth a special effort this year to
improve liaison with physicians in their offices as well as in follow-up of
persons discharged from hospitals. (These figures do not include home
nursing visits which are shown elsewhere.)
• 144,359 visits were made to adults over 65 years of age, which represents a
55-per-cent increase over the past year. Services include the traditional
nursing care, and special geriatric clinic services such as screening tests for
hearing, vision, blood pressure, mobility, nutrition, and general health counselling. Visits to homes for the elderly, including personal care facilities
where consultation is offered to both operators and residents, are included
in this total.
• 274,812 professional services were rendered via telephone by public health
nurses, which represents an increase of 19 per cent over the previous year.
• 12,408 services in addition were provided by nursing auxiliaries such as
aides, volunteers, and students.
 I 28 PUBLIC HEALTH SERVICES REPORT,  1974
SCHOOL HEALTH
Trends noted in reviewing services for the school-year were an increased enrolment in kindergarten, especially in areas served by the Health Branch. A
decrease is noted in individual services to school-aged children, with a corresponding
increase in group counselling and health education for both elementary and high
school students.
• In the 17 Provincial health units there is an over-all increase of 4,001
children enrolled in kindergarten, 21 per cent higher than the previous year.
• In Greater Vancouver public schools, kindergartens increased by 2,540
(39 per cent).
Enrolments in all other grades showed:
• In the area served by Provincial health units, an increase of 5,953 pupils
(1.7 per cent).
• In Greater Vancouver a decrease of 3,658 pupils or a 2.4-per-cent decline
in total grade-school enrolment.
• The Capital Region showed very little change in either kindergarten or
grade-school enrolment.
It is apparent that a greater proportion of the 5-year-old population are attending kindergarten. This trend enhances the opportunity for early health screening and early detection of health problems, and instigation of remedial service.
This trend, in combination with enriched service by the public health nurses
to other pre-school-aged children, helps to ensure that no child will be hampered in
his school experience by undetected health problems. However, many recognized
physical or emotional handicaps present a serious challenge to school and health
personnel alike in their effort to effect change or assist the child to perform at
optimum ability.
• 253,754 services were provided to individual pupils, a decrease of 3,910
(1.5 per cent) from the previous year.
• 6,761 planned conferences were held with teachers, an increase of 2,465
(57 per cent).
• 6,008 group sessions were held with students for the purpose of health
education and development of positive health habits through the group-
discussion process. This was an increase of 1,746 (40 per cent) over the
number of group sessions held last year.
These figures suggest an increased emphasis by public health nurses on motivation of students to improved health awareness and greater acceptance of personal
responsibility to protect their own health. Where Family Life Education programmes are sponsored by school personnel, the public health nurse provides
assistance and consultation as required.
• 39,871 other services, mainly home visits, were carried out by the public
health nurses, 947 fewer than in the previous year.
 SCHOOL HEALTH
I 29
Public health nursing auxiliaries play an important role in performing routine
procedures, thus allowing more public health nursing time to be spent in family
services.   Nursing auxiliaries carried out the following services in schools:
• 59,193 vision-screening procedures;
• 16,278 hearing tests;
• 5,921 other services.
Table XIII shows the number of individual students who received nursing
service for a specific health problem, and the number of students whom the nurse
referred for further investigation or treatment.
MENTAL HEALTH
Social and cultural values continue to inhibit individuals or families with mild
to moderate emotional problems from seeking help. Too often, those who do want
help in early stages of depression, anxiety, behavioural and interpersonal problems
do not find professionals with both the time and skill necessary to support them in
a programme conducive to change.
There is still too little known about the prevention of mental illness beyond
prevention of disease or injury which adversely affects the brain or central nervous
system. Nevertheless, there is an increasing awareness of the need for "healthy"
early emotional experience.
Public health nurses have developed a unique recognition as "health advocates"
welcomed into the home. Given the necessary knowledge and skill they have the
opportunity to recognize life situations which are emotionally unhealthy for the
infant and young child. Many such situations are recognized. The real challenge
is to plan necessary corrective action.
In-service education to assist staff in meeting this challenge has been ongoing
since 1962.   A variety of mental health related courses are planned each year.
Special community programmes in which public health nurses have been
involved include
parent effectiveness training,
crisis intervention.
behaviour modification programmes,
marital counselling.
learning disability programmes,
community education,
other parent groups, including
prenatal classes.
• 10,051 visits were made to persons who exhibited developing emotional
problems, an increase of 14 per cent over the previous year. Slightly over
50 per cent of the visits were on behalf of adults.
• 11,984 visits were made to persons of all ages with a recognized mental
illness. There was a 21-per-cent decrease in services to school-aged children
in this category, with a slight increase in all other age-groups. Over all,
there was a 6-per-cent increase from the 11,265 visits made in the previous
year.
The trend indicated is that schools find resources within their own staff to work
with these children, while public health nurses spend more time with other age-
groups and in primary prevention programmes.
The public health nurse works closely with the staff of the Mental Health
Branch and relies upon them for consultation.
 I 30 PUBLIC HEALTH SERVICES REPORT,  1974
HOME CARE PROGRAMMES
CO-ORDINATED PROGRAMMES
At a time when the quality, quantity, and costs of health care are of increasing
concern to all, attention is being given to the various alternative types of health care
delivery. Home care services provide a service to patients who require active
medical, nursing, rehabilitative, and other ancillary services, but do not need the
expensive facilities of an acute hospital or other institution. They are a vital part
of the continuum of health care services and effect the following benefits:
1. Provide co-ordinated health care services to selected patients at a level
appropriate to their needs.
2. Provide this required health care economically and efficiently in the home,
thereby
(a) reducing the length of hospital stay through earlier discharge to home
care;
(b) preventing the unnecessary admission of patients to expensive acute
hospital care or other institutional facilities.
3. Maintain the family unit and encourage family involvement and responsibility for the care of the patient.
Home care services, more comprehensive in some areas than others, are available to most of the people in British Columbia. Those areas not receiving home
care services are, in the main, isolated districts too far from centres to make such
services feasible in relation to staffing, costs, and in some cases, patient safety.
At the present time, there are two types of home care programmes in the
Province. Both are financed by the Provincial Department of Health, through
Provincial health units and through two metropolitan health agencies. Both types,
the Traditional Home Care Services and the Special Home Care Projects, exist
within the same areas and in Provincial health units have the same Public Health
Nursing Co-ordinator. However, the cost of the service to the patient and criteria
for acceptance varies. It is hoped that these will be completely integrated within the
next year, and that just one common programme will exist throughout the Province.
Services of the traditional home care programme are available on written
request of physicians to persons requiring nursing care in the home.
• Care is available in all areas of the Province within reasonable access of
public health offices, i.e., over 9*0 per cent of the Provincial population.
• It provides professional nursing care to the patient at no cost to himself.
• It is now being extended to include physiotherapy services at no cost.
• Working with the patient's physician, the Public Health Nurse Co-ordinator
arranges for ancillary services required by the patient and assumes responsibility for co-ordination of services to the patient and his family.
• Public health unit nurses made 134,784 home nursing visits during the year.
This was an increase of 29 per cent over 1973. Over 78 per cent of these
visits were to persons over 65 years of age.
• Effective June 1, 1974, the Provincial Department of Health assumed financial responsibility for the Victorian Order of Nurses in British Columbia,
thereby eliminating any charge to patients for this service.
• The introduction of Pharmacare and reduced ambulance costs has greatly
assisted many chronic patients on care in the home.
 HOME CARE PROGRAMMES
I 31
SPECIAL HOME CARE PROJECTS
Special Home Care Projects provide co-ordinated care to patients discharged
early from acute hospitals and selected patients in lieu of admission to hospitals.
• All services required by the patient, i.e., nursing, physiotherapy, homemaker,
meals-on-wheels, medication, supplies, social work, orderly, transportation,
laboratory, dietitian, etc., are provided by the project at no cost to the
patient.
• Special Home Care Projects, financed completely by the Provincial Government, now operate in Greater Vancouver, the Capital Regional District,
New Westminster-Coquitlam, Surrey-Delta, Prince George, Vernon, Kelowna, Nanaimo, Kamloops, Chilliwack, Abbotsford, Maple Ridge, Langley,
and Penticton. New projects are also being organized in Courtenay, Duncan,
Nelson, Kimberley, and Trail. This service is therefore available in almost
all major population areas.
Over 6,367 patients were served by the Special Home Care Projects.
These patients received 63,569 nursing visits, 6,048 physiotherapy visits,
20,416 hours of homemaker service, and 2,371 meals. Medications were
supplied to 3,523 of the patients and dressings and supplies to 3,198. A
further 1,000 services included transportation, dietitian, laboratory, orderly,
and other services.
• Average length of stay in the project was 10.9 days per patient.
• Average total cost per patient was $145.25. This cost was covered by the
Department.
PHYSIOTHERAPY SERVICES
During the year, one full-time physiotherapist and seven part-time physiotherapists provided consultative services to patients, public health staff, physicians,
and personal homes in eight health units. A total of 2,319 visits and 2,024 assessments was made for patients on the traditional home care service. Although the
physiotherapist's work has been related mainly to the home care programme, a need
has been shown for more service to be provided in other health facilities, and they
visited 701 other types of institutions such as community care facilities, schools,
etc. Staff education for nurses included 395 group sessions, and 864 individual
consultations. The physiotherapist's potential contribution to preventive and educational work has been well demonstrated, and for this reason a senior consultant
has been appointed who will be providing consultation to the physiotherapists as
their numbers increase, and as they become involved in more health programmes.
PREVENTIVE  DENTISTRY
The most significant event in 1974 in the field of dental care for the children
of this Province was the agreement reached in February between the Minister of
Health and the College of Dental Surgeons of British Columbia to establish a joint
study to develop a Comprehensive Dental Programme for the children of British
Columbia.
