History of Nursing in Pacific Canada

Through the years with public health nursing : a history of public health nursing in the provincial government… Green, Monica M. 1984

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\ ol Public Health Nursing
ncialipovernment. Jurisdiction
Br itisH Columbia
Monica M. Green
A History of Public Health Nursing
in the Provincial Government Jurisdiction
British Columbia
Monica M. Green
Published by
The Canadian Public Health Association
Monograph Series, "Public Health in Canada"
Scientific Editor: John M. Last MD
 Price $8.50
First Edition 1984
Copyright 1983 Canadian Public Health Association
1355 Carling Avenue, Suite 210, Ottawa, Ontario, Canada  K1Z 8N8
All rights reserved including the right to
reproduce in whole or in part in any form.
Printed in Canada by:
M.O.M. Printing, 300 Parkdale, Ottawa, Ontario  K.1Y 1G2
ISBN 0-919245-23-4
Public health nurses, in British Columbia have demonstrated leadership in
developing preventive health services, and in promoting health on a local or
community level.
This history has been written as a tribute to the many public health nurses who
through the years built a solid foundation for the present day community health
nursing service. The story of the step by step development of the public health
nursing service will assist younger nurses to understand how the service evolved
as the Province grew and society changed. The contribution of many public
health nurses and colleagues made this History possible.
I am grateful for the support of the British Columbia Ministry of Health, and
the Director of Public Health Nursing, Miss Lavinia Crane, who encouraged me
to continue after a slow start; to Miss Alice Beattie, who spent a great deal of
time reviewing the material and verifying events; to Dr. J. A. Taylor, who was
particularly helpful concerning the early days; to Mrs. Joyce Brake, Camosun
College Instructor, who arranged the first typing by her student, Mrs. Yung
Quach; to Dr. David A. Clarke, President of C.P.H.A., who supported the
project, and the C.P.H. A. Executive Director, Mr. Gerald Dafoe for publishing
the book and Dr. John Last for editing.
Very much appreciated is the financial assistance received from the British
Columbia Heritage Trust.
(1) The British Columbia Heritage Trust
 Table of Contents
First Permanent Provincial Medical Health Officer (1899) 5
The Early 1900s and Some of the Health Problems 5
School Nurses Are Needed 5
The School Medical Inspection Act of 1911 6
First Provincial School Nurse — 1913 6
School Nurses Appointed in Larger Cities 7
Better Follow-up of School Medical Inspections Needed 7
The Public Conscience Awakens After The War 8
The New System of Public Health Nursing 8
The First Course for Public Health Nurses Commences at
The University of British Columbia 9
The Public Health Nursing Service Commences 12
Public Health Nursing a Success 14
New Incentives to Stimulate the Organization of Public
Health Nursing Districts 14
Health Centres and Nursing Districts Commence 15
How the Public Health Nurse Operated (Office, Clinics, etc.) 16
The Early Record System 18
Public Health Nursing in the Twenties 20
The Public Health Nurses' Bulletin and Selected Reports 23
Public Health Nursing Uniforms and Insignia 28
The Public Health Nursing Service Grows in the Twenties 28
The Public Health Nursing University Course
Becomes a Requirement 30
The First Move Towards Full Time Medical Health Officers
and the First Health Unit 30
The Twenties Introduce the Health Unit Concept 31
Tuberculosis Nursing Supervisor for Public Health Nurses 32
Public Health Nursing in the Depression 36
Gradual Expansion in the Thirties 41
Getting Around in the Thirties 43
The Generalized Service Established as Best 45
New Health Units in the Thirties 46
More Health Protection Needed 47
The First "Refresher Course" 47
Dr. H. Esson Young Directs the Public Health Nursing Service     48
The Need for a Public Health Nursing Director 48
 Public Health Nursing Variations in the Thirties 49
Population Growth in the Forties 52
The First Public Health Nursing Director 53
The Division of Public Health Nursing Gets Under Way 54
Public Health Nursing News and Views 56
Travel in the Forties 56
Study Groups for Public Health Nurses 59
The Public Health Nursing Council 61
Public Health Nurses as Venereal Disease Epidemiology
Workers 63
Changes in the Public Health Nursing Division 63
The Second Director of Public Health Nursing 64
Public Health Nurses do Immunizations 66
World War II is Over 67
The Department of Health and Welfare Formed — 1946 68
The Reorganization of the Public Health Nursing Service 68
The Public Health Institute 70
The Public Health Nurses' Uniform Insignia 76
The Public Health Nurses' Uniforms of the Forties 76
The First Organized Home Care Program — 1947 77
The Third Director of Public Health Nursing 78
The Great Flood of 1948 79
What the Generalized Public Health Nurse Did in the Forties        80
Public Health Nursing Service on Selected Indian Reserves 81
Tuberculosis Field Nursing 82
First Time Study and Case Load Analysis — 1948 82
Federal Health Grants Assist the Development of the
Public Health Nursing Service 83
Some Factors Creating Nursing Changes in the Late Forties 83
The Need for More Local Public Health Nursing Supervision        84
The Plan for Local Supervision and First Appointments 84
The Criteria for Supervisory Positions 87
Professional Training Plan for Supervisory Nurses 87
Continuing Shortage of Public Health Nurses Spawns
the Internship Training Plan 89
The Hamilton Report — 1949 90
How Programs Changed 94
The Baillie — Creelman Report — 1950 98
Poliomyelitis Becomes the Major Communicable Disease
Concern 99
 The Atomic Age Brings Civil Defence Nursing
Awards for Distinguished Service — (Diphtheria Epidemic)
Organized Home Care Programs Extend
New Community Health Centres
Negotiations and Bargaining
Public Health Nursing Consultants' Program
Improvements in Working Conditions
The Number of Public Health Nurses Increases
Some Administrative Changes
Home Nursing Expands at Ten Cents Per Capita
First Procedure Manual and Physiotherapists for Home Care
Public Health Nursing Liaison with Hospitals and Doctors
Involvement with Mental Health Increases
More Public Health Nursing Help for the Elderly
More Indian Reserves Served by Provincial
Public Health Nurses
Preventive Programs Expand
Research Studies in Public Health Nursing
Health Unit Aide Service Expands
Institute and Other Staff Education Changes
Federal-Provincial Public Health Nursing Consultation
The Sixties End
Hospital Days Replacement Program Initiated
Home Care Programs Increase and Co-ordinators Appointed
Public Health Nursing Liaison Increases
More Experimental Programs
Health Promotion Adds New Dimensions
Renewed Emphasis on Preschool Assessment
Public Health Nursing Community Care Co-ordinators
Public Health Nursing Uniforms Become History
Staff Education Programs Adjusts to Increased Numbers
of Public Health Nurses
Changes in the Educational Preparation of Public Health
Public Health Nurses Attain Bargaining Rights
Changes in the Division of Public Health Nursing to the
  v:/■••.'; :.:x:;,-M$/<.rf<
 Pioneer Days
Public health nursing in British Columbia had its roots in the pioneer days. It
developed slowly, adapting to changes, as the most westerly province in Canada
emerged into present day society. Nurses of an earlier era shared the rugged
country and problems of the early settlers, and overcame many difficulties to
evolve into the efficient present day public health nursing service. The history of
public health nursing is closely tied to the development of the province, and is
woven into the fabric of the provincial health department and the evolution of
local health services.
When British Columbia became a province in 1871. it had a very small
population, consisting of only 34,247 persons, with Victoria and New Westminster the only towns. The bulk of the population was not included in the census as it
was on the move following the discovery of gold in places such as Yale, Lillooet
and Barkerville. There was no organized health service, although a Provincial
Board of Health existed and could be called into action to deal with emergencies
such as epidemics of cholera, typhoid fever and smallpox.
The vast geographical area of British Columbia with its unique topography
presented many challenges to the development of a public health nursing service
for all the people of the province. The small population was centred on Vancouver Island and the lower mainland with the remainder scattered over the
large area of the province. Access to many areas was difficult because of the
rugged coastline in the west, and the mountain ranges of the interior, which were
gradually settled as boats, roads, railways and airlines improved transportation
and communication. Nine distinct geographical areas emerged as the result of
settlements along the rivers, valleys and plains. They were Vancouver Island,
Greater Vancouver, Fraser Valley, Okanagan, Cariboo, Skeena, Peace River,
Kootenays and Coast Garibaldi. The population centres of these areas remained
near the main highways, leaving vast areas of rocky, mountainous, and wilderness country with little or no populaton. Over fifty percent of the total population continued to be located in Greater Vancouver and the Fraser Valley. As a
result, for many decades Vancouver was the main health resource and education
centre for the entire province. Forestry, fishing and mining have played a large
part in the economic development of the province and have tended to create a
very mobile and transient population where many men work apart from their
families over long periods of time. Although some stable farming communities
exist they have not had a dominating effect on the way of life in the province.
Many small towns and cities have transient populations which fluctuate in size
with the rise and fall of the changing economy. These factors tend to create
individual and family health problems.
  first Permanent Provincial Medical Health Officer — 1899
The population grew slowly and by 1899. as it ncared 100.000. the first
permanent health officer was appointed when Dr. C.J. Pagan, a medical practitioner, was appointed Secretary of the Provincial Board of Health. The organization was the forerunner of the present Provincial Ministry of Health, and Dr.
FagaiJ assumed practical control of all matters relating to health. The Provincial
Board of Health had been formed originally to cope with emergencies such as
outbreaks of smallpox or typhoid and to deal with matters such as cemeteries,
removal of nuisances etc. Dr. Fagan was concerned, however, with the total
health of the people and their environment.
The Early 1900s and Some of the Health Problems
By 1911, the population had increased to 393,000 and about this time there
was a sudden influx of people to the province which was reputed to be the great
land of opportunity. Land development companies started to bring in settlers
from Britain, the prairies and the United States to establish farms and ranches in
the ()kanagan and on Vancouvci Island. Small communities sprang up near the
mines, sawmills, logging operations and fish canneries in the interior and northern coastal areas. Vancouver had become the terminus of the Canadian Pacific
Railway with 100,000 population. Reports indicated the following population
figures in interior centres: Trail, 2000; Rossland, 5000 miners. 1000 men and
families. 2000 transients and 100 Chinese; Quesnel, 100 whites, 100 Chinese;
Ashcroft, 300 whites. 50 Chinese. Communities existed at Barkerville, Golden.
Fort Steele, Nelson, Kaslo, Revelstoke. Nakusp, Alberni, Duncan and Chemainus. At this time too, 8000 Japanese, 2000 Sikhs from India, and 1500 Chinese
entered the province from Asia. The diverse population with its varied cultural
sackground was scattered throughout the province and presented a fertile field
or health problems. A concerted effort was needed todosomethingabout them.
Dr. Pagan investigated health problems and published his findings and
ccommendations in the Annual Reports of the Provincial Board of Health. In
913, tuberculosis was the leading cause of death and accounted for 10% of all
leaths. In addition other contagious diseases accounted for a further 7% of all
leaths. Children were particularly susceptible to contagious diseases and in
914. Dr. Fagan reported a 25% death rate from all causes for children under
wo years of age. He was particular!) concei ned about tuberculosis control and
he need foi better infant and child cat eand he was detei mined to do something
bout these problems.
chool Nurses Are Needed
As early as 1908, Dr. Fagan recommended that the "health of school children
tould be constantly and systematically supervised by specially trained nurses,
ho could not only attend to many health matters, but also impart reasonable
 and practical knowledge of health matters, and refer those requiring care to their
physicians." He also stated "there is a need for school nurses to visit schools
daily, take note of sore throats, prepare cultures for examination in the laboratory for diphtheria bacilli, and visit the homes of children absent without known
cause to help reduce the incidence of diseases such as diphtheria and scarlet
fever." It was some time before his recommendations would be put into effect!
The School Medical Inspection Act of 1911
It was during Dr. Fagan's time that important legislation was passed which
was to have a far-reaching effect on public health nursing. This was "An Act to
Provide for the Medical Inspection of Schools" of 1911. This act was guided
through the Legislature by Dr. H. Esson Young, Minister in the McBride
government, who was responsible for the Provincial Board of Health and the
Department of Education. Dr. Young was to assume the position of Secretary of
the Provincial Board of Health in 1915 following Dr. Fagan's retirement in 1914.
The Act provided for the medical examination of every school child in the
province once a year. A complete record of the physical condition of each child
was to be entered on a card which would remain in the school, and transfer when
the child changed schools. The card was to be filled in by the medical examiner,
and show the results of each year's examination during the child's school life.
The Act provided for a report to be sent to parents pointing out the existence of
defects, and advising that the family physician or dentist be consulted as indicated. Local physicians were appointed to do the medical inspections at the
schools. The Act also provided that the municipalities and cities would pay for
the service in their areas and that the Provincial Board of Health would pay for
the service in the large unorganized areas of the province.
First Provincial School Nurse — 1913
The School Medical Inspection Act was a good beginning, but it was apparent
that medical inspections alone were not the answer to the poor health and
contagious diseases found among school children. Also, as medical inspections
proceeded, it was apparent that some assistance was needed to help with organization, planning and the follow up of the results. Accordingly, Miss Blanche
Swan (Lewis) was appointed in 1913 as the first provincial school nurse, whose
job was to assist with the school health program. She was assigned to field work
in the unorganized territory. She was to see that the School Inspection Reports
by the school medical inspectors were properly filled in, and to impress teachers
with the importance of the new medical program. Miss Swan helped with the
administration of the program from her headquarters in Victoria. She visited
rural districts, helped with the medical inspections in numerous schools, and
wrote annual reports, as well as consolidating the data received from various
In her annual report in 1915, Miss Swan recommended that school nurses be
 employed in local districts, where they would be able to follow up the results of
the medical inspections She also stressed the need for improved school sanitation She was sent to investigate chemical closets that were in use on Vancouver
Island, and found them to be a failure in rural schools In fact she was able to
show that they were a source of contagious disease 1 he chemical toilets were
discarded as the result ol net investigation. It is interesting to note that about this
time school boards were asked to oil the school floors to reduce dust, as studies
had shown that this practice would reduce the bacterial count in the air Oiling of
floors was continued into the forties in most rural schools
In 1916. a second provincial school nurse. Miss \. Locke was added. I hese
centrally located nurses were eventually replaced by local nurses as the need for
more nursing service lor the school age child was realized.
School Nurses Appointed in larger ( ities
Immediately after the School Medical Inspection Act was passed, a lew school
muses weic appointed by school boards, either full or part-time in the larger
cities Miss I lizabeth Breeze, in 1910 became the first school nurse in Van-
COUver, and was charged with supervising the health of 9800 school children in
16 schools. Her first report stated that her duties included inspection of children
loi cleanliness, skin conditions such as impetigo, scabies and the ever-present
pedk uIosis  Bj 1915 there were five registered nurses employed as school nurses
Miss E. Breeze, Miss A. McLellan, Miss A. Jeffers, Miss E. Ewart and Miss
II   Bone.
Victoria School Board employed Miss M. Gimmer. while Miss Alice Stark
wasemploved in New Westminster kclownaand Kamloops employed Miss H.
I he employment of registered nurses as school nurses continued into the
1920's when a new system ol registered nurses trained additionally in public
health was introduced. I he work of the school nurses was directed towards
improving the health of school children mainly through the reduction of contagious diseases and skin infections; inspection of children for defects such as
dental decay, abscessed tonsils, skin conditions etc. Weighing and measuring
and health teaching were part of the nurse's program. She also helped enforce
quaiantine regulations and visited parents at home to discuss the children's
health problems. Hei work varied according to the wishes of the school board.
the school medical inspector and her own priorities
Better Follow-up of School Medical Inspections Needed
When Dr. Young was appointed Secretary ol the Provincial Board of Health
in 1915, live years had elapsed since the School Medical Inspection program had
been started, and he was anxious to know how successful it had been. According!) he sent questionnaires to the teachers in unorganized areas to obtain their
opinions regarding the results of the program. I he teachers were unanimous in
 their opinion that great benefits had resulted for some children, particularly
among parents who appreciated that certain defects, if not corrected, harmed the
child both physically and mentally. These parents took steps to have problems
corrected. However, they said that many parents were indifferent or antagonistic. Dr. Young concluded that the weakness in the procedure was the absence of
follow up explanations to parents concerning the need for proper medical or
dental attention. He stated that there was a great need to improve the follow up
system. He believed that corrections would be made if parents understood the
reasons for the recommendations, and that a nurse should be available to visit
the parents at home and explain why care was needed.
A few municipalities and school boards were employing school nurses, as
noted previously, and Dr. Young concluded from the questionnaires and from
the reports of the nurses that the school nursing system should be expanded. He
also believed that such a system would be the first step towards a more comprehensive community public health nursing system.
The Public Conscience Awakens After The War
Another important factor favoring the introduction of public health nurses,
which Dr. Young later pointed out in an address to the Canadian Public Health
Association in 1928 was the "awakening of the public conscience." He stated that
prior to World War I (1914-18) "the voices of public health authorities were
crying in the wilderness. The public was not concerned. Epidemics were considered visitations from providence." Health authorities had been largely concerned with sanitation. The public was appalled to learn that one third of the
Canadian army recruits had been rejected as unfit. The health of the young
which should have been at its peak was found wanting. The war had shown that
general health measures had prevented outbreaks of disease, as well as demonstrating the benefits of good health and medical care. The public was now in a
mood to accept advice in health matters, and at the same time health authorities
had broadened their scope to include general health protection, advice, and
preventive health measures.
The New System of Public Health Nursing
Dr. Young believed that with the awakening of the public conscience after the
war, it was now time to find a system of improving general health, and he
proposed to start with children. By improving the follow up of the medical
inspection program to include family health teaching, he hoped to improve the
health level of the general population. This meant the employment of someone
educated in public health work and understanding preventive measures. Dr.
Young concluded that the logical person to do this was a nurse trained in public
health. Such nurses were rare, and in British Columbia, non existent, as nurses at
that time were trained for curative work which did not include prevention. Dr.
Young developed a broad plan which would encourage the application of known
 health information and improve the general health of the people of British
Columbia I hi* plan wa*to be the foundation ol the present day public health
|)r \ oung'l plan involved two main objectives I he first was to establish an
educational program which would equip nurses for public health district work,
and the sctond was to set up health centres throughout the province from which
thes would work
I he nurses would be known as public health nurses, and they would be
"gcncralt/cd" or what Dr Young termed a "single nurse" I hat is. the public
health nurses Would not be limited to one specific area of health, such as working
with school children or with tuberculosis patients, hut would be equipped to deal
with the general health problems ol all members ol the family and the
I he health centres were to be set up in local districts, and a health committee
or hoard representing various groups in the community would be established to
assist the public health nurse and to administer the service,
The lirst Course for Public Health Nurses ( ommences at
I he I niversily of British ( olumhia
Di Young set about establishing a public health nursing training course at the
I 'Diversity of British Columbia which he had helped found in 1908. He was an
influential figure on the campus as he had been instrumental in getting the
University established when he was the Minister of Education I hen loo, with
the war over, the Red Cross was looking lor worthwhile projects to sponsor. Dr
Young was able to interest them in funding the first course lor a period ol three
years. I he Red ( ross, at that lime, decided to sei up eight nursing stations in
remote pails ol the province which would employ graduates of the course
Bv 1919. the Department ol Nursing and Public Health was established on the
Old I auview Campus ol the University, ol British Columbia, and Dr. Young's
idea was under wav as the first public health nursing course lor registered nurses
commenced It was the lust in Canada and the British Empire! I he diploma
Course was fourteen weeks when it started and later was extended to a lull
academic yeai I ectures were on the campus, practice was arranged in selected
aieas and field tups to appropriate places were arranged as part ol the learning
experience. 1 he nurses were prepared to work in a community setting and deal
with current health problems I he first class graduated in I920and helped form
the nucleus ol the newly established public health nursing service.
V the demand lor public health nurses increased, the Bachelor ol Applied
Science in Nursing program was added and in 1923 the first three nurses
graduated I his program provided students with the opportunity to qualify as
tcgistcrcd nurses and to obtain a Bachelor ol \pplied Science degree I he first
two veais ol this program were given at the university followed by twenty eight
months ol hospnal training alter which ihc nurse completed registration as a
 nurse in British Columbia. The Vancouver General Hospital entered into an
agreement with the university to provide the practical experience. The nurses
were fully recognized graduates of the Vancouver General Hospital. A final year
of study at the university completed the six year program which then qualified
the nurse for a B.A.Sc degree. Another option was made possible later which
granted a B. A. degree to nurses who completed three years of academic program
upon graduation from the hospital. The total program was comprehensive,
fitting the student to meet organizations, and carry out health programs as they
related to health education and teaching.
 The Prosperous Twenties
The twenties brought a period of unprecedented prosperity in British Columbia. Industrial growth had come to the province and with it improved financial
times. In the aftermath of World War I, the interior mines were prosperous and
pulp and paper was being produced in the mill towns of Powell River and Ocean
Falls. Expanding markets had stimulated the lumber industry. The Canadian
merchant marine was shipping all over the world. Great quantities of wheat were
being shipped through the harbor of Vancouver. Employment was at a high level
and everyone was making money.
The old Cariboo road was rebuilt and became the first important road link
between the mainland and the Okanagan.
The influence of the mountains which created large valleys was apparent as
the people of these valleys developed rather special regional characteristics
rather than a provincial uniformity. The type of life and the background of the
early settlers influenced their life style. One found quiet, well-read ranchers in
the Okanagan, miners in Kamloops, vigorous outdoor people on the Cariboo
ranches, fishermen in the Skeena and farmers in the Omineca, who lived different life styles but showed a common interest in improving their situations.
Vancouver had become the great metropolitan city of the province containing
about one third of the total population. It was an aggressive materialistic city
which could not entirely dominate the rest of the province which demonstrated
more varied interests and outlook. Because of these differences, one can understand how health services developed in each part of the province.
The decade of the twenties was a good time for people to consider new ideas
and to learn how to improve health. It was therefore possible for Dr. Young, the
Secretary of the Provincial Board of Health to make a good start on his plan for
developing health centres and public health nursing districts, and eventually to
establish some public health units.
The Public Health Nursing Service Commences
As the population of the province neared half a million, the first health centre
was established in 1919, in Saanich, which is a rural municipality adjoining
Victoria city. It was known as the Saanich War Memorial Centre, and financed
through local taxes and grants from the Provincial Board of Health. Miss Jessie
Foreshaw was appointed as the first public health nurse.
The same year, Miss Barker was employed as a district nurse in Cowichan,
while plans for the establishment of the Cowichan Health Centre were being
worked out. In 1920 the Cowichan Health Centre was established at Duncan and
Miss B.E. Hall, a qualified public health nurse was appointed.
In 1920, the Rural Esquimalt Nursing District with headquarters in Langford
was formed with Miss Helen Kelly the first public health nurse.
By 1921, the University of British Columbia had graduated 56 public health
  nurses from its program and 15 had been placed in rural settings. Three had been
recruited in Saanich but records do not indicate where the remainder were
employed. Seven were appointed to either Red Cross demonstration districts
such as Kamloops or to stations which were providing district nursing service in
isolated districts such as East Arrow Park, Creston, Vanderhoof, Fort Fraser
and Waldo. Some were employed in Vancouver as school nurses and with
agencies such as the Victorian Order of Nurses etc. By 1920 the provincial public
health nursing service had become a reality.
Public Health Nursing a Success
The public health nursing service made a good beginning. The public health
nurses had been given a sound basic education, and were generally enthusiastic
young women who responded well to the people in their districts and also fitted
into the professional and social life in their communities. They were well
accepted and held in high regard because of their personal and professional
abilities. They were able to introduce new ideas concerning public health, and to
point out ways of improving the health of the people in their districts. The public
health nurses set the stage for the expansion of public health services which
would eventually lead to broader and more diversified health services to be
provided later through health units with full time medical health officers.
New Incentives to Stimulate the Organization of
Public Health Nursing Districts
In 1921, another step forward in the financing of public health nursing
districts came when the Department of Education agreed to provide to a local
district the same grant for a public health nurse as for a teacher. This new grant
plus the grant from the Provincial Board of Health provided most of the funds
needed to employ a public health nurse who could be employed either as a school
nurse or a district nurse. As a district nurse she would have a generalized
program and look after about half as many school children as the school nurse.
To help small rural schools obtain a public health nursing service, a number of
schools were permitted to "group together" to form a nursing district which
would be large enough for one public health nurse to serve. At that time each
school district in a rural area had its own school board, while in a large city area,
all the schools were administered by a larger school board. A school board in
unorganized territory was the only agency that could levy a tax over the exact
area of the school district, so it was a logical organization to represent the people
of the district.
The "grouping" of small school districts to form larger districts suitable for a
public health nursing service was the beginning of plans for sharing the costs of
health service for the common good. It provided another incentive to encourage
the development of new public health nursing districts. For example, in 1928, the
Kelowna Rural Schools Health Association was formed to employ a public
 lealth nurse in a district with twelve small school boards.
Before a district could be established it was necessary for an organization to be
let up locally so that funds could be obtained to establish a budget to cover the
:ost of the service. Usually the initiative was taken by an organization such as the
Women's Institute, a school board or the Red Cross. A local health association,
:ommittee, or board was then formed to be responsible for administering the
ervice. It represented the special interests of the local people. Fixed provincial
;rants were available from the Provincial Board of Health and the Department
if Education. The British Columbia Tuberculosis Society usually gave yearly
;rants decreasing in amount over four years. Local funds which made up the
lalance of the budget were received from local school taxes and grants from
irganizations and clubs. The public health nurse was employed by the board,
nd had been recommended and approved by the Provincial Board of Health,
^he board looked after local expenses which consisted of her salary and trans-
ortation costs as well as office and other costs. The public health nurse
ubmitted a monthly report when she appeared at the regular meeting of the
oard. The board gave her the needed support to conduct her various activities
l the district.
lealth Centres and Nursing Districts Commence
The health centre and nursing district concept was to provide a generalized
ublic health nursing service for all the people in a designated geographical area,
lealth centres were to be established in large population districts, while nursing
istricts were to be set up in more rural communities. The basic generalized
ublic health nursing service was to be similar throughout the province,
[though the manner of providing the service would vary with local conditions,
he service provided was to be administered by a local health board, association
r committee, while technical and professional advice was to be provided by the
rovincial Board of Health. The boards would be made up of individuals
presenting organizations which had helped sponsor the service, and with
horn the public health nurse would work, such as the Women's Institute, Red
ross, I.O.D.E. (Imperial Order of the Daughters of the Empire) etc. When
nancial support came from the school board, it was also represented. When the
nancial support came entirely from the school board then the school board was
le advisory health committee.
The first two health centres were established on Vancouver Island in Saanich
id in Cowichan. Both provided buildings with good living quarters, office and
inic space. Saanich had six hospital beds for about four years for special tonsil
inics, special treatments etc. The public health nurses lived in the health centres
id paid for their room and board. This money helped employ a housekeeper
ho also provided a telephone answering service for the nurses when they were
rsy working in their districts. The public health nurses were on call twenty-four
)urs as the service included home deliveries and home nursing.
 As the health centres became known, the nurses were asked to help in all kinds
of emergencies. They often found themselves acting as a crisis centre. Also
people would bring them old clothes and garden produce for distribution to the
poor which they did in their free time. The arrangement to have the public health
nurses live in the health centres was very satisfactory at that time, as private
accommodation was hard to find, also all public health nurses were single and
there was no need to provide accommodation for husbands or children. It was
the custom for a nurse to resign on marriage.
As nursing districts were located in smaller population areas, the public health
nurse did not as a rule work out of a "Health Centre." She used the best possible
place available to her for her work and in many instances used her own home
which was frequently a small cottage. Her home then became her headquarters
where she stored her confidential records and had her telephone. When the
public health nurse was a "boarder" messages were relayed to her by the landlady
who usually was most helpful. She often was able to fill in the background on
callers! In some communities such as Langford, a single nurse district, the public
health nurse worked from her home which was called a health centre.
The Esquimalt Rural Nursing district boasted in its 1922 annual report that it
had the most economically run health centre on Vancouver Island or perhaps in
all British Columbia. They pointed out that "all other health centres had
headquarters to keep up, either a building, or equipment, or necessary offices
rooms and equipment. 'Nightingale' the name of the home of the nurse in charge
at Colwood is used as the professional headquarters of the service, where minor
accidents are attended to, dressings etc., when not done at the home of the
patient, and here also the telephone calls for the nurse are taken and booked. A
comparison of overhead expense with other health centres will show the advantage with regard to expense." Needless to say, the public health nurse was the
major subsidizer of the centre.
