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THE UNIVERSITY OF
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b University of British Columbia,!
ISSUED BY THE
PROVINCIAL BOARD OF HEALTH, BRITISH COLUMBIA
Public Health Nurses' Bulletin
TO THE PROVINCIAL PUBLIC HEALTH NURSING STAFF.
NEVER before has the nurse had an opportunity such as that which
is opening to-day for the Public Health Nurse. For years we have
been thankful that she kept from slipping backward—to hold her own and
to make the slight forward step which enabled her to retain her hold was
all that could be expected.
But at last we know that she can go forward! The social problems
of our Province are being searchingly examined; experiments will be
made, but not in a haphazard way—each step will be checked. The
sound work which has already been accomplished by the Public Health
Nurse and Physician in the Health Centres will provide the control in the
new community welfare experiments. The nurse will find an outlet for
all her energy, and to-morrow she will see the fulfilment of all her dreams
May you receive from the Easter Refresher Course all the stimulus
aud encouragement you are looking for and return to the tasks awaiting
you which you will at length be able to number as faits accomplis.
MABEL F. GRAY,
Assistant Professor of Nursing, The University
of British" Columbia.
TABLE OF CONTENTS.
A School Nurse's Day-dream. By Jennie Hocking, K.N 3
North of the Peace River. By M. Claxton, R.N 4
Remarks from Fernie. By W. E. Seymour, R.N , 5
Story of Five Years at Keremeos. By B. G. Thomson, R.N 6
Ladysmith and District. By E. G. Allen, R.N 7
Dental Problems of the Day. By M. A. Twiddy, R.N S
Discussion Groups for Mothers. By E. M. Carruthers, R.N 10
Inkameep Indian Reserve. By Rita M. Mahon, R.N 11
An Attempt at Stock-taking. By Mary E. Grierson, R.N 14
I Fresh Fields and Pastures New." By H. Kilpatrick, R.N 15
I Some Reflections." By D. E. MacKenzie, R.N 17
First Impressions in Revelstoke. By Agnes Thorn, R.N 18
A Sikh Well-baby Clinic. By Annie S. Law, R.N 21
Work in Sayward. By Edith M. Walls, R.N 23
Vernon. By E. E. Martin, R.N 24
Populaeity and the Three C's. By G. Homfray, R.N , 25
The Problem of Teeth in Children. By D. E. Tate, R.N 26
The Generalized Public Health Nurse. By E. Lowther, R.N 27
Nelson's Health Problem. By Kathleen Gordon, R.N 28
Medical Relief. By Beryl McPherson, R.N 31
Public Health in Westbank. By Grace Hill, R.N 32
Rain or Shine? By Muriel Upshall, R.N 33
Mental Health in our Schools. By P. Charlton, R.N 34
Toxoid. By M. R. Smith, R.N 35
Organizing the Nursing Services of a Healtfi Unit. By Bertha Jenkins, R.N... 36
Progress of Public Health in Kamloops. 1925-35. By Olive M. Garrood, R.N. 38
A SCHOOL NURSE'S DAY-DREAM.
Miss " S." stepped into her car one day
And sped to the West-side School away.
Her aim to weigh and measure a class
And see if all could the eye-test pass.
The road was clear and the air was great,
Miss " S." she travelled at quite a rate,
Got there at ten forty-six, I'd say—
Recess, and all the children at play.
Thought to herself, while they have their fun
I'll park out here and enjoy the sun.
Miss I S." was tired and the sun was warm.
Her eyes they closed after one big yawn.
Far in the distance she heard a sound
Like muffled footsteps from all around.
Still nearer and nearer came 1 lie tread
So our nurse raised up her drowsy head;
She looked and saw a most wondrous sight,
Thousands of nurses in blue and white,
Behind them stretched for miles and miles
Doctors and dentists, and ;ill with smiles.
They said, " We've cars, equipment, and cash,
Tone diagnoses for every rash,
Hospitals, clinics, glasses, shoes,
And pasteurized milk for everyone's use.
A law has been passed and health is free—
We're to hand it out unsparingly.
Let's now remedy ev'ry defect,
Quarantine even a ' cold ' suspect.
Our job is to make the whole world well,
When you need our help just ring this bell."
She woke to find though the bell was gone,
Quite loud in her ears still rang its song ;
Playtime was over and school went in,
Miss " S." jumped out with her usual vim;
She weighed and measured and tested eyes,
Thought of her dream with a little sigh.
They needed an army, and she but one,"
To see that some healthy worlc was done;
Though results she got were to be admired,
'Twas the " left undones " that made her tired.