This study was directed to take into account geographic consideration of need;
geographic consideration of total dental man-power availability and future supply;
costs of education of needed personnel, lags in implementation, and cost-effective-
 I 32 PUBLIC HEALTH SERVICES REPORT, 1974
ness estimates for different personnel mixes; preventive dental programmes to reduce
needs and promote early and regular utilization; and the impact of the children's
programme on the adult care system.
A well-qualified committee was appointed to supervise the study and appropriate research staff hired. Visits were made to various centres where auxiliary dental
personnel were being trained and employed to perform more complex functions
than presently authorized in this Province. Consultants from across the continent
provided advice and guidance in the study. Throughout, liaison was maintained
with, and input received from, the Department of Education and the British Columbia Medical Centre. The report of the Committee was made available to the
Minister of Health toward the end of 1974.
The establishment of the Division was increased by the appointment of an
Assistant Director and a dentist trainee, the latter being a person not having received
graduate training in dental public health. The following additional dental auxiliaries
were authorized—supervisor, dental hygiene, 1; dental hygienists, 3; certified dental
assistants, 4; noncertified dental assistants, 12; providing a total of 46 positions.
During the year an attractive uniform was designed and made available to all
dental auxiliaries.   This is worn when visiting schools or working in a clinic setting.
To provide dental service on a fee-for-service basis in communities without
a resident dentist, four young graduate dentists were employed during the first six
months of 1974 and seven during the latter six-month period. During 1974, more
than 30 communities benefited by this service. During the early part of the year,
two large motorhome-type vehicles were purchased and equipped as two-chair
dental offices with modern dental chairs, units, and X-ray machines. Apart from
water and electricity, these vans are entirely self-sufficient with a propane furnace
for heating and air-conditioning for the summer months. It is planned that early
in 1975 two further such units will be purchased and similarly equipped to be in
use in the summer of next year. To supplement this service the College of Dental
Surgeons is preparing a pilot programme whereby dentists in practice in the metropolitan areas will provide a continuing service on a rotation basis to two centres
on the Queen Charlotte Islands.
In order to provide an incentive for the establishment of a dental practice in
communities lacking suitable rental accommodation, the Division, in co-operation
with the Department of Public Works, prepared plans and specifications for a large
twin mobile home unit which will include living accommodation for the dentist and
his wife and two dental operatories, a small laboratory, and waiting area. Arrangements for the establishment of these facilities have been worked out.
In Greater Vancouver, dental health programmes are provided in health units,
schools, and a mobile unit by the City of Vancouver, School District No. 41
(Burnaby), and the North Shore Union Board of Health. In Greater Victoria,
since 1920, dental health services were provided in the schools by dentists and
dental assistants employed by the Board of Trustees of the Greater Victoria School
District. In 1973, with funds provided by this Department, these services were
extended to the three adjacent school districts. As of April 1, 1974, the responsibility for these services was assumed by the Capital Regional District, which has
been successful in attracting two dental hygienists to the staff. With this transfer
of authority it will be possible in time to extend the dental health programmes in
this region to persons other than students, e.g., to prenatal classes and child health
conferences.
 PREVENTIVE DENTISTRY
I 33
Two 27-foot motorhome-type vehicles have been purchased and equipped as dental clinics
to provide better service to communities which do not have a resident dentist.
Each mobile dental clinic used by dental public health externs is fully equipped as a modern,
self-contained two-chair dental office complete with X-ray unit and autoclave.
 I 34 PUBLIC HEALTH SERVICES REPORT,  1974
Dental programmes in the 17 health units providing services to the remaining
population of the Province are initiated and supervised by the five regional dental
consultants of this Division.
Assistance is given to public health nurses for the dental component of prenatal classes and for counselling at child health conferences and during home visits.
The 3-year-old dental birthday card programme instituted 10 years ago was
continued with marked success. The members of the dental profession are to be
commended for continuing this programme since its inception without a change in
fees. It was significant that more than 90 per cent of the families involved took
advantage of the service where a well-trained dental auxiliary was available for
telephone follow-up.
The school dental health programmes now being developed in all regions as
dental auxiliary personnel become available are based on those pioneered and
proven effective in the Okanagan Region. Visits were made to Grades I, III, V, and
VII. On each visit, education and motivation were appropriate to the age-level.
Also included were two "Brush-Ins". In addition, motivation was encouraged by
newspaper articles, television interviews, and radio spot announcements. At the
first visit each year to the school, cards were given to all pupils in the grades visited.
The family dentists were requested to sign and return the cards to the local health
unit when any necessary treatment was completed if the child was still under regular
care. After a reasonable period of time, if the card was not returned, an appropriate
follow-up was carried out. At the last visit to a school, all pupils in the grades
received a dental inspection, from the results of which the programme was evaluated.
For example, when this programme commenced in 1966, in the rural schools of
the Kelowna School district, 16.1 per cent of Grade VII students suffered premature extraction of one or more permanent teeth. Over the years this percentage
has steadily decreased, until, in 1974, only 6.6 per cent of Grade VII students
suffered in this way.
To evaluate the effectiveness of all dental health programmes on a Province-
wide basis a methodology was devised in 1955 and field-tested in 1956 and 1957.
This system was based on the examination in each of the seven dental regions of
random samples of about 250 public school children at the age-levels of 7, 9, 11,
13, and 15 years. Clearly defined criteria were established for the assessment of
dental health status. All regions were first surveyed in the period 1958-60 to
provide baseline information. The second series of surveys was completed during
the years 1961-67 and showed a statistically significant improvement for several
dental health indices and an over-all trend toward an improved dental health status
at all age-levels. The third series of surveys was commenced in 1965 and completed in 1974. The result of the 1974 survey in the Okanagan Region was tabulated and compared with earlier surveys in 1960 and 1967 and with other regions
of the Province. It is interesting to note that, during this period, the total number
of permanent teeth of 15-year-olds attacked by dental caries in the Okanagan Region
had been reduced by 25 per cent, for 11-year-olds by 34 per cent, and for 7-year-
olds by 37 per cent. In 1960, in the Okanagan Region, 54 per cent of the 15-year-
olds suffered early extraction of permanent teeth, but this fell to 38 per cent in
1967 and to 26 per cent in 1974. (This approaches the 20 per cent reported in
1973 for the Greater Victoria School District.)
To promote the early detection of cancer in the oral cavity, cancer diagnostic
kits continue to be issued to each dentist newly registering to practise in this
Province.
 PREVENTIVE DENTISTRY
I 35
At the close of 1974 the ratio of population per dentist in this Province was
one dentist to every 2,017 persons. This ratio has gradually improved since 1967
Nevertheless, there is a great disparity between the metropolitan and rural areas.
The ratio in Greater Victoria is 1:2,140, whereas 1:2,631 pertains in the north and
northwest of the Province. In addition to the 1,148 dentists licensed and resident in
British Columbia, there were at the close of 1974, 256 dental hygienists and 552
certified dental assistants also licensed to practise in this Province.
In summary, there was a further expansion in the activities of the Division,
and improvements have been made in the dental health status of the children of
British Columbia. It is hoped that this benefit will extend into adulthood. Nevertheless, the Province-wide dental health surveys clearly indicate the obvious need
for further improvement.
NUTRITION  SERVICE
The establishment and evaluation of new and innovative services were the
major focus for 1974 in community nutrition as both headquarters consultant staff
and field operations personnel increased in number.
HEADQUARTERS CONSULTANT OPERATIONS
Selected components of the community nutrition programme are considered
to require a highly sophisticated resource input. Those areas include health promotion, nutrition education and counselling, and food service administration. As
a demonstration of the organization and function of such central services, in
August 1973 a headquarters consultant was employed to provide service to adult
and child community care facilities in food service administration and nutrition
education. Questionnaires distributed to a sample of operators of adult facilities
had determined that all aspects of quantity food service needed to be stressed.
In 1974 a nutrition workshop format was designed. Seven workshops were
organized with the local health units, and conducted in the following areas: Maple
Ridge, Kelowna, Nanaimo, Abbotsford, Port Alberni, Chilliwack, and Prince
George. Presentations included participation from other members of the health
team, including public health nursing, public health inspection, and local nutritionists or dietitians if available. Operators of mental health homes generally attended
these workshops as did the staff of selected small hospitals as determined by the
dietary consultant with the British Columbia Hospital Insurance Service. Evaluation of the workshops indicated improvement in the nutrition knowledge and attitudes
of the operators.
A similar programme with greater emphasis on nutrition education was initiated
with operators of child care facilities, conducted in four areas, and evaluated. Both
programmes will be offered to additional communities in the future.
Particular benefits of service included its intradepartmental co-ordination,
health team involvement, local organizational component, quality resource input,
and measurable change in participant performance. As a result, in November of
1974, two additional consultants were added to the headquarters staff in the areas
of health promotion in the schools and education in maternal and infant nutrition.
It is anticipated that further programme development in these areas will vary with
the addition of field personnel.
 I 36 PUBLIC HEALTH SERVICES REPORT, 1974
FIELD OPERATIONS
In September 1973 the first field nutritionist in the Provincial service was
assigned to Boundary Health Unit. Several specific objectives were established
for this service, with emphasis on
• the provision of information and counselling to nutritionally vulnerable
groups such as infants, pre-school children, adolescents, and the elderly,
with a direct counselling service for "at risk" pregnant women; and
• the provision of research information, motivation, and guidance to those with
direct community contacts.
In 1974, progress toward each specific objective was evaluated. For example,
improvement of the nutritional health of pregnant women was considered to be a
priority on the basis of Nutrition Canada data. Nutritional status and weight gain
of the pregnant woman is related to birth weight of the infant. A programme was
evolved whereby pregnant women were urged to attend prenatal classes early in
their pregnancy. They received nutrition information and those considered to be
at risk, through a screening procedure administered by physicians and public health
nursing staff, were referred for individual counselling by the nutritionist. Encounter
and evaluative reports maintained on these women indicated that substantial
improvements were made in nutrition knowledge, attitude, and food-consumption
practices as a result of these counselling sessions. Follow-up indicated that of the
seven infants delivered to date none were considered to be of low birth weight.