School nurses employed by school boards usually had quite satisfactory
medical rooms set aside for them in the schools. Also a limited amount of clerical
work and message taking was provided through the office of the school
How the Public Health Nurse Operated (Office, Clinics, etc.)
The operating expenses of the public health nursing service consisted mainly
of salary and travelling costs. Free office space was usually supplied in one of the
schools. For work in the school, the public health nurse used a medical room or a
class room, or the teacher's lunch room. A corridor might be used for vision
testing. Classrooms were frequently used for community health clinics, when
parents would come to the local school with their small children and infants. At
times, community or church halls were made available for clinics usually at no
charge. However the public health nurse might have to get a wood stove fire
going to warm the building. Privacy was rare, although screens were used. Most
 often the public health nurses laundered the linen at home.
Special pieces of equipment such as baby scales were donated by an organization such as the I.O.D.E., or borrowed from the local drug store. For many years
to come public health nurses had inconvenient, poorly heated office quarters,
located in the cheapest available space. They usually "made do" so that a service
could be established.
Travel through the district presented problems. For example when the first
public health nurse was appointed to Cowichan, she used the daily train service
which was unsatisfactory. Then the Health Committee,bought her a bicycle,
which improved the situation. Finally the Red Cross bought a second hand car
for her use. The above situation continued into the thirties as Miss Dorothy
Priestly reported in 1973 when the new modern health centre was opened in
Prince Rupert:
"I was the first public health nurse in Prince Rupert, called a school
nurse by everyone but myself. I arrived on Sept. 1st, 1937 and was taken to
the City Hall where I was greeted with a small pair of foot scales, and one of
the old black record books, quite empty. They were happy that I had all the
equipment I needed to start with these two things. An office to work in
never entered the picture, or a car. Well what would I need a car for? From
that time, I scrounged a little space here and there when school opened.
Never did I get transportation and I walked for 5>/2 years."
The same story with variations existed throughout the province as public
health nurses gradually became established, starting in a very humble way.
The Early Record System
There was no well defined method of keeping records or setting up files at this
time. The public health nurse used the school medical records as a starting point.
These records were kept in the school and contained the results of the school
medical inspector's examinations. The public health nurse carried a small black
book with classroom lists on which she had recorded pertinent data to use for
home visits etc. The school medical record was transferred with other school
records by the school principal when the child moved to another district. The
public health nurse set up individual records which she also carried for infants,
preschool children or adults being supervised or receiving service. Her records
on all tuberculosis patients were sent to her from the Supervisor of Tuberculosis
Nursing when each new case was diagnosed. The nurse did her own clerical
work. Letters were handwritten unless the public health nurse could type. Then
she used her own typewriter. She usually used her own stationery and stamps
too. However these were not great expenditures as there was little correspondence. (Stamps were three cents.)
The system was fairly simple, but required the public health nurse to keep her
records up to date. This system remained until the early forties when the general
record and the family health record were introduced.
%.    ^
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 Public Health Nursing in the Twenties
Detailed reports of the public health nurse's work in Cowichan and Duncan
were published in the annual Provincial Board of Health Reports in 1923 and
1924, which serve as examples of the type of program being carried out there as
well as elsewhere in the province.
As could be expected, activities were directed towards the major health
problems of the day — the high infant death rate, contagious diseases, malnutrition, rickets and poor sanitation. Emphasis was placed on teaching personal
hygiene and general health practices. The following activities were noted in the
• All new babies were visited at home, and followed by monthly visits to help
teach mothers the best way to feed and care for their babies.
• Infant well baby clinics — were held either at the health centre or in the most
suitable place in the district. The public health nurse weighed and measured the
baby and advised the mother on care. At periodic intervals local physicians
volunteered their services to examine the babies. Those needing further medical
care were referred to their own physicians.
• Monthly letters on child care as prepared by the Federal Government were
sent to the mothers.
• Preschool children received a similar service at clinics but were only followed
up for a particular problem.
• School children — Schools were visited regularly, and the public health nurse
inspected all the children in each classroom for contagious diseases and skin
conditions such as impetigo, scabies, as well as head lice. She weighed and
measured the children monthly, gave health talks, encouraged children to make
health posters, inspected school sanitation (water containers and privies) and
carried out other special activities.
• Little League courses on child care were held in the schools for girls ages 10
— 14 years. Successful students received a badge and certificate from the Provincial Board of Health.
• Special clinics were organized for chest X-rays, Eye and Ear examinations,
Tonsils and Teeth. Some were held in the health centres.
• Home Nursing course for adults — a twelve week course was offered with
successful candidates receiving a certificate from the Provincial Board of
• Health Teaching — was done for individuals and groups. Talks were given,
posters displayed, and educational exhibits set up at fall fairs etc. Available
literature on personal hygiene and diet was distributed.
• Nursing Care in the home — This service was offered in most centres on
Vancouver Island. This was a 24 hour service including maternity and home
deliveries. A small charge was made. Many people at that time carried a
Metropolitan Life Insurance policy which included a limited number of free
visits. The company was billed for these visits.
   Students ol l.iltlc league Mother's Classes      Saanich 1922
• Contagious Diseases — Homes were visited, families shown how to isolate
the patient and carry out quarantine regulations. Homes with communicable
diseases were placarded by the medical health officer with large colored signs
that read "Diphtheria", "Scarlet Fever" etc.
• Tuberculosis Patients at home were visited regularly when they were given
supplies such as sputum cups and bottles for sputum tests, X-rays arranged, and
the patient and family advised on the progress as well as the recommended care
of the patient.
• Transportation - Few people had cars, and the public health nurse often
found it necessary to take patients to a physician or hospital.
• Goitre There were goitre areas in the province, where preventive treatment
was given. The school medical officer ordered iodine tablets which were given
everyday for six months under the supervision of the nurse. In 1929 five percent
of all children had goitre problems. However in Kamloops it was 11.5%, Revelstoke and Kootenays 1 l'(, whereas Vancouver and Vancouver Island had a
lower rate of 2.5%. The problem was not solved until iodized salt was introduced
in the early forties.
The Public Health Nurses' Bulletin and Selected Reports
The Public Health Nurses' Bulletin was published each year from 1928 to 1939
by the Provincial Board of Health. It was intended to inform the public health
nurses of progress being made in the development of the public health nursing
service in the province. Each public health nurse submitted a narrative report on
a subject of her choice. These reports give a very good insight into the commun-
 ity involvement of the public health nurses in the development of better health
care. A number of excerpts are quoted to illustrate the work in this period.
Public Health Nursing Program — For Every One in the Family
It is sometimes hard to translate programs into people and actions taken
to improve a health situation. Here is how Miss H. Kelly P.H.N, worked
through what she called her "social service" program. This might have
other names now — Mental Health, Rehabilitation, School Health etc.
"In a large district, such as the one in which I am operating as nurse in
charge of the Esquimalt Rural Nursing Service, the service necessary to
bring about the desired results of educating the people to a realization of
the benefits derived from supporting such a service in their midst is very
Apart from the usual aims and objects of a Public Health Nurse, which
include the dissemination of all information tending to check the spread of
infectious and contagious diseases, and the inculcation of habits of right
living amongst the people, child welfare, etc., social service must play a
very important part in the daily life of a nurse in charge of such a service.
If all the work accomplished by a Public Health Nurse could be made
public, there would be no difficulty in obtaining the vote of the people at
the annual ratepayers' meetings for the extra small assessment towards the
upkeep of the service in their midst, but much of her work has of necessity
to be kept confidential, and therefore much of the benefits of the service are
known to only the few.
I will quote one case of many, withholding, of course, names and
anything which may lead to identification, whereby the State has been
saved, potentially, many thousands of dollars; the State, and thereby the
The case deals with the Social Service Branch of the work. I learned of a
family living away back in the bush, where there were three boys who,
owing to them living outside the 4-mile limit, had never attended school.
Accompanied by the vicar of the parish, I went to investigate the case.
Taking my little car up miles of rough trail with barely room at times to
pass, we eventually located the place where the family in question were
living. There we found a shocking condition of things in general. The three
boys, ages 6, 8, and 10, had not only never been inside a school, but were
unable to speak properly, owing to the fact that the father was almost
stone-deaf and the mother on the verge of a mental collapse through
loneliness and lack of association with her fellow-creatures.
Within two weeks we had the family moved to the village of- -, and very
soon after that had collected sufficient clothing for the boys to attend the
school there. This was some months ago, and the boys are now doing well
at their studies and show fine promise, and the mother, though still
 suffering more or less from her terrible experience of loneliness in the bush,
shows great improvement, and no reason at all why she should not become
a normal healthy woman. The father, a good workman, but severely
handicapped by his extreme deafness, will have the chance to become a
useful self-supporting citizen, as I succeeded in interesting the local
Women's Institute and the Nursing Association to the extent of procuring
an ear-trumpet for him.
That is only one case from one portion of the district; but it will serve to
show how necessary it is for a Public Health Nurse, when in charge of a
district, to give and have a wide view of the opportunities of service, and for
the people to realize this service and support it liberally, and thereby save
themselves increased taxation in the future. It will not require a very vivid
imagination to realize what a burden such a family would have become to
the State eventually had they been left to their own devices."
Helen Kelly, P.H.N. Colwood   Public Health Nurses' Bulletin, Oct. 1924
Public Health Nursing Program — Health Teaching in a Rural School
Miss Isabelle M. Jeffares. public health nurse, reported as follows in the 1924
Public Health Nurses' Bulletin, on how she had assisted teachers with their
health teaching by means of a health book competition and playlet:
Cowichan Lake School Fair
I had accepted an invitation to attend the School Fair at Cowichan
Lake, our most rural school, about 20 miles from the Health Centre
headquarters, and present the prizes for the Health book Competition,
which were given by the Provincial Board of Health. Cowichan Lake
School is in the centre of a logging community and most of the children
come from the different camps.
On arrival at the school we found the judges were busy in the school
house with the exhibits, and sports in progress on the grounds; a group of
about forty parents being accommodated on roughly put up benches or on
the desks from the school house.
In the school house the different exhibits were arranged attractively, our
interest, of course, being centred on the "Health Books." Imsi February it
had been suggested to the teacher that, if she cared to take the matter up, a
prize would be given for the best essay, poster, or book on any health topic-
taken up by the School Nurse during the term. About eighteen books and
several posters were sent in competition; some of them were a great
surprise. The majority of the books were illustrated with cut outs, while
some had little pencil or water colour sketches, all of them being made to
look as much like a book purchased in a shop as possible. One clever little
book on "Milk" had an amiable looking cow on the front cover and a very
tiny milk bottle in the centre of the back cover.
 After the sports had been run off and the judges had completed their
task, the pupils put on a little health playlet, in which there was paraded
before a little, pale, thin "City Boy" all the good things he could procure
more easily by living in the country. The children were dressed to look the
part of the article they represented; for instance, "Egg" was a tiny golden-
haired girl, carried in a large basket covered with white crepe paper. When
all the "Good Things" were arranged around the little boy and he was
considering their real value, in walked a procession of his old-time "Enemies, " headed by a large "Coffee-pot," and followed closely by "Pie" and
"Candy." It was not very long, however, before the superior strength of
"Milk" and his faithful supporters was felt, the "Enemies" chased afar off
and thin, little "City Boy" left to his new friends."
Isabelle M. Jeffares, P.H.N. Duncan
A Public Health Nurse's Comments on Her Work in a Rural District
— Keremeos
"It often seems hard to believe that so much can take place in a space of a
few years. Before I went in training most of my life was spent in outdoor
work and as the hours flew by I dreamed many things. One of these was to
become a nurse and go about doing good, helping people who were in
trouble, etc. When our community first had a District Nurse I used to envy
her unendingly and think of the wonderful opportunities she had for doing
good. As soon as possible I trained at the Vancouver General Hospital,
took the Public Health course with field work at Saanich Health Centre,
and came back to my community to do Public Health Nursing. I find it is
not quite so simple, and, try as I may, I cannot recognize in myself the
District Nurse of my dreams. I always liked the people here, which was one
of my incentives for coming back to them, but since I've been working
among them I appreciate them more than ever.
Before leaving the Coast I was talking to a prominent doctor, who stated
that he considered it a pity to do District Nursing, where what I had
learned would only fall to disuse. I only wish I could see him now, as I
would have better material for argument, as I'm sure if he spoke to our
local doctors, who by the way are miles distant, he would change his
opinion. One must be ready for any emergency, and in serious cases such as
pneumonia, where the patient can't be taken to hospital and the doctor can
only come every second day, there is a great responsibility.
One of the things that makes District Nursing here a pleasure is the
co-operation of the doctors. Nothing is too much trouble for them, and
when in doubt over some small illness, where the patient feels they can't
afford to have the doctor, if I phone the doctor, he is only too pleased to
explain the best course to take.
I find the school-work very interesting and pleasant; the children are so
  enthusiastic, especially the little ones. I find their interest greatly stimulated by giving small prizes for health chores, etc. At Christmastime, with
the help of the primary teacher, we put on a health play, which was very
successful. I would like to mention here that the teachers are a wonderful
help to the nurse, and that it is greatly appreciated. The percentage
underweight has improved since last September from 60 per cent to 48 per
cent, at the present time. I held a tonsil clinic early in November for the
school children of Keremeos and Cawston. There were eight children
operated on, and I have been very pleased to see the marked improvement
in the children since then. One of them gained 4 lbs in a month, and they
have not been home from school with colds as in previous winters. I started
on February 1st to give a series of talks and demonstrations in practical
nursing to a class of Canadian Girls in Training in Cawston, and later I
started classes in Keremeos for girls from 14 to 20. These classes are well
attended and the girls seem interested in the work."
Patricia East, School and District Public Health Nurse
Public Health Nurses' Bulletin 1927
Public Health Nursing Uniforms and Insignia
The first public health nurses wore a distinctive blue uniform to indicate that
they were district community nurses in contrast to hospital nurses who wore
white. They wore plain tailored bright blue shirt waist dresses in the style of the
early twenties. The skirt was just above the ankle, the dress was belted with long
sleeves, trimmed with white starched or celluloid collars and cuffs. A slim black
tie was worn with an official "pin."
As the provincial government had recognized the public health nursing service
as an official service of the government, Dr. Young was able to secure permission
to have the British Columbia Government insignia incorporated in the official
pin. It was a small round blue and gold pin with the government crest in the
centre in gold with "Public Health Nursing" lettered in gold in the cobalt blue
border. This pin continued into the thirties.
There was no official coat or hat at that time although most of the public
health nurses wore blue berets or felt hats.
The school nurses did not wear a special uniform although some wore their
white hospital uniforms, or white coats over civilian clothing.
The Public Health Nursing Service Grows in the Twenties
The first public health nurses were well received in their districts. The local
people generally appreciated the work being done, and word of this new service
gradually spread to adjoining communities. The Provincial Board of Health
began to receive requests to start similar services in other parts of the province
and so the service gradually expanded. The fact that the public health nurse was
also a school nurse, and for all children, whether rich or poor helped provide an
  easy entrance to all the homes in the district. This was one of the greatest factors
in making the public health nursing service acceptable to everyone in the district.
The concept of a public health nursing service for all was new but most acceptable because of the way the service was organized. Also the educational background and enthusiasm of the newly appointed public health nurses was an
asset, as they were generally outgoing persons dedicated to developing services
which would benefit the health of everyone in the district.
The Public Health Nursing University Course Becomes a Requirement
In 1928, the Provincial Board of Health ruled that all nurses working as public
health nurses must have completed a university course in public health nursing
to be eligible for permanent employment either as a school or public health
nurse. All applicants for positions in the districts covered by the Provincial
Board of Health had to be approved before grants were paid to local school
boards or health associations. As a result the local services turned to the
Provincial Board of Health to fill a vacancy, or to find a public health nurse for
them when one was needed. A very close liaison developed between the Provincial Board of Health and the local health service. Dr. E. Young, Secretary of the
Provincial Board of Health recruited public health nurses directly from the
University of British Columbia, interviewed prospective candidates, and
arranged their employment. He required the public health nurses to send him
monthly narrative and statistical reports so that he would know of the progress
being made in the various districts. This included a special report on the service
in the schools which was forwarded to the Department of Education to justify
payment of their grant. The policy of qualified public health nurses only for
public health work had a great influence in the future development of public
health in the province.
The First Move Towards Full-Time Medical Health Officers and
the First Health Unit
As public health nurses became more involved in community health work they
found health related problems which they could not solve alone. It became
apparent that there was a need for a full time medical health officer to direct and
co-ordinate the health service. All communities had part time medical health
officers either appointed by the municipality or city, or by the Provincial Board of
Health in unorganized territory. School boards had part time medical inspectors
who were local physicians. In many instances the two part time positions were
held by the same physician. Although the system provided for some needed
services, particularly in emergency situations, it did not generally work too well as
far as the conduct of routine work or health planning was concerned. The
physicians had little or no training in public health as their interest and education
had generally been directed towards the treatment and care of sick people. Patient
care naturally came first with the result that planned public health clinics, or
 school visits with the public health nurse, frequently had to be cancelled because
of medical emergencies. Many were too busy to give the time needed to this part of
their work which did not particularly interest them. The public health nurses
wasted much time waiting for them for clinics, waiting for appointments etc.
Dr. Young was of the opinion that full time medical health officers should be
appointed, and in 1927, he was able to convince Saanich Municipality to use
funds normally allocated for part time assistance such as the school medical
inspector and medical health officer, and employ a full time medical health
officer who would be responsible for all health matters in the municipality. Thus
the first health unit was formed in Saanich in September 1927, when Dr. David
Berman was appointed. His staff consisted of two public health nurses, two
school nurses, and a clerical assistant. Some sanitary health inspection services
were made available through the municipality. It was the first rural health unit
and a similar organization became the objective of districts in other parts of the
There is some difference of opinion on the use of the term "health unit." The
question arises as to whether the term should apply to an area with funding from
only one local source such as a municipality or whether the term correctly
applies to a geographical area or unit composed of more than one local government. However, Saanich Health Unit is generally considered the first provincial
health unit.
The Twenties Introduce the Health Unit Concept
The Saanich Municipal Health Service with its full time health officer and
public health nurses working out of a health centre proved to be effective and
efficient. New ways were considered to provide a similar type of service to
smaller communities. Smaller population clusters in rural areas lacked a tax
base, which presented difficulties in raising sufficient funds to employ the well
qualified staff that larger centres could afford. At the same time, the smaller
number of people could not justify the funds for full time staff. Thus the concept
of smaller communities joining together to form a health unit which could share
the cost of employing qualified public health staff for the benefit of everyone in a
designated geographical area, or health unit was developed.
The South Okanagan was an excellent area to introduce the health unit
concept, when Dr. G.A. Ootmar, in 1928, was appointed full time Medical
Officer and Sanitarian in Kelowna City, and Medical Officer and School Medical Inspector over a large unorganized territory (100 square miles). The unit
included Kelowna City which appointed its school nurse, Miss Frances Leyne,
and a School Medical Inspector, Dr. W.J. Knox, and the area served by the
Kelowna Rural Schools Health Association which employed Mrs. Anne Grin-
don as a public health nurse to serve the district in which twelve rural schools
were located. This set up formed the Kelowna Health Unit which became the
first health unit to demonstrate that a rural and city area with different forms of
 local government could join together to provide a good health service.
Both health units eventually were to be reorganized to cover more municipalities, cities, villages and unorganized territory so that they would be truly local
provincial health units. The Kelowna Health Unit was reorganized in 1940, to
become the South Okanagan Health Unit. In 1948, Saanich became the Saanich
and South Vancouver Island Health Unit, later being reorganized as the Greater
Victoria Metropolitan Board of Health (1961) and finally the Capital Region
District Community Health Service (1973).
Tuberculosis Nursing Supervisor for Public Health Nurses
Tuberculosis continued as the first cause of death among infectious diseases
during the twenties and was therefore a major health problem. In 1921, there
were 521 deaths from tuberculosis when the population was only 524,000. The
Provincial Board of Health accordingly took over the main responsibility for the
treatment and care of tuberculosis patients. Active cases of tuberculosis were
admitted to provincial tuberculosis hospitals for treatment, to learn how to care
for themselves, and also to limit the spread of the disease. Suitable patients were
permitted to return to their homes and communities to be supervised then by a
Travelling Medical Officer, Tuberculosis Specialist, and the local public health
The Provincial Board of Health established a community service for tuberculosis control which provided chnics for patients and their contacts, held at
periodic intervals throughout the province in the larger population centres. At
these clinics, X-rays and other tests were taken, examinations made and medical
advice given. The public health nurse followed up the patients by visiting them at
home, advising them on personal care, infection control etc. A central registry of
all known cases and contacts was established at the headquarters of the Tuberculosis Division in Vancouver. As tuberculosis was an infectious disease, advice
and guidance was made available to private physicians as indicated, by the
Travelling Medical Officer, and by a specialized Tuberculosis Nursing Supervisor. Generally the local physicians left the management of tuberculosis to the
health service.
Miss Josephine (Jo) Peters was the first nurse to hold this position, after her
initial employment by the Rotary Clinic in 1921 to help the public health nurses
in the Vancouver area. In 1924 she was appointed by the Christmas Seal
organization to work with Dr. A.S. Lamb, Travelling Medical Officer and first
medical tuberculosis consultant for the province charged with supervising
patients living outside institutions. Miss Peters was appointed Travelling Nurse
to accompany Dr. Lamb to his clinics, take X-rays, and to advise public health
nurses on the management of patients and their contacts. In 1937 she was
appointed Supervisor of Tuberculosis Nursing and continued to assist field
nurses until her retirement in 1948. She kept in touch with the public health
nurses so that they could instruct patients on the care being recommended as
 each new case was diagnosed, and when the condition of patients changed. On
initial diagnosis she sent the local public health nurse the green record known as
the P.H.7., which contained pertinent information such as the diagnosis, time
for next sputum test, X-ray etc. This system proved to be excellent as treatment
at that time was mainly limited to good personal hygiene, adequate rest, and
regular examinations which were essential to determine the course of the disease.
Josephine Peters at her retirement cottage. Yellow Point, Vancouver Island — 1949
   The Depression Years — The Thirties
The prosperous twenties came to a close with the New York stock market
crash of 1929 which was the forerunner of the great depression of the thirties. Its
effects were felt in far off British Columbia as the economy came to a standstill.
Businesses retrenched, cities and municipalities cut budgets and eliminated
many services. Money became scarce as fewer people were employed. "Unemployment Insurance" did not exist, and Social Assistance which was then known
as "relief was limited to severe hardship cases. Many families broke up as men
began to ride the rails across the country in search of seasonal or any kind of
work. The government finally established work camps for men, mainly in the
interior of the province, where they were usually occupied with road work.
It was a time when many people could not pay for medical or hospital care. As
a result they were reluctant to visit or call a physician except in the most dire
circumstances. When physicians were used they were often paid in kind by
garden vegetables, butter etc. The need for health care and medical treatment
was great but few people could afford private care. Most people hospitalized
were "ward" care or non-paying patients.
Public Health Nursing in the Depression
The public health and school nurses responded to the depression as best they
could. They carried on with their regular programs and set about organizing the
people in their districts to help the less fortunate according to their situations.
They interested organizations and clubs in providing money for persons in
special need of treatment and care such as eye examinations, glasses, layettes,
camps for the undernourished, tonsil and adenoid removal clinics (there were no
antibiotics at this time and many badly infected T&A's). They distributed used
clothing, cod liver oil samples etc.
The following report from the Peace River Health Unit indicates how one area
worked out its plan for a tonsil clinic with limited finances and the help of the
Tonsil Clinic in the Peace River Block
"The tonsil clinic was in full operation upon my arrival in the Peace
River Block. It has proved a very successful method for the removal of
diseased tonsils among the children here.
Following the regular examination of the school children, it was apparent that some were affected with diseased tonsils which were detrimental to
the health. Parents in many cases had been informed of these conditions,
and except in a few cases had not taken any action. Reasons for this were
due chiefly to the characteristic conditions of this part of British Columbia.
The majority of people live on homesteads, some of which are a very
long distance from a doctor or hospital. Often the only means of travel is
 a] a
jBh''1 *  ''^jB>       1      '"
J4ifcrSj£?'" tjj
1                    *■
Dorothy Tate (Slaughter),  Muriel Smith      Heather Kilpatrick, P.H.N., Cowichan Health
(Dann), P.H.N.'s — Saanich 1934 Centre — Duncan 1935
Isabel McMillan (Staples), Florence Barbaree
(Graham),  Nancy  Law,  Healther  Kilpatrick,
P.H.N.'s, Cowichan Health Centre — Duncan     Anna Larson (Mason) P.H.N.
1937 1938
Maple Ridge
 by team, and at times travelling is practically impossible due to poor roads
and climatic conditions. Also, on the other hand, during the good weather
both men and teams are busy on the land.
Many parents also feel they are unable to meet the added expense which
would be entailed in such work. They are really trying to build a home from
the beginning, which is typical of pioneering, and they really need their
finances for the maintenance of themselves and children.
Another reason, although it may not always be a major one, is lack of
knowledge of hygiene and the way to maintain health. Time, money, and
mind have been occupied with building a home and making a living. The
people do not realize the value of practising all the health rules, nor know
that tonsils can be detrimental to health in that they are sometimes the
forerunners of serious diseases such as rheumatism and cardiac conditions.
However, through the efforts of the staff of the Health Unit, many parents
are learning the value of health rules put into practice and are more ready
to cooperate.
Because of these difficulties it was decided that a different plan must be
put into effect, in order that the work could be done successfully on a large
scale. The chief aims were to have the defects corrected and to make no
distinction between the economic conditions of the people whatsoever. An
arrangement was made whereby a special flat rate was to be paid to cover
the hospital and doctors'fees. For the few who were unable to pay the full
rate, arrangements were made that they could work out the balance on
various schools where there is a certain amount of work to be done such as
painting and kalsomining, repairs, moving of privies, and also putting in
the year's supply of wood and ice.
Following the completion of these arrangements, the members of the
health staff interviewed the parents, advising them of the need of the
removal of the diseased tonsils and adenoids. From those parents who
were in favour of the work they obtained a written permission from them,
and also made arrangements for payment, to be either in full or part cash
and part by working.
The clinic was held during July and August of 1937. The children were
transported to and from the hospitals by members of the health staff.
Following the return of the child home, the parents were instructed regarding the post-operative care, as the majority of the children remained in the
hospital for a day following the operation. Usually, within the next week,
and another home visit to note the progress of the child, and to give further
instruction, if necessary. The mothers seemed to appreciate these follow up
visits, as they felt the Health Unit was sharing the responsibility of caring
for their children by giving the needed instruction.
One of the greatest factors in the operation of this clinic was the
distances that had to be covered in transporting the children. At times trips
 from 70 to 95 miles were made. In some instances the parents co-operated
and brought their children to a central point where they were met by a
member of the staff On one of these trips, which was made partly by boat,
members of the staff and two children spent the night on a sand bar in the
Peace River. They felt little the worse for their experience, however, except
for lack of sleep, and looked upon the night's outing as one of the episodes
that made life in the Peace River Block varied.
Tonsillectomies were advised in 147 cases and 138 children had their
tonsils and adenoids removed, showing how successful the first tonsil clinic
in the Block proved to be. The results are manifesting themselves, as there
is improved health among these children. In one case, a boy has gained 12
pounds and is now taking a keener interest in his health. Thus through
clinics and other means, the Health Unit is trying to teach people of the
Block that "an ounce of prevention is worth a pound of cure."
Kathleen Shepherd, P.H.N., Rolla.
P.H.N.'s Bulletin, March 38
Immunizations were still urgently needed to protect the public from certain
contagious diseases so that the public health nurses set up clinics for protection
against diphtheria, scarlet fever and smallpox, whenever and wherever they
could be arranged. In some locations where local physicians attended baby
clinics the public health nurses were permitted to give the injections but not
vaccinate for smallpox. Vaccination for smallpox was required before a child
could attend school unless parents could prove they were "conscientious objectors." Free biologicals were supplied to physicians by the Provincial Board of
Health, and parents were encouraged to have their children immunized by their
own physician or at a public health clinic. However as physicians charged a fee
for each injection the cost was prohibitive for most families. Because of the
availability of the public health clinics in the local school and district clinics, the
community protection level was raised in those districts where public health
nursing services were available.