NORTH OF THE PEACE RIVER.
Four years of public-health work in this new section of the Peace
River Block—and what is there to show for it? I'm afraid not very
much. When I look around, I wonder what I have been doing!
Of course, it is not a whole-time job, as much of my time has to be
devoted to the little Red Cross outpost hospital, which is run in conjunction with the public-health work.
All the same, I don't feel satisfied. And now the time has come to
move the outpost farther north across the Beatton River to a still more
newly opened-up district, where the settlers are particularly isolated
from doctor and hospital by bad hills and lack of roads.
And so we have just moved over. The people this side of the river
are delighted to have a nurse, and the little hospital, which they built
themselves, getting out the logs, and giving their labour.
But regarding the advance of public-health work, I foresee the same
obstacles—poverty, indifference, and superstition.
The standard of living over here is decidedly low. I am confronted
right away by the problem of over-crowding, lack of right feeding, lack
of good water, lack of adequate sanitary arrangements, and most serious
of all, lack of desire for better conditions. And I might almost add—
lack of time!
They need so much that my little bit of public-health work seems
just a I drop in the ocean."
More and more I realize that public opinion has to be functioning
well in advance before there can be much reform work done.
However, I am not really as pessimistic as I sound, for I find that
there is a very | alive " Women's Institute functioning in this district,
through which I hope to do great things. I know it will give me a good
backing and be very helpful.
Nor do I really blame the settlers for their apparent indifference to
health matters. On the contrary, I admire them tremendously for most
things. Many of them are putting up a brave fight against existing
adverse conditions. Necessity is showing herself the " mother of many
inventions." It is the country of 1 home-mades." So much is homemade, from pickles and rugs to threshing machines and looms for weaving. The only two threshing machines over here were made from a patient
collection of scrap iron of all sorts. The cylinder was made from a log
and cleverly cut to requirements by hand. Of course the foundation is
the faithful old Ford car that brought the family in, so optimistically,
two or three years ago. The tires, cut and sewn together, are used for
belts in a most ingenious manner.
So these people, who work so hard and so courageously trying to
help themselves, are undoubtedly worth helping. Therefore, with the
backing of the Public Health Department, I am ready to put forth fresh
effort in this new district and to go on hoping that some seed may bear
fruit some day.
M. Claxton, R.N.,
Cecil Lake, B.C.
REMARKS FROM FERNIE.
I have spent eight years in Fernie—years of depression, relief, ami
upheaval. During my first year I drew up a programme and kept to it
more or less faithfully, realizing that a programme of this sort must of
necessity be more or less elastic.
During the last few years I have felt that doing the work which
seemed most needed was the better way, of dealing with the situation.
Here we have more than fifty per cent, of the people on relief and a large
foreign population. All service clubs, churches, and private individuals
have done splendidly in meeting conditions and aiding in emergencies
as they arose, but | building for the future " has seemingly had to give
place to | scraping for the present," and that may not be such a catastrophe either as some imagine.
Through the grey skies of depression it has often been difficult to
remember to look for the silver lining which is essentially a part of the
dark cloud, but I really think I do see it and can give a concrete outline
Out of 500 children in the Public Schools only nineteen are underweight, and in more than fifty per cent, of these cases the cause is not
due to relief rations. Whenever needed our children have had appendix
and tonsil operations as well as other surgical and medical treatments
in hospitals. Our district has taken care of its handicapped children
and sent them to the Solarium, the School for the Deaf and the Blind, or
helped them in their homes.
We have provided clothing where most needed, infants' layettes, milk
for malnourished and sick children, also for newly-confined mothers,
and no children have had to come to school in even the very worst weather
insufficiently clad and shod.
A great deal of emergency dental work has been done, and I do not
worry nearly so much about the lack of attention to first teeth, as the
second set seems to take care of itself in a truly marvellous manner.
I find that the child of foreign parents, particularly the Italian, has
a better tooth structure than the Anglo-Saxon has.
Our pupils are clean, healthy, happy, wonderfully free from infectious diseases, of good physique, self-reliant and eager, and I really think
that the years of depression have helped to give them a better idea of
real values in life than the former years of prosperity ever did.
In fact, I have faith in our young people, and feel that mentally,
morally, and physically they will rise to their "responsibilities in life and
will be worthy of our respect and admiration as good healthy honourable
citizens, and that is the best that can be expected of them, and the best
return they can make us for our efforts to help and guide them.
Winifred E. Seymour, R.N.,
THE STORY OF FIVE YEARS AT KEREMEOS.
It is with pleasure I have read the articles published at intervals in
our monthly bulletin and written by other nurses in the Province.