Other highlights of the health unit nutrition programme included
• preparation and distribution of materials on infant feeding;
• survey of the needs of pre-school parents and day care supervisors with
regard to nutrition information;
• weekly consultation with public health staff in health unit suboffices;
• workshop for public health nurses on prenatal nutrition and nutrition education methodologies;
• nutrition education demonstration project for Grade III and IV students in
a selected Surrey school;
• input to homemaker training courses;
• provision of advisory services to public health staff regarding standards for
food service in community care facilities;
• development of a study to determine information and method of communication which are most appropriately used with low-income families;
• survey of the food-consumption patterns of 170 East Indian families to
determine nutritional inadequacies and to provide the basis for the development of nutrition education materials for these new Canadians.
Evaluation of each major component of this programme indicated that expansion of this service was both justified and necessary. In November 1974, recruitment was proceeding for the addition of five field nutritionists to be stationed in
health units throughout the Province.
An extensive summer research programme was conducted in Nutrition Services.
Some of the projects were
• assessment of the nutrition knowledge, attitudes, and practices of the public
health nurses in British Columbia;
• development of nutrition education materials for use in community care
facilities;
• survey of the attitudes and practices related to the use of megavitamins in the
Greater Vancouver area;
 NUTRITION SERVICE
I 37
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o
nutritional assessment and counselling as a component of a health and
physical fitness promotion for selected public service personnel;
investigation of the dietary practices of Chinese Canadians;
an assessment of the role of dietary folate (a vitamin) in the folate status
of women who are pregnant or taking oral contraceptives;
• investigation of the etiology of growth failure as related to small-for-date
infants;
• development of audio-visual aids for nutrition programmes;
• production of three nutrition "commercials" directed at pre-schoolers and to
be used as public service announcements on television.
The first project was particularly useful in determining the levels of nutrition
knowledge, attitudes, and practices of public health nurses as a baseline for evaluation of the over-all impact of the total nutrition programme in-service.
Additional activities of the Nutrition Service included
• production of six half-hour segments of the "Senior Chef" television series
designed for senior citizens;
• production of a half-hour film entitled "Let's Buy Better Food" concerned
with selecting the most nutritious foods for the food dollar;
• Prenatal Nutrition Education Workshop for public health nurses;
• a number of leaflets and scripted slide shows were produced for public information.
PUBLIC  HEALTH  EDUCATION
The Division of Public Health Education was established in 1946 to provide
for the health education needs of the Health Branch at that time. These needs
include library facilities, films, and educational materials.
Important advances have occurred in the health care delivery system in this
decade. Health education has encouraged these advances by undertaking an
imaginative programme of consultation and technical services. Today, with the
appointment of Community Health Educators at the health unit level, further
development in the use of the consultation process can occur in carrying out preventive educational work in the community.
Increasingly, the Division of Public Health Education has become a resource
centre providing consultant and technical services to health units, to the Department, other departments, agencies, and the general public health and health related
programmes.
The Division, in co-operation with other health staff, continues to produce
half-inch educational video-tape material in black and white for in-service education
and special community health projects. Updating of the audio equipment to
broadcast standard has made it possible to produce radio clips on such subjects as
immunization and food-handling. The production of pamphlets, leaflets, and
posters on health educational matters was undiminished in 1974.
Summer student projects included educational slide series on nutrition, venereal
disease, and home care; video-tape production on such subjects as food-handling,
Pearson and Glendale Hospitals; a research project on health education as it is
being performed by educators in the health field within the Province.
 1 38 PUBLIC HEALTH SERVICES REPORT,  1974
During the year, divisional staff were involved in a number of specific projects:
• Working with ACTION B.C. in mounting a special exhibit at the PNE.
• Recording the activities associated with the fitness programme for public
servants.
• Participation in the Province-wide distribution of educational material to
pharmacies. This work was undertaken primarily by the Pharmaceutical
Association of British Columbia, assisted by the National Department of
Health and Welfare and this Division, and will be completed in 1975.
The Division continued its projected three-year programme to replace worn-
out audio-visual projectors located at health unit offices throughout the Province,
and has implemented a dubbing service for audio and video tapes for health units
and other departments of Government.
Library services to the Department, health units, and the public has expanded
with the appointment of a full-time librarian, who will now be responsible for
the book, slide, transparency, and video-tape libraries.
VITAL STATISTICS
The Division of Vital Statistics continued to undertake the wide variety of
duties involved in administering the Vital Statistics Act, the Marriage Act, the
Change oj Name Act, and Part II of the Wills Act. These duties are carried out
through the main office in Victoria, a branch office in Vancouver, and 103 district
offices and suboffices throughout the Province.
In addition, the Division provides a centralized statistical service to the Health
Branch and to certain other Government departments and voluntary health agencies.
These services are provided through the Division's Research Section in Victoria
and a research office in Vancouver.
REGISTRATION SERVICES
Table XIV, which indicates the volume of documents processed under the
above-mentioned Acts in 1972 and 1973, reflects the following main features:
• The total volume of vital registrations accepted and certificates issued continued to increase, although the number of livebirth registrations remained
about the same as in 1973.
• The continued steady upward trend in the number of registration of wills
notices under the Wills Act reflects the growing public awareness and
utilization of this service, which was introduced in 1945.
• There was a further marked increase in the number of applications for
changes of name under the Change oj Name Act, which resulted partly from
the broadening of the application of the Act in 1972.
Revised vital statistics registration forms for births, deaths, marriages, and
stillbirths were introduced in February. The revisions were based on model forms
developed over several years by the Vital Statistics Council of Canada.
BIOSTATISTICAL SERVICES
The Registry for Handicapped Children and Adults continued to receive
registrations of handicapping conditions at the rate of about 250 registrations
monthly. In addition, about 200 reports of congenital anomalies were received
each month.
 VITAL STATISTICS I 39
A paper entitled "The Use of a Registry Caseload Survey in Predicting Trends
in Rehabilitative Needs for the Handicapped" was prepared and presented for publication. Another paper entitled "The Amount of Hereditary Disease in Human
Populations" was accepted for publication in the Annals oj Human Genetics.
During the year the consultants to the Registry presented papers or addresses
based on Registry material at the Canadian Cleft Palate Commission in Toronto,
the International Congress of Pediatricians in Buenos Aires, the meeting of the
American Society of Genetics in Portland, Ore., and at the Mayo Clinic in New
York.
The Cancer Register continued to operate within the general framework of the
Registry, and the service was strengthened by the appointment of a part-time consultant during the year.
The Administrator of the Registry attended the annual meeting of the International Association of Cancer Registries in Montecatini, Italy, in October.
Toward the end of the year the name of the Registry was changed to the
Health Surveillance Registry, a name which more fittingly reflects the present nature
and scope of its activities. The cancer register will be operated as a subregister of
the registry.
The Division continued to provide mechanical processing and statistical consultant services to the British Columbia Cancer Institute in connection with the
Cytology Screening Programme for cervical cancer. Data on about 400,000 screening tests undertaken during the year were transferred to punch cards, and the records
of screenings in the previous year were tabulated and analysed.
Extensive services were rendered to the Director of the Division of Preventive
Dentistry in connection with the development of a dental care programme for
children in the Province. Besides providing a variety of statistical data to the
committee established for this purpose, two members of the Division's Research
Section served as consultants to the committee.
The Research Section was also involved in the development of a new methodology for dental health surveys, designed to give greater statistical reliability to the
data collected. Sample selection and statistical processing of the data compiled in
the Okanagan Region dental health survey were carried out during the year.
Two studies on the caries-inhibiting effects of mouth rinses were completed
during the year. The resulting data were processed, and a statistical analysis presented to the sponsoring agency and other interested persons.
A Research Officer was appointed to represent the Department on the Executive
Committee of the Perinatal Morbidity and Mortality Programme, which was established by the British Columbia Medical Association in the current year with financial
assistance from the Provincial Government. During the year the Committee examined statistics supplied by this Division relating to infant morbidity and mortality,
as a basis for formulating their approach to the study in 1975.
Data derived from the Physician's Notice of Live Births or Stillbirths were
again analysed and presented in the form of an annual special report entitled "The
Newborn." A study of infant and perinatal mortality among registered Indians was
undertaken, and the results presented in a special report.
The Division continued to provide information on congenital anomalies, ascertained from multiple sources, to the Department of National Health and Welfare in
connection with the continuing national surveillance study of congenital anomalies.
A Research Officer was selected to represent the Health Branch on the Provincial Metric Conversion Committee.  This committee was appointed to collaborate
 I 40 PUBLIC HEALTH SERVICES REPORT,  1974
at the Provincial level with the National Committee on Metric Conversion, which is
working toward complete conversion to the use of metric units by the year 1980.
The expanding statistical needs of the Community Care Facilities Licensing
Board, which is responsible for the licensing of personal care homes for the aged
and day care centres for children, were dealt with during the year. Because of the
Board's need of up-to-date listings and statistics at short notice, priority has been
given to the computerization of these records, and the requisite procedural changes
were completed before the end of the year.
There was a considerable expansion in the coverage of the Special Home Care
Projects, designed to relieve pressure on acute care hospitals. Individual patient
records relating to these projects were processed and statistics supplied to the Division of Public Health Nursing.
Assistance was given to a public health nursing consultant in a study designed to
assess the effectiveness of the public health nursing/physician liaison programme
which has been in operation for the past few years.
The Division assumed responsibility for processing two new continuing series
of survey questionna:res, which were introduced respectively by the Consultant in
Public Health Nutrition, and by the Director, Division of Speech and Hearing.
The Research Section maintained statistical services to the Division of Tuberculosis Control, the Div'sion of Venereal Disease Control, the Mental Health Branch,
and the G. F. Strong Rehabilitation Centre. These services included the editing and
processing of individual records, and the preparation of statistics required for annual
reports and to meet special inquiries.