The majority of public health nurses worked alone, as only four health units
had been established up to the thirties, and these were much smaller than the
present day units. Most of the public health nurses worked in single nurse
districts and were assisted by a part time medical health officer who was also the
sanitary inspector. The part time health officers usually had busy practices and
had little time available for preventive work. Usually they were willing to help
with specific problems brought to their attention, but they did not provide
general leadership in the development of health programs or facilities.
The excellent results of the communicable disease program of education and
immunization was pointed out by Dr. Young in his 1934 annual report when he
stated that the death rate from scarlet fever, measles, whooping cough and
diphtheria had dropped from 58.9 in 1911, to 7.4per 100,000population in 1933.
 At baby clinics the emphasis was on health teaching of child care. No treatments were done and conditions needing medical attention were referred to
physicians. The public health nurses visited in the homes to ensure that proper
care was given.
The public health nurses were generally expected to be available at all times,
and were frequently called in the evenings or at weekends. They were often asked
to decide whether a physician should be called. Few people had telephones or
cars, and public transportation was non existent except in big cities. Taxis were
not available in many small towns. Public health nurses found themselves
spending a good deal of time transporting sick children home from school, to the
doctor, or hospital. At that time it was the only way that many could get needed
Report from an Isolated District on Vancouver Island— Sayward
My District Work, Past And Present
" Well nigh ten years have passed since I was first appointed as District
Nurse in Sayward, although prior to that I had on many occasions been
called upon to assist, in times of need, settlers and loggers in this vicinity. I,
as a qualified nurse, was sought in cases of emergency, and felt glad on
those occasions that I was able to lend my assistance to those so sorely in
need. But upon being officially appointed I discovered the unpleasant fact
that many of the settlers did hot look upon my work at all favorably. This
was especially true in regard to the supervision of the school children, the
installing of sanitary appliances and improvements in the little buildings.
However, there is nothing like perseverance to win a cause; now the
schools are equipped with water filters (which were most decidedly
needed), individual drinking cups, medicine chests, and proper sanitary
outhouses. Last, but not least, I have won the co-operation of parents and
School Boards.
This district is still very much in the pioneering state, being isolated by
the lack of road connection with the rest of the island. Only the bi-weekly
visit of a Union steamship keeps this scattered district in touch with the
outer world. Therefore very few changes have taken place in my ten years
of service.
For the past four years Dr. Youlden, dentist, has been sent in by the
Provincial Board of Health and attends the school children and tiny tots.
For the past five years the Coast Mission ship "Columbia" has carried a
doctor on board. They touch in here about every two weeks, and on very
urgent occasions can be reached by wireless. Co-operation with the Mission workers is a great help in serious and hospital cases. One case in
particular I well remember: it was when a miner was badly mangled by an
explosion. Three days after the accident, which took place far up in the
hills, the "Columbia" docked at Alert Bay and our patient wasremovedto
 the Mission hospital, where he was immediately operated upon. But
unfortunately help of this kind cannot be always at hand and we must
make the best of things and do the best we can.
The prenatal work is carried on as far as possible, and I must add a word
in praise of the postnatal letters, which are certainly most helpful to young
mothers in isolated places.
Two years ago a little cemetery was opened in Sayward, in which there
now lie five occupants. It is one of my duties as District Nurse to lay out the
In summing up my work, it is this: Prenatal work; bringing into this
world little lives; care of children and their various ailments; accidents;
sickness; and, last of all, watching through the long hours of the night as
the grim reaper takes his toll.
There is likely to be much development going on in Sayward during the
coming years, as a very large logging camp is making arrangements to start
operations in the valley. This will make a great deal of activity in the
district and serve to bring in more settlers, which will add considerably to
the range of work in this district.
Edith M. Walls, R.N., Sayward
Public Health Nursing Bulletin 1933.
Gradual Expansion in the Thirties
During the thirties, in spite of the poor financial situation, a number of
communities decided to employ either a public health nurse or a school nurse.
The number of public health nurses in the province gradually increased as new
public health nursing districts were formed in communities such as Port Alberni,
the Peace River, Dewdney, Nelson, Chilliwack, Maple Ridge, Abbotsford etc.
The number of nurses being prepared for public health nursing at the University
of British Columbia kept pace with the demand.
The work of the public health nurses was being recognized as pointed out in
1934 in Dr. Young's Annual Report. "The public health nurses have been one of
the bright stars of our work. The Board of School Trustees of British Columbia
introduced a motion at their annual meeting to make the establishment of public
health nursing mandatory throughout the province." The recognition which the
public health nurses received was encouraging as they usually worked alone in
districts under difficult conditions and did not always appreciate the impact of
their work. The following report explains how one public health nursing service
First Public Health Nursing in the Peace River (Report)
"On to the Peace!" is the slogan that has been drawing many new
residents to this part of the country. The writer journeyed five months ago
into the Peace River District, being sponsored jointly by the Red Cross and
 the Provincial Board of Health. The Peace Block is a vast rolling country,
with huge cut-banks gouged into it. The banks are covered with golden
birch. Patches of stubble surround the clearing of the homesteader. There
he lives in a little log cabin, often with only a dirt floor. His nearest
neighbour is a mile away at least, usually farther.
I have charge of twelve schools and their districts, scattered over mountains and along the banks of streams, in an area of 120 square miles.
Transportation is difficult, as the weather is likely to change unexpectedly
from 60 below to above zero. The roads may be lost beneath heavy snow
and ice, or submerged beneath floods of water. The thick gumbo is almost
impossible for a car, and is bad even on a horse.
Last week I had to take a maternity case into Pouce Coupe, to the Red
Cross Hospital. It is only 40 miles and the roads had been cleared of snow
for the mailman, who comes through once a week. I keep my car 3 miles
from where I live because of the bad drifts. It was necessary to harness my
team and in the open cutter drive to the place where my car is kept. Picking
up my patient, we drove into Pouce Coupe in the car. It had started to snow
before we turned homeward, but by pushing ahead we managed to get
back within 8 miles of my home, when the car stuck in the snow in a field. I
had to walk 2 miles back in a real blizzard to the home of one of my
committee-men, who drove me to my own team. The drifts were so bad by
this time that we could not keep to the road. We upset three times into the
snow in weather 60° below zero! We were lost in a woods with which I am
perfectly familiar and could not find the gateway to ourownplace. It was3
a.m. before we reached home. Just a day's work in the Peace!
The work as a whole has taken a great hold on the community. I have
twelve committees, one in each district. Each has a representative on the
Central Committee, which meets once a month. They work hard and are
taking a keen interest in public health matters. They all want to help
toward the development of health services in other parts of the country in
time to come.
This is a country of no water, unless you are lucky enough to live near a
creek or river. This presents a real problem to the school trustees, as wellas
to the parents, to see that there is a sufficient water supply to meet the needs
for both drinking and washing. Since most of the water comes from the
melted snow and ice, we have started giving iodine to many of the school
children to prevent goitre. This is done under the direction of our school
The most interesting event was the "family" clinic which I ran in five
districts. Each family was taken as a unit and all the children — infant,
pre-school, and school— were examined by Dr. Becworth. Many of the
mothers travelled long distances to reach the clinics, where they were
greeted by members of the committee who assisted with the weighing and
 the taking of records. The mothers took a great interest in the whole
programme. For many of them it was their first trip in years farther than a
few miles from their homes. We are- planning to complete all twelve
districts in this way and should have some interesting statistics when we are
I hope that the day will soon come when we have more Public Health
Nurses up here. There is much to do. People are gradually filling in all the
farm lands. This part of the country has wonderful prospects and a
fascination all its own. But, like all the Northland, it is a stern master and
demands stamina and courage in all those who choose to settle here. In a
land where all the news and messages travel by "moccasin telegraph" and
neighbours are scattered, a real community spirit of helpfulness and
patience must develop."
Nancy E. Dunn, R.N., Rolla
Public Health Nurses' Bulletin 1932.
Getting Around in the Thirties
Some of the public health nursing committees purchased cars for the public
health nurses to use in their work. This occurred particularly when home nursing
service was provided. In 1936 a standard Ford cost $865.50 according to the
Cowichan Health Centre Report of that year. A special Provincial Board of
Health grant of $500.00 was given to help with this purchase.
Jennie Hocking, Marjorie Sutherland, Muriel Smith (Dann), Esther Naden (Gordon). Saanich
P.H.N.'s — 1934
 Alice Beattie, P.H.N., Cowichan Health Centre — Duncan 1939
However, in those days cars^were neither reliable nor comfortable. Mrs.
Geraldine Langton (nee Homfray) a former public health nurse at Duncan
recalls how the public health nurses used to take along hot water bottles and
wrap themselves well in quilts for night trips. At that time cars did not have
heaters, and were open to the air. When it rained, isinglass (similar to clear
plastic) curtains were fastened on with domes. (Zippers had not been invented).
Snow tires were for the future, but chains were in use. Mrs. Langton relates that
she had no car when she transferred to Chilliwack and had to travel by "Shanks'
Mare," so she tried a bicycle without much success. Then she bought a car and
the school board agreed to pay her $ 15.00 per month to use the car for work. She
served a large rural farm district.
As might be expected in the Peace River, horse and sleigh or cutter were used
on some trips while some public health nurses used a horse to make their rounds
a good part of the year. Boats, too, according to this ditty
"I'm writing a ditty,
About a nurse in a city.
She starts in the morning
Hopes of health restoring
 In the course of her travels
She gets stuck in the mire
Or, what is much worse
May have a flat tire.
Her arms waving wildly
To people who pass
She hopes they will help her
And offer her gas.
At night while on duty
If the telephone rings.
She wonders who it is
As she grabs up her things.
She jumps in her car —
The night's black as pitch
She steps on the gas
And goes in the ditch!
On leaving the car
She climbs in a boat
And then does her best
To keep it afloat
When at last with her patients
All night she has tarried
She drags herself home
And decides to get married."
V. F. & D. T. Saanich Health Dept.
A solution for everything!
The Generalized Service Established as Best
During the thirties the generalized public health nursing service was firmly
established as the best method of community health nursing service. This
decision was reached following trials in various districts. For example, in
Nanaimo the generalized system was tested against the specialized school system. The following report by Miss Maxine Morris (Dunn) in the 1939 Bulletin
explains the findings:
"The public health nursing service successfully completed a six month
trial to find out whether a generalized service by each of two public health
nurses would be preferable to the previous system with the school public
health nurse limiting her work to school children and giving some assistance at well baby clinics. In the new system each nurse provided all the
service in her own district and this proved to be best."
The generalized system was used in the new demonstration health units
 started in the thirties and in the new districts being organized, with the results
indicating that this system was best, both from the community's and the public
health nurse's point of view.
New Health Units in the Thirties
Three demonstration health units were financed jointly by the Provincial
Board of Health, the Rockefeller Foundation, and the local district. The first
was set up in 1930 in North Vancouver, followed by the Metropolitan Health
Committee Unit in 1937 which included Vancouver City and the rest of Burrard
peninsula; then the Fraser Valley Health Unit was established in 1938 for the
Matsqui-Sumas-Abbotsford area. The Peace River Health Unit was established
and paid for by the Provincial Board of Health in 1935. Elsewhere, the public
health nurses carried out the generalized public health nursing service and set the
pattern for new districts and health units to be developed later.
It is interesting to note that the health officer and staff of the Peace River
Health Unit worked from their homes, as there was no common office.
The following ditty tells how the work in the Peace River Health Unit
A Ditty From The North
"In B. C 's Peace River Country 'tis scarce three years ago
We started our Health Unit here amid the frost and snow.
People said it wouldn't prosper, 'Wait till 50 below,'
or 'Mud of the Peace River Country just won't let car
wheels go.'
Our first Director, Dr. Cull, a very wise young man,
Said to his public health nurses, 'Let's get busy while we
We'll get to know these people. We'll immunize them all,
And to round up mumps and measles, we'll a/ways be on call.
We'll examine all school children. I'm sure we're elected
To find their defects and their ilk, and then get them corrected.
Our duties are many, our handicaps great.
There's hard work ahead — let's blame it on fate.
The weather and mud is as bad as they told us,
And now my good nurses, let nothing dare hold us!
We've immunized the people against all that we can,
And now they're asking for more — Such are the ways of man!
Teeth and tonsils have had a share of close attention
And other problems we've checked off— too numerous to mention.
4 6
 Three years we have been striving and our unit stands true,
Schemes and plans for further service, spur us on to work
Of course our staff has changed a bit. Dr. Cull has gone away.
Some of our nurses left us, Dr. Hershey's come to stay.
These are our ways of travel: by boat, by sled, by car,
On horseback, in a wagon. Sometimes on foot we are.
The weather's really not so bad when you dress in proper togs.
Mud roads can be conquered — why just chop down some logs!
Most residents greet us with smiles and pleasant words,
In the local vernacular we're really 'not bad Birds.'
We carry on the same old job we first set out to do.
There's something in it has allure. I'm sure you'd feel
it, too.
So if you'd like some Public Health work to prevent your
getting blue
Come up to the Peace River Country. She'll put a spell on
Rita M. McFarlane P.H.N.
Public Health Nurses' Bulletin, March, 1938.
More Health Protection Needed
The 1930 s were notable as a time when public health nurses concentrated not
only on nursing problems, but attempted to interest the people in their communities in more general health control measures such as better sanitation, pure
water, milk etc.
Sewage disposal was very primitive, particularly in rural districts. Pit privies
were common at homes and schools. Public water supplies were raw. Provincial
rural electrification had not been completed. Many schools and homes still used
kerosene lamps. Refrigerators were not in common use even in cities. Chlorina-
tion of water supplies, pasteurization of milk, improved sewage systems were
some of the community needs. Public health nurses tried to interest the public in
supporting the introduction of new preventive health measures. They talked of
the need for full time health services which would include a full time medical
health officer and a sanitarian. They tried to explain the need for more comprehensive health protection.
The First "Refresher Course"
The need to keep up to date was recognized when the first "Refresher Course"
 was held in 1923 on the campus of the University of British Columbia organized
by Miss Ethel Johns, the Director of the University Public Health Nursing
Program. It was arranged with the Provincial Board of Health as a three day
meeting to assist the public health nurses with their field programs and to
provide them with an opportunity to exchange ideas. As the first Refresher
Course was successful, similar courses were arranged annually until 1939. This
sty pe of educational program commenced again in 1941 under provincial auspices and was renamed "The Public Health Institute."
Dr. H. Esson Young Directs The Public Health Nursing Service
Dr. Young employed the first public health nurse in 1919 and continued
during his time to interview, accept or reject, and place public health nurses as
requested by the local health committees or school boards. As he was keenly
interested in how each public health nurse was progressing, he required a
monthly written report of her activities. He would frequently telephone for
clarification, and send back his comments. By the late thirties he was over
seventy-five years of age and found it increasingly difficult to keep up with the
greater numbers of public health nurses and the expanding work of the Provincial Board of Health. He began to plan for a public health nursing director to
take over the responsibilities of the nursing service.
The Need for a Public Health Nursing Director
About this time, public health nurses began to feel the need for assistance of a
public health nurse in an advisory position from the Provincial Board of Health.
Miss Madeline Putnam (Werts) wrote in the 1939 Bulletin "There is a need
for a generalized field supervisor to set standards and develop a uniform service." As can be imagined, each public health nurse set her own standards and
emphasized the areas she felt needed attention. Often she worked hardest at the
programs which she liked and from which she derived the most satisfaction,
sometimes limiting or not giving other services. For example, she could spend
most of her time with school children and have limited time for visiting new
babies. As the number of public health nurses grew, the need for more advice and
guidance from a nursing consultant on the staff of the Provincial Board of
Health became evident. By this time too, a nursing supervisor was advising the
public health nurses on the tuberculosis program and they were frequently
seeking help from various members of the nursing faculty at the University of
British Columbia. This was no longer sufficient and plans were in the making.
 Public Health Nursing Variations in the Thirties
As the thirties drew to a close, public health nursing service was available in
the province in a variety of ways. They included:
(1) Health centres, such Saanich and Cowichan, and Nursing Districts such as
Langford and Qualicum provided a generalized service including school,
home nursing and maternity services. This type of complete service was
confined to Vancouver Island.
(2) Public health nursing service — Most rural areas such as Kelowna Rural,
Nanaimo Rural, and Chilliwack District provided the generalized service
which included school nursing. Home nursing was on a short term and
demonstration basis.
(3) School health nursing service — provided in many larger cities and towns
such as Victoria, New Westminster, Kelowna, Penticton, Fernie, Nelson,
and Nanaimo.
(4) The Victorian Order of Nurses, a national organization, utilized provincial
grants to assist in financing a few branches where they provided generalized
health service in addition to their usual bedside nursing service at Oliver,
Gibsons and Westbank. In Victoria and in the Vancouver area they also
provided some infant health care.
(5) The Red Cross — public health nurses operated out of Out Post Hospitals,
and gave some community service in some areas where there was no resident
physician. In 1921 there were nurses at East Arrow Park, Waldo Malakwa,
Kamloops, Vanderhoof, Creston, Fort Fraser and Mt. Olie (North Thompson). They also supplied a home nursing service in New Westminster.
(6) Indian Health Service — The National Department of Health and Welfare
provided a generalized public health nursing service on the Indian reserves
of the province, (except for a small number served by provincial public
health nurses).
(7) The Vancouver Metropolitan Board of Health provided public health nursing service in its area, while the Victoria Order of Nurses provided the home
nursing service.
 The Forties — The War Years And Aftermath
I hrec major events brought the thirties to a close and affected the continued
development of public health and public health nursing in the forties.
I he first was the death in 1939 ol Dr. H. Lsson Young, the Secretary of the
Provincial Board of Health and Provincial Health Officer, altera distinguished
career in the health field for over thirty years. During his time he built the
foundation for public health and became known as the'Tather of public health in
British Columbia." Dr. Young was succeeded by his protege. Dr. Gregoiie 1 •'.
Amvot, who had set up the demonstration health unit in North Vancouver, and
returned from the American Public Health Association in the United States to
accept the appointment. Dr. Amyot was in agreement with Dr. Young's plans
which he proceeded to develop.
The second major event was the appointment of Miss Heather Kilpatrick as
the first Director of the Division of Public Health Nursing which had been
established in 1939.
The third major event was the Second World War which began in September,
1939, and stimulated the economy and the way of life in the province so that it
would be forever changed. With the war on, the depression was soon over.
Unemployment ceased as men and women joined the military services or worked
in war-related industries. The war provided not only financial relief for the needy
but also opportunities for many to learn new trades, to travel and become
exposed to life outside their own narrow villages, towns, and cities.
The war, too, affected public health nursing. As the war progressed, more
physicians joined the services and public health nurses were reminded that they
were the "home front," and expected to remain to help the civilian population. In
fact, in the early years of the war, recruiting officers gave a very low priority to
public health nurses so that very few made it into the military services. The
public health nurses manned the "home front," providing needed health services
for those left at home. As part of their war effort they increased the number of
home nursing and first aid courses to enable families to become more self reliant
in their new situation.
Population Growth in the Forties
During the forties, the population increased by 42%. The 1941 Census had
given the population as 818,000, and during the following decade it increased to
over a million (1.165,000). The greatest percentage population increase was in
the north and in the interior of the province. The Peace River increased by
67.2%, the Cariboo by 57.7%, and the Okanagan by 50%. The increase was due
to settlement brought about by improved and new roads as well as generally
improved transportation. This unprecedented population increase led to shortages of medical, nursing and other professionals to fill the need for service,
particularly in the outlying parts of the province. Training facilities in the
 Heather Kilpatrick, the first Director of Public Health Nursing — 1940
province were inadequate so that more and more persons from outside the
province had to be recruited to fill the need. This was true for public health
nurses as well as institutional nurses.
The First Public Health Nursing Director
Miss Heather Kilpatrick R.N., B.A., B.A.Sc. was appointed as the first
Director of Public Health Nursing in September, 1940. She proved to be an
excellent choice, as her quiet capable manner inspired confidence in her coworkers and the public health nurses. She was an experienced public health
nurse, having worked as a staff nurse and supervisor in the Cowichan Health
Centre at Duncan. A graduate of the degree program in Public Health Nursing
at the University of British Columbia, she had completed the post graduate
course in Administration and Supervision at the University of Toronto, as well
as a travelling fellowship in which she had studied a number of public health
 nursing programs in the United States. Her post graduate studies had been
sponsored by the Provincial Board of Health to help prepare her for this
important assignment. She was welcomed by the public health nurses!
The Division of Public Health Nursing Gets Under Way
Following her appointment. Miss Kilpatrick set about expanding public
health nursing services into new areas of the province. She met with interested
organizations such as local branches of the Women's Institute and school boards
to tell them how to go about organizing public health nursing districts. While she
was Director, ten new districts were established and a number of existing
districts extended to include new areas.
Another of her objectives was to expand existing school nursing services into
full community public health nursing services. As the Provincial Board of
Health had the authority to approve new public health nursing appointments,
no new school nurse appointments were approved. Currently employed school
nurses were encouraged to expand their program to include community services.
However, a certain amount ol resistance occurred. Most school nurses worked
the same hours as school teachers, but the latter had a shorter day and work
week, two months summer holidays, plus long Christmas and Easter vacations
while public health nurses were working six days a week, with fewer holidays.
However most school nurses gradually added preschool children to the immunization program and started some well baby clinics.
Miss Kilpatrick had reviewed the work of the public health nurses on field
visits, and believed that the time had come to shed some of the non-nursing
activities such as transporting sick children home from school, distributing
clothing to the poor, giving out free samples of vitamin pills etc. Also the number
of routine school inspections and weighings no longer seemed necessary as
nutrition and hygiene had generally improved.
The Provincial Board of Health had planned that the Director of Public
Health Nursing would administer the public health nursing service and that four
consultants would supervise and guide the work of the public health nurses in the
field. During the forties the goal of acquiring four consultants was not reached,
but by 1943 it was possible to appoint two excellent public health nursing
consultants. Miss Dorothy Tate (Slaughter) and Miss Helen Carpenter. Both
consultants had very good backgrounds of experience in public health nursing
plus additional University preparation in Administration and Supervision in
Public Health Nursing.
The Public Health Nursing Director and consultants visited the public health
nurses in their districts to learn at first hand about their problems and difficulties. Besides viewing the district, they usually met with the local public health
nursing board or committee members to discuss administrative matters. Discussions frequently centred on such items as transportation costs, who should
provide the nurse's car, office or clinic space, clarification of the role of the
 Residence and  office of Marjorie Staniforth      Marjorie Staniforth (Wisby), P.H.N. Progress,
(Wisby), P.H.N., at Progress in the Peace River      Peace River, home visiting — 1943
- 1942
Kelowna Public Health Nurse carries baby scales from clinic at Winfield Hall — 1941
 board, as well as policies with regard to specific programs such as the enforcement of the Communicable Disease Regulations, reporting of communicable
diseases etc. They were able to provide guidance and support to the public health
nurses and would refer special problems to appropriate members of the Provincial Board of Health. At that time there were very few agencies in British
Columbia which provided assistance to children with special physical or mental
problems. However the consultants were able to assist the public health nurses to
solve most of their local difficulties.
The addition of the two public health nursing consultants to the staff of the
Division of Public Health Nursing provided Miss Kilpatrick with more time for
administrative planning. At that time there were 41 public health nursing
positions in the provincial service.
Public Health Nursing News and Views
A monthly newsletter, "Public Health Nursing News and Views" was started
by Miss Kilpatrick in 1941 to provide a vehicle for the exchange of information
between public health nurses and to foster the feeling that all the nurses belonged
to a province-wide organizaticn in spite of the fact that many worked alone.
Besides items of educational and practical value inserted by its editors, there
were many interesting contributions from the public health nurses. Personal
news such as marriages, new appointments, new districts and resignations kept
the staff up to date. "News & Views" was a mimeographed bulletin which
replaced the earlier printed Bulletins established in the 1920 s. The Division of
Public Health Nursing edited and compiled the monthly publication until it was
taken over in 1950 by the Division of Health Education as a medium of
communication for all field staff. "Public Health News and Views," as it was
then renamed, was a most valuable publication which documented provincial
policy changes, introduced new record forms, reference material etc. It was
discontinued in 1976.
Travel in the Forties
By 1940, the public health nurse's use of the cars owned by the local health
committee or school board had become contentious. It was wartime, gas was
rationed and cars were not readily available for purchase. The nurses' cars were
sometimes seen being driven on the weekend and coming from their homes by
persons not familiar with the public health nurses' working hours. As there were
very few health centres or main offices, much of the public health nurse's work
was conducted from her home. Also "the car" was usually garaged by the public
health nurse for security reasons, and to save storage charges. Most of the public
health nurses would have preferred to drive their own cars for work but there
was no provision for this possibility. However by 1941 a new policy was
established which allowed the public health nurse to be paid a flat rate of $35.00
per month to drive a car for work. This new policy was a mixed blessing as it
 ! '  "": i*.-.-•■ ~ i>S.
Marjorie Staniforth (Wisby), P.H.N., on the
way to quarantine for mumps. Progress, Peace
River— 1942
Pauline Yaholnitsky, P.H.N.
worked well for a public health nurse in a compact district with good roads such
as Kelowna city, but not for the public health nurse with a spread out rural
district with poor roads, who could not break even because of engine failures,
need for more new tires etc. Also this policy worked against recruitment. Few
public health nurses could afford this luxury after completing a university
program. Also nurses were in short supply because of the war. By 1945 the policy
was again changed and the Provincial Board of Health began to supply cars to
the local districts.
One should not pass the forties without comment on some of the problems of
the day — cars, roads, and accommodation. As noted previously, in the early
days the public health nurses covered their districts on foot, by bicycle, rail, and
horse. In the forties as immunizations and other clinical programs expanded the
public health nurse needed more equipment with her to conduct her daily work.
This included the nursing bag, immunization supplies such as a portable stove,
gas for the stove, syringes, needles, pots for boiling, records, scales for weighing
babies etc. The public health nurse needed all these items when she set out on a
visit to one of her districts where she would visit a school, hold a clinic and make
some home visits all in one day. A car was a necessity. Contrary to common
belief that in the old days cars were better built, the fact is that cars were
generally unreliable, especially in bad weather, they shook apart, tires easily
became flat, and the ride was generally rough and uncomfortable. One could say
that the old style cars had some advantages, as Mrs. Bertha Thomson, public
health nurse at Keremeos discovered. She had been accustomed to fording the
 Similkameen River in an old beat-up car with a high clearance, and in 1942 when
it was finally replaced with a sleek new low-slung model, the smart new car
couldn't make it across the river and she had to go the long way around!
The main highways outside the lower mainland were mostly unpaved "wash
board." The local roads were very narrow dirt roads. Not only was the driving
rough but vision was obscured in summer by clouds of dust and flying gravel.
There were few service stations or public telephones so that when the car broke
down, or got stuck, the public health nurse was on her own. Farmers were kind
and were usually agreeable to getting a team of horses to pull the nurse's car out
of the mud. In the Cariboo and the North there was the dreaded "gumbo" of
spring break up and fall freeze up when roads were impassible. Ferries with
limited sailings crossed lakes and rivers which today have good bridges like those
at Nelson, Kelowna and over the Peace River.
Then, too, there were situations which required special ways of getting there.
For example Miss Pauline Siddons recounts how in 1952 she had to travel in an
ore bucket up Hedley Mountain to the top of the mine, and return later with the
ore bucket nearly full. She was always afraid they might dump the bucket before
she jumped off! Public health nurses grew accustomed to riding the "scooter"
over the rails when returning to Squamish from a visit to the Pemberton Valley.
In a few isolated districts the public health nurse was depended upon for
transportation in an emergency. For example:
mm        ;lf%.
Marjorie Staniforth (Wisby), P.H.N. Progress,
Peace River — 1943 "Gumbo"
Marjorie Staniforth (Wisby), P.H.N. Progress,
Peace River — 1943
 Miss Marjorie Staniforth (Wisby) located at Progress in the Peace River
recounts in 1943: "Just as I was about to get supper a call came through the
only phone in the district. It was an excited grandmother who said her
daughter was about to have a baby. I dashed to my cottage across the street
from the store where the phone was, grabbed the maternity outfit which I
had supplied myself with and kept in sterile bundles for such an emergency,
as I lived 23 miles from the nearest hospital. My district covered a large
area 20 to 40 miles in different directions. At night we had no phone
connection to any doctor, but I could be reached at any hour day or night.
Someone was a/ways in the store or their house which was attached had a
telephone extension and they would come over with a message. The roads
were very muddy with deep ruts. One had to be careful not to fall into them
as it was easy to break an axle. I covered the 15 miles as quickly as possible.