The Mechanical Tabulation Section continued to undertake the editing, coding,
punching, and tabulating of all records submitted for processing by the other divisions
and agencies served by the Section.
During the year, plans were laid for substituting the Division's out-dated unit
record tabulating equipment by a computer terminal connected to the data processing
installation of the Computer and Consultant Services Branch of the Department of
Transport and Communications. The substantial operation of systems analysis and
programming which is involved was commenced during the year and accelerated
during the last quarter.
IN-PATIENT CARE
In-patient care for tuberculosis patients is provided at the Willow Chest Centre
and at Pearson Hospital, with the latter also caring for persons under the Provincial
Extended Care Programme in addition to post-poliomyelitis patients with major
residual respiratory disabilities.
The number of patients with tuberculosis at Pearson Hospital has decreased
in the past year, resulting in only two wards being required for them—all male.
Those at Willow Chest Centre have remained fairly constant in number and both
female and male patients are cared for there. Renovations at the centre have
continued to be delayed.
In the meantime, one of the four extended-care wards is being used to facilitate
floor renovations in the two tuberculosis wards. These repairs will be completed
in the near future and will permit utilization of all the extended-care beds, provided
sufficient staff are available. Willow Chest Centre patients continue to be transported
 IN-PATIENT CARE I 41
to Pearson Hospital dental, ophthalmology, and otorhinolaryngology clinics without
any difficulty arising.
With the number of patients at Pearson Hospital remaining at lower levels,
there have been slight decreases in the work loads of the laboratory and X-ray
services to the tuberculosis wards primarily. However, the extended-care patients
have had increased laboratory services which appear to be related to more follow-up
tests of acutely ill patients. It is hoped to obtain additional equipment for certain
blood chemistry studies to be performed in the laboratory in emergent situations.
An automatic film processor was obtained, resulting in more rapid service to the
patients.
Changes in personnel have increased to some extent, especially in the Nursing
and Activity Services Departments. Most of these have been due to retirement or
seeking other employment.
A new position of Executive Housekeeper, combining housekeeping and maintenance services at Pearson Hospital and Willow Chest Centre, was established and
filled.
The hospital pharmacist retired after many years of service and a replacement
has been appointed.
A major change in personnel management has been the appointment of a
Personnel Officer who has been of invaluable assistance in the over-all area of personnel practice.
The Nursing Service has completed a review of its establishment for Pearson
Hospital and Willow Chest Centre, resulting in improved supervision of nursing care.
This is the first stage of studies of the standards and requirements for patient care,
and already benefits are evident. During the year, several nurses successfully completed the Canadian Hospital Association's Nursing Unit Administration course.
In conjunction with the Activity Services Department's physiotherapists and
occupational therapists, the nursing staff co-ordinated their related services to the
patients, particularly in the activities of daily living. This resulted in improved care.
The Activity Services Department, because of staff shortages for physiotherapy
and occupational therapy, has been unable to treat patients as frequently as in the
previous year. However, the actual level of patient care has not been proportionately changed, and this is attributable to the concern and industriousness of the staff.
A high level of service has been maintained, much to the benefit of patients. The
summer student employees were of inestimable value in assisting in the programme.
The Social Service Department maintained its aid to patients at Pearson Hospital and Willow Chest Centre. Alcoholism remains as a problem with many
tuberculosis patients and constitutes a significant portion of the staff work load.
Referrals to agencies or associations in the private sector continue to be of
assistance to many patients. A number of extended-care patients, for example, are
now employed outside the hospital, some to a sufficient degree to merit eventual
discharge.
The Dietary Department was busy in its efforts to adjust to rising food costs
and at the same time was able to institute more individualized menu service. The
following are some of the highlights:
• Considerable time was required in effecting temporary changes necessary
for planned renovations to Willow Chest Centre.
• In conjunction with the Public Works Department a recommendation for
new facilities for Pearson Hospital food services was submitted.
• Tests were conducted on the use of microwave ovens for patient food
reconstitution.
 I 42 PUBLIC HEALTH SERVICES REPORT,  1974
• Improved menus service to Willow Chest Centre patients was provided with
the assistance of the Vancouver General Hospital, which supplies the food.
• The dietary staff provided support for the weekly summer barbecues arranged
by the Department of Activity Services.
The Business Office provided excellent support for the operations of the
various departments.
The staff education programme enabled a number of persons to attend seminars
and conferences. Among the latter was the World Federation of Occupational
Therapists Congress in Vancouver. In-service educational programmes have progressed well and one for orderlies is now in effect. The role of student-teaching in
the community has been expanded and now includes social and case aide workers,
food service supervisors, recreational, occupational and physiotherapists, medical
record technicians, and licensed practical nurses, whose numbers increased in 1974.
The services of voluntary organizations continued to be of benefit to the
patients in the matter of entertainment, visiting, donations for equipment, and beauty
parlour services.
AID TO HANDICAPPED
April 1, 1974, marked the 20th anniversary of a programme to provide
rehabilitation services to the handicapped of British Columbia through the auspices
of the Health Branch. Services were begun in a modest way on April 1, 1954, and
have continued at a gradually accelerating pace. The system of delivery has been
described in previous annual reports and the only other area in the world which
utilizes a somewhat similar system, which is based on the philosophy of community
operated and oriented programmes, is Switzerland.
While the expansion was not as great in 1974 as was reported in the previous
three years, the Division was able to consolidate services and reorganize one of the
regions by creating a South Fraser Region and a North Fraser Region out of the
Fraser Valley Region. This provided an improved service on both sides of the
Fraser River. In addition, one more region was added and developed during the
year. A consultant was appointed and trained and assigned to the Northwestern
Region, with headquarters at Terrace. Service is now available to those residing
in and around such centres as Prince Rupert, Kitimat, Terrace, and Smithers. The
consultant also made contact with the Queen Charlotte Islands, Stewart, and Telegraph Creek. The Province is now divided into nine regions.
A new committee was developed in association with the G. F. Strong Rehabilitation Centre in Vancouver. Through this the Division is able to bridge the transition
from rehabilitation in an active treatment centre to rehabilitation in the community,
and, through the bridge afforded by the Aid to Handicapped Committees in communities throughout the Province, necessary services can be continued without
interruption after the patient returns home.
TRAINING AND ASSESSMENT PROGRAMMES
In the previous Annual Report, mention was made of two new programmes
which had been developed with the assistance of personnel of Vancouver Community College (Special Programmes Division), the Department of Manpower, and
the Provincial Department of Education.   These programmes were related to the
 AID TO HANDICAPPED
I 43
needs of the deaf in vocational orientation and in the development of a training
programme for interpreters. This year a further programme to aid the young
disabled person with multiple handicaps was arranged with the assistance of the
above-mentioned departments and, like the others mentioned above, is housed in
Vancouver Community College under the direction of the staff of the Special Programmes Division. In addition to the facilities offered in the college, also utilized
are the programmes and the expertise of the staff of the Opportunity Rehabilitation
Workshop which provides the milieu for expert pragmatic assessment.
COST BENEFIT ANALYSIS
During the year a cost benefit analysis of the programme in the Upper Island
Health Unit was undertaken. The purpose of the study, primarily, was to obtain
some information about whether a monetary benefit could be demonstrated as a
result of the provision of appropriate rehabilitation services to disabled persons. It
has long been a contention of those in the rehabilitation field that properly applied
rehabilitation services result in dividends related to relieving the community of
certain financial burdens entailed in the support of the disabled. Also, that such
services assist the disabled toward a more satisfactory and independent, personal
adjustment in the community. The work entailed in the study was undertaken by
a private firm of management consultants. The study took 10 months to complete
and encompassed the total period of the eight years that the programme for the
Division for Aid to Handicapped has been in operation in that particular area of the
Province and the results are available for review.
Calculation showed that the average annual expenditure on the disabled in
that particular area of the Province was $57,000. The study report states: "The
benefit cost ratio of $175,000 over $57,000 annually, i.e. about 3 to 1 is the minimal
benefit of this programme. In fact the level of annual administration expense is
sufficient to allow for the intake of additional clients, while the annual disbursements
postulated at $16,000 a year are not required into perpetuity. From an investment
standpoint, the investment in the programme to date is probably in the order of
$200,000. Present worth of the recurring annual benefit of $175,000 is probably
in the order of $1.75 million. On this investor's viewpoint, the benefit cost ratio
would be over 8 to 1."
The above study applied only to the work of one of the Aid to Handicapped
Committees in the Province. At the end of 1974 there were 50 such committees. It
is fair to speculate that if a similar study could be made in the case of every committee, the results would vary somewhat from the above-quoted study but, in general,
a positive and favourable result would be demonstrated. Such being the case, a
substantial fiscal return to the community and to the Province is being achieved
through the rehabilitation programme of the Division.
LABORATORY SERVICES
During 1974 the work load of the Division of Laboratories increased by nearly
8 per cent from 557,000 tests in 1973 to about 600,000 tests in 1974. The number
of tests performed in 19*74 at the Main Laboratories and at the Branch Laboratories
 I 44
PUBLIC HEALTH SERVICES REPORT,  1974
in Nelson and in Victoria is compared with the corresponding figures for 1973 in
Table XVI. Major increases occurred in cultures for fecal streptococci in water
(a recently introduced test), animal virulence tests for Corynebacterium diphtheria
(147 per cent), cultures of throat swabs (73 per cent), processing and reporting
special serological tests performed at reference laboratories (33 per cent), viral
serology (33 per cent), examinations for intestinal parasites (15 per cent), and
culture of food poisoning specimens (13 per cent). Major decreases occurred in
examinations for atypical Mycobacteria (21 per cent), cultures of feces for
enteropathogenic Escherichia coli (18 per cent), completed coliform tests on water
specimens (17 per cent), and examinations for pinworm (15 per cent).
Two autoanalysers perform 750 to 900 screening tests for syphilis per day.
The increase in work load for the diagnosis and control of gonorrhoea and
diphtheria reflect the current epidemics in British Columbia of these two communicable diseases. The increased work load in the search for parasites similarly mirrors
the demand for laboratory investigation of travellers and immigrants from countries
where parasitic and exotic infections are prevalent.
PROJECTS BY SUMMER STUDENTS
For the second year, university students were employed by the Division of
Laboratories from May to August, eight under the Innovation '74 Programme and
13 under the Experience '74 Programme. While most students worked on scientific,
administrative, or clerical projects, some were employed on supportive duties. All
performed useful tasks of benefit both to themselves and to the laboratories.
 LABORATORY SERVICES I 45
BACTERIOLOGY SERVICE
Diphtheria
In the year under review, 372 virulent strains of Corynebacterium diphtheria
were isolated from 355 persons—a dramatic increase from 132 in 1973. Included
were isolations from swabs of throat and of skin lesions. An outbreak of faucial
diphtheria due to C. diphtheria intermedius occurred on Vancouver Island with six
cases and 36 carriers. In the Interior of British Columbia, nine carriers of C.
diphtheria gravis were discovered in the Indian population.
Opportunistic Pathogens
Some 1,600 unusual gram negative organisms were isolated from a variety of
clinical specimens. These opportunistic pathogens included strains of Acinetobacter
(455) and of Pseudomonas aruginosa (87).
Food Poisoning
The number of specimens cultured for food-poisoning organisms increased to
220 in 1974 from 194 in 1973. Potential food-poisoning agents were isolated in
seven incidents—Staphylococcus aureus (5) from chicken croquettes, barbecued
chicken, Easter egg, home-canned salmon, and turkey meat; Clostridium perjringens
from liver; and Streptococcus jacalis from hamburger. Botulism, suspected in five
incidents of food poisoning, caused the death of two women who ate salmon eggs,
subsequently found to contain Clostridium botulinum Type E toxin. The other
incidents included three cases of carbon monoxide poisoning (two fatal), one case
of tick paralysis, and one case of bowel obstruction.
In two potential food-poisoning incidents, the patients remained asymptomatic
after eating improperly canned commercial food. No toxin was demonstrable in
these foods by laboratory tests.
REFERENCE SERVICES
Tropical and Parasitic Diseases Reference Service
The number of fecal specimens examined for parasites increased by 15 per
cent from 13,700 in 1973 to 15,750 in 1974. This was largely due to increased
demand for parasitological examination of immigrants and of travellers returning
to British Columbia. The reference service provided advice on preparing for travel
in the tropics and on the diagnosis and treatment of tropical and parasitic diseases
acquired in the tropics. Exotic drugs, not available commercially in Canada, were
supplied for 29 patients during the year.
Botulism Reference Service for Canada
The Service investigated two Canadian incidents of suspected botulism. In
one, the diagnosis proved to be alcoholism; in the other, pesticide poisoning, not
botulism, was responsible for the death of 25 wild ducks.
On April 1, 1974, the duties and responsibilities of the Botulism Reference
Service for Canada were transferred to Health Protection Branch, Ottawa. The
British Columbia Provincial Laboratories continued to carry out initial diagnostic
tests for botulism and to collect specimens and epidemiological information for the
Service in Ottawa from suspected cases in British Columbia.
 I 46 PUBLIC HEALTH SERVICES REPORT,  1974
VIROLOGY
Influenza
The first influenza of 1974 was reported from Courtenay in February. During
March, absenteeism reached 20 per cent in schools at Terrace, Grand Forks, Trail,
and Surrey. From each of these areas the Virology Service demonstrated influenza
virus type B, closely related to influenza B/Hong Kong prevalent in 1973. Symptoms included fever, nausea and vomiting, sore throat, cough, and generalized
muscular aches and pains, and sometimes dizziness, ataxia, and photophobia.
Rubella
Since the German measles (rubella) epidemic of 1970/71, and since the
introduction of Province-wide immunization in 1970, the Provincial Laboratories
diagnosed an average of 14 cases of rubella per year. The estimated number of
laboratory-diagnosed cases of rubella rose to 200 in 1974. More than 90 per cent
of these patients were 15 years of age or older. From 1970, the immunization
programme was directed primarily at pre-school and elementary school children up
to 12 years of age. The rubella detected in 1974 occurred in unimmunized adolescents and adults.
The Provincial Laboratories continued to provide the hemagglutination-inhibi-
tion (HI) test for rubella. The number of tests carried out in 1974 was 45 per cent
greater than in 1973.
PLANNING
With the establishment of the British Columbia Medical Centre, the Provincial
Division of Laboratories will relocate to the Shaughnessy site where it will provide
public health laboratory services for the Province. Preparation of the conceptual
plan for closely related Provincial Laboratory and clinical microbiology services
proceeded in 1974.
EMERGENCY HEALTH  SERVICE
In 1966 the Government of Canada entered into a formal agreement with the
Government of the Province of British Columbia "to develop and maintain an
emergency health service and to establish and maintain within the Province of
British Columbia a stock of medical supplies and equipment for use in an emergency." In the agreement the term "emergency health service" was defined as
"the organization created and the measures taken by Canada or British Columbia,
as the case may be, for the purpose of giving medical care to civilian casualties and
for meeting the public health problems that may result from a major natural disaster
or an attack by an enemy power." Under the agreement, the Government of Canada
has made available to the Province about $3 million worth of emergency health
supplies. Although these are owned by the Government of Canada, they have been
pre-positioned at over 100 locations in British Columbia for use by Provincial
authorities for the special reasons stated above.
It is in this sense that the term "emergency health service" has been used in
previous Annual Reports of the Health Branch. The Health Branch role has been
co-ordinated closely with that of the Provincial Emergency Programme (formerly
known as the Civil Defence Programme). The Provincial Emergency Programme is
 EMERGENCY HEALTH SERVICE
I 47
authorized by the Emergency Programme Act, for which the Provincial Secretary
is the responsible Minister.
During 1974 the term "emergency health service" was given an additional
meaning. At the spring session, the Legislature passed the Emergency Health Services Act. In this Act, "emergency health service" is defined as "the provision of
first aid or medical services in emergency situations." (These are not necessarily
the result of large-scale disasters. They include situations involving accidents or
illnesses encountered daily throughout the Province.) The Emergency Health Services Act established a Commission directly responsible to the Minister of Health.
It empowered the Commission
• to provide emergency health services;
• to establish emergency health centres;
• to assist hospitals and other health agencies to provide emergency health
services;
• to establish or improve the necessary communication systems;
• to make available medically trained persons in those parts of the Province
which are not adequately served;
• to recruit, train, and license emergency medical assistants;
• to provide ambulance services.
Because the Emergency Health Services Commission is not, organizationally,
a part of the Health Branch, it would not be appropriate to present here a report of
the activities of the Commission. However, it should be noted that the Commission's
Executive Officer has been appointed Co-ordinator of Emergency Health Services.
This has made him responsible for health measures taken at the time of a major
natural disaster or an attack by an enemy power, as well as for the health measures
taken to cope with daily emergencies.
COUNCIL OF  PRACTICAL NURSES
The British Columbia Council of Practical Nurses,* under the authority of the
Practical Nurses Act, has completed 10 years of its obligations in carrying out its
mandate under this Act. In total, 68 meetings of the Council have been held and
approximately 11,000 applications for licensing considered. The disposition of these
applications is shown in Table XVII at the end of this Report. In addition to the
regular meetings of the Council, numerous committee meetings were held, including
credentials, education, and financial. Consideration was given to many special
cases where additional clasification had to be obtained regarding the previous training of applicants.
While it is the principal function of the Council to assess applications for
licences and issue such licences to suitable qualified persons, the Council has also
made preliminary assessment by various members in relation to the changing
philosophy in health care delivery. One member of Council was appointed to the
Educational Planning Committee, Practical Nursing, of the British Columbia Medi-
* The 10 members of the Council are appointed by Order of the Lieutenant-Governor in Council on the basis
of nominations by
(a) the Minister of Health (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).
 I 48 PUBLIC HEALTH SERVICES REPORT,  1974
cal Centre, which has been set up to review the practical nurse training programmes
within its jurisdiction.
In an advisory capacity the Council continued to serve the Department of
Education in matters relating to the training of the practical nurse orderly. More
frequent Council meetings were arranged to cope with the additional matters put
forward for consideration.
PUBLICATIONS
Be aware! Beware oj botulism, Rx Bulletin, Health Protection Branch, Health and
Welfare Canada, 5:34-35, March-April 1974, by E. J. Bowmer.
Botulism in Canada, Canadian Journal of Public Health, 65:231, May-June 1974,
by E. J. Bowmer.
Trichinellosis in British Columbia: Eight incidents traced to pork and bear meat.
In Trichinellosis (Proceedings of the Third International Conference on
trichinellosis), ed. C. W. Kim. Intext Educational Publishers. New York
(in press), by E. J. Bowmer.
A Preschool Screening Programme on Central Vancouver Island: A Two-year
Follow-up. Canadian Journal of Public Health, 65: September-October 1974,
by A. Thores and J. Philion.
Strabismus detection: Prospective study. American Journal of Ophthalmology, 77:
February 1974, by L. D. Kornder, Joanne N. Nursey, J. A. Pratt-Johnson, and
Alice Beattie.
Strabismus detection: Retrospective study. American Journal of Ophthalmology,
77: February 1974, by L. D. Kornder, Joanne N. Nursey, J. A. Pratt-Johnson,
and Alice Beattie.
The Amount oj Hereditary Disease in Human Populations. Annals of Human Genetics, 38: October 1974, by B. K. Trimble, and J. H. Doughty.
Chap. 18, Diseases oj the gastrointestinal tract caused by metazoan parasites. In
Gastroenterology, pp. 984-1028, ed. A. Bogoch, McGraw-Hill, New York,
1973, by E. J. Bowmer.