As I drove up, the grandmother stood there ringing her hands. I stopped
the car and called, "How often are they coming?" I had no idea if I had got
there on time, or if I could possibly take the patient 15 miles to the hospital.
The grandmother said, "Every three years!" I wondered why I had rushed.
Of course, she meant children, not pains. As it turned out, I was able to get
her to the hospital with the stork flapping its wings close behind."
Overnight accommodation was where you could find it. Miss Staniforth
relates how she travelled with the School Inspector and the Medical Health
Officer, Dr. J.A. Taylor to Moberly Lake in late January in 40 below (F.)
weather. They went as far as they could by car, then changed to horse and wagon
to cover the last 15 miles over frozen ground on a narrow road, spent the night in
an unused school where they built a fire, and slept in their outdoor clothes in
sleeping bags. In the morning they hiked back a mile to the Hudson Bay Post for
breakfast, then set up a clinic, which was attended by every family in the district.
Notice had come by "runner" the previous night. Providing public health
nursing throughout the various parts of the province required ingenuity and
Study Groups for Public Health Nurses
Miss Heather Kilpatrick encouraged the public health nurses from adjoining
districts to come together for monthly study sessions or group meetings. The
sessions were usually held on Saturday morning, which was part of the work
week, as the five-day week had not arrived. Pertinent public health topics were
discussed at these sessions. In the early days it was not possible for groups to be
formed in all areas because of the limited number of public health nurses and in
some instances the travel distance between districts was too great, being 100 or
more miles over poor roads.
 P.H.N.'s following a Study Group Meeting on Vancouver Island — 1948
However, the public health nurses on Vancouver Island and the Okanagan
and Kootenays met regularly. As the numbers of public health nurses increased,
more groups were formed. Usually they met in a central location, or they might
take turns visiting various districts. Working time was used for the meetings, and
personal time for the return trip home which was often a number of hours.
Favorable comment on the subjects and contributions of the following regional
groups was made by Miss Dorothy Tate in 1945 in her annual report.
Vancouver Island — Simplification of record forms
Fraser Valley — Revision of Prenatal Letters
East Kootenay — Simplification of Sanitation Problems
Okanagan — Special Reports
Peace River — Clarification of Personnel Policies and Educational Facilities.
Gradually as more health units were formed in the late 40 s and 50 s and more
public health nurses were employed, health units were able to form their own
study groups. The meetings were usually held in conjunction with the health unit
staff meeting when health unit policies and programs were discussed.
The study groups served a useful function, contributing to ongoing education,
assisting with the development of general policies, and also serving as a way of
keeping the public health nurses working well together.
 The Public Health Nursing Council
When the public health nurses attended the first Institute meetings in 1941 and
1942, there were rumblings of discontent about such matters as salary levels,
insufficient car allowances, lack of pension plans, etc. Miss Kilpatrick believed
that the best way to bring these matters to the attention of the Department was
through approved resolutions from the group. In this way individual nurses who
might raise problems at a general session would not be singled out as troublemakers or agitators. Therefore on April 22, 1943, at the Institute, a special
meeting of public health nurses was called, and chaired by Miss Isabel Louks
(Foster). At this meeting the Public Health Nursing Group was formed, with
Miss Alice Beattie elected as first chairman and Miss Joyce Leslie the first
secretary. At this meeting a representative committee was formed "to stimulate
discussion and draw up plans for future Institutes." Six members were elected to
represent the regions as follows:
Fraser Valley — Miss Dorothy Priestly for 16 public health nurses.
Okanagan Valley — Miss Lucille Giovando for 9 public health nurses.
East Kootenay — Mrs. Joanne Brewster for 4 public health nurses.
Peace River — Miss Marjorie Staniforth for 4 public health nurses.
Vancouver Island — Miss Alice Beattie for 16 public health nurses.
Cariboo — Miss Eileen Snowden for 2 public health nurses.
In all they represented 51 public health nurses. In 1944, the group became
known as the Public Health Nursing Council. Some of the early activities
included the circulation of professional journals and the organization of
regional "study groups." They submitted suggestions on the need for more
literature on immunizations, the need for procedure manuals, medical insurance, pension plans, travel allowances, etc.
A "Uniform Committee" was formed in 1945 representing all areas, advisory
to the Director. It met annually at Institute time, and generally conducted
business by correspondence.
In 1948, the first constitution and by-laws of the Public Health Nursing
Council were passed, and were amended in future years as the organization
developed. At first verbal reports from the regions were presented at the annual
meetings which were in time replaced by written reports. The regional representatives became "the Executive" which held a special meeting prior to the general
session. These were long meetings at which resolutions were deliberated well into
the night.
As problems concerning various record forms were frequently raised at Council meetings, a Public Health Nursing Records Committee was set up in 1950,
chaired by Miss Monica Frith, Director of Public Health Nursing, with representative public health nurses and Mr. John Doughty, Director of the Division
of Vital Statistics. The Committee met monthly to approve new records, revise
or delete others, and to establish the flow of records. The first meetings were held
in Abbotsford. As the Department grew and more records came into use this
committee was reorganized as the Provincial Records Committee in 1957.
 In 1947, when the public health nurses became civil servants they became part
of the Provincial Civil Service with its particular policies and regulations. These
did not always fit the situation of a public health nurse in the field. The Director
of Public Health Nursing made representation to the Civil Service Commission
on behalf of the public health nurses, particularly regarding matters such as
salaries, holidays, sick leave, etc. However, by 1950 the Civil Service Commission agreed that duly elected representatives of the majority of field public health
nurses could make representation in person and present "briefs" to them concerning matters within their jurisdiction. Accordingly at the 1951 Annual Public
Health Nursing Council meeting, the first Personnel Practices Committee was
elected consisting of Miss Mary Dunn (Manson), chairman, Miss Fern Primeau
and Miss Dorothy Priestly. A detailed brief was presented to the Chairman of
the Civil Service Commission to make him aware of the responsibilities of the
public health nurses and the need for higher pay. The continuing work of this
committee is shown later under "Negotiations and Bargaining."
In the fifties the public health nurses were trying to increase their knowledge,
and learn new skills but there was very little available in the way of short courses
or workshops offered by the University. The College system and "Continuing
Education" had not come into being in this province, so that the Public Health
Nursing Council decided to set up an "Education Committee" to assist the
members. The committee compiled literature on available programs, and in
1963-64 set up a correspondence"course in conjunction with the Institute program on "the Scientific Method in Public Health Nursing," with 131 public
health nurses participating (almost half). This was followed by other courses on
research, and "The Canadian Society". The Committees activities filled a great
need at the time.
The work of the Public Health Nursing Council met its objective of "promoting the professional development and welfare of the public health nurse" before
being discontinued in 1974 when the British Columbia Government Nurses
Union was formed. Much credit must go to the executive and committees, as
well as the presidents who guided its development. The presidents were:
1943-45 Miss Alice Beattie 1958-59 Mrs. Phyllis Piddington
1945-46 Miss Ann Murray (Quayle) 1959-60 Miss Lavinia Crane
1946-47 Miss Eva Moody 1960-61 Mrs. Anna Mason (Larson)
1947-49 Miss Dorothy Priestly 1961-63 Mrs. Florence Graham (Barbaree)
1949-50 Miss Aileen Bond 1963-64 Miss Kirsten Weber
1950-52 Miss Nan Kennedy 1964-66 Mrs. Frances Berry (Hobson)
1952-54 Mrs. Pat Kahr 1966-68 Mrs. Edith Fisher
1954-55 Mrs. Doreen Park (Gifford) 1968-70 Mrs. Diane Ouston
1955-56 Miss May Macartney 1970-72 Mrs. Sheri Wood
1956-58 Miss Joan Sutcliffe 1972-74 Mrs. Susan Frizzell
Ann   Murray  (Quayle),   Venereal   Disease
Epidemiology Worker — Nanaimo 1945
Public Health Nurses as Venereal Disease Epidemiology Workers
By 1945, Dr. Donald H. Williams, Director of the Division of Venereal
Disease Control located in Vancouver, realized that although the war was over
venereal diseases were still in epidemic proportions and likely to spread rapidly
throughout the province. Better follow up and treatment was needed outside
Vancouver. Local clinics were established for treatment in high incidence areas,
but the main effort was to be directed toward the prevention of new cases and the
treatment of known contacts. Accordingly, an experienced and capable public
health nurse, Miss Alice Beattie, was appointed to head up the field operation
from the Vancouver headquarters. At the same time three public health nurses
were made responsible for certain regions of the province. Miss Janet Kennedy
(Egger) covered the Okanagan and Kootenays; Miss Ann Murray (Quayle),
Vancouver Island; and Mrs. Nan Sewell, the Fraser Valley, The Vancouver area
was serviced by the clinic until 1947 when Miss Queenie Donaldson, public
health nurse, was appointed for the Vancouver Metropolitan Health Service.
The public health nursing epidemiology workers visited the health units and
nursing districts, reviewed the local venereal disease situation and assisted the
public health nurses to incorporate epidemiological methods into the follow up.
The program was successful and continued into the 1950's when health units
finally accepted full responsibility for venereal disease control.
Changes in the Public Health Nursing Division
In July, 1944, Miss Heather Kilpatrick resigned for an appointment to a war
relief agency — United Nations Relief and Rehabilitation Administration
(U.N.R.R.A.). She had accomplished a great deal in a short time and had "set
the stage" for a new director. She made a good start in organizing the public
health nurses into a unified provincial group. Communications with individual
public health nurses had improved through field visits, the Public Health Nurses'
News and Views, Study Groups, the Institute, and the Public Health Nursing
 Council. Many of her objectives had been accomplished and a general plan for
the future was established.
In September, 1944, Miss Helen Carpenter, Public Health Nursing Consultant, returned to Eastern Canada, and two provincial public health nurses who
had been enrolled in post graduate studies in health administration at Public
Health Schools in the United States under the sponsorship of the Provincial
Board of Health returned to fill the two Public Health Nursing Consultant
positions. They were: Mrs. Isabel Foster (Louks) R.N., B.A.Sc. (U.B.C.),
M.P.H. (Johns Hopkins), Miss Monica Frith (Green) R.N., B.A., B.A.Sc.
(U.B.C.), M.P.H. (University of Michigan)
The Second Director of Public Health Nursing
Miss Dorothy Tate (Slaughter) succeeded Miss Kilpatrick as Director of
Public Health Nursing in September, 1944. She had been a public health nursing
consultant for a year and was well prepared for the appointment. In addition to
her experience in public health nursing and tuberculosis, her academic qualifications included a B.A.Sc. from the University of British Columbia, and the M.A.
degree in Administration in Public Health from Columbia University. Miss Tate
carried on the general policies of her predecessor. In the 1945 Annual Report she
lists the following expectations: (1) a uniform salary schedule to be instituted for
all provincial public health nurses. At this time, on appointment, a basic salary
was suggested to the local employing board, which was usually acted upon.
However, some districts paid more, while some gave annual increases and others
Dorothy Tate (Slaughter), Second Director of Public Health Nursing — 1944
 did not. The proposed schedule was to start at $1380 per year or $115.00 per
month, and rise by $60.00 per year for four years when the salary would be $ 1620
per year. A further increment would take place at ten and twenty years. This new
schedule was an increase from the basic salary of $112.50 per month
which had been in effect for several years. It should be noted that this schedule
was somewhat similar to the teachers' schedule. The above plan did not in fact
come into effect as the "reorganization" discussed later provided a different
schedule. (2) a standard uniform had been selected by a nursing committee and a
grant of $20.00 was to be available to help purchase the uniform. (3) policy
manuals of approved written procedures would be started. (4) records to be
simplified and (5) as too few public health nurses had agreed to join a proposed
medical insurance plan, it could not be implemented.
Needless to say it was some time before all the objectives were reached.
However, the tuberculosis manual which appeared immediately was the first
major manual, and at the same time an "information kit" on venereal diseases
provided the public health nurses with an up-to-date guide on that subject. Miss
Dorothy Tate became Mrs Warren Slaughter and left in June, 1948 for Saudi
Arabia. Mrs. Slaughter had recognized the special problems of the public health
nurses and had tried to meet their requests. She was to return later to the staff of
Boundary Health Unit and to be appointed in 1955 as Public Health Nursing
Consultant working out of a new office which was to be established in
Ethel Fairbanks, P.H.N. Neighborhood clinic in a home — Duncan
 Public Health Nurses do Immunizations
During the early forties, renewed emphasis was placed on the need to protect
the public from contagious or communicable diseases, especially when there
were known preventive agents available such as vaccination for smallpox,
biologicals for diphtheria, typhoid, tetanus, whooping cough and scarlet fever.
Communicable diseases had not yet been controlled as indicated in the 1942
annual report which stated that there were 60 cases of diphtheria, 1,750 cases of
whooping cough, and 39 cases of typhoid fever (the population was under one
million). The best way to accomplish control was to attain and maintain a high
level of immunity in the community. A major target group was in the schools.
As physicians and part time health officers left for the war, the remaining
physicians had little time for preventive service and they were glad to pass
immunizations on to the public health nurses who then assumed responsibility
for planning and organizing clinics as well as giving the injections (five for scarlet
fever!). Policy guides were set up by the Provincial Board of Health. Picture the
scene — different from today.
The public health nurse has arrived at a rural school with all her equipment
transported in her car over a dusty unpaved road. The consent cards have been
collected and the children and teachers are ready. The equipment consists of an
electric hot plate if there is electricity or a coleman gas stove, preferably with two
burners plus two pots so that needles can be boiled on one and syringes on the
other. She has swabs, skin disinfectant, plus individual records for each child.
She sets up wherever there is a convenient space which may be in the back of the
classroom or a hall, or sometimes the teachers' lunch room, if there is one. She
boils her equipment fop 20 minutes in water which she may have had to bring
with her. She then proceeds with the injections, filling one syringe for a number
of injections, using a fresh sterile needle for each child. Later, special "Control
Syringes" were introduced which are supposed to prevent back leakage and five
injections are given per 5 cc syringe. Care must be taken to see that the correct
child receives the correct dosage and that it is recorded. Once back in her office
she is responsible for cleaning and repacking equipment. It was many years
before health offices received small portable sterilizers and some twenty years
later before sterile disposable equipment was made available.
However, the main point is that the public health nurses in the provincial
service were the first in Canada to actually do immunizations rather than just
organize and prepare for them to be done by a physician. The public health
nurses were well trained in preventive medicine, familiar with the materials used,
and were able to use their judgement in assessing the amount, time, and spacing
for biologicals. Very few problems arose out of the millions of biologicals
administered over the years. One of the great advantages was to make it possible
for small numbers of immunizations to be given in sparsely settled areas where it
was uneconomical for a physician to visit for this purpose. As a result, the public
health nurses were able to achieve a high level of community protection from
 most communicable diseases. In the health units organized at this time, the
medical directors continued to do immunizations, but gradually as their areas
extended, and their work loads increased, they too were glad to pass this task on
to the public health nurses. It should be noted that smallpox vaccinations by
public health nurses were not permitted until the late forties. Undoubtedly the
change in policy contributed to the world-wide fight against smallpox and the
eventual eradication of the disease.
Doris Carter, P.H.N., counsels mother in office of Health Centre — Nanaimo 1948
World War II is Over
With the war over in 1945, the province was ready for change. Public health
nursing districts had been established throughout the province so that ninety
percent of the population was receiving service. However, there still remained
many rural areas with small populations outside the established nursing
The need for expanded public health service had become evident, and yet by
1945, there were only six health units outside the metropolitan area of Greater
Vancouver, i.e. Saanich, South Okanagan, North Okanagan, Skeena, Central
Vancouver Island and the Peace River. Public health nurses continued to point
out the need for full time medical health officers, sanitary inspectors and clerical
 assistants. Another step in the reorganization of public health nursing service
was to take place before the goal of full time health units throughout the
province could be accomplished. A continuing shortage of qualified public
health nurses existed, and at the same time the demand for service was great in
newly-settled and growth areas. The population was increasing quickly and
spreading into the north and the interior.
The Department of Health and Welfare Formed — 1946
In 1946 "the Department of Health and Welfare Act" was passed, replacing
the Provincial Board of Health with the Department of Health and Welfare. Dr.
G. F. Amyot became the first Deputy Minister of Health. The Honorable George
Pearson was the first Minister, and so health was now officially represented in
the Cabinet.
At this time Dr. J.S. Cull continued as Director of the Division of Local
Health Services, and direct advisor to the Director of Public Health Nursing. In
1948 he was succeeded by Dr. J .A. Taylor, who had been a health unit director of
the Fraser Valley, Peace River, North Okanagan and Central Vancouver Island
Health Units. He was to hold this position for thirteen years and become Deputy
Minister from 1962-1972. Because of his extensive field experience and personal
qualifications, he was to be a great support to the Division of Public Health
Nursing in the coming years. By 1946 the Deputy Minister of Health had
delegated the major responsibility for the smooth running of the public health
nursing service to the Director of Public Health Nursing through the Director of
the Division of Local Health Services. However, he still depended upon the
Director of Public Health Nursing to advise him concerning general nursing
developments and changes and to represent the province in various provincial
health and nursing committees.
The Reorganization of the Public Health Nursing Service
In 1946, organizational changes in the Department of Education provided an
excellent opportunity for the Department of Health and Welfare to reorganize
the public health nursing service and to equalize local costs. At the same time
certain benefits could be made available to the public health nurses which would
attract staff to fill the many vacancies existing and anticipated in the future. Dr.
M. A. Cameron had recommended to the Department of Education that the 649
school districts be absorbed into 74 proposed school districts. Action was to be
taken on this recommendation. In many instances the proposed new school
districts contained the same schools as the public health nursing districts which
had been established to provide service over natural geographical areas. Some
city school districts were extended into the surrounding rural communities
which were not receiving public health nursing service. The Health Department
decided that the time was opportune to reorganize the public health nursing
districts to coincide with the new school districts.
 A study had shown that the local cost of public health nursing service varied
widely, from about eleven cents per capita in Saanich to sixty cents per capita in
the Skeena area. The higher cost was due mainly to higher transportation costs
brought on by greater distances between settlements and homes, poor roads,
higher gasoline costs, more overnight accommodation costs, etc. In addition
there was a lower population to support the cost. It was agreed that the local cost
should be the same throughout the province and that the rate would be set at
thirty cents per capita. At that time the total cost of the service was $1.00 per
capita. The cost was compared to the price of a package of cigarettes (25 cents).
Dr. Amyot expected Federal Health grants to compensate the Provincial
government for one third of the cost, so that the total cost would be split evenly
three ways, (ie) Federal, Provincial and Local.
Under this new plan most local communities would benefit from a reduced
cost, and the proposed benefits could lead to a stable staff situation. It was
proposed that the public health nurses become civil servants with a similar salary
scale throughout the province (except for the bonuses which all government
employees received in the northern interior). They would receive other benefits
not available under the existing set up such as a pension plan, workmen's
compensation coverage, sick leave, and most important, the ability to transfer
from one district to another without loss of accumulated benefits.
It was necessary for each school board in the provincial area to agree to the
proposed change. The Director of Public Health Nursing, Miss Dorothy Tate,
and the Public Health Nursing Consultant, Miss Monica Frith, travelled the
province to discuss the changes and obtain agreements from the school boards
before the changes could be implemented. During 1946-47 the change gradually
took place. Every school board was approached and subsequently agreed to the
new organizational structure.
The local areas agreed to provide office space for the public health nurse and
the Department of Health and Welfare agreed to provide transportation, salary,
and operating expenses. The total cost of the service was accepted by the
Department and the local cost of 30 cents per capita was billed back to the school
boards. It should be noted that at this time many schools and communities were
located in "unorganized" territory and that the only taxing authority that
covered organized municipalities, cities, villages and unorganized territory was
the local school board. The local school boards then collected the tax and
continued in an advisory capacity in the administration of the service. In some
locations the public health nursing advisory committees continued with their
function. However as time went on, without the stimulation of an annual fund
raising drive, many of the advisory committees became less active in community
public health issues. In the meantime health unit administration was increasing
and union boards of health were becoming viable.
The reorganization saw the closing of one of the chapters of public health
history as the Cowichan Health Centre was refinanced and absorbed into the
 Central Vancouver Island Health Unit. Mrs. Margaret Moss had been instrumental in establishing the centre in 1920, and in keeping the committee active for
a quarter of a century. The old building which had been office and residence was
ultimately abandoned. The office moved into a modern new health centre which
was named "The Margaret Moss Health Centre" to perpetuate her memory.
The Public Health Institute
"Continuing Education" had been recognized as a staff need, and in 1941 the
Public Health Nurses' Refresher Course was replaced by the "Institute" which
was set up for public health nurses, medical health officers and sanitarians.
During the first years the three day meeting was held during the Easter school
holidays at the Empress Hotel in Victoria. The philosophy was that all staff
should participate jointly in educational programs concerning new developments in public health in order to develop a team approach to public health
problems. The program was planned by Dr. Amyot, Dr. Cull, and Miss Kilpatrick, and presented at joint sessions, with time being allocated for separate
meetings for the various disciplines. This approach worked well when the staff
was small, and public health fairly new. Apart from the educational value and
the objectives of improved teamwork and morale, the meetings contributed to a
feeling that the staff belonged to an important organization. The public health
nurses realized that they were not working alone, and that there were similar if
not worse health problems in other districts. The cost of the Institute was shared
with the participants paying for their accommodation and meals while the
Provincial Board of Health paid for transportation and a banquet. The banquet
was the highlight of the social program, which featured baked Alaska, held on
high and lighted, as the waiters paraded into the ballroom at the Empress. For
the first fifteen years the staff from designated health units presented "skits"
generally satirizing their district work — some in operetta form. These were
great fun both in preparation and presentation. It would be best not to comment
too much on the "after the banquet" get togethers which, too, became a
As Dr. Amyot was highly regarded in the United States by public health
leaders, he was able to attract outstanding public health figures to the Institutes
as key speakers.
One of the highlights of the forties was the combined meetings of the Canadian Public Health Association and the Western Branch of the American Public
Health Association in Vancouver in 1948. Apart from the advantage which the
staff had in meeting with public health workers from the entire North West, it
provided Dr. Amyot with the opportunity to show off "his public health nurses"
of whom he was justly proud. At this time British Columbia had the best overall
coverage of public health nurses in the North West (94% of population). Mrs.
Slaughter (Tate) and Dr. Amyot arranged a great pageant when all the public
health nurses marched on to a stage in their new uniforms — winter, summer,
 Skit by Central Vancouver Island Health Unit at Institute banquet in the fifties. Florence Graham
(Barbaree), P.H.N., performing
and_ northern —to stand beneath the new British Columbia Public Health
Service Crest. The script which was read to honor the public health nurses
The March of Public Health in British Columbia
They march through rain and blizzard!
They journey over mountain and river!
They press on to the end of the road— those intrepid individuals — who
give personality and meaning to that intangible wealth of a nation —
Go north to the Peace! — Go East to the Kootenays —travel the length
and breadth of riotous British Columbia, and you'll encounter the colorful
threads of a web of wisdom — each strand an individual whose aspirations
are driving will, and striving, to the high purpose of bringing wealth to a
nation — the Public Health Nurse — serving British Columbia.
The march is not the sound of tramp, tramp, trampingfeet — nor is it the
throbbing roar of planes in the sky. It is the march of Spring — the beauty
of gentleness — the lovely tide of Nature's unhurried march of light and
The wealth of British Columbia — the Public Health Nursing service.
Who whips into action when unknown illness strikes a school child and
takes one life, two lives, six young British Columbian lives. Who directs
  sanitation engineering for canneries, camps, boom towns and ghost towns
where faulty disposal may endanger innocent British Columbian lives.
The Public Health Nurse is the tactile probe of a tremendous purpose
—clothed in the workaday title of the British Columbia Department of
Health. She is the link between those credulous individuals who comprise
the public, and the specialists who arm the department with knowledge
and skill.
You'll meet our Public Health Nurse in places where strong men do not
expect to see women — as on a precipitous road in the Public Health
District of Nelson — in Winter. There's sleet in the air. On the road, it has
turned to glare ice.
Why is our Public Health Nurse on this slippery mountain road?
She is going to visit the district.
Why should anybody visit a district country school on a winter day?
Last Fall the Doukhoubors burned down the school. Sessions are being
held in a tent — heated by an oil stove — lighted by hanging lamps. Thirty
children — crowded in the tent — sometimes too cold — sometimes too
hot — can develop an amazing amount of trouble in an amazingly short
time —trouble that causes many a heartache — many a night of watching a
child in fever.
Good ol' Public Health Nurse. Nobody knows WHY she does it but she
DOES it — over crooked mountain roads —by boat where there is no road
— by dogteam across white snowfields — and by courage when the only
road is through the heart of that resistant individual who — multiplied
many times — makes the slow-moving public.
The first Public Health Nurse appointed in British Columbia to the
generalized service was in Saanich. Nineteen nineteen was the year — and
the month — April. Spring was moving in the heart of the Legislators.
Within four years —four more nurses were added to the staff— year by
year, the staff has proved itself as the working front that bears the brunt of
contact with that persistant individual who argues that health is just a
gamble — you have it, or you don't.
Today, there are 240 Public Health Nurses in service throughout the
cities and rural areas of British Columbia — serving with the British
Columbia Public Health service — in the greater Vancouver and Victoria
area — with the Victorian Order of Nurses — and with industrial and
commercial industries.
Today — 94% of the population of British Columbia receives Public
Health Nursing service. The first University in the British Empire to offer a
course in public health nursing leading to a University degree was the
University of British Columbia.
These facts throw the bright light of accomplishment and high purpose
on British Columbia's achievements in Public Health.
  From the landing of Captain Cook at Nootka in 1778 up to the present
hour —far-sighted health officials have taken a prominent part in the
development of that priceless asset — Canadian Health — through the
development of our own British Columbia Health Service.
We pay tribute today to the women who continue to play dominant roles
in the development of British Columbia's Health Service.
The Public Health Nurse — the Mobile flexible force of the Public-
Health service — the spectacular?— Yes!— In the Cariboo we see a Public-
Health Nurse travelling on horseback — by canoe — stopping only to rest
in a deserted hunting cabin — pushing on to the logging camp, where a
woman — seriously ill, awaits.
In the Peace River — in Winter — we see the Public Health Nurse
clothed in colorful regalia, — parka — ski suit — sealskin boots —
travelling by air — by horse and sleigh — through blinding snow storms
—to Moberly Lake, where the Indians hopelessly caught by a diphtheria
outbreak await her help.
The commonplace? — Yes. Watch the Public Health Nurse — in her
smart blue uniform — moving quietly — deftly through the community
—in Summer — in Winter— in Fall and Spring. She is the point of contact
for maternal health — child hygiene — adult hygiene — for control of
communicable diseases —for sanitation — and for health education.
Behind the Public Health Nurse stretches an intricate organization
bearing the wisdom of centuries — the skill of science — and the enlightened purpose of men and women whose enterprise and devotion are
building a nation already wielding power and opinion in the councils of the
Behind her stands a triumph of democratic organization — the local
Health Unit — the local advisory Public Health Committee — the local
Health Officer and the profound resources of the administrative headquarters in Victoria and Vancouver.
The Public Health Nurse has won the right to wear British Columbia's
coat of arms. She wears it lightly, debonairly, as the gold and silver spur
that mingles the depth of British Columbia's glorious motto — with the
breadth of the Public Health Nurse's day-by-day endeavour.
"Splendor sine occasu" — Magnificence without intention. The artless
beauty of nature — the ramparts of the snowclad Rockies — the Majesty
of the Cascades — the endless forests of green — the blue of mountain
lakes — where no man's foot has ever trod. These are the symbols of the
unseen service of the Public Health Nurse — the quiet word of confidence
spoken to a lonely woman —frightened by the approach of physical events
beyond her ken — the happy words spoken to a mother watching over her
child — the healing word of inspiration — spoken to a broken soul.
Joined with this noble crest is another symbol — the ancient sign of
 service —the winged staff of Mercury — instant and without delay.
High symbolism, to match noble intention — a badge for the brave — to
be worn with pride through danger and beyond — breathing into it the
shining light of magnificence without intention — "splendor sine occasu".
This — the insignia of the British Columbia Public Health Service.
SALUTEthe advance guard — who carry health to our province — who
symbolize the Canada of tradition — in the Pacific North West — the
Public Health Nurse serving British Columbia.