Chap. 19, Diseases oj the gastrointestinal tract caused by protozoan parasites. In
Gastroenterology, pp. 1029-1050, ed. A. Bogoch, McGraw-Hill, New York,
1973, by E. J. Bowmer.
Chap. 21, Food Poisoning. In Gastroenterology, pp. 1087-1112, ed. A. Bogoch,
McGraw-Hill, New York, 1973, by E. J. Bowmer.
 TABLES
I 49
TABLES
Table I—Approximate Numbers oj Health Branch Employees
by Major Categories at the End oj 1974
Physicians in local health services	
Physicians in institutional and other employment.
Nurses in local health services	
Nurses in institutions	
Public Health Inspectors	
Dentists in local health services	
Laboratory scientists	
Laboratory technicians	
Public health engineers	
Statisticians	
Others	
17
19
377
75
94
6
36
41
11
8
941
Total
1,625
Table II—Organization and Staff oj Health Branch (Location and Approximate
Numbers oj Persons Employed at End of 1974)
Health Branch headquarters, Legislative Buildings, Victoria  81
Health Branch office, 828 West 10th Avenue, Vancouver  51
Division of Vital Statistics—
Headquarters and Victoria office, Legislative Buildings, Victoria __. 78
Vancouver office, 828 West 10th Avenue, Vancouver  23
Division of Tuberculosis Control—
Headquarters, 2647 Willow Street, Vancouver
25
Willow Chest Centre, Out-patient Care, 2647 Willow Street, Vancouver      27
Victoria and Island Chest Clinic, 1902 Fort Street, Victoria     11
New Westminster Chest Clinic, Sixth and Carnarvon, New Westminster        9
Division of In-patient Care—
Willow Chest Centre, 2647 Willow Street, Vancouver
98
Pearson Hospital, 700 West 57th Avenue, Vancouver  329
Division of Laboratories—
Headquarters and Vancouver Laboratory, 828 West 10th Avenue,
Vancouver   111
Nelson Branch Laboratory, Kootenay Lake General Hospital       1
Division of Venereal Disease Control—Headquarters and Vancouver
Clinic, 828 West 10th Avenue, Vancouver     26
132
101
72
427
112
26
 I 50 PUBLIC HEALTH SERVICES REPORT, 1974
Division for Aid to Handicapped—
Headquarters, 64 Broadway Centre, 805 West Broadway, Vancouver      19
Nanaimo	
Vernon 	
Prince George	
Surrey	
Terrace	
Trail	
Victoria  .	
Local Public Health Services (Health Units, Including Home Care Projects)—
East Kootenay, Cranbrook  33
Selkirk, Nelson  15
West Kootenay, Trail  31
North Okanagan, Vernon  39
South Okanagan, Kelowna  61
South Central, Kamloops  49
Upper Fraser Valley, Chilliwack  46
Central Fraser Valley, Mission  45
Boundary Health Unit, Cloverdale  80
Simon Fraser, Coquitlam  62
Coast-Garibaldi, Powell River  23
Central Vancouver Island, Nanaimo  72
Upper Island, Courtenay  34
Cariboo, Williams Lake  25
Skeena, Prince Rupert  34
Peace River, Dawson Creek  25
Northern Interior, Prince George  55
26
729
Total   1,625
There were also part-time employees in many of the places listed.
 TABLES
I 51
Table III—Comparison oj Public Health Services Gross Expenditure jor the Fiscal
Years 1971/72 to 1973/74, Excluding the British Columbia Overall Medical
Services Plan.
Gross Expenditure
Percentage of
Gross Expenditure
Percentage
Increase or
Decrease
(—)
Over
Previous
Year
1971/72
1972/73
1973/74
1971/72
1972/73
1973/74
$
6,689,345
4,711,304
1,973,397
1,379,613
Nil
832,178
Nil
80,484
647,938
209,138
Nil
$
7,531,472
4,902,690
2,080,058
1,618,211
Nil
996,926
544,444
300,657
686,712
241,508
119,666
$
8,349,310
4,989,879
2,735,681
2,153,547
1,138,599
1,052,931
956,344
743,306
725,830
260,886
Nil
40.5
28.5
12.0
8.3
Nil
5.0
Nil
0.5
3.9
1.3
Nil
39.6
25.8
10.9
8.5
Nil
5.2
2.9
1.6
3.6
1.3
0.6
100.0
36.2
21.6
11.8
9.3
4.9
4.6
4.1
3.2
3.2
1.1
Nil
10.9
In-patient care 	
Cancer, arthritis, rehabilita-
1.8
31.5
General administration and
consultative services	
Summer employment pro-
33.1
Division of Laboratories.-	
Prescription  Drug  Subsidy
Plan 	
Alternative care facilities	
Division of Vital Statistics	
Division of Venereal Disease
Control 	
5.6
75.7
147.2
5.7
8.0
(*)
Totals.  	
16,523,397
19,022,344
23,106,313(2)
100.0
100.0
21.5
1 Not applicable.
2 The total for Public Health Services gross expeoditure in 1973/74 with the inclusion of
British Columbia Overall Medical Services is $112,166,786.
1,060,473 for
Table IV—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 1974—
Master of Science in Audiology (Murray State U, Kentucky) 	
Diploma in Public Health (U. of Toronto School of Hygiene)	
Total
Commenced Training During 197^
Diploma in Public Health (U. of Toronto School of Hygiene)
Bachelor of Science in Nursing (UBC)
Bachelor Science in Dentistry (U. of Toronto)	
Master's Degree in Public Health (U. of North Carolina)
2
1
1
1
Total
 I 52 PUBLIC HEALTH SERVICES REPORT, 1974
Table V—Training of Health Branch Staff by Means of Short Courses
(Types of training, universities or other training centres, and numbers trained)
A course in Instruction on the Operation of Autoanalyzer Equipment, Technicon
Inc., Tarrytown, N.Y. (The Technicon Corp.)     1
Profession Practice Conference, Toronto (Can. Soc. of Hospital Pharmacists) ___    1
Second Annual Public Health Nurses Nutrition Workshop, Victoria  (Prov.
Health Dept.)   21
CDA Council of Health Care Conference on Dental Auxiliaries, Banff (Can.
Dental Assn.)      3
Principles of Video Production, BCIT (Prov. Health Dept., Interdepartmental
Committee on Staff Training and Public Service Commission)  2
IRMA Conference (Industrial Relations Management Assn. of B.C.)  1
Seventeenth Annual Refresher Course (School of Hygiene, U. of Toronto)  4
Habilitation of the Handicapped Child, UBC (G. F. Strong and UBC Health
Sciences)   4
Conference on Home Sewage and Water Supply, Columbia, Ohio (Ohio Dept.
of Health)      1
Understanding and working with families (UBC)  3
Vancouver Island Regional Institute for Public Health Nurses  6
An Introduction to the Psychology of Aging (Centre for Continuing Ed., UBC) 1
1974 Conference for Directors of Clinical Service Programs in Speech Pathology
and Audiology, New Orleans (American Speech and Hearing Association) 1
Infant Toddler Care, Admin. University of North Carolina, Greensboro (North
Carolina Centre for Infant/Toddler Care)   2
Health Education Dynamics, Vancouver (B.C. Health Ed. Council)  1
Ryerson Polytechnical Institute Correspondence Course  15
TB.? TODAY??   School of Nursing, Ottawa (U. of Ottawa School of Nursing
and Can. TB. & Respiratory Disease Assn.)  1
Maternal Health Nursing (UBC Div. of Continuing Ed.)   3
Venereal Disease Contact Interviewing, Los Angeles (U.S. Public Health Service)   1
CSA Subcommittee on Septic Tank Functional Design, Rexdale, Ont. (Can.
Standards Assn.)  1
Workshop on Food Poisoning, Ottawa (Health Protection Branch)   1
Development Seminar, Executive Secretaries, Banff (The Banff Centre, School
of Management Studies)  4
Conference of State and Territorial Epidemiologists (Centre for Disease Control, Atlanta)  1
Health Care Evaluation Seminar, Winnipeg  1
Structural Pest Abatement Course (B.C. Dept. of Agriculture)   1
Industrial Medical Association Meeting, Miami  1
7th International Congress of the World Confederation of Physiotherapy (World
Confed. for Physical Therapy)  1
AWWA 94th Annual Conference (AWWA)  1
Course in Medical Mycology (McGill U., Montreal)  1
Enterostomal Therapy (St. Paul's Hospital, Vancouver)  1
 TABLES
I 53
Table V—Training of Health Branch Staff by Means of Short Courses—Continued
Plaque and Preventive Dietetics, The Dental Office (UBC)	
Visit Departments in Japan concerned with air pollution and industrial health
(Tokyo and Osaka) 	
Building Nursing Practice on Standards of Care, Harrison Hot Springs (UBC
Health Sciences Centre) 	
Canadian Orthoptic Society Annual Meeting (Can. Orthoptic Soc.) 	
The Stoma Rehabilitation Clinic	
Speech and Hearing Mini Institute, Vancouver (Prov. Health Dept.)   13
An Advanced Seminar and Workshop in Techniques of Counselling (UBC)	
16th Annual Health Physics Course (Radiation Protection Bureau) 	
Continuing Education Course for Pharmacists	
Early Nutrition and Later Life (UBC)	
School for Impedance Measurement Technique, Vancouver, B.C.  (American
Electromedics Corp.) 	
Seminar on Home Care Information, Patient Selection (U. of Ottawa)	
B.C. Conference on Venereal Disease (BCMA and Prov. Health Dept.)   17
Projection '74 Toronto (Can. Dietetic Assn.)	
Intra-Oral Course for Dental Assistant Certification (UBC)  (B.C. College of
Dental Surgeons)	
Early Childhood Education (U. of Victoria) 	
Northwest Regional Conference,  Eugene,  Ore.
America) 	
(Child Welfare League  of
Visit Provincial Laboratories, Edmonton Connaught Laboratories, Toronto, and
attend seminar in Toronto on Electron Microscopy in Diagnostic Virology,
Edmonton and Toronto	
Workshop in Basic Counselling Skills, Calgary (The Pastoral Institute, Calgary)
World of the Heart and Lung, Seattle (Cardio-Pulmonary Research Institute and
U. of Washington School of Medicine)	
Nutrition Education Workshop (UBC School of Home Economics) 	
Meeting of International Association of Cancer Registries, Montecatini, Italy	
Environmental Marine Biology (U. of Victoria Div. of Continuing Ed.)	
Four-day workshop on Physical Assessment (UBC, Continuing Ed. in the Health
Sciences) 	
29th Annual meeting, International Northwest Conference on Diseases in Nature
Communicable to Man, Boise	
Workshop in Parent Effectiveness Training	
AWWA Chlorination Seminar, Portland, Ore. (AWWA Ed. Committee) 	
A course in Parasitology, Royal Jubilee Hospital (in co-operation with U.S.
Navy Laboratory Services)	
Topical Symposium on Population Exposures, Knoxville (Health Physics Soc.)
Principles of Biohazard and Injury Control in the Biomedical Laboratory, School
of Public Health, Minneapolis (National Cancer Inst, of U.S.A.) 	
 I 54 PUBLIC HEALTH SERVICES REPORT, 1974
Speech and Hearing "Mini Institute", Kamloops (Div. of Speech & Hearing)  18
Annual Conference of American Society of Tropical Medicine and Hygiene,
Honolulu (to present a paper) 	
Western Canada Water and Sewage Conference, Calgary	
Community Mental Health Courses for Public Health Nurses  20
Expanded Nursing Roles in Primary Health Care (UBC) 	
Symposium of Western Canadian dialysis personnel, Edmonton (Foothills Hospital, Calgary) 	
Northwest Association of Occupational Medicine, Portland, Ore. 	
Instruction in performance of the radioimmunoassay test for the diagnosis of
serum hepatitis (SH); instruction in conducting investigation of Mycoplasma pneumonia; instruction in conducting investigation of Epstein-Barr
virus (California State Laboratories) 	
1974 Canadian Speech and Hearing Association Annual General Meeting and
Annual Convention of Ontario Speech and Hearing Association, Toronto
(Can. Speech & Hearing Assn. and Ontario Speech & Hearing Assn.)	
Refresher Course in Radiology of Chest Diseases (U. of Toronto)	
Study Conference of Council for Childhood Education, Toronto (Council for
Childhood Ed.) 	
Defense Medical Association (Ottawa and Toronto) (Ministry of Health)	
Seminar on Waste Management Technical and Resource Recovery, San Francisco (U.S. Environmental Protection Agency) 	
Occupational Health Nursing Course, New York	
Family Life and Life Skills course .	
Cross-connection Control Seminar (BCW and WA) 	
First National Conference on Venereal Disease Prevention, Centre for Continuing Education, U. of Chicago (MASHA)
Birth Planning (Dept. of Health Care and Epidemiology, UBC) 	
UBC Residency Program for Assistant Directors (Fac. of Graduate Studies,
UBC) 	
Industrial First Aid (St. Johns Ambulance and Workers' Compensation)	
International Association of Water Pollution Research Conference  (French
Government) 	
 TABLES
I 55
Table VI—Reported Communicable Diseases in British Columbia, 1970-74
(Including Indians)
i Rate per 100,000 population.
2 Infectious and serum hepatitis combined.
3 Not reportable.
4 Late notification not shown in previous Report.
1970
1971
1972
1973
1974
Number
of
Cases
Ratel
Number
of
Cases
Ratel
Number
of
Cases
Ratel
Number
of
Cases
Ratel
Number
of
Cases
Ratel
Amoebiasis 	
Diarrhoea  of  the  newborn
(E. colt)  ...          .    . .
5
54
9
143
532
6
8
2
1,910
(2)
14
32
155
(3>
(3)
166
644
5
0.2
2.5
0.4
6.7
24.9
0.3
0.4
0.1
89.4
(2)
0.6
1.5
7.2
(3)
(3)
7.8
30.1
0.3
1
64
11
126
548
8
6
1,954
(2)
1
17
45
91
1,168
200
241
306
5
0.2
2.9
0.5
5.7
24.9
0.4
0.3
89.0
(2)
0.1
0.8
2.0
4.2
53.2
9.1
11.0
13.9
0.2
1
60
11
72
415
73
16
5
1,894
26
34
22
102
1
84
97
202
454
13
(4)7
0.1
2.7
0.5
3.2
18.5
3.2
0.7
0.2
84.3
1.2
1.5
1.0
4.5
0.1
3.7
4.3
9.0
20.2
0.6
0.3
29
51
34
320
36
25
1,755
25
1
47
20
102
1
77
158
212
836
1
1
3
1.3
2.2
1.5
13.9
1.6
1.1
75.8
1.1
0.1
2.0
0.9
4.4
0.1
3.3
6.8
9.2
36.1
0.1
0.1
0.1
2
52
69
91
302
7
2
1,381
11
43
12
66
342
573
203
789
6
0.1
2.2
2.9
Dysentery, type unspecified-
Food infection—
Salmonellosis	
3.8
12.6
0.3
Food intoxication—
Staphylococcal 	
0.1
Hepatitis—
Infectious-	
57.7
0.5
Leprosy	
Meningitis—
Bacterial 	
Viral
1.8
0 5
2.8
Q.fever	
Rubella	
14.3
23 9
8 5
Streptococcal   throat   infec-
32 9
Trichinosis	
Tularaemia	
Typhoid   and   paratyphoid
Western equine encephalitis.-
Totals	
3,685
172.4
4,792
218.2
3,587
159.7
3,734
161.3
3,951
165.0
Table VII—Reported Infectious Syphilis and Gonorrhoea, British Columbia,
1946, 1951, 1956, 1961, and 1966/74
Year
Infectious Syphilis
Gonorrhoea
Number
Ratel
Number
Ratel
194fi
834
36
11
64
71
72
68
45
76
73
98
101
149
83.0
3.1
0.8
3.9
3.8
3.7
3.4
2.2
3.6
3.4
4.4
4.4
6.2
4,618
3,336
3,425
3,670
5,415
4,706
4,179
4,780
6,070
7,116
7,921
8,955
9,300
460.4
1QS1
286.4
1956	
1961 	
244.9
225.3
1966            	
290.8
1967                   _
242.0
1968    	
1969    	
208.6
232.0
1970
285.2
1971	
325.7
1972
352 5
1973-	
1074.2 	
386.6
388.3
1 Rate per 100,000 population.       2 Preliminary.
 I 56 PUBLIC HEALTH SERVICES REPORT,  1974
Table VIII—Statistical Summary of Selected Activities oj Public Health Nurses,
September 1972 to August 1974, Inclusive1
1973/74 1972/73
Expectant parents—
Class attendance by mothers      23,645 20,516
Class attendance by fathers     11,789 12,038
Prenatal home visits        4,119 3,802
Postnatal home visits      22,582 21,110
Child health-
Infants—
Conference attendance      59,572 55,152
Nursing visits      41,437 37,135
Services by auxiliaries        1,503 377
Pre-school—
Conference attendance   101,004 95,716
Nursing visits      31,431 30,424
Services by auxiliaries      19,159 10,857
Home care services—
Nursing care visits (traditional)   148,141 104,422
Project visits      63,569 14,480
Psysiotherapist visits        4,343 2,791
Project visits        6,048 2,748
School service—
Directly by nurse   253,754 257,664
Directly by auxiliaries      81,392 82,524
Teacher/nurse conferences        6,761 4,296
Home visits      39,871 40,818
Group sessions with pupils       6,008 4,762
Meetings with staff       2,537 2,052
Conferences with staff      62,559 67,438
Adult health supervision visits      69,531 51,217
Mental health visits      22,035 20,060
Family services—
Total visits to homes  239,775 204,813
Professional service by telephone   274,812 230,565
Services by auxiliaries      12,408 4,770
Immunizations—
Smallpox      98,565 92,379
Poliomyelitis    178,273 150,451
Basic series of diphtheria, pertussis, and tetanus     24,896 21,061
Rubella       28,214 27,842
Measles (rubeola)      23,568 21,370
Other (mostly reinforcing doses)   196,473 171,362
Total doses   549,989        484,465
l Services provided by public health nurses under the jurisdiction of the Health Department in local health
services, but does not include service provided by Greater Vancouver, Victoria, Esquimalt, Oak Bay, and New
Westminster.
 TABLES
I 57
Table VIII—Statistical Summary oj Selected Activities of Public Health Nurses,
September 1972 to August 1974, /wcto/ve1—Continued
Tests—
Tuberculin 	
Other  	
Disease control—
Tuberculin visits
Venereal disease visits	
Communicable disease visits
1973/74
1972/73
17,734
15,110
16,444
5,445
9,236
6,309
10,553
9,863
3,643
7,860
i Services provided by public health nurses under the jurisdiction of the Health Department in local health
services, but does not include service provided by Greater Vancouver, Victoria, Esquimalt, Oak Bay, and New
Westminster.