The Public Health Nurses' Uniform Insignia
The British Columbia Public Health Nursing Service Crest was designed by
Inspector Karl Ledeaux, an eminent member of the British Columbia Provincial
Police which no longer exists. The "Crest" consists of a crown to represent the
Monarchy, followed by the flag of British Columbia, and the caduceus which
consists of two snakes representing healing, coiled around a winged wand or
staff. The latter represents an ancient herald's wand as carried by the messenger
god Hermes or Mercury. This symbol is frequently used to represent medicine or
health. In this crest it represented the educational or teaching aspects of health
care. Balancing the symbols was the inscription "B.C. PUBLIC HEALTH
Although the crest was initially designed for the public health nurses' uniform
it gradually became the official "logo" and was used on all literature and
correspondence from the Health Department for about thirty years. The health
unit director and public health inspectors for many years wore small silver
insignia lapel pins as part of their official identification. The crest has many
pleasant memories. It was first introduced in the 1948 pageant at the Western
Branch meeting of the American Public Health Association and the Canadian
Public Health Association. It was also part of the silver spoons awarded to
public health nurses on retirement with long service records.
Public Health Nurses' Uniforms of the Forties
In the early forties Miss H. Kilpatrick tried to introduce a standard uniform but
because of the war was unsuccessful in securing suitable material. At this time the
public health nurses wore a kind of uniform which was a blue shirtwaist-style
dress, similar to earlier styles with stiff white celluloid collars and cuffs. Each
nurse chose her own style and material.
By 1944, on the recommendation of a committee of nurses, a standard
uniform was introduced. It was a tailored, made-to-measure bright navy blue
suit, with a white shirtwaist blouse worn with collar and lapels over the jacket.
The colored embroidered crest introduced in 1948 was worn on the left sleeve of
the jacket, which closed with three brass insignia buttons. The style and somewhat formal aspect of the uniform was much in vogue after the war. This suit
continued for many years, and was adapted to style changes, as skirts and jackets
 lengthened and shortened according to the current fashion.
A navy blue gabardine greatcoat was worn in cold weather (with zip-in lining),
and in extremely cold weather as in the North, public health nurses wore ski
pants and parkas as indicated.
In summer the uniform was a robin's egg blue sharkskin American Golfer
dress. This was a smart shirt waist style, and washable. A silver brooch with crest
was worn at the neck. All crests and pins were on loan from the Department.
The public health nurses were generally happy with their smart distinctive
appearance. They were easily recognized and their uniform proved to be an
advantage in providing an easy entry into homes, when travelling alone, when
the car broke down, or if someone had a message for the public health nurse.
Children always recognized the public health nurse and waved to her as she went
by! The R.C.M.P. could be aware of her travels and be ready to assist in an
The First Organized Home Care Program — 1947
The organized "Home Care" program was not entirely new to the province
when it was introduced in 1947, as bedside nursing in the home had been part of
the public health nurses' work since they were first employed in Saanich and
Cowichan. However, as time went on, more hospital beds became available and
the demand decreased. This was evident when the Metropolitan Life Insurance
Company discontinued home nursing coverage as part of their policy in the early
As the work of the public health nurses changed and new programs were
developed, home nursing care was given only on a short term or demonstration
basis. The public health nurse would visit a home and teach someone in the home
how to give the needed care. She would return as often as needed to supervise the
care given and to help the family. Acutely ill patients were sent to hospital.
In 1947, the South Okanagan Health Unit planned to introduce home nursing
in an organized or continuous manner as part of their service, and at the same
time get a homemaker service started. It was found that one of the most urgent
needs for many persons ill at home, was for homemaker or housekeeping service.
There was need for someone to do simple home routines, get meals, and perhaps
provide personal care similar to that which a relative would give a sick person.
Some professional nursing care was needed especially for chronically ill persons.
The Kelowna area agreed to set up a homemaker service and the Health
Department agreed to provide nursing service. Additional part time nurses
would be employed for holidays and the weekends. During the week the public
health nurses would provide the care and their districts would be reduced if they
had a heavy load of home nursing. Public health nurses would continue the
policy of teaching the patient to be as self-reliant as possible with the expectation
that care could eventually be discontinued. As this project was experimental, no
charge was made locally for the home nursing service.
 Prior to setting up the service, consideration had been given to the possibility
of bringing in another agency such as the Victorian Order of Nurses for this
service. However it was agreed that it would be preferable to have the existing
health service set up the program thus avoiding duplication of administration
and keeping costs at a minimum.
Miss Alice Beattie, Nursing Supervisor of the Division of Venereal Disease
Control was seconded for three months to get the program started. It was proved
that it was possible for a health unit to add a home care program with additional
staff. With the homemaker service established at the same time under the city of
Kelowna Welfare Department this program provided the basis for further
developments at a later date in the home care service.
The Third Director of Public Health Nursing
Following her marriage Mrs. Dorothy Slaughter (Tate) left in June, 1948, to
be succeeded by Miss Monica Frith (Green) who had been Public Health
Nursing Consultant for almost four years. Miss Margaret Campbell (Jackson)
who had joined the Division in 1948 was appointed to the consultant position.
She had been a staff nurse at Abbotsford and Kamloops and senior nurse in the
Kamloops-Lillooet-Ashcroft area. She joined the Division as a Supervisor, and
on her return from the University of Michigan where she completed the M.P.H.
degree she was appointed Assistant Director.
vlonica Frith (Green), third Director of Public     Margaret Campbell (Jackson), Assistant Direc-
Kealth Nursing on a visit to Vanderhoof — 1948     tor of Public Health Nursing — 1948
 The Great Flood of 1948
In the spring of 1948, the snow on the mountains with rivers flowing into the
Pacific Ocean was greater than usual, and had an abnormally high water
content. During the early part of May, while British Columbia hosted the joint
annual meetings of the Canadian Public Health Association and the Western
Branch of the American Public Health Association in Vancouver, the weather
was glorious, sunny and warm. As the public health staff returned home the
unseasonably hot weather continued, while the level of the rivers rose, and the
Fraser River quickly reached flood level. Before dykes could be strengthened,
water seeped through the banks spilling into the Fraser Valley as it had never
done before, inundating farmlands, homes, villages and towns. Land communication to the interior was cut when roads were covered with water in the worst
flood in recorded history.
At that time there were no health units in the Fraser Valley, although the
region was completely staffed with public health nurses who served their districts. The government declared an emergency, and appointed Dr. George F.
Elliot, Provincial Health Officer to represent the Health Department on the B.C.
Flood Control Committee, and to organize additional health services as indicated. Miss Margaret Campbell from the Public Health Nursing Division was
assigned to Abbotsford, where the main activities of the Committee were located
and was made responsible for co-ordinating the public health nursing services in
the Fraser Valley.
The public health nurses automatically set about helping flood victims as their
areas became involved by providing information about such matters as food and
water safety, sanitation, first aid, etc. Some nurses had to use boats to check the
condition and administer health care or advice to people who refused to leave
their homes. Miss Betty Pickard (Bradley), a public health nurse, was a key
figure in helping the people in the Agassiz district. It had been decided that
typhoid fever was a threat, and that typhoid immunizations should be commenced. Accordingly, clinics were set up quickly to protect the residents and
workers on the dykes. Over 35,000 persons were completely protected by three
individual injections, while many thousands more received a booster dose, or an
incomplete series. Besides organizing and manning the clinics, public health
nurses supervised the evacuation centres set up in the wartime Air Force base at
The use of the public health nursing staff during this emergency demonstrated
the advantage of the "reorganized" system whereby all public health nurses were
centrally employed and it was possible to deploy staff as needed. Public health
nurses from districts not involved, such as Gibson's, volunteered to supplement
the staff in the Valley.
Although most of the flood damage was in the Fraser Valley, places such as
Trail on the Columbia River also had extensive flooding, while other centres had
only minor problems.
 Once again the public health nurses were commended for their dedication,
hard work, and long hours (no overtime compensation). No flood borne disease
occurred. This was due largely to the services of the public health nurses, the
sanitary inspectors, and to the general public health measures instituted as well
as the co-operation of the public.
What the Generalized Public Health Nurse Did in the Forties
The Director of Public Health Nursing, Miss Monica Frith, outlined in her
1948 report the activities of the average public health nurse as follows:
— Serves a population of around 5,000 people. Usually lives in the largest
community and travels 20-50 miles to serve the adjacent rural area.
— Supervises the health of around 1,000 school children usually at 2 large and 8
one or two-room schools. During routine school visits she organizes and
assists with school medical examinations. She inspects children not seen by
the doctor, and visits the children's homes to explain physical or behavioral
difficulties to parents. She advises on the lunch program, helps the teacher
with classroom instruction on health matters, provides the latest information
and watches over the environment and sanitation of the school. She watches
for communicable or skin diseases. She keeps immunizations up to date, and
routinely does vision and hearing screening.
— Supervises about 20 persons with tuberculosis, their families and contacts.
— Organizes and conducts about 5 child health conferences (formerly Baby
Margaret Latimer, P.H.N., inspects school children at Cowichan Lake School in the 40 s
 Clinics) with an average attendance of 15-20 infants and preschool children
per month.
— Makes numerous home visits for infant supervision particularly in areas
where scattered populations make clinics or child health conferences
— Organizes and conducts immunization clinics available to all.
— Conducts health teaching both for groups and individuals on general health
practices stressing diet, personal care, home sanitation, etc.
— Home nursing on short term basis, plus demonstrations of procedures to
teach family members home care.
— Provides general health service to persons living on certain Indian Reserves.
— Selected public health nurses provide field experience of two weeks or a
month for nurses from the University of British Columbia Nursing program.
— Selected public health nurses provide short field experience in public health
nursing for undergraduate students from hospital schools of nursing, (i.e.)
Royal Inland, Kamloops; St. Eugene, Cranbrook; Royal Columbian, New
Westminster; St. Joseph's, Victoria.
— Other special activities (i.e. flood, mobile clinics, etc.) as indicated.
In 1948, 94% of the people in the province had public health nursing service
available to them.
Public Health Nursing Service on Selected Indian Reserves
Public health nurses serving with the Department of National Health and
Gladys Skinner (Piket) P.H.N., Fort St. John, visits Halfway Reserve — 1942
 Welfare were located in various parts of the province to provide public health
nursing service to Indians living on Indian reserves. However, some small
reserves were in or adjacent to districts served by provincial public health nurses.
As it seemed very inefficient for the Indian Health Services' public health nurses
to travel long distances for a few people when there was a provincial public
health nurse nearby, arrangements were made for the provincial nurses to
provide service in this situation for certain reserves. The Health Department
received payment at the rate of $1.25 per year, for each registered Indian
belonging to the reserve. In the late thirties this plan was in effect on Vancouver
Island at Nanaimo and Alberni Canal, in the Okanagan at Penticton, Oliver,
and Keremeos, in the East Kootenays at Cranbrook, Creston and Tobacco
Plains, and at Lillooet in the Fraser Canyon. As time went on and more
provincial public nurses were added, more reserves were taken over. The plan
worked well, as public health nurses carried out a preventive health service on
the reserves through special clinics and home visits. The public health nurses
from the Provincial and Federal agencies exchanged pertinent information and
often completed projects together.
Tuberculosis Field Nursing
Tuberculosis continued as a major health problem in the forties and remained
the fourth leading cause of death until 1948. In 1942 there were 527 deaths, in
1946 there were 575. Tuberculosis hospitalization, treatment and prevention
costs utilized the major portion of the health budget. However, determined
efforts were being made to control this disease. By 1948 mobile X-ray vans were
added, to travel throughout the province in an attempt to X-ray everyone. The
Christmas Seal organization partly sponsored this service and assisted with the
organization. As could be expected the success of the venture depended upon the
local public health nurses and the health units. Everything else stopped when the
mobile X-ray van arrived and everyone worked full out to get everyone X-rayed.
This effort to find tuberculosis cases, and then treat them with new drugs finally
paid off, as the tuberculosis death rate began to drop by the end of the forties.
First Time Study and Case Load Analysis — 1948
The first time study and case load analysis was carried out by the public health
nurses in 1948 as set up by Miss Lyle Creelman. She had just returned from
U.N.R.R.A. (United Nations Relief and Rehabilitation Association) where she
had been administrator of nursing activities for the British zone in Germany. She
was the former Director of Public Health Nursing for the Vancouver Metropolitan Health Committee and had some time available while waiting for her
appointment as the Director of Nursing for the World Health Organization.
(She too was a graduate of the B.A.Sc. program from the University of British
Columbia and also held a Master's degree from Columbia University). She
agreed in the interval to look into the administration of the provincial public
 health nursing service. To do this she had each nurse complete a case load
analysis and a detailed time study. These studies provided valuable objective
data on which service needs could be assessed along with other pertinent
information. As a result of this first study, Miss Creelman concluded that the
public health nurses were spending too much time on non-professional clerical
work and recommended that clerical time be made available to them. In subsequent years, similar studies with appropriate modifications were used to measure particular programs.
Federal Health Grants Assist the Development of the Public
Health Nursing Service
1948 marked the year that the Federal Government through the Department
of Health and Welfare recognized the need to improve health services in the
provinces and made funds available for this purpose. British Columbia was
given a two and a half million dollar grant to be used to set up new health
services, to expand existing services and to train health professionals. Specific
grants were available for certain services such as general public health, hospital
construction, mental health, tuberculosis, professional training, research etc. A
complicated formula for each grant was established. It is noteworthy that 35
cents per capita was available in the general public health grant rising to 50 cents
per capita in eight years. Projects for the use of the funds had to be approved
provincially and federally before any money could be spent.
In the first year of the grants, nine new public health nursing positions were
added, an internship plan was established to qualify nurses for public health
nursing and an educational program was set up for supervisory public health
nurses. New equipment was made available for the use of the public health
nurses such as movie projectors, slide machines, audiometers, new films and
reference texts for local public health libraries. Over the years the grants made
new information and technology available to be used for community health
Some Factors Creating Nursing Changes in the Late Forties
In 1948, the Hospital Insurance Act was passed which made hospital care
available to all residents of the province. A small co-insurance of one dollar a
day was charged while in hospital and the monthly premium which was set
initially was removed by 1952. The provision of hospital care for everyone
changed the structure of care in the province. No longer were patients either
"pay" or "non-pay". The non-pay patients had for many years received care from
appointed physicians and interns. Now everyone would be admitted as a "first
class patient."
Also new antibiotics came on the market as the "sulpha" drugs were introduced to combat infection. Acute infections became controllable for the first
time. Scarlet fever immunizations were discontinued in favor of drug therapy.
 Many new drugs would follow so that patient care changed drastically. New
drugs effectively treated gonorrhoea and syphilis and reduced the infectious
Also early ambulation got under way. Up to this time a simple appendectomy
kept a patient in hospital 14 days and in bed until just before discharge. The same
was true for a maternity patient.
These changes altered the picture of both hospital care and treatment of
patients at home.
The Need for More Local Public Health Nursing Supervision
The need for more local or close at hand supervisory assistance and guidance
for public health nurses emerged in the mid-forties. In the early years each public
health nurse had been responsible for the program in her own district. She
usually worked alone except in a few larger centres such as Saanich and Cowichan where several nurses were located. However, as the population of the
province grew, so did the number of public health nurses and more two or three
nurse districts were established. In multiple nurse districts, one of the public
health nurses, usually the most experienced nurse or the nurse who had been
there longest was considered the senior and saw that the office ran smoothly.
However, she did not officially direct or oversee the work of the other public
health nurses, and the individual programs could vary. The transient population, characteristic of British Columbia, began to expect a uniformity of service
as they moved around the province, and complained when they did not find the
same public health nursing service in another community, e.g. "Why were there
no prenatal classes?" Also as new districts were formed, health unit directors
wanted to establish more uniformity of program within their units. It was
generally believed that this could be accomplished best by having a supervisory
nurse who could visit the branch or district offices and help the public health
nurses adjust their programs, when necessary, to fit into established health unit
The Division of Public Health Nursing believed that a basic minimum generalized service should be available to all persons within the province, and that this
could best be accomplished by providing leadership and supervisory assistance.
The first start had been made in 1942 when Miss Heather Kilpatrick and Miss
Fyvie Young (U.B.C. Instructor in Public Health Nursing and Dr. H.E. Young's
daughter) arranged for Miss Kathleen Leahy from the University of Washington
in Seattle to give a five day course for potential supervisors at the University of
British Columbia. It was recognized that a different educational background
was necessary for this type of position.
The Plan for Local Supervision and First Appointments
By 1948 a plan was devised to provide more local supervision for public health
nurses. The need was accentuated by the ever increasing local demand for more
 public health nurses, and the lack of qualified and experienced nurses to meet the
requests. With the war over, road building began again and more people moved
to the province and especially to the north and central interior. The need for
more public health nurses was easy to forecast!
The idea of more supervisory help was welcomed by some public health
nurses, especially the recent graduates who made up over half of the provincial
staff. However there remained a large group who had enjoyed the freedom to
plan their work and conduct it according to their judgement and who did not like
the idea. It was agreed by the Division of Public Health Nursing that supervision
would be introduced on a local level in such a way that the standard of service
would remain high and that every effort would be made to allow the public
health nurses the opportunity to use their initiative as they had done in the past.
This would be brought about by developing supervisory nurses who showed
talent for this type of work and in addition had assistance through special
Dorothy Priestly, P.H.N. Supervisor, Central Vancouver Island Health Unit on retirement — 1965
The first public health nursing supervisor to be appointed locally was Miss
Dorothy Priestly in 1947. She was a former hospital supervisor who had opened
the Prince Rupert Nursing District in 1937, and served in the Chilliwack and
 Duncan nursing districts. She was appointed to the Central Vancouver Island
Health Unit which had expanded to include the Cowichan Health Centre area
with a total complement of eleven public health nurses located in six centres.
Miss Priestly continued as supervisor in the Health Unit until her retirement in
February, 1965. She was noted as a competent supervisor and gracious lady. Her
influence was such that many of her young public health nurses eventually went
on to senior and supervisory positions. She also made an outstanding contribution in helping to design health centres which would make the work of the public
health nurses efficient and convenient for the public.
Later in 1947 Mrs. Pauline Yaholnitsky was appointed Regional Supervisor
of the three northern units — Peace River, Cariboo and Skeena. She too was an
experienced public nurse, who had opened the Rolla district in the Peace River
in 1935 and Quesnel, in the Cariboo, in 1940. In 1944 she was the first public
health nurse to be appointed Acting Director of the Peace River Unit, a position
Pauline Yaholnitsky, P.H.N. Supervisor of the Northern Interior Region. Anne Wiens, P.H.N.
— Quesnel, 1956
 which she held for three years. In addition to the public health nursing course,
Mrs. Yaholnitsky had completed a special program in Public Health Nursing
Administration at McGill University. She became a well known, popular and
historic figure in the north as she made her rounds assisting the public health
nurses with their work. She was known not only for her able organizational
ability but also as an expert sportswoman. She always created quite a stir when
she appeared at the Institute with her fashionable and elegant hats. Mrs. Yaholnitsky, or "Yoho" as she was known, served as Regional Supervisor until she
retired in 1957.
Two more regional supervisors were appointed pending a time when full time
supervisors would be required in each district. Miss Mary Dunn, a well qualified
public health nurse who had completed a Master's program in administration
from Columbia University was appointed in September 1948, to the Saanich and
South Vancouver Island Health Unit and in addition covered the Gibson's and
Howe Sound Nursing Districts. Eventually her services were limited to the
Health Unit when the number of nursing staff increased. Miss Dunn remained
until 1959 when she left for Rhodesia to become Mrs. John Manson. In 1951
Miss Margaret Cammaert was appointed as regional supervisor for the Koote-
nays. These appointments marked the beginning of the new local supervisory
program for the public health nursing service.
The Criteria for Supervisory Positions
General criteria were established in the late forties to help determine the
number of supervisory positions required. The plan recommended at that time
by the National Organization of Public Health Nursing of the United States was
adopted for use. It stated that one full time supervisor was required for eight to
ten public health nurses. Where there were fewer, a senior nurse was appointed
who also carried a smaller district than a staff public health nurse. The size of her
district depended upon the number of nurses being supervised. This system was
suitable for the provincial service where there were many small centres some
distance from each other. The above criteria worked well for many years.
Professional Training Plan for Supervisory Nurses
The new Federal Health grants were designed to assist in professional training
in order to up grade general health services. Projects for long and short term
training were approved in 1948, and it was therefore possible to begin a plan for
the orderly introduction of public health nursing supervision to the service and
to provide candidates with the educational background needed to carry out their
special responsibilities.
The short term project began with a short course for nineteen potential and
supervisor nurses in 1948 in Victoria, in an old unused building near the Parliament Buildings. Miss Marion Murphy, Professor from the University of Michigan, and a former Supervisor and Consultant Public Health Nurse gave a two
 P.H.N.'s attending the first Supervisory Course for Public Health Nurses in Victoria
week condensed version of the university course in supervision and returned for a
two week follow up the next year. The public health nurses attending began to
understand their changed role and as a result set about their new tasks with more
enthusiasm and understanding. It should be noted that at that time there was no
one in Canada with comparable background to conduct the course. The University of British Columbia was still concentrating on the basic program. This first
supervisors' course provided a good introduction to administration and supervision for those who were proceeding for additional education. It also had the
advantage of the group getting to know one another. The following public health
nurses attended Miss Marion Murphy's course in 1948:
Miss Joan Appleton, Summerland; Miss Doris Carter, Vernon; Miss Margaret Campbell, Victoria; Miss Margaret Cammaert, Trail; Miss Mary Dunn,
Saanich; Miss Betty Elliot, Coquitlam; Miss Monica Frith, Victoria; Miss Freda
Hilton, Cranbrook; Miss Nan Kennedy, Chilliwack; Miss Eva Moody, Courte-
nay; Miss Janet Pallister, Surrey; Miss Dorothy Priestly, Nanaimo; Miss
Dorothy Paulin, Victoria; Miss Fern Primeau, Vancouver; Miss Marjorie Staniforth, Dawson Creek; Mrs. Madeline Werts, Kelowna; Miss Barbara Smith,
Delta; Mrs. Pauline Yaholnitsky, Quesnel.
The long-term project consisted of two bursaries per year for two suitable
supervisory nurses to complete an academic year of post graduate training in
administration and supervision as related to public health nursing. The candidate was to be a member of the field staff showing potential for this type of work.
 The candidate remained on full salary, received tuition fees, a small book
allowance, and the necessary travel expenses. A return in service of three times
the length of the course was required.
At this time diploma programs were available in administration for public
health nurses at McGill University and the University of Toronto. Public health
nurses with a baccalaureate degree generally preferred to enroll in a Master's
Public Health Course available to them only in Public Health Schools in the
United States.
The first senior nurses to accept bursaries to include administration and
supervision were Miss Barbara Smith who enrolled in the University of Toronto
program, and Miss Margaret Campbell who attended the University of Michigan. Miss Smith was to remain on staff for 32 more years as she retired in 1980
with 37 years of experience. Miss Campbell remained until 1954.
Over the years the two annual bursaries were to provide opportunities for
further education for all supervisory public health nurses as the number of
bursaries kept pace with the appointment of supervisory and consultant public
health nurses.
Continuing Shortage of Public Health Nurses Spawns
the Internship Training Plan
After the war, in 1946, a large number of nursing sisters qualified as public
health nurses using their discharge credits, and filled many of the existing
vacancies. Thereafter, a shortage continued of public health nurses to meet the
demand. The reorganization of the public health nursing service in 1947 created
a need for many new positions. A number of districts were enlarged, as in Nelson
where there had been one public health nurse and another was now required as a
large rural area had been added to the district.
In 1948, the public health nursing trainee or internship plan was set up to meet
the need for more qualified public health nurses. It called for the temporary
employment of suitable registered nurses to work in the public health field for a
short time. They were placed in carefully selected districts under the close
supervision of a qualified public health nurse, who first arranged a planned
orientation course which permitted the nurse to assume limited responsibilities
for a small public health nursing district. The registered nurse must have
indicated that she intended to enroll in a recognized course in public health
nursing after a limited period of experience. If the nurse was not suitable for
public health nursing she resigned. Federal Health Grants were made available
to the trainees while attending University amounting to $100.00 per month
stipend, a $25.00 book allowance plus tuition fees. In exchange the nurse agreed
to work for a period of two years after completing the course. Ten bursaries per
year were made available for ten years, then increased to 15 for another decade.
The plan continued for over twenty years with minor adjustments in the benefits,
.and over 225 registered nurses qualified for public health nursing. The few
 trainees who failed to fully complete their work commitment repaid their
financial obligations. During the latter part of the sixties fewer nurses took
advantage of the bursaries although many benefited from the field experience.
The program proved to be worthwhile both to the nurses and the Department.
One of the many advantages to the service was the establishment of a pool of
public health nurses with good field experience being available to open up new
districts after they completed their university program. Without this group of
qualified public health nurses the service would not have been able to expand
and maintain a good level of service throughout the province. Many of the
nurses initially received a diploma or certificate in public health nursing were
able to utilize their university credits when they returned at a later date to
complete a degree program in nursing.
The Hamilton Report — 1949
Public health nursing in the 40's closed with a favorable report made by Miss
Lucile Petry, Assistant Surgeon General, United States Public Health Service,
in 1949 as part of her contribution to the James A. Hamilton and Associates
Report on Hospital Services in British Columbia. In her report Miss Petry
states: "The Health Branch of the Department of Health and Welfare has an
exceedingly well conceived plan for public health nursing services in the province, and has succeeded in implementing the plan extensively. The combination
of local and provincial financing and design of program bring sound planning
and operation. The fact that the Provincial Health Service is often first on the
scene and aims at a comprehensive service should avoid the complications found
elsewhere, where two or more services with slightly different functions must later
go through the difficult stages of co-ordination and final integration. ... the
desirable trend towards generalization of public health nursing service is well
advanced here.... the nurses are generally well prepared and receive expert and
dynamic leadership. A stimulating permissive atmosphere pervades the service,
and co-operative planning is evident both among nurses themselves and between
nursing service and administration."
The forties created many changes which built a firm foundation for growth,
and the future seemed bright as the worth of preventive services had been
 The Fantastic Fifties And
Their Influence On Public Health Nursing
The decade of the fifties was another period of change as the economy
gradually picked up due to new construction, road building, industrial and other
developments which had lagged behind during the war. The interior of the
province opened up with easier access from the coast due to new roads, airlines,
ferries, and the reactivated Pacific Great Eastern Railway (now British Columbia Railway) to the interior. Prosperity once more seemed on its way.
The population gradually increased both from immigration and a new high
birthrate much above the depression level of 13/14 to 25/26 per 100,000. The
greatest percentage increase was in the Peace River, Northern Interior, Cariboo
and Okanagan. Another trend was apparent as the over 60 age group was
increasing twice as fast as in the rest of Canada. The affluent society had arrived.
It was a good time generally, as production stepped up, prices remained relatively stable, jobs were plentiful, and the unemployed were relatively well cared
for by the government.
There were fewer young people coming into the labor force because of the low
birth rate during the depression. As a result.there was a continuous shortage of
nurses and especially of public health nurses. Those who graduated had their
choice of positions both in and outside the province. The Public Health Nursing
Division was able to fill positions only because of the public health nursing
trainee program and because it was possible to recruit 50 percent of the new staff
from outside the province. The British Columbia Public Health Service was
becoming known as a good agency. In spite of the drawbacks, the number of
public health nurses in the province just about doubled over the decade as new
districts were set up and existing services expanded to meet the population
increase which was about 25 percent.
By 1959 there were 449 public health nurses employed in public health nursing
in British Columbia as follows:
191 — Provincial Service
152 — Metropolitan Health Committee of Greater Vancouver
8 — New Westminster City (part of Simon Fraser Health Unit)
15 — Victoria City, Esquimalt, Oak Bay Health Departments
24 — Indian Health Service - Federal Government
59 — Victorian Order Of Nurses
How Programs Changed
During this period there were scientiic and medical discoveries which altered
the public health nursing service to fit with the changing concepts of the
treatment and prevention of disease and the promotion of positive health. Some
of these developments included Salk vaccine for the prevention of poliomyelitis,
streptomycin for the treatment of tuberculosis, B.C.G. vaccination for tubercu-
 P.H.N, confers with truck driver en route to Kaslo in Selkirk Health Unit — 50 s. "Travel in the
P.H.N.'s car en route to the Lardeau country — 50 s
 Shirley Gow(Labrousseure), P.H.N., ready to fly from Port Alberni to Bamfield — 1952. "Travel i
the Fifties"
Jean Fleming, P.H.N., travelling with Social Worker and driver to Halfway Indian Reserve off
Alaska Highway — 1959
 Jean Fleming, P.H.N., Dawson Creek, travels by dog team to Halfway Indian Reserve — 1959
losis, measles vaccine, the reintroduction of home nursing, housekeeping or
homemaker services, prenatal and parentcraft classes, expanded resources for
the treatment of handicapped children and adults, more emphasis on rehabilitation, and more mental health resources. Better tools became available for
screening such as the portable "otochek" for hearing screening and illuminated
boxes for vision testing. More films, slides etc. for health teaching were provided. These developments required public health nurses to have a broader
preparation and to adjust their programs to adapt to new developments.
A two pronged approach was made to deal with the new developments. The
first was to provide more in-service education for existing staff and the second
was to encourage the enrichment of the content of university preparation for
public health nurses.
An annual in-service education program was set up for short courses on
pertinent topics. The first was a two-week mental health course in 1953 given by
Miss Ruth Gilbert at the University of Washington. It was followed by a
two-week prenatal care course at Nanaimo's new health centre, given by Miss
Aileen Hogan from Maternity Centre, New York, a five-day Pediatric Course in
Vancouver given by local pediatricians and a one-week course in interviewing
techniques given by Dr. James Tyhurst at the Mental Health Centre at Burnaby
in 1959. These programs were attended by public health nurses from all parts of
the province and included nurses from other agencies. Also much new material
 "PRENATAL" Institute held in Nanaimo Health Centre. Alice Beattie, Dorothy Slaughter (Tat
Monica Frith (Green), Barbara Smith — 1957
was presented each year at the annual Institute meetings when all the publ
health nursing staff were present.
Nursing students from hospital schools of nursing and the University learne
more about the practice of public health nursing as more opportunities for fiel
placements became available in new districts throughout the province.
Public health nurses continued to be well prepared, adaptable and able t
adjust to needed change. However, everything was not perfect as was brougl
out in the Canadian Public Health Association Report of 1950. Much moi
needed to be done!
The Baillie — Creelman Report — 1950
The "Baillie — Creelman" report presented in June, 1950 by the "Stud
Committee on Public Health Practice in Canada" provided guidelines whic
were to have a positive effect on the provision of public health nursing and publ
health in British Columbia in the future. Miss Lyle Creelman, former Director <
Public Health Nursing for the Metropolitan Health Committee, Vancouve
referred to earlier, and Dr. J.H. Baillie of the Canadian Public Health Associi
tion visited the provinces and conducted a Canada wide study on the practices <
the nurse and physician in official agencies to determine what bearing the:
practices might have on the recruitment and maintenance of public health stal
 Their most relevant recommendations included:
(1) More qualified public health nurses to be prepared by universities.
(2) More public health nurses to become qualified for supervisory positions.
(3) Lay workers to be used for non professional activities.
(4) Clerical assistance to be made available to public health nurses.
(5) Volunteers to be used to expand programs.
(6) As part of better supervision, the importance of staff education was
stressed. Also the need for staff evaluations and policy manuals.
(7) Suggestions on programs were made such as:
— a reduction in the amount time spent in the school program.
— more time for prenatals.
— the public health nurse should be used more as a mental health worker.
(8) Demonstration and research of completely generalized public health nursing services including bedside nursing should be done.
(9) Personnel Policies — improved salaries to encourage recruitment.
(10) Public health nurses to do immunizations legally.
(11) Health Centres to be used to provide full public health services.
The above recommendations today seem quite logical but at the time caused a
good deal of controversy. Also some would cost money, which might not be
welcomed by the politicians who would have to find the funds.
Poliomyelitis Becomes the Major Communicable Disease Concern
Communicable diseases were gradually decreasing as a major health concern,
brought about by intensive immunization and improved sanitation. By the end
of the fifties no diphtheria cases had been reported in three years and it seemed
that this disease was being eradicated. Tuberculosis was on the wane due to
improved treatment which had moved largely to the community level. At this
time public health nurses were giving about 1,000 injections of streptomycin to
patients each month. In 1958, the tuberculosis sanitorium (350 beds) at Tran-
quille closed. Venereal disease was still a problem and public health nursing
epidemiology workers were located in the health units in the high incidence areas
of Dawson Creek, Prince George and Prince Rupert for follow up and treatment
of cases and contacts.
However the number of poliomyelitis cases continued to increase. In 1954
there were 787 cases with 26 deaths. Epidemics broke out in the late summer and
local communities would get into a panic state. Public health nurses were
involved in epidemiology but there was no known preventive measure until Salk
vaccine was introduced in 1955. The first year 49,000 children were immunized
in the province. Because of the great fear everyone wanted protection and the
next year 100,000 persons were immunized (3 doses each) at mass clinics held
throughout the province at which the public health nurses administered the
vaccine in syringes and needles made available through the Kinsmen's clubs. It
was estimated that by the end of the fifties one quarter of a million, or almost all
 School immunization clinic. Marysville, East Kootenay — 1955
Children wait their turn for immunization at Marysville School, East Kootenays — 1955
 persons under the age of nineteen had been protected by Salk vaccine. The
vaccine subsequently became available at all child health clinics on a routine
The Atomic Age Brings Civil Defence Nursing
The atomic bombs dropped over Hiroshima and Nagasaki helped finish the
war with Japan in 1945. This new weapon with its potential for killing and
maiming the civil population struck terror in the minds of people who felt
helpless to cope with this unknown weapon. By 1950, information had been
collected on the effects of the bomb, the treatment of victims and how best to
minimize the effect. The federal and provincial governments set up a series of
courses to educate key persons on how to deal with the possibility of atomic
attack. The federal government established a Civil Defence Department with the
ultimate purpose of encouraging local planning to take care of a possible attack.
Included was the training of necessary personnel and the stocking of medical
supplies in emergency hospitals, first aid depots, emergency kitchens, and giving
instructions to the population on how to protect oneself.
The Public Health Nursing Division took an active part in the preparation
and organization of an educational program dealing with the nursing aspects of
Civil Defence and ABC (Atomic, Bacterial, Chemical) Warfare. In 1951, Miss
Margaret Campbell, Assistant Director, and Miss Fern Trout, Instructor, Registered Nurses Association of British Columbia, initiated a two hour orientation session on this subject which they presented to hospital and public health
nurses in the smaller centres throughout the province. That same year a four day
course was presented in Vancouver by a team of experts from the staff of the
Federal Department of Health and Welfare to 75 nurses, representing all regions
of the province many of them public health nursing supervisors. The participants returned to their districts and conducted condensed versions of the course
to local groups of nurses. Gradually throughout the fifties and sixties nursing
instructors received basic training in ABC Warfare, and the subject was gradually integrated into the basic nursing curriculum. With their new knowledge
public health nurses were able to be active participants in the drawing up of local
disaster plans. Fortunately there have been no atomic attacks, and the material
has been adapted for use in other civil disasters such as floods, fires, air crashes,
Awards for Distinguished Service — (Diphtheria Epidemic)
Newspaper headlines were made in January, 1950 when it was discovered that
two public health nurses had heroically helped control a diphtheria epidemic in a
remote northern community. Miss Aileen Bond, Senior Public Health Nurse
from the Peace River Health Unit, and Miss Amy Wilson, Public Health Nurse,
Indian Affairs, Whitehorse, were the heroines. Miss Wilson answered a call for
help in -50° F weather from a remote Indian village known as Halfway Valley off
  Amy Wilson, P.H.N., Indian Affairs, Whitehorse, with team of horses as she leaves for Halfway
Valley Indian Reserve — Dec. 1949
Travel to diphtheria epidemic at Halfway Valley Indian Reserve. Amy Wilson, P.H.N.; Aileen Bond,
P.H.N. - Dec. 1949
 the Alaska Highway, to find the Indians starving, and a diphtheria epidemic in
progress. She telegraphed for help and on Christmas Eve Miss Bond volunteered
to leave Dawson Creek to assist and bring in needed medical supplies. She made
the trip by small plane, horse and sleigh and snow shoes under treacherous
travelling conditions and in extremely cold weather. Miss Bond's official report
stated — "The Indian camp where the diphtheria raged was discovered by
spotting a funeral fire on a nearby hill showing that there had been another death
that day (3 deaths at that time). When approached at night the forlorn camp
looked most eerie, for it consisted of a collection of canvas teepees and a few
squalid unchinked rough shelters. The only sound of life was the multitude of
miserable hounds, and smoke curling from the tops of the tents. The primitive-
ness of this camp was beyond description — the houses had no floors — no
windows — no furnishings other than cotton blankets on the ground, and one
stove with a black pot in which all food was cooked and eaten.
On first inspection three acutely ill patients were found. Two had complete
membranes covering their throats, and the third had had his membrane removed
by another Indian who had reached in with pliers and extracted the complete
membrane. This patient's life was saved by the operation. There were five deaths
in all and only four of the 52 inhabitants escaped the disease." The public health
nurses strapped the antitoxin and penicillin to their bodies to keep them from
Aileen Bond, Snr. P.H.N. — Dawson Creek Amy Wilson, P.H.N. — Whitehorse
 $&m ?mth, JL^fc,
fublic ^salirr ^ntse
JVfoarfr for ^fetmgufeljA jierfrte
In recognition-of outstanding courage and devotion to duty
in combating and promoting control of an epidemic of diphtheria
in Halfway Valley, Peace River District, British Columbia, in
December, 1949, and January, 1950.
JL his epidemic, originating among the Indians in Stoney
Creek Reservation, required the provision of control measures in most
primitive surroundings and during extreme winter weather.
JL his action, involving personal sacrifice and personal risk
above and beyond the normal call of duty, is an excellent example of
co-operation between the Federal and Provincial health services in joint
action for the protection of the public health. It adds a magnificent
chapter to the developing history of public health nursing in Canada.
April 1950
 freezing! For ten days, broth or hot brandy and sugar were the only nourishment
for the indians. Food was eventually dropped by R.C.A.F. planes. As the
epidemic subsided the public health nurses commenced immunizing all persons
within travelling distance of the highway and in ten days had inoculated 947
The work of the public health nurses received much publicity at this time. The
government felt that they deserved special recognition, and struck a new medal
"The Distinguished Service Medal" for heroism above and beyond the call of
duty. The specially created medal was centred with a small diamond added by
the Health and Welfare Minister, the Honorable George S. Pearson to show his
personal appreciation of their heroic action. The medals were presented April
15th at the annual Public Health Institute at the Empress Hotel in Victoria by
the Acting Premier, the Honorable Gordon Wismer.
Organized Home Nursing Programs Extend
At this time, the advantages of hospital-based home care was being advocated
due to the success of the Montifiore plan in New York. As the Vernon hospital
had a bed shortage, a study project was introduced by the North Okanagan
Health Unit in 1951, in cooperation with the Vernon Jubilee Hospital to determine whether a similar home care project could be successful in a small community. It was planned to use the services of private physicians, public health nurses
from the Health Unit, local social workers, and to set up a new homemaker
service. The study was conducted for six years, and demonstrated that hospital
beds were saved and adequate service provided to patients. Patient stays in
hospital were shortened, resulting in better acute care bed utilization. The
service was expanded later to accept all patients needing care, not limited to
hospital discharges.
Utilizing the experience of the two successful projects (Kelowna and Vernon),
the Health Department established a pattern of home nursing care which could
be part of health unit service. Saanich and South Vancouver Island Health Unit
led the way, setting up in 1954, the first organized home nursing service funded
by a local assessment. An additional charge often cents per capita was levied
locally (in addition to the existing thirty cents). No charge was made to the
patients. Emphasis was placed on teaching the patient or the family to eventually
take over the care of the patient whenever possible, under the public health
nurse's supervision. Weekend nurses were employed, and as the service grew the
first part time registered nurse was employed on a half time basis to do routine
home nursing. She was Mrs. Elizabeth Fosker who worked for twenty years in
this capacity.
In the early years of the program it was necessary to educate not only the
public health nurses but doctors and other professional workers on the value of
home care. Rehabilitation nursing was an essential part of the service, which
involved getting the patient to do as much as possible for himself (or herself).
 The new theory of early ambulation and activity had not been fully accepted by
all. Sometimes the public health nurse who gave the care during the week would
work hard to encourage the patient to get out of bed and do as much as possible,
while the weekend old time nurse would kindly put the patient back to bed and
do everything for him. However, in time these obstacles were overcome.
Gradually new home nursing care districts were set up where the residents
agreed to the additional levy often cents per capita, and nine districts (Kelowna,
Vernon, Saanich, Courtenay, Campbell River, Powell River, Ladner, Keremeos
and Qualicum) were established by the end of the decade. By 1959 complete
statistical analyses were being made of the programs, including the diagnosis of
the patient, type of care given, time involved in care, travel, etc. The costs could
be easily worked out. The data from the annual statistical reports formed the
basis for making changes in the program.
These programs demonstrated that patients with mental or physical problems
could be cared for adequately at home and that beds could be better utilized in
general hospitals and other types of institutions if similar community programs
could be established.
New Community Health Centres
One of the great features of the fifties was the building of community health
centres when a total of sixty were constructed. The funds came from Federal
Health Grants when equally matched by provincial and local money. At long
last, public health nurses had suitable working quarters of which they could be
proud. The health centres were all sizes, designed for nurses in single and
multiple nurse branch offices and larger health unit headquarters. It was a joy to
have adequate space for child health conferences where counselling could be
private and space for mothers' classes including room for exercise classes. There
were offices for visiting clinics, workrooms for autoclaves, cupboards for medical supplies, pamphlets, projectors, libraries, etc. Some had auditoriums for
community health education and other meetings, while others made space
available to local health related agencies. A local club such as the Kinsmen's or
Rotary usually sponsored the building. Often the district donated the land and
some labor, while grants were available from the B.C. Tuberculosis Society, the
B.C. Cancer Society, the Red Cross, and other agencies. The health centres were
at last visible and attractive and helped raise the morale of the staff and the
prestige of the service in the community. Some districts honored pioneers by
naming the centres for them such as, The Eileen Ramsay Health Centre at
Quesnel to honor this public health nurse who served there from 1946 to 1960.
The Margaret Moss Health Centre at Duncan honored the longtime president of
the first health centre at Duncan. Where health centres were not built improved
accommodation was arranged in provincial buildings and rented quarters using
similar designs.
 Similkameen Health Centre. Keremeos "Open-     New Oliver Health Centre — 1957
ing Day"— 1955
New Community Health Centre, South Okanagan Health Unit — Kelowna 1953
Rossland Health Centre for one nurse. Nancy
Lee, P.H.N. Supervisor; Joan Sutherland,
P.H.N. — 1957
Negotiations and Bargaining
During the fifties the process of bargaining was evolving in professional and
other associations, and British Columbia was at that time, and continues to be
the most "unionized" province in Canada. The climate in the Registered Nurses
Association of British Columbia (RNABC) was changing as they began to
improve benefits for their members. They had been certified in 1946 as a
bargaining agent under the Labor Relations Act and had established provincial
salary schedules. All provincial public health nurses were members of the
RNABC. Also as civil servants they could belong to the B.C.. Government
Employees' Association which was seeking bargaining rights. The BCGEA had
been meeting with the provincial government representatives to discuss benefits
for their members, and they would have been happy to include the public health
nurses in their group. However, the Civil Service Commission advised the public
health nurses through the Public Health Nursing Council that as they were a
"group" they could represent themselves, or have another person or agency
 represent them. For a number of years the public health nurses could not give
majority approval for representation to either the RNABC or the BCGEA and
settled on representation by the Personnel Practices Committee of the Public
Health Nursing Council.
The first brief was presented to the Civil Service Commission in 1952, by Miss
Mary Dunn, Public Health Nursing Supervisor of the Saanich and South
Vancouver Island Health Unit, and Chairman of the Personnel Practices Committee. In this brief only salaries were considered and it was requested that the
RNABC schedule be followed which would pay a public health nurse $245 per
month. The salary in effect was $221 per month, less than paid elsewhere in the
province to nurses with similar qualifications. Subsequently all members of the
three member committee met with the Civil Service Commission, but it was not
until 1959 that the public health nurses gained the salary level recommended by
the RNABC. In 1966, Miss Evelyn Hood, the Labor Relations Director of the
RNABC began to accompany the committee to the meetings with the Civil
Service Commission. The Committee became more active as they began to
investigate all aspects of personnel policies, working conditions etc, as the pace
of labor activities quickened in nursing and elsewhere. It studied many procedures and methods currently in effect, and it is interesting to note that by 1974,
they drew up an excellent paper on the feasibility of staff public health nurses
evaluating their supervisors.
By 1974, the last members of the Personnel Practices Committee participated
in negotiations as the public health nurses' representatives, as civil servants had
attained the right of collective bargaining. Two members, Miss Sandra McKen-
zie, and Miss Vera Andrews represented the public health nurses in the Professional Nurses group of the British Columbia Government Nurses' bargaining
Public Health Nursing Consultants' Program
The public health nursing consultants continued to be generalized although
each one had special responsibility for specific programs. Because of their
special backgrounds they were able to help supervisory nurses with general
management and career plans for staff nurses, as well as program development.
They introduced many new ideas to help improve the local service.
In 1951 the first regional consultant, Miss Margaret Cammaert was appointed
to the East and West Kootenays based at Trail. She had been a staff nurse at
Summerland and a senior nurse in the Trail-Nelson area following her graduation with a B.S.N, from the University of Alberta. In 1950-51 she completed an
M. P. H. degree at the School of Hygiene at Johns Hopkins University, where she
had specialized in maternal and child health. Miss Cammaert's assignment
included trying out new ideas in her specialty to determine whether they could be
introduced into the provincial setting. As a result of local trials, new policies
were established such as routine teacher-nurse conferences which replaced routine annual school medical examinations, an appointment system for child
 McBride's New Health Centre. Joan Sutcliffe,
Supervisor P.H.N.; Winifred Bryant, P.H.N.
— 1958
Ponticton Health Centre. Public Health Nursing Supervisors Nancy Lee, Hazel Whittington.
— 1957
Summerland office of the South Okanagan
Health Unit. Hattie Empey, P.H.N.; Madeleine
Werts, Snr. P.H.N.
Trail   Health  Centre.   Headquarters  of West
Kootenay Health Unit — 1958
Official Opening Day, Qualicum Health Centre,
Central Vancouver Island Health Unit — June
New head office of East Kootenay Health Unit,
Cranbrook. Frances Hewgill (Mitchell), Kay
Marshall, Rena Rankin, Kay McKinnon, Charlotte Brown, Monica Frith (Green) — 1958
 health conferences and improved reference materials made available to all
public health nurses. She revised the much used infant and preschool monthly
letters which had been originally written by the federal government so that they
could be sent out by the Provincial Health Department. By 1954 it was concluded that the work of public health nursing consultants would be most
effective when centrally located and Miss Cammaert was transferred to a newly-
established office in Vancouver on Laurel street in one of the old buildings
originally used by the University of British Columbia.
During this period Miss Margaret Campbell continued as Assistant Director
with special responsibility for research studies and home care.
A new consultant position was established in Victoria in 1951 with a mental
health specialty. Miss Lucille Giovando was appointed upon her return from the
University of Minnesota where she had specialized in mental health. She was an
experienced public health nurse having served in Rural Kelowna in 1943 until
she opened the Cumberland Public Health Nursing District in 1946, and had
been a senior nurse at Nelson. In addition to her general responsibilities, her
assignment was to promote mental health and increase referrals to mental health
travelling clinics.
By 1955, Miss Campbell, Miss Giovando, and Miss Cammaert had moved on
to positions with the World Health Organization. The Division was fortunate to
recruit suitable replacements.
Mrs. Dorothy Slaughter (Tate), the former Director of Public Health Nursing, who was employed as a staff nurse in Boundary Health Unit rejoined the
Division in the Vancouver-based consultant position in 1955.
Alice Beattie, Consultant P.H.N.; Geoffrey Page. Supervisor, Division of Vital Statistics — 1956
 Miss Alice Beattie joined the Division in 1956 after completing advanced
studies at the University of Washington. Her name has been mentioned previously as supervisor of nursing in the Venereal Disease Division and in connection with the establishment of the first home nursing service at Kelowna. Miss
Beattie graduated from St. Joseph's Hospital in Victoria and completed the
Public Health Nursing program at the University of British Columbia in 1938.
Prior to opening the Courtenay Public Health Nursing Service in 1941 she was
employed as a public health nurse in the Cowichan Health Centre in Duncan and
later was supervisor in The West Kootenay, South Okanagan and Boundary
Health Units. Her first assignment as Consultant along with Mr. Geoffrey Page
from the Division of Vital Statistics was to investigate the need for clerical and
other non-professional field staff, and to recommend standardized office procedures and administration. All main offices and branch offices were visited by this
task force, and far reaching recommendations were made in the final report
which became the "Administration Bible" for many years. Miss Beattie con-
tinuea to work on the policy manuals, advised on the school health program,
and revamped the public health nurses' records committee so that it had broader
representation and became the Public Health Records Committee. For a
number of years she continued as consultant to the clerical staff in addition to
her nursing responsibilities. This was not inconsistent as most of the records
handled by the clerical staff were public health nursing records. Miss Beattie was
able to see the health unit aide position established and to advise on this new role
in the health units.
Following Miss Beattie's appointment, the other public health nursing consultant position was not filled due to general cuts in the Civil Service. However the
Director and two consultants continued to visit their ever expanding districts
and to generally assist the supervisory nurses with their work. Fortunately Mrs.
Pauline Yaholnitsky, Northern Supervisor, was able to provide public health
nursing consultation to the northern health units. Emphasis was being placed on
staff development to encourage talented public health nurses to obtain good
varied experience in the field and to take advantage of educational opportunities
to fit them for future responsibilities in leadership positions. This was always an
"iffy" situation as romance, matrimony, and family responsibilities also played
an important part in the decisions. However the overall objective of the continued improvement of service was the guide.
During the fifties the Director was able to hold regular senior nurse meetings
at Institute time. The Director and consultants arranged an educational program and provided a forum for the supervising nurses to share their concerns
and obtain assistance with their particular problems.
Improvements in Working Conditions
(The Five Day Week, Clerical and Aide Assistance, Orientation, etc.)
In the overall, working conditions for public health nurses in the fifties had
 ™*W^HB I MX),:
5S*'iS9 All,--   .-^  v.-
Lunch time in the Cariboo Health Unit (old), Prince George 1952. Bruna Facchin, P.H.N.; Pauline
Yaholnitsky, P.H.N. Supervisor; H.T. Lowe, M.H.O.; Elizabeth Layton, P.H.N..
Laurel Benham, San. Inspector: Elizabeth Layton, P.H.N.; Miriam Cressman, P.H.N.; Sheena
Smith, P.H.N. Cariboo Health Unit (Old) — Prince George 1952
 improved. The five day week had come in allowing two day weekends. Public
health nurses were no longer officially on call on the weekends as "weekend"
nurses were employed in most districts.
No longer did newly employed public health nurses start on their own and just
do their best. Planned orientation to the program and the district was arranged.
Staff education was being conducted on a local level and elsewhere. There were
opportunities to qualify for educational leave and to obtain bursaries for
advanced education related to the public health nurse's work.
Although salaries were not high they were adequate. The public health nurses
now contributed to the provincial government superannuation plan, and to the
medical benefit plan available from the British Columbia Government
Employees' Association.
However too much time was still being spent on non-professional activities, as
indicated by annual time studies. In 1958, for example, 4% of their time was spent
in activities which could be done by an aide while 4.8% of the time was being spent
in non-professional clerical duties. The Survey Team (Beattie and Page) had
recommended a ratio of one clerk to four public health nurses. In the past a
clerk-secretary had always been available for the health unit director, and some
clerical assistance had been available to the public health nurses depending upon
the local situation. Now additional clerks were being added according to the
recommended ratio, in both a full and part-time basis. The need for "lay"
positions was pointed out again (as recommended in the Baillie-Creelman
report). The Civil Service Commission was reluctant to employ another type of
worker but agreed to try out two health unit aides who would assist the public
health nurses in preparing the nursing and medical supplies, i.e. clean, sterilize or
autoclave needles, syringes, catheters, etc., also clean the refrigerator, stock the
biologicals, etc. As no classification was available in the Civil Service Manual
they were employed as "bottle washers". In 1957, the first appointments were to
Saanich and Boundary Health Units involving seven health centers.
Much use was made of volunteer workers who continued to assist public
health nurses at special clinics and child health conferences. Valuable time was
contributed by the hundreds of volunteers who greatly augmented the public
health nurse's time so that she could spend more time on professional activities.
The fifties saw the completion of health unit coverage in the province as the
Simon Fraser, West Kootenay, South Central, Boundary and Selkirk Health
Units were established. The public health nurses now worked within the health
unit structure rather than in independent nursing districts.
 Coffee time, Port Alberni office, Central Vancouver Island Health Unit. B.C. Chapman, Clerk; Joan
Grace, P.H.N.; Lillian Cawthorne, P.H.N.; Betty Pullen, P.H.N.(R) — 1959
Freda Hilton, P.H.N. Supervisor, East Kootenay Health Unit — Cranbrook 1957
 Public Health Nurses gather for a staff meeting at Duncan, Central Vancouver Island Health Unit.
Gladys Skinner, Myrtle Saxton, Marian Mortimer, Florence Graham, Alice Heron (King) — 1955
Christine Grant, P.H.N., Lake Cowichan, prepares for a Child Health Conference — 1956
 i. :
. .rJL?',. .
,;:, ..«<.
Margaret Baird (Wilson) P.H.N. Ready to go! — Saanich 1961
 The Turbulent Sixties
The sixties became another period of growth and change both in the province
and in the public health nursing service. The population increased by 35% to
over 2 million people. Immigration accounted for most of the increase, as the
birthrate fell steadily from a high of 26.1 per 1,000 population in 1957 to 17.0 in
1969. The age distribution was presenting new problems as the post-war "baby
boom" moved through the system. Forty percent of the population was under
twenty years of age, creating a need for more services for children and young
adults. At the same time the over sixty age group (13% in 1968) was increasing,
creating a need for more services for the elderly.
After the stability of the fifties, social unrest marked the sixties which were
characterized by the rebellion of youth against tradition, the status quo, and
authority. Existing ways were questioned and many young people developed an
alternate lifestyle which was exemplified by the "hippy" movement which came
from California. The new free lifestyle to some extent created new areas of health
concern. It centred around communal living, vegetarian diets, sexual freedom
and drug use, resulting in an increased venereal disease rate, increased illegitimacy, malnutrition and family breakdowns. Changes in approach to these
health problems became necessary. Such things as street clinics became a reality
as public health nurses made every effort to meet and help young people in their
own environment. Also, new plans were gradually developed to assist the aging
The Number of Public Health Nurses Increases
In 1960 the number of public health nurses employed had been sufficient to
meet the service needs of the existing programs, but as time went on, new
positions were needed to serve the increased population and the new programs.
In 1960 there were 222 public health nurses in the provincial service and by 1970,
the number had increased to 342. As the decade commenced in 1960 there was a
total of 490 public health nurses employed in agencies within the province.
Provincial Service 222
Metropolitan Health Committee of Greater
Vancouver I59'/2
Indian Health Service (Federal Health Department) 24
Victoria, Oak Bay, Esquimalt Health Departments I5/i
New Westminster City (part of Simon Fraser Health unit) 8
Victorian Order of Nurses 61
The Division of Public Health Nursing was hard pressed as the decade
advanced to find the funds for new positions and to recruit public health nurses
for the many vacancies. Few of the public health nurses who completed their
programs at the University of British Columbia were willing to work in outlying
or rural parts of the province where most of the vacancies occurred.
 Fortunately federal health grant training funds were still available, so that
during the sixties over 100 registered nurses became qualified for basic public
health at university, while 20 qualified public health nurses completed additional
one year university programs to prepare themselves for senior positions. It is
interesting to note that 20% of the total public health nursing staff by 1970 had
received part of their professional education assisted by federal health grants.
The nurses who accepted bursaries for university education returned to the
service and became the stable group of public health nurses who formed the
backbone of the service.
Recruitment was possible because the service had gained a country wide
reputation as a good agency where public health nurses were permitted to use
their initiative, and given the opportunity to advance through proven ability.
Apart from the public health nursing trainees recruited in the province, public
health nurses were recruited from other parts of Canada, and Health Visitors
from Britain helped make up the staff complement. By the end of the decade the
public health nursing service had developed so that the rural parts of the
province could now have the same high quality public health nursing service as
urban and city areas. Some argue that the service was better.