Table IX—Statistical Summary oj Public Health Inspectors' Activities,
1971-74, jor 17 Provincial Health Units
1971
1972
1973
1974
(Estimate)
3,952
5,022
9,668
12,257
698
I1)
(1)
I1)
1,505
1,622
1,962
2,803
448
775
1,064
1,434
561
337
437
430
260
260
280
288
86
(2)
(2)
(2)
690
1,703
2,442
3,169
753
498
546
852
186
212
274
285
336
(2)
(2)
(2)
1,437
1,741
1,603
1,659
1,296
1,566
1,946
2,135
745
1,718
1,567
1,356
291
454
418
575
487
384
365
426
369
345
387
363
797
366
318
310
1,115
1,298
1,801
2,022
907
1,343
1,516
741
767
449
518
638
861
797
917
1,056
1,110
1,305
1,516
1,461
4,637
4,975
5,716
5,611
1,968
2,042
2,431
938
2,914
2,551
2,692
2,709
1,6031
303}-
1,003
1,543
638
520J
3,614
17,554
22,585
30,212
552
438
528
565
214
399
772
848
4,881
6,307
5,395
6,039
9,976
10,685
11,719
15,495
3,927
3,376
3,440
3,528
2,138
1,963
1,870
2,536
2,299
2,524
2,740
848
310
338
314
508
3,849
3,109
3,225
3,648
1,139
1,234
1,535
1,568
Food premises—
Eating and drinking places..
Food processing 	
Food stores	
Other  	
Factories 	
Industrial camps...
Hospitals	
Community care3..
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 andother)..
Waste disposal _. 	
Public water supplies—
Inspection.. _.
Samples	
Private water supplies—
Inspection	
Samples..
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..
i Included in "other food premises".
2 Included in "community care".
3 Includes boarding-homes, youth hostels, day-care centres, hospitals, and other institutions.
The estimates for 1974 do not include the services provided by student Public
Health Inspectors and a considerable number of students employed under the
Summer Employment Project.
 I 58
PUBLIC HEALTH SERVICES REPORT, 1974
Table X—Number and per Cent oj Children Receiving Basic Immunization
Prior to Entry to Kindergarten (September 1973)
Greater
Vancouverl
Capital
Region
Remainder of
Province^
Total
Total  children enrolled in Kin-
7,957
2,513
19,659
30,129
Type of Immunization
Number
PerCent
Number
PerCent
Number
PerCent
Number
PerCent
4,623
5,605
4,880
4,119
58.1
70.4
61.3
51.8
641
1,860
1,737
1,682
25.5
74.0
69.1
66.9
11,603
13,760
12,702
12,217
59.0
70.0
64.6
62.1
16,867
21,225
19,319
18,018
56.0
Diphtheria, pertussis, and tetanus—
Polio
Ruhflla
70.4
64.1
59.8
i Figures for Richmond not available (School District No. 38).
2 Figures for New Westminster and Coquitlam (School Districts Nos. 40 and 43) not available.
Table XI—Number and per Cent oj Pupils Immunized at End oj Grade V
(June 1974)
Greater
Vancouverl
Capital
Region
Remainder of
Provinces
Total
Total pupils in Grade V.	
10,449
4,231
30,788
45,468
Type of Immunization
Number
PerCent
Number
PerCent
Number
PerCent
Number
Per Cent
7,794
8,776
6,407
5,660
74.6
84.0
61.3
54.2
3,266
3,814
4,010
1,536
77.2
90.1
94.8
36.3
23,360
26,386
25,401
9,721
75.9
85.7
82.5
31.6
34,420
38,976
35,818
16,917
75.7
Diphtheria, pertussis, and tetanus...
Polio
85.7
78.8
37.2
1 Figures for Richmond not available (School District No. 38).
2 Figures for New Westminster and Coquitlam (School Districts Nos. 40 and 43) not available.
Table XII—Number and per Cent oj Girls Immunized jor Rubella at End oj
Grade V (June 1974)
Greater
Vancouverl
Capital
Region
Remainder of
Provinces
Total
Total girls enrolled in Grade V	
4,845
4,348
89.7
1,817
1,642
90.4
14,698
12,201
83.0
21,360
18,191
85.2
i Figures for Richmond not available (School District No. 38).
2 Figures for New Westminster and Coquitlam (School Districts Nos. 40 and 43) not available.
 TABLES
I 59
Table XIII—Pupils Referred for Health Services
Capital Regioni
Area Served by
Health Branch2
Reason for Referral
Referred to
Public Health
Nurse
Referred by
Public Health
Nurse for
Further Care
Referred to
Public Health
Nurse
Referred by
Public Health
Nurse for
Further Care
Vision    ...
2,099
1,031
243
688
1,045
2,491
1,291
487
143
242
483
1,084
21,147
9,168
1,486
5,443
5,062
13,900
12,862
Hearing   	
2,579
Speech  	
780
Emotional  .    	
2,443
Skin conditions  	
1,894
Other 	
4,487
Totals	
7,597                  3,730                56,206                25,039
Per cent of enrolment	
16.0        I             7.9                    15.3
6.8
1 Total enrolment, 47,492.        2 Total enrolment, 367,899.
Table XIV—Registrations Accepted Under Various Acts and Materials Issued
Registrations accepted under Vital Statistics Act—
Birth registrations	
Death registrations	
Marriage registrations-
Stillbirth registrations-
Adoption orders	
Divorce orders	
Delayed registrations of birth-
Registrations of wills notices accepted under Wills Act-
Total registrations accepted	
Legitimations of birth effected under Vital Statistics Act.^
Alterations of given name effected under Vital Statistics
Act	
Changes of name under Change oj Name Act	
Materials issued by the Central Office—
Birth certificates	
Death certificates	
Marriage certificates	
Baptismal certificates	
Change of name certificates-
Divorce certificates	
Photographic copies	
Wills notice certification	
Total items issued-
Nonrevenue searches for Government departments by the
Central Office	
Total revenue	
1973
1974
(Preliminary)
34,211
35,420
17,717
19,780
21,251
21,640
365
320
1,839
1,750
5,412
6,320
446
390
27,233
34,570
108,474
120,190
227
250
251
280
1,555
1,640
75,043
78,190
8,465
9,080
8,592
8,220
22
3
1,697
1,880
303
260
9,124
10,140
11,621
12,610
114,867
120,383
12,244
11,940
$463,556
$488,600
 I 60 PUBLIC HEALTH SERVICES REPORT, 1974
Table XV—Case Load oj the Division jor Aid to Handicapped,
January 1 to December 31,1974
Cases currently under assessment or receiving services, January 1, 1974  1,306
New cases referred to Aid to Handicapped Committees outside
Vancouver Metropolitan Region  781
New cases referred to Aid to Handicapped Committees in
Vancouver Metropolitan Region—
Vancouver   317
Vancouver General Hospital     30
Richmond      14
New Westminster     24
Total  385
New cases referred from other sources     54
Cases reopened (all regions)   273
Total new referrals considered for services, January 1, 1974,
to December 31, 1974  1,493
Total cases provided with service in 1974  2,799
Analysis oj Closed Cases
Rehabilitated—
Employment placement made—
Canada Manpower     83
Division for Aid to Handicapped     22
Other   376
Total .  481
Job placements not feasible—restorative services completed  50
Not rehabilitated—
Severity of disability  121
No disability      4
Unable to locate clients     62
No vocational handicap     17
Other   131
Total .  335
Other-
Transferred   117
Deceased      12
Total      995
Cases assessed and found not capable of benefiting from services      688
Total cases closed in 1974  1,683
Cases remaining in assessment or receiving services  1,116
Grand total  2,799
 TABLES
I 61
Table XVI—Statistical Report oj Tests Perjormed in 1973 and 1974, Main
Laboratory, Nelson Branch Laboratory, and Victoria Branch Laboratory
Item
1973
1974
Main
Nelson
Victoria
Main
Nelson
Victoria
Bacteriology Service
Enteric Section—
Cultures—
Salmnnella/Shigelln
14,331
3,855
194
6,283
11,514
3,125
14,755
97,347
194
31,691
21,812
1,167
374
532
13,692
1,326
28,947
2,863
6,893
40
2,668
12
174,583
7,532
8,389
5,223
272
5,108
1,538
22
5,085
8
30
14,431
3,159
219
6,942
4,309
17,440
3,437
15,709
105,353
480
29,992
22,157
1,099
295
568
15,749
1,125
28,694
2,385
7,251
376
2,819
4
181,292
9,285
8,958
5,315
1,973
248
2,091
140
210
126
35,831
2,091
4,406
2,124
340
139
426
253
4,746
1,102
8
Miscellaneous Section—
Cultures—
C diphtheria!             	
74
617
305
7,666
Hemolytic Staph/Strep.    .
54
1,956
6,763
1,392
17
2,209
1,803
7,145
2,396
955
20
Tuberculosis Section—
Cultures—M. tuberculosis  	
Smears—M. tuberculosis     	
6
6
2,219
2,185
—
3
2,414
4,192
168
471
46
15,890
	
2
Parasites—
Fseces 	
2,706
51
3,392
370
42
3,382
496
Water Microbiology Section—
Presumptive/Confirmed coliform test	
3,820
Completed coliform test	
96
609
	
18
Other tests (algEe, shellfish)	
Serology Section—
Syphilis—
Screening 	
5,498
2,126
17,349
ASTO	
824
707
908
Widal, Brucella, Paul-Bunnell	
335
189
693
Virology Service
Virus isolation—
1,930
208
287
341
24,660
1,498
2,623
4,475
Rubella  	
	
Serological identification—
Hasmagglutination inhibition—
Rubella.-	
	
	
	
Totals	
495,364
12,876
48,690
538,083
9,795
52,251
556,930
600,129
 I 62 PUBLIC HEALTH SERVICES REPORT, 1974
Table XVII—Licensing oj Practical Nurses
(Disposition of applications received since inception of programme in
1965 to December 31, 1974)
Received  11,070
Approved—
On the basis of formal training  6,635
On the basis of experience only—
Full licence  396
Partial licence  875
  1,271
  7,906
Rejected  1,589
Deferred pending further training, etc  1,158
Deferred pending receipt of further information from applicants      214
Awaiting assessment at December 31, 1974      203
  11,070
Number of licences issued to December 31, 1974     7,192
Number of practical nurses holding currently valid licences at December 31,
1974       5,73 8
i Report subject to updating.
Printed by K. M. MacDonald, Printer to the Queen's Most Excellent Majesty
in right of the Province of British Columbia.
1975
880-1274-2284

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