Some Administrative Changes
In response to the increase in staff and new programs two consultant positions
were added in the Division of Public Health Nursing in Victoria during this
decade. Two well qualified public health nurses who had come through the ranks
were appointed. Miss Lavinia Crane was appointed in 1961, and Miss Pauline
Siddons in 1969.
Miss Crane graduated from the Vancouver General Hospital and the University of British Columbia with a B.Sc.N. in 1951. She had been a staff public
health nurse at Squamish and Abbotsford and a Senior Nurse at Chilliwack and
in the Peace River. As she had completed the M.P.H. degree at the University of
Michigan with special experience in home care, she was given special responsibility for this developing program.
Miss Siddons, a 1942 graduate of the University of British Columbia course in
public health nursing had served as a staff public health nurse at Keremeos,
McBride and Agassiz. She completed the B.S.N, program at the University of
Toronto, majoring in administration and supervision in 1967, and then became
supervisor of the East Kootenay Health Unit, followed by the South Okanagan
Health Unit. As Miss Siddons was particularly concerned with the contribution
which public health nurses could make to mental health, she was given special
responsibility for this program which was receiving more attention. Miss Siddons subsequently completed the M.P.H. degree at Johns Hopkins University.
The Director, Mrs. Monica Green (Frith) no longer carried a district and was
concerned with overall planning, organization, budgets, staff recruitment, education, etc. The province was divided into four public health nursing consultant
 I ,
Sflfc OF THs
New Health Centre. East Kootenay Health Unit. Donna Ross, P.H.N.; Fernie, Mary Kershaw,
P.H.N.; Nelson, Pauline Siddons, P.H.N. Sup. Cranbrook "Opening Day" — Natal 1961
areas. Each consultant visited her area at least twice a year and more often as
indicated. Through the years travelling had become easier and it was no longer
necessary for the consultants to be away from their headquarters for three or
four weeks at a time. In the early days when the consultants had to drive to
districts such as the Kootenays, it was a two-day trip to reach the destination.
With air travel it was possible to fly to all parts of the province in a few hours and
return home on the weekend. However, budgets were limited and great care had
to be exercised to remain within the travelling allowance. Usually the consultant
visited more than one unit on each trip. The consultants were well received and
entertained and became thoroughly familiar with the local situation. Thus they
were able to present the local public health nurses' point of view in any program
In January, 1962, Dr. G.F. Amyot retired after 21 years as head of the public
health service which he had carefully developed, based on the concept that a
good local health service was essential. A guiding principle was that the limited
funds should be used where it would do the most good for the greatest number of
people. He was able to obtain budgets for preventive health service which made
it possible for the public health nursing service to expand throughout the
province. His continued support and encouragement kept the morale of the
public health nurses high.
 He was succeeded by Dr. J.A. Taylor as Deputy Minister of the Health
Branch. With his extensive field experience and 14 years as Director of the
Bureau of Local Health Services, he understood the many problems which
public health nurses encountered in their work, and he too gave strong support
to the Division of Public Health Nursing and individual public health nurses.
The Division of Public Health Nursing continued as part of the Bureau of Local
Health Services where broad policies were discussed and liaison made with the
other divisions and health personnel at regular staff meetings.
In 1961 the Metropolitan Board of Health of Greater Victoria was formed.
This was a consolidation of the health services in the area — Victoria City, Oak
Bay, Esquimalt and the Saanich and South Vancouver Island Health Unit. Miss
Joan Russell was appointed as the first Director of Public Health Nursing for the
entire area. The staff continued to be employed locally except in Saanich where
they continued as provincial employees.
Home Nursing Expands at Ten Cents Per Capita
One of the programs to expand was home nursing. The feasibility of adding
this program to the general service had beendemonstrated in Kelowna, Vernon
and Saanich. The local cost had been established at ten cents per capita for the
municipality with the balance made up by the province. Other districts wanted
the same service but all were not organized so that they could be financed in the
lsla Tuck, P.H.N., Saanich, changes dressing for senior citizen — 1969
 same way. However it was agreed that a suitable area with a legal description
such as a fire protection district, a water district or a village could request the
service under the same plan. The senior nurses and supervisors actively canvassed their districts to assess the need and arranged for local petitions to
indicate financial support when it was possible to set up a service. This was a
slow, tedious organizational method as it required house to house canvass.
However it enabled the program to go ahead with full support. By 1960 there
were 26 home nursing districts and by 1969 the number had increased to 113
districts receiving home nursing service from 65 health centres. This meant that
80% of the population within health unit areas now had this service available.
When the home nursing service provided by the Victorian Order of Nurses was
added, a total of 92% of the population of the province was now served. Both city
and rural areas had similar services available. Great credit goes to the senior
public health nursing staff who expanded the service across the province in little
more than a decade. Patterns of care were established at this time which formed
the basis for future expansion.
First Procedure Manual and Physiotherapist for Home Care
By 1962 the first home nursing manual was developed by the Public Health
Nursing Division. It was the first procedure manual suitable for use in the provincial service and small enough to be carried in the nurse's bag. Up to this time
■Jf'Aff^.ft  /'■*' '
Public Health Nurses Ruth McCubbin and Elaine Clarke are assisted in their work by Consultant
Physiotherapist Kay Thompson — Saanich 1967
 various adaptations of institutional and other agency bedside nursing manuals had
been tried, which did not always fit the situation. It was revised in 1964 when the
important section on daily living exercises and rehabilitation were added.
In 1962 another advance was made with the appointment of the first public
health physiotherapist. She was Mrs. Christine Leach who was employed on a
part time basis in the Saanich and South Vancouver Island Health Unit to
develop a better activation program for patients in the home care program. Her
job involved teaching public health nurses how to set up and carry out simple
activation programs. Her approach was so successful that during this decade six
part time physiotherapists were added in other districts to do similar work.
Treatment was not part of this service. As time went on the role of the physiotherapists expanded and the numbers increased.
Public Health Nursing Liaison with Hospitals and Doctors
Liaison with hospitals and doctors too was changing as the population and the
number of public health nurses and doctors increased in most communities. In
the early days of public health nursing there was usually only one public health
nurse in the district, and one hospital so that it was possible to have informal
discussions with the nurses and doctors concerning the follow up of selected
,.    .:.'      -
Maxine Bolton (Smith), P.H.N. — Oliver I960
 patients. Most of the public health nurse's concerns had been with new babies
and a few patients who might require some home supervision. However as the
home nursing programs developed and patients were discharged earlier for care
at home regular public health nursing visits to hospitals were necessary. Rather
than have a number of public health nurses visiting the hospital, one was
designated as a "liaison nurse" for this purpose. At this time, too, scheduled
visits to physicians' offices and clinics were instigated to assure follow up of
patients needing home nursing supervision.
Involvement with Mental Health Increases
After medicare was introduced in 1966 it became less time consuming for
public health nurses to see that needed medical care and treatment for physical
conditions was arranged. No longer was it necessary to spend a great deal of time
finding organizations to sponsor the correction of defects such as cleft palates,
dislocated hips, and vision problems etc. However, many emotionally-based
problems remained to be recognized and care arranged.
Because of the shortage of facilities for psychiatric nursing training, a number
of the older public health nurses had not receive psychiatric clinical experience
during their basic nursing preparation. Fortunately by 1965 it was possible to
arrange with the Mental Health Service for the public health nurses lacking this
experience to complete a two-month special course which included a one-week
workshop at the Woodlands School on "retardation". In four years 68 public
health nurses completed the total program while 108 participated in the Woodlands School program.
This program gave the public health nurses new impetus to tackle mental
health problems especially in relation to the screening, treatment and care of
persons with emotional problems. The work with retarded children was especially stimulating and public health nurses developed new attitudes of hope and
helpfulness which they were able to pass on to parents in their districts. As a
result, many new groups were encouraged to form local organizations and to
establish new facilities for the education and care of retarded persons such as
summer camps, schools and special school classrooms. The "making up" of this
educational deficit had a tremendous effect on the advancement of the total
mental health program in the province.
As the Mental Health Branch's new policy was the decentralization of diagnosis and treatment services, new mental health centres were being established
throughout the province. By 1969, 15 centres had been set up, the majority in
health unit buildings. This arrangement was made to facilitate easy liaison with
the new community mental health service. Public health nurses were becoming
more and more involved with referral, treatment and care of patients as evidenced by 17,310 visits in 1969 utilizing some five percent of their time.
Miss Pauline Siddons' appointment in 1969 as Public Health Nursing Consultant with special responsibility for mental health was particularly appropriate at
 this time. She was able to clarify the public health nurse's role in relation to the
new program and to identify the preventive aspects of mental health which are
part of basic public health nursing programs. She provided consultation for the
public health nurses and liaison between the two community nursing services as
well as arranging special in-service education in mental health.
More Public Health Nursing Help for the Elderly
The increased number of elderly people in the general population presented
many special health problems. As mentioned previously, the home nursing
service had helped many elderly patients with medical problems to remain in
their homes. Other "support" services were required, such as "meals on wheels"
which started in 1966 in Saanich, the first in a provincial area. It was operated by
the local social welfare department. Miss Helen McAleese, public health nursing
supervisor, had encouraged the service and provided a list of "shut-ins" to start
off the service. It was soon followed by similar services in Nelson, Kamloops and
Public Health Nurse counsels senior citizen
Homemaker services expanded that same year when special grants became
available from the Social Welfare Department. As grants did not cover the entire
cost, many of the public health nurses were active in helping to organize local
sponsoring organizations. |
 About to attend clinic at Lower Post Indian Reserve, Mile 620 — June 1962
Prophet River school children waiting for the Public Health Nurse — June 1962
 Other local clubs took on activities such as the "Friendly Visitors" in
Kelowna. New senior citizen recreation centres were started in a number of
communities and public health nurses served on many of the boards of these
organizations. (New Horizons' grants did not come in until much later). One
outstanding example of a special contribution was the work was done by Mrs.
Anna Mason, senior public health nurse at Penticton in initiating, with a local
board, a comprehensive senior citizens' complex which included residential and
day-care activities.
"Sixty and Up" clinics were established in some senior citizen centres such as
Kamloops where special screening was done for hearing, vision, blood pressure
and other disabilities, as well as general nutrition and health counselling.
More Indian Reserves Served by Provincial Public Health Nurses
Seventeen Indian reserves were added in the sixties to those already being
visited by provincial public health nurses so that they were now providing service
to thirty percent of the Indians living on reserves. In fact, they were providing
public health nursing service to over half of the native population, as twenty-
eight percent of the total Indian population of the province was now living
permanently "off reserve". A special effort was being made by the federal
government to extend provincial coverage, as the philosophy at that time was
that the Indians should have the same health care as the general population.
Almost all Indian children attended district schools where the provincial public
health nurses provided the health service. The public health nurses visited the
reserves regularly, made house to house visits, held clinics, and referred those
needing more care to appropriate agencies. In fact, more time was needed for
this group as they had more health problems than the general population. The
policy caused difficulties in some districts where public health nursing service
was limited. Most of the new reserves taken over were on the basis of exchange of
service by federal and provincial public health nurses while service to others was
billed at $ 1.25 per capita to the federal government as agreed a number of years
Many new projects were encouraged on the reserves, such as home nursing and
homemaker courses, recreation, etc. Support was provided as needed by the
Federal Department of Health and Welfare, Medical Services Directorate, which
had assumed the responsibilities of the former Indian Health Services in 1963.
Preventive Programs Expand
Although primary prevention was still necessary for the protection of the
public's health, more attention was being directed towards secondary prevention
— the correction of defects at the earliest possible age. More emphasis was being
placed on the screening of infants and preschool children by the public health
nurse to detect mental and physical defects particularly for speech, hearing,
vision and mental retardation. New techniques were being used in homes, clinics
 Oral Polio Clinic. Silverton school children, Slocan Valley, Myrna Robinson P.H.N. — New
Denver 1962
Rural schools visited regularly by Public Health Nurse. Perry Siding school
Robinson, P.H.N.
1962.  Myrna
 Public Health Nurse screens for hearing loss with audiometer
and schools for the early identification of defects. Parents were invited to bring
their preschool children to attend assessment clinics being held at regular
intervals, all four-year-olds being encouraged to attend.
The school health program was completely revamped in 1962, following an
intensive review of the program and consultation with teachers, public health
nurses, and the Department of Education. Many innovative procedures were
included as well as some which were already in effect in a few schools. The new
program set a minimum basic health service for all schools. Miss Alice Beattie,
Public Health Nursing Consultant, was instrumental in consolidating the material which formed part of the local program manual. It is interesting to know that
by 1969, the provincial public health nurses were supervising 350,000 school
In 1960 the Rheumatic Fever Prophylaxis program, which had been introduced the previous year on a trial basis in four health units, was expanded to all
health units. As part of this program, public health nurses supervised children up
to 18 years of age who had been afflicted with rheumatic fever and placed on
antibiotic prophylaxis to prevent permanent cardiac damage.
In 1962 the new oral Sabin vaccine for Poliomyelitis was introduced, and
 Public Health Nurse prepares child for a vision test
Marilyn Dahl, P.H.N., vaccinates a school child for smallpox — Saanich 1970
 Public Health Nurse instructs a prenatal class on stages of pregnancy and childbirth — 1972
Prenatal class attended by fathers and mothers. Victoria Health Centre. P.H. Nursing instructors
Margaret Baird (Wilson), Margaret McLellan (Acton) — 1962
 public health nurses held "blitzes" throughout the Province for those needing
Immunizations in 1969 amounted to over half a million to children for
protection against diphtheria, whooping cough, tetanus, poliomyelitis and smallpox. Red measles vaccine was added that year and rubella vaccine the following
year. It was estimated that savings to the British Columbia Medical Plan
amounted to $750,000 through the administration of antigens by the public
health nursing staff.
Venereal diseases continued to increase in numbers and "Speed Zone" epidemiology was introduced to try and halt the spread. The objective was to treat on
epidemiological grounds before the diagnosis was confirmed, thus eliminating
possible further spread of the infection. Public health nurses in some high
incidence areas such as Prince Rupert always carried oral penicillin with them so
that they could dispense it as they made their rounds.
Expectant parent classes continued to be popular, particularly for first-time
parents when both mother and father would attend evening classes. Classes were
also available during the day for mothers only, as well as for single or adopting
parents as warranted. By now the scheduled evening work was creating "overtime" problems, but most health units gave equivalent time off to the public
health nurses working in the evenings.
A new poison control program had been set up, with the centre in the local
hospital. Public health nurses were asked to do follow up in the homes to help
establish home safety in situations of accidental poisoning.
Research Studies in Public Health Nursing
Although the Public Health Nursing Division had much statistical data on the
activities of public health nurses it was becoming increasingly difficult to measure the results of their work in terms of reduction of disease, etc. No longer were
dramatic effects being shown from the control of communicable diseases
although continued vigilance was necessary to keep the community protection
level high. The public health nurse was no longer the only community health
worker as social workers, school counsellors, psychologists, etc. were involved
with many of the same families as the public health nurses.
To help clarify the results of the public health nurses' activities a number of
research studies were initiated. Encouragement and stimulation in research
methods came from Dr. Donald Anderson, Professor of Epidemiology and
Research, University of British Columbia Health Sciences who conducted a
series of correspondence courses and workshops for public health nurses under
the sponsorship of the Public Health Nursing Council's Education Committee.
By 1965 the public health nurses had tried small studies and had become
interested in more research when a major study was undertaken to measure the
effectiveness of the public health nurse's family visits. Similar studies had been
conducted in the United States under the sponsorship of the Department of
 Health, Education and Welfare who kindly made their Western Nursing Consultant, Miss Hazel Shortal available for consultation. Miss Lavinia Crane, Public
Health Nursing Consultant, directed the "Patient Progress Study" which
involved 36 public health nurses in six health units over a six month period. The
results showed that the public health nurses met their objectives and that their
work was effective although less easy to measure than in the past.
A comprehensive mental health study was done in 1966 to determine how
involved the public health nurses had become in selecting patients for referral to
mental health clinics and in subsequent follow up. The study demonstrated the
importance of the public health nurse in case finding as she selected over forty
percent of the patients seen at clinics, and referred another thirty percent who
had been brought to her attention by colleagues such as teachers, counsellors etc.
This study showed that the new mental health involvement would justify the
addition of public health nursing staff. The study did not include the traditional
preventive aspects of mental health incorporated into other basic programs.
Other projects included small studies of various aspects of the school health
program with every health unit participating. Also Boundary Health Unit
conducted an extensive study on vision testing of children. South Okanagan
Health Unit studied selection methods for follow up of preschool children
through the use of special criteria at child health conferences.
The public health nurses were generally very interested in participating in
studies and conducted many small studies that resulted in improved policies and
Health Unit Aide Service Expands
Public health nurses' time studies had repeatedly shown that they were spending too much time (about 4-5%) on certain non-professional activities that were
necessary to get the work done, such as cleaning, sterilizing, or autoclaving
nursing and medical supplies. There was no one else to do thesejobs. It had been
pointed out by study teams such as Baillie and Creelman in 1950, and Beattie and
Page in 1956, that this was poor use of public health nursing time. It had not been
possible to persuade government officials to expand the aide program introduced in Saanich and Boundary Health Units in 1957. As the immunization and
home nursing programs accelerated with the increased population, the funds
were finally available and in 1962, health unit aide service was instituted in all
health unit offices. The aide positions were part time based on a ratio of seven
hours of service per public health nurse per month. Part time help was readily
found, and the aides took pride in their work and by giving it their undivided
attention maintained a high standard. In some smaller offices the part time clerk
added the aide work to her clerical duties.
By the time disposable sterilized equipment was introduced in 1966, the health
unit aide service was well established. About this time, the "baby boom" children
filled the schools and created an unprecedented need for immunizations and
 other services. In 1968, trials were conducted to determine whether carefully
selected and oriented health unit aides could carry out routine tests such as
vision and hearing screening on children in schools. They proved capable and by
1971 health unit aide activities were increased to take over some of the routine
work outside the health unit office. This gave the public health nurses more time
to concentrate attention on the children screened out for further follow up. Miss
Alice Beattie, Public Health Nursing Consultant, advised on the studies and
supervised the introduction of the health unit aides.
Institute and Other Staff Education Changes
By the late sixties the Public Health Institute had gone through many adaptations. It had moved from the Empress Hotel in Victoria to the Georgia Hotel in
Vancouver and then to student residences on the campus of the University of
British Columbia. The new setting accentuated the "Continuing Education"
aspects of the meeting, and offered better facilities for the larger number of staff.
The format had changed from one key speaker to carry the main theme, to fewer
outside speakers and more group sessions and local specialists. The public health
nursing section meetings featured more field reports from staff nurses, and
pertinent nursing developments. Seniors and supervisors held their own special
meeting one day prior to the three day Institute to discuss their particular
problems. The Institute had become so large that the traditional dinner had been
abandoned. However it was still an exciting time for the public health nurses to
get together with their friends, to find out about other districts and to plan for
possible transfers, etc. Opportunities were made available for meeting with the
Director and Consultants. The Institute provided an excellent opportunity to
know what was happening in public health both at home and elsewhere.
In addition to the one day Senior Meeting a "workshop" was arranged every
three years for the seniors and supervisors to help meet their special educational
needs. In 1963, Dr. Ruth Freeman, Johns Hopkins University School of
Hygiene led a one week course on supervision techniques as related to public
health nursing at the Grosvenor Hotel in Vancouver. Three years later she
returned to give a one week course in administration to the supervisors and
medical directors. In 1970 Dr. Loretta Ford, Professor from Colorado University, gave another stimulating workshop on "Expertise in Public Health Nursing". Senior nursing staff from the Greater Vancouver and Victoria Health
Departments were included.
Staff and senior public health nurses also participated in a limited number of
suitable short courses at Department expense, as they became available at the
University of British Columbia's Continuing Education Department.
Federal-Provincial Public Health Nursing Consultation
The first Federal-Provincial Public Health Nursing Meeting was held in
Ottawa in the late fifties, chaired by Miss Dorothy Percy, Principal Nursing
 Officer, Department of National Health and Welfare, and attended by all the
provincial Directors of Public Health Nursing or their representatives, and the
Federal Nursing Consultants concerned with public health nursing programs.
These meetings provided an opportunity for the directors to learn at first hand
about the services available to them from the Federal Department of Health and
Welfare, and at the same time gave the federal participants specific information
about the provinces. Miss Esther Robertson, Consultant in Maternal and Child
Health, Miss Evelyn Pepper, Consultant in Civil Defence, and Miss Mildred
Walker, Consultant in Occupational Nursing attended the first sessions. Arrangements were eventually made for all three consultants to visit and conduct
workshops in British Columbia. At the first meeting the directors presented
provincial program reports, which were updated at the subsequent meetings
held annually. New developments and much "how to do" information was
exchanged. At later meetings specific programs were selected for review. In 1972
Miss Olivette Gareau, an experienced public health nurse and educator, was
appointed to replace Miss Percy. She realized that better communication
between nursing groups was indicated, and instituted joint federal-provincial
meetings attended by provincial representatives of community health, hospital
and Federal Health Services. These meetings resulted in better relationships
between the three groups, more co-operation in in-service education, and greater
participation in planning on a federal level. As a result of the meetings with
public health nursing directors, Miss Gareau, Director of Community Health
Services initiated a provincially represented "Advisory Committee on Community Health." The meetings also tended to standardize and improve the quality of
public health nursing programs across the country. They were particularly
helpful to provinces whose public health nursing services had developed slowly.
British Columbia was able to offer some consultant service, particularly on
home care services, to other provinces as a result of discussions at the meetings.
Workshops were conducted in Saskatchwan by Mrs. Monica Green in 1966, and
continued by Miss Lavinia Crane. Later Miss Crane visited and provided
detailed guidance for the development of the home care programs in Prince
Edward Island, Nova Scotia, and New Brunswick.
The Sixties End
The sixties came quietly to an end with no single event marking their demise.
By this time the British Columbia Public Health Nursing Service was considered
a leading public health nursing organization with a strong field and administrative staff. Many former public health nurses were making, or had made, important contributions to the development of nursing and public health at home and
elsewhere. To mention a few, Miss Eleanor Graham had been Executive Director of the Registered Nurses' Association of British Columbia, followed by Miss
Nan Kennedy. Mrs. Janet Bailey (Pallister) was Director of Public Health
Nursing in Alberta; Mrs. Margaret Jackson (Campbell) was on the Nursing
 Faculty of the University of Alberta; Miss Margaret Cammaert was Consultant
with the Pan-American section of the World Health Association; Miss Jessie
McCarthy and Miss Kirsten Weber were on the faculty of the University of
British Columbia in the Departments of Health Care and Epidemiology, and
Nursing respectively. Miss Dorothy Kergin was at the University of Michigan in
preparation for the position which she would have as Assistant Dean of the
School of Nursing at McMaster University, and later Director of the School of
Nursingat the University of Victoria. Many, too, were makingspecial contributions to the community. Miss Joan Appleton (Norris) was awarded the "Freedom of the City" of Penticton, for her special activities and later became the first
woman on the British Columbia Board of Parole and alderman of Pitt Meadows
Municipality. Miss Vera Andrews was alderman of Cranbrook, while a number
of other public health nurses became active on local school boards. Miss Trenna
Hunter, who had been Director of Public Health Nursing for the Metropolitan
Health Committee of Vancouver was granted honorary membership in the
Canadian Public Health Association for her outstanding contribution to public
health nursing.
   The Seventies Begin
The province continued its strong growth pattern in the seventies. By 1971 the
population was close to 2,200,000 which was just about double the population of
twenty years earlier. Many small villages had become cities and urban centres.
New public health nursing services were required in "instant towns" such as
MacKenzie and Sparwood. Over the years the concept of health as concerned
only with disease prevention and control had broadened so that the public now
understood that health services included community programs which would
minimize hazards that generated morbidity and mortality. Public health nursing
had continued to expand its outlook to include new areas of concern due to the
changing health needs of the population, now threatened with new technology,
chemicals in the environment and family and lifestyle changes.
Hospital Days Replacement Program Initiated
The seventies started on an optimistic note with a "breakthrough" in the home
care program. Although it had been pointed out repeatedly that the existing
program was saving the government a great deal of money (at least $166,000
estimated for limited service in 1970), the Division of Public Health Nursing
Diane Ouston, Snr. P. H.N. visits a patient in hospital prior to admission to the home care program
— 1970 New Westminster.
 believed that more could be done with more staff. This had been demonstrated in
the 1950's in the Vernon pilot program. By 1970 the cost of hospital beds had
greatly increased, and the Royal Columbian Hospital in New Westminster was
extremely short of hospital beds. The home care program in the Simon Fraser
Health Unit was doing its best to accept as many patients as possible from the
hospital. The potential for more was there with the addition of more nurses and
auxiliary or support services. In 1970, Mrs. Diane Ouston, Senior Public Health
Nurse in the Simon Fraser Health Unit was in charge of the home care program
and also president of the Public Health Nursing Council. As was the custom, she
and other members of the Council as well as the Director of Public Health
Nursing met with the Minister, the Honorable Ralph Loffmark to discuss the
general public health nursing service. He was particularly interested in the home
care program and the potential for making better use of existing hospital
facilities. He asked Mrs. Ouston ifshecouldset up a program in her Health Unit
if she had the necessary funds, in order to show that home care could be as good
as hospital care for selected patients. She immediately accepted the challenge
and with the assistance of Miss Lavinia Crane, Public Health Nursing Consultant and the senior staff of the Health Unit, Miss Barbara Smith, Public Health
Nursing Supervisor, and Dr. J. Munroe, the program got under way in 1970.
Both hospitals in New Westminster were involved, the Royal Columbian and St.
By the end of the first year it was shown that the cost of the comprehensive
home care program which included nursing, physiotherapy, drugs, homemak-
ers, meals on wheels and supplies as indicated was one quarter of the cost of
acute hospital care. The new program was called the "Hospital Days Replacement Program" and patients could have this service without charge for the
equivalent number of days that they would have been in hospital. Those patients
needing care over a longer period were transferred when their term expired to the
regular public health nursing service program. They then had to pay for services
required other than nursing. As might be expected this service was utilized by
people in all age groups with 63% being under 65 years of age.
Home Care Programs Increase and Co-ordinators Appointed
Home Care Co-ordinators were appointed to set up similar hospital days
replacement programs in 1972 in two different communities. Kamloops and
Victoria were approved for further study and Miss Betty Short was appointed to
Victoria and Miss Kathy Iszatt to Kamloops. These were big undertakings as
new full and part time nurses had to be employed, equipment procured, and in
some situations homemaker and food service to be organized, as well as liaison
with other professionals, etc. Assistance came from the supervising nurses and
directors of the health units while Miss Lavinia Crane, Public Health Nursing
Consultant responsible for home care, provided guidance as well as assistance
with in-service education as required. The three projects were carefully moni-
 tored in the Division of Public Health Nursing before further expansion took
place. This occurred very rapidly and by 1974 the Hospital Days Replacement
Program was available in all large and medium-sized communities to 80% of the
By June 1974 the Health Department had integrated the Victorian Order of
Nurses branches of the Greater Vancouver and Victoria areas into the service
and in 1975 included the remaining Surrey branch. Thus there were no charges
being made directly to the patients for nursing care prescribed by a physician. In
1973 Mrs. Diane Ouston returned from completing the M.P.H. degree at the
University of Michigan with special experience in home care and became
responsible for the total home care program. By 1974 the regular organized
home care and the hospital days replacement programs were consolidated. Each
area then had a full time home care co-ordinator.
Public Health Nursing Liaison Increases
Public health nursing liaison had become more structured as the number of
physicians increased in the community. In formal visits to the hospital the liaison
nurse attempted to see physicians regarding home follow-up of patients needing
care. Also in a number of communities the liaison public health nurse made
routine visits to physicians' offices and clinics. In 1974, the Annual Report
indicated that public health nurses made 7,464 routine visits to physicians'
offices, 6,623 visits to general hospitals and 8,507 visits to other agencies on
behalf of persons receiving care from the public health nurse. Liaison and
co-ordination of service continued to be an integral part of the public health
nurse's work.
More Experimental Programs
In the early seventies, a number of the health units took advantage of Local
Initiative Program (L.I. P.) grants and student grants to enrich local services for
handicapped, elderly and disadvantaged people in their communities. For
example, in the Selkirk Health Unit the public health nurses helped organize a
program of recreation, outings, and special dinners for senior citizens. These
projects showed what could be done and paved the way for other organizations
to continue these services with partial support from New Horizons grants.
About this time public health nurses also used the opportunity for "lay"
assistance provided by "Incentive Trainees", (Welfare recipients being reintroduced to activities outside the home).
Health Promotion Adds New Dimensions
The promotion of health had always been one of the major objectives of the
public health service. In the late sixties and early seventies it became clear that
the prevention of disease by broad health measures such as the provision of safe
water, milk and food, plus immunization programs, medical, nursing and phar-
 macy care, etc. was not the complete answer to positive health. More concern
was being expressed by the general public on the need to improve the quality of
life, and the fact that much more individual effort was needed to maintain and
improve health. The machine age had reduced the need for physical exertion,
leaving more leisure time and flabby muscles. Accordingly, much of the public
health nurse's educational efforts were now directed toward encouraging more
individual effort to improve health through such measures as more exercise,
better nutrition etc. Drug and alcohol control and safety education were stressed
in individual counselling and in group sessions.
Renewed Emphasis on Preschool Assessment
More emphasis was being directed toward special preschool clinics for 3 and
4-year-old children. New screening methods to test for deviations from the
normal had become available such as the Denver Developmental Screening Test
designed for nurses to test motor, language, and personal-social development.
There was also new vision and hearing testing equipment. Early treatment can
contribute to future progress and prevent the serious effect of deviations from
the normal and resulting costly treatment. The new tests and follow up care
learned by the public health nurses during in-service education, were being
utilized- in the increased number of special clinics for preschool children.
Public Health Nurse Janice Sturdy administers the Denver Developmental Screening Test
 Public Health Nursing Community Care Co-ordinators Appointed
As public health nurses became more involved in the care of the elderly in their
homes they found that they had a contribution to make to the care of the elderly
in community care facilities. Up to this time most of the facilities were "personal
care" homes, small and privately operated. Most of the operators were nonprofessionals concerned not only with care but with making their facility pay.
They were generally known as "Rest Homes" or "Boarding Homes for the
Elderly." Although they were licensed for ambulatory persons only, many of the
residents needed some nursing care. Occasionally public health nurses were
called on to give the care they might give in a private home. Extended Care Units
in general hospitals or Intermediate Care homes as known today did not exist.
There were a few private nursing homes in the larger centres. The first government built institutions for personal and intermediate care were completed in
In 1969, the Health Branch first became involved in the licensing of community care facilities when it was represented on the interdepartmental Licensing
Board. The Licensing Board determined the suitability of the institutions giving
care to adults and children and issued appropriate licenses. By 1971 the Health
Branch became responsible for the Community Care Licensing Act. The inspection of facilities in the community then passed on to the health units, and public
health nurses became officially involved in the quality of care being given in
these institutions. Previously public health nurses had been visiting many of the
personal care homes to encourage recreation and activation programs and to
advise on general health care and sanitation. They assisted with meal planning
supported by provincial nutritionists. They also encouraged volunteer groups to
take on special projects. If a physiotherapist was available she might set up the
activation program. In 1969, public health nurses were making 1,000 visits per
year to personal care homes and the numbers of visits tripled by 1975. As day
care facilities for infants and preschool children were covered by the Act, public
health nurses encouraged improvements in conditions when they visited these
centres. Here, they found a captive audience for much early screening for defects
such as impaired vision and hearing.
Eventually it proved to be most efficient to have one experienced public health
nurse in the health unit with special interest in this type of care take responsibility for the program. She became known as the "Community Care Coordinator."
Public Health Nursing Uniforms Become History
The public health nursing standard uniform as introduced in the late forties
continued, with minor modifications, to conform to current fashions. The suit
was still being worn, with the length of the skirt and jacket changing with the
times. In the sixties when mini-skirts were popular some public health nurses
shortened their skirts to "mini." In 1970 a light blue color replaced the darker
 blue. As variety and change was the mark of the sixties, it carried over into
uniforms. A variety of blouse styles were worn. When women started wearing
pant suits to work in the early seventies this style too became optional for public
health nurses. The "American Golfer" had been the original summer uniform
dress. Other light blue dresses were tried until 1960 when blue and white
pinfeather was introduced. The crisp washable dress with hat to match, was most
attractive in both the one or two piece styles. The navy blue gabardine coat
remained standard although it was cut along straighter lines as the fashion
dictated. By 1971 the color changed to light blue with a choice of material in
Harris Tweed or gabardine.
Hats became a problem as new high hair styles such as the famous "beehive"
became popular in the sixties. In 1960 the "Glengarry" had been replaced by a
"pillbox" with a small woven insignia replacing the large gold pin. Hats were
being worn less and less and by 1971 they were declared optional. A white toque
or tam was worn in the winter with a white scarf.
The public health nurses looked very smart in their summer and winter
uniforms. In the sixties freedom from conformity became a dominant force and
some nurses particularly the young staff members, saw the uniform as detracting
from their individuality, as well as being a symbol of authority. This trend was
evident-ina number of hospitals where nurses no longer wore uniforms as well as
in the Mental Health Clinics where mental health nurses did not wear uniforms.
Another factor was cost. In 1974, the uniform suit cost less than sixty dollars and
the coat, eighty. The initial uniform grant of $150.00, more than covered the
basic cost, while an allowance of $100.00 was available each year for the
purchase of a major itejm. Some nurses felt the cost of all items should be
In 1974 the public health nurses first contract with the government was signed,
and the uniform allowance was given up in exchange for salary parity with
institutional nurses and other benefits. When the uniform was discontinued in
1975 a tradition of fifty years ended with the blue uniform no longer the symbol
of public health nursing in the provincial service.
Staff Education Program Adjusts to Increased Numbers of Public Health
By 1972 there were over 600 full time staff in all categories in local health
services and it was no longer feasible for the annual Public Health Institute to
provide the major staff education program for such a large multi-discipline
group. Over 300 public health nurses were employed as staff, seniors, and
supervisors, in addition to the many registered nurses involved solely in the
home care program. A new plan of regional institutes and workshops was
introduced as an alternative.
Regional or mini-institutes commenced in 1972 for staff public health nurses.
Three regions were established with the plan to hold a regional institute each
 year. Each public health nurse attended the institute in her region. On intervening years she had the opportunity of participating in a suitable educational
program offered by a university college, or health agency, or another regional
institute. In this way one special educational program was available to every
nurse every year.
The first regional institute was held in Kamloops in the main office of the South
Central Health Unit and proved so successful that the plan proceeded. Facilities
were excellent in the new building with its theatre style auditorium which was the
right size for the participants. Mrs. Kay Marshall, Public Health Nursing Supervisor, and the public health nurses looked after local arrangements, while the
program itself was set up by the Division of Public Health Nursing following the
usual questionnaires to the staff regarding their wishes. There was a return to the
traditional hospitality hour and dinner with entertainment. Everyone had a good
time and enjoyed the informality of the smaller group.
As each health unit had sent at least one official representative it was possible
to arrange a meeting of the Public Health Nursing Council in the evening.
The following year, in 1972, the Fraser Valley Region held its institute in
Vancouver, utilizing the facilities of the Christmas Seal auditorium in the
Tuberculosis Pavilion. The third year the institute was held in Victoria for the
Vancouver Island public health nurses at the Newcombe auditorium of the
Provincial Museum.
Also in 1972 it was arranged that all senior staff would meet for educational
purposes once a year. The first meeting was held at the University of British
Columbia in one of the residences after the winter session finished. Medical
health officers, dental officers, public health inspectors, senior clerks, senior and
supervisory public health nurses and specialized public health workers all
attended. Apart from joint opening and closing sessions, the public health
nursing supervisory staff met together to discuss matters related to their special
responsibilities. The senior staff meetings were held annually and were open to
the senior staff of the official Vancouver and Victoria health services.
Other educational meetings were arranged on a special basis for home care
workers and community care co-ordinators, as the numbers warranted.
The new educational plan seemed to meet the in-service education needs of the
public health nurses at that time.
Changes in the Educational Preparation of Public Health Nurses
The Department of Nursing and Health at the University of British Columbia
was the only institution within the province to prepare nurses for public health
nursing. In the early years of the program which started in 1919 the number of
graduates kept pace with employment opportunities. However, as the population increased the number of graduates was insufficient to meet the increasing
needs of the province. The degree program in nursing was preparing nurses for
public health nursing, as well as teaching and hospital administration.
 1940 Graduates of B.A.Sc in Nursing Program
- U.B.C.
Department of Nursing University of British
Columbia Faculty. Miss Mabel R. Gray (centre).
Professor and Head Miss Margaret Kerr (L) and
Mrs. Geraldine Langton (Homfray) (R), instructors of Public Health Nursing in front of the
Science Building — 1940
The. university made a number of administrative changes to improve the
education of students as well as to encourage enrolment in the nursing programs.
In 1951 the University of British Columbia School of Nursing was formed as a
near autonomous unit within the Faculty of Applied Science. The eventual goal
was to have all basic nursing education under the direction of the School of
Nursing. The B.S.N, degree replaced the B.A.Sc. at that time. However, the
program remained a long one, consisting of three years on campus, and almost
three years of clinical hospital experience and lectures. The diploma course was
still popular for registered nurses wishing to become public health nurses. Many
who had qualified by a diploma in public health nursing were anxious to obtain a
degree but this was a long process. By 1958 the School of Nursing undertook to
integrate university and hospital experience by providing the basic instruction
and clinical supervision. A gradual shift was made in student experience from
the Vancouver General Hospital to St. Paul's Hospital until by 1961, all hospital
clinical experience was at St. Paul's Hospital. Public health nursing experience
continued to be provided by health units throughout the province and in the
Vancouver area in blocks of two to four weeks. The field guides were experienced public health nurses on staff, who planned and supervised the students'
day to day practice in public health. The program was gradually modified and
reduced to a total of five years. Concurrent field experience was introduced on a
year-round basis. It was then necessary to utilize health services adjacent to the
University so that the students could commute weekly for their field experience.
Health units in the Vancouver area and the lower Fraser Valley were suitable
training areas. As all students were required to have public health field work, a
 number of public health nurses were spending a great deal of time on "educating" students when they had been employed primarily for service. The university
gradually eased the burden by supplying additional field guides. Block field
experience of four weeks continued to be provided in other health units for
students wishing broader public health experience.
Public health nursing had become increasingly complex and the education
offered in the degree program was the preferable preparation for public health
nurses. Many public health nurses who had qualified for public health nursing
by the diploma course or health visitors' course were returning to university
making determined efforts to obtain a degree in nursing.
By 1972, a major stumbling block to the recruitment to the nursing degree
program was overcome when suitable high school graduates were accepted
directly into the program. Prior to this it was necessary to have completed the
equivalent of first year university. This reduced the length of the program to four
years (from five) and provided a program similar in length to other professional
programs being offered university students. This change greatly increased the
enrolment of students from high school as well as the number of registered
nurses eligible to improve their academic standing.
The University of Victoria had contemplated a nursing degree program for
many years and by 1975 began setting up a program for registered nurses. In
1976 the first class of sixty nurses was enrolled in the B.Sc.N. program which
would take them approximately two years.
At last there were two universities preparing nurses for public health practice
and the Division of Public Health Nursing could look forward to employing well
prepared nurses to meet the challenges of the future.
Public Health Nurses Attain Bargaining Rights
In 1972 all civil servants (soon to be known as public servants) were given the
right to form a union to bargain with the government concerning salaries, fringe
benefits, etc., along with the right to strike. This eliminated the presentations of
the Personnel Practices Committee of the Public Health Nursing Council as the
spokesman of the public health nursing group. Public health nurses now became
a part of the British Columbia Government Nurses' bargaining unit, and were
permitted as a professional association to bargain as part of a nursing group.
This group consisted of all nurses in the government service, both institution and
community-based. The first negotiations took place in 1974 at which time a
professional negotiator from the Labor Relations section of the Registered
Nurses Association represented the nurses and was spokesman for the selected
nursing representatives. Only Nursing Directors were considered "Management" and excluded in the first contract, although in subsequent contracts it was
possible to exclude more senior staff. Benefits in the first contract settlement
finally gave the staff public health nurses salary parity with hospital staff, along
with such items as improved travel allowances, recognition of overtime etc.
 Uniform allowances were lost. Public health nurses accepted union membership
with mixed feelings. Naturally they were pleased with the benefits which now
helped recruitment and staff stability.
Changes in the Division of Public Health Nursing to the Mid-Seventies
i nree long time members of the Division of Public Health Nursing retired
after an extended period with very few changes. The first to leave was Miss Alice
Beattie who had begun her career in Dr. Young's time in the Cowichan Health
Centre. As a consultant Miss Beattie will long be remembered for her contribution to expansion and administration of the clerical service, the introduction of
health unit aides and the development of the new school health program following local research studies. Miss Beattie completed a total of 35 years of varied
and dedicated service, resigning in January, 1974.
Soon after, in July 1975, Mrs. Dorothy Slaughter retired after 35 years to her
credit. Mrs. Slaughter's first appointment had been to the first provincial health
unit in Saanich, while the first Health Officer, Dr. D. Berman was still the
Director. Mrs. Slaughter's contributions as the second Public Health Nursing
Director have been noted. Her many activities as liaison officer with the Vancouver Divisions and voluntary agencies contributed to general program development. The St. John's Ambulance Association officially recognized her work
when they invited her to Ottawa in 1962 to be invested by Governor General
George Vanier as a sister in the Order of St. John's Ambulance.
In December 1975, Mrs. Monica Green resigned after 35 years service of
which 30 years were in the Public Health Nursing Division as Consultant and
Director. She had seen the service grow in three decades, from a time when there
were fewer than fifty public health nurses in the provincial service to around 340
at the time of her retirement. She was honored in 1967 to be made a Fellow of the
American Public Health Association, and given an honorary membership in the
Canadian Public Health Association following her retirement.
Miss Lavinia Crane, Assistant Director of Public Health Nursing, was
appointed Director of Public Health Nursing in December, 1975. As noted
previously Miss Crane was a long time member of the staff, having been in the
Division since joining as a consultant in 1961. Well qualified professionally and
personally she was a popular choice.
Fortunately there were well qualified public health nurses available for the
other consultant positions which came open. The first was Mrs. Diane Ouston, a
1959 graduate of the B.S.N, program of the University of Alberta. She had
joined the service as a staff nurse at Kamloops and had been a Senior Nurse in
the Simon Fraser Health Unit where she had the major responsibility for setting
up the demonstration Home Nursing Care program. Prior to accepting the
position she completed the M.P.H. degree from the University of Michigan. She
was appointed Consultant in September, 1973.
Mrs. Margaret Wilson (Baird) was appointed in September, 1974 to a new
  consultant position on her return from Ontario where she had been on the
teaching staff of the University of Windsor School of Nursing. She had previously been a staff nurse in Saanich and a supervisor in the West Kootenays at
Trail. She had graduated from the University of British Columbia with a B.S.N,
in 1961, with the M.N. from the University of Washington and M.P.H. from the
University of Michigan (1974).
Mrs. Joyce Winter B.Sc.N. from Western University, London, Ontario was
appointed in August, 1974 to the Vancouver centered public health nursing
consultant position. Her previous experience had included work with the Victorian Order of Nurses in Ontario, and appointments since 1955 in Boundary
Health Unit as a staff and Senior Nurse, as well as Senior Nurse in Simon Fraser
Health Unit.
The staff changes took place smoothly and the Division of Public Health
Nursing continued to function as a well rounded unit working well with the
central office administration and the field staff. A major adjustment was the
advent of the Union which required new routines as all public health staff were
now members of various groups which had slightly different guide lines.
The years have shown that the work of the community based public health
nurse has changed somewhat, and that over the years some health problems have
been solved, while others have been alleviated by health and social benefits. New
problems have arisen, largely due to new technology, increased longevity, and
larger numbers of people crowded into smaller spaces. The public health nurse's
work has shifted to meet these new challenges. However much remains the same
with new application. Reports of the seventies such as those of the Canadian
Public Health Association Task Forces and the Foulks Report of 1973 stated
that more preventive health services are needed. The present level of preventive
service must be maintained and expanded through innovative approaches to
solve the new health problems. Public health nurses will need to continue to
modify their programs to meet changing situations. Through the years they have
demonstrated that they can set high standards of achievement which stand as a
challenge to those who follow.
Amyot, GF. Some Historical Highlights of Public Health in Canada. Presented to the Canadian
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Annual Reports. The Provincial Board of Health  1911-1945; The Department of Health and
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Appendix I
Miss Blanche Swan (Lewis)
first provincial school nurse
Miss M. Locke,
second provincial school nurse
Miss Gregg, School Nurse (M)
Saanich Health Centre
Miss E. Foreshaw
Miss Edna Gray (V.O.N., Red Cross
Cowichan Health Centre
Miss Bertha E. Hall
Esquimalt Rural (Langford)
Miss Helen Kelly
Nanaimo City
Miss J.H. Woods
Miss Thom (Red Cross, Prov.)
Miss Frances Whittaker
Miss Janet Hardy
Nanaimo Rural
Miss Amy Lee, School Nurse
Miss Edith Walls
Miss Jean Dunbar, School Nurse
Armstrong and Spullumcheen
Miss A.L. Mercer
Miss E.M. Wade, School Nurse
Miss M.A. Davie
Keremeos (reorganized)
Miss O. Gawley
Qualicum and District
Miss H. Murray
Kamloops (reorganized)
Miss Olive Garrood, School Nurse
Port Alberni
Miss Mary Grierson
(Red Cross, Prov.)
*Public Health Nurse except where School Nurse indicated
V.O.N. — Victorian Order of Nurses
Prov. — Provincial funding
M — Municipal funding
 Kelowna Rural
Mrs. Anne F. Grindon
Miss M.A. Twiddy (V.O.N., Prov.)
Chilliwack Municipality
Miss Winifred Green
Maple Ridge and Mission
Miss H. Fawcett (Moody)
Chilliwack City
Miss Helen Peters, School Nurse
Penticton (reorganized)
Miss M.A. Twiddy
Miss 0. Ings
Miss A.E. Lee
North Vancouver
Miss Norah Armstrong (M.)
Miss E. Lowther (M.)
Miss Hilda Barton (V.O.N., Prov.)
Lake Cowichan (Youbou)
Miss V. Miller (first resident)
Miss Nancy Dunn
Ft. St. John
Miss Nancy Cunningham
Dawson Creek
Miss Rita Mahon
Mrs. Pauline Yaholnitsky
Miss J. Arnould
Miss Muriel Upshall (M.)
Miss Eileen Williams (M.)
Prince Rupert
Miss Dorothy Priestly
Miss Kay Gordon (Williams)
School Nurse
Miss Mary Shand (M.)
Miss Alice Thornloe (M.)
West Vancouver
Miss Ethel Brooks, School Nurse
Matsqui — Sumas —
Miss Beth Ochs (Rotter)
Miss Evelyn Maguire
Miss Marion Miles (Pennington)
Maple Ridge
Miss Anna Larson (Mason)
Miss Mary Grierson
Miss Lillian Wooding (V.O.N., Prov.)
Port Alberni (reorganized)
Miss Joyce Leslie
Miss Marion Bellis
Mrs. Pauline Yaholnitsky
Fernie and District
Mrs. Joanne Daem (Brewster)
Miss Bertha Jenkins, School Nurse
Creston and District
Miss Marion Miles (Pennington)
Miss Alice Beattie
Coquitlam and Fraser Mills
Miss Freda Hilton
Miss Anna Larson (Mason)
Miss Kay Ellis (Richman)
Cranbrook and District
Miss Isabel Louks (Foster)
Prince George
Miss Eileen Snowden (Ramsay)
Miss Mary Gregory
Williams Lake
Miss Viola Davies
Powell River
Miss Eleanor Graham
Miss M. Betsy Quayle
Miss Elizabeth Hahn
Miss Lucille Giovando
Miss Marjorie Staniforth (Wisby)
Miss Betty Picard (Bradley)
Campbell River
Miss Violet Hele
Surrey Municipality
Miss Ann Elyea (Hales)
Miss Frances Stewart
Miss Eileen Snowden (Ramsay)
Hope and District
Miss Susie Jones
Salmon Arm & District
Miss Phyllis Purslow (Swaisland)
Esquimalt Municipality
Miss Merle Franke (M.)
Delta Municipality
Miss Barbara Smith
Oliver (reorganized)
Miss Janet Pallister (Bailey)
Alberni Canal
Miss M. Betsy Quayle
Miss Evelyn Teir
Miss Nora Woods (Shannon)
Fruitvale — Salmo
Miss Elizabeth Ochs (Rotter)
Kamloops (reorganized)
Miss Margaret Campbell (Jackson)
Dorothy Brown (Vetterli)
Caroline Daouk
Aileen Bond
Kay Comerford
Invermere — Golden
Kay Marshall (Reid)
Burns Lake
Miriam Cressman
Barriere — Blue River
Served from Kamloops
Ocean Falls
Ada O'Brien (Clegghorn)
Gibson's (reorganized)
Clara Nygren
Marion Boyd
Dorothy Newman
Lorraine Carruthers (Houghton)
Frances Hewgill (Mitchell)
(resident nurse)
Salt Spring Island District
Served from Sidney
Queen Charlotte Islands
Served from Prince Rupert
Served from Kamloops
Served from Nelson
Salt Spring Island District
Elizabeth Layton (resident)
Grand Forks
Marion Boyd
Pauline Siddons
Prov. Govt. Employees' Health
Service — Victoria
Evelyn Dalman
Dorothy Kergin
Miriam Cressman
Telegraph Creek (reorganized)
Lillian Whiteside
Golden — (separate district)
Jean Oliver
Port Hardy
Freda Easy
Chizuko Furuya (Diemert)
Caroline Riddell (Andrews)
Faye Hurrell
Gold River
Joan Seguin (part-time)
Lois Halko (part-time)
 Bella Coola
Gold River — Tahsis
Vancouver City (M.)
Miss E. Breeze
Miss Elliott
Miss Sanders
Mrs. Lillian McComb (part-time)
Mrs. Rebecca Bancroft (part-time)
Mrs. May Douglas
1910    School Nurse
1919 Taberculosis Nurse
1920 Child Welfare Nurse
 Appendix II
East Kootenay (Cranbrook)
Miss Nora Woods (Shannon)
Miss Nancy Lee
Kootenay Region
Miss Margaret Cammaert
Selkirk (Nelson)
Miss Margaret Latimer (Cormack)
Miss Helen MacAleese
West Kootenay (Trail)
Miss Alice Beattie
North Oranagan (Vernon)
Miss Grace White
Miss Joan Russell
Mrs. Evalyn Allingham (Greene)
South Okanagan (Kelowna)
Mrs. Madeline Werts
Miss Alice Beattie
Penticton                    Mrs. Anna Mason
Rutland                       Miss Lula McComb
South Central (Kamloops)
Miss Lorraine Carruthers
Miss Helene Boehme (Williams)
North Kamloops        Mrs. Joan Wilson
Central Vancouver Island (Nanaimo)
Miss Dorothy Priestly
Nanaimo                     Mrs. Jessica Field
Cowichan Health Centre {Duncan)
*Year health unit established.
 Duncan                       Miss Bertha Jenkins
(reorganized)          Mrs. Florence Graham (Barbaree)
Port Alberni               Mrs. Maxine Smith (Bolton)
Upper Island (Courtenay)
Miss Margaret Whillans
Miss Fern Primeau
Coast Garibaldi (Powell River)
Miss Annette Stark
Miss Willa Davies
Upper Fraser Valley (Chilliwack)
Miss Nan Kennedy
Miss Mary McKinley (Robertson)
Abbotsford                 Miss Hedy Reimer
Central Fraser (Maple Ridge)
Reorganized in 1965 from North Fraser (Mission)
Mrs. Patricia Kahr
Miss Dorothy Ladner
Simon Fraser (New Westminster)
Miss Barbara Smith
Coquitlam                   Mrs. Phyllis Madden (Dangerfield)
New Westminster       Miss Barbara Bryson
Port Coquitlam          Mrs. Diane Ouston
Boundary (Cloverdale)
Surrey Nursing           Miss Janet Pallister (Bailey)
Boundary Health       Miss Alice Beattie
Whalley                       Mrs. Jean Keays
Cloverdale                  Miss Pat Knowlton
Langley                       Miss Margaret Latimer (Cormack)
(Langley became part of Central Fraser in 1965)
Northern Region (Cariboo, Skeena, Peace River)
Mrs. Pauline Yaholnitsky
Northern Interior (Prince George)
(Reorganized from old Cariboo in 1962)
Miss Mary McKinley (Robertson)
Miss Joan Sutcliffe
■■  ■
 Cariboo (Williams Lake)
Mrs. Helen Peters (Chernoff)
Miss Ardice Buchanan
Skeena (Prince Rupert)
Miss Joyce Leslie
Mrs. Helene Williams (Boehme)
Terrace                       Mrs. Donna Beattie
Peace River (Dawson Creek)
Miss Aileen Bond
Mrs. Helene Williams (Boehme)
Ft. St. John                Miss Elizabeth Upton
Health Centre             Mrs. C.A. Lucas
Saanich and South Vancouver Island (Reorganized)
Miss Dorothy Paulin (Smillie)
Miss Mary Dunn (Manson)
Metropolitan Board of Health for Greater Victoria (Reorgan
Director of Public Health Nursing
Miss Joan Russell
Vancouver Metropolitan Health Department
Directors of Public Health Nursing
Miss Elizabeth Breeze
Miss Aletha McLellan
Miss Lyle Creelman
Miss Trenna Hunter
Miss Eva Williamson
Supervisors of Health Units
Miss Margaret P. Campbell
Miss O.E. Kilpatrick
Miss E. Stoddart
Miss Geraldine Homfray (Langton)
Miss Muriel Upshall
Miss Norah Armstrong
Miss Mary Shand
Supervisors in Special Services
Tuberculosis               Miss E.M. Elliott
Child Hygiene            Miss L. Saunders
School                         Miss A. McLellan
Appendix III
Consultants, Van.
Directors of
& Regional
Heather Kilpatrick
Dorothy Tate
Pauline Yaholnitsky
1947-59 Regional
Dorothy Tate
Helen Carpenter
Supervisor, Northern
Josephine Peters
Monica Frith (Green)
Isabel Foster (Louks)
Monica Frith
Margaret Cammaert
Regional Consultant
for Kootenays —
Doris Bullock
Fern Primeau
Lavinia Crane
Vancouver 1954-55
Dorothy Paulin
(Smillie) 1948-49
Dorothy Slaughter
1955-75 Vancouver
Venereal Disease
Margaret Campbell
(Jackson) 1948-54
Joyce Winter
1975-82 Vancouver
Alice Beattie
1945 —Sup.
Lucille Giovando
Janet Kennedy
(New position)
Ann Murray
Alice Beattie
Nan Sewell
Lavinia Crane
Quennie Donaldson
Pauline Siddons
Diane Ouston
Margaret Wilson
(Baird) 1974-
(Van.) 1946
Occupational Health
Evelyn Dalman
Alice Heron (King)
Roma Worley
Jessie McEachern
Yvonne Nedelec
New Westmins.
Joan Anderson
  University of British Columbia Library
Subject to RecST
^PR 1 5 1999-
j^P o r> mo^
Jubfect to Recall
SEP t 5 fggg
n^n 1 R '■ ■■".■■■
3 9424 01696 5474
• Mrs. Mo-nica.r;
received her^B'.A. in .1-939.   ,  :~:' ?T ■■
the Universal*   ifcBrjtish*
-ti-^v       '    ;        ■fstrict. In 1944. she attended-trie'!   . ?frt
obfaine^'a-syfaiter's Degree in Public Health, a
to become 3J2onsultant Public Health Nurse in       -•-'
1948, she. became Director of Public Health >      .if
vears of service.   ' -„-;
rreen was honoured hv heino ni
the .Amefi^'ar^JBWRe -He d^fi**1 -
FellcA\'.   .. \ ......
In 19\75.s/ie was presented \vi rrl ■•"'   : rd of Men
" Canad^K';|,jLibIicJ^caIth- Association for her oStstaj "
health'sejA'Ices^id public health nursing in 'trie.fit'
made ^f H Jrro-u,rary Life Member of the
anTtfic^f.^intri ofCPH"  ': •■•-»v~- ^/fg ■
Few\.pJbpile toylay know ortbe contribution that ;
the deyelopipe^-'of British Columbia's : ' day'com      r
n io public
: offhe province, and the c'y - oflocal 1
I ri'ursg.s were the first conn r


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