The monthly bulletin is always of great interest to me. It interests
me to read about the various diseases, especially contagious, which crop
up at intervals, wondering at the same time how soon we may expect
a case and thanking God that so far we have escaped.
When I came here live years ago 1 had lots of ambition and was full
of altruism and high ideals. I still retain my ideals. I have lost a great
deal of altruism, and the only ambition I have left is to attempt to teach
common-sense in regard to health and to try to get people to give the
same square deal to us that we are trying to give to them.
Of material things there was very little to work with right from the
beginning. 1 was not here long before I noticed that touching the
pocket-book was a very sensitive procedure. There was some excuse for
this in that the purse has been rather flat these last fiye years.
I had to make the best of conditions as they were. We at least had
the minds of the people to work on, and as human psychology lias always
been a subject of all absorbing interest to me, I found this approach
I decided to present health in simple, easily understood, straightforward facts. I have tried never to use any elaborations or fanciful
phrases and always to present the truth. I have read with care all the
articles published by the Vancouver Health League. They appealed to
me for their reasonableness and straightforward presentation of facts.
I have quoted from these and have given them to those who were particularly interested or appreciative to read.
My health talks to the school children have been prepared mostly
from the Hygeia; these talks have been of interest and have, I believe,
borne a little fruit. This fall, I happened to be very busy on the district
in September and missed giving a health talk. The teachers kept saying
I When are you going to talk to us ? "
Practical demonstrations are done in the home. We make mustard
plasters and linseed poultices, prepare enemata and bowel irrigations,
give bed baths and babies' baths, make feeding formulas, keep tab of
the baby's weight, review feedings month by month, and review the health
rules for the pregnant mother.
We have some splendid nurses among our mothers. I encourage the
use of clinical thermometers. Most of the mothers can read a thermometer well. It is the only guide we have to complete recovery from
minor illnesses, which often become serious if neglected. We have
learned to realize that time is saved by putting a child1 to bed when it
first shows a temperature and keeping him there until he is normal.
This also isolates him somewhat and retards the possible spread of
infection. A high temperature does not seem to send the mother into
I I fit." She is calm and wants the matter looked into. Rashes and
other abnormal conditions are conscientiously reported. We administer
cod liver oil from November 1 to May 1.
We have formed the habit of using mineral oil and laxative foods in
case there is a chronic appendix which might be irritated into an acute
one if drastic purgatives were used.
We see to it that we get our daily vitamin in our food—Vitamin A
in milk, Vitamin B in coarse cereals, Vitamin C in tomatoes. All these
things are normal everyday affairs, like getting breakfast.
I must confess there has been no spectacular accomplishment. I do
think we have made a beginning. There is a glimmer of health consciousness in the minds of the people. I know these people so well, too
well maybe, which may account for some of the altruism petering out.
We have been terribly handicapped by not having a resident physician nearer than thirty-two and forty-five miles. Since the Hedley Mine
opened we have a Medical Health Officer at Hedley, eighteen miles of
splendid road. He is going to look after us and has in mind a health
contract for the people consisting of a small monthly payment for each
family. I have every reason to believe that this scheme will materialize.
It gives the people such a sense of security to have some one who will
come in case of illness. What this means to me, no one can guess.
Dr. Wride has only been known to us a short time, but we have all
acquired the greatest confidence in him, as he has already proven himself
up-to-date, conscientious, businesslike, and gracious.
B. Thomson, R.N.
LADYSMITH AND DISTRICT.
I entered hospital for my training as a nurse nearly eleven years
ago with the idea and intention of caring for the sick. I have seen many
benefit from this care to the extent of being restored to permanent good
health; others much improved, and sufficiently cured to enjoy a normal
life. There were still some who paid repeated visits to the institution. In
so many instances it was plainly lack of knowledge that had led to the
breakdown of their " physical resistance "—perhaps through contact with
a sick person, neglect, or carelessness on the part of the person affected.
I began to feel that surely there must be another side to sickness, that
After graduating, I spent three years working with the knowledge I
had acquired and then decided to train for a Public Health Nurse.
During the past three years which I have spent as School Nurse for
above districts, ten in all, I have many times witnessed the fruits of
preventive work. The parents and the public, in general, appreciate the
advice of the Public Health Nurse, and especially the early visits or
inquiry when the child is absent from school. Recently when I inquired
on the first morning of absence, a mother said " that is what I call
service," and so I explained to her that the early check-up meant a whole
lot more for both the pupil and the contacts.
In this community the people are very proud of having Public Health
Service and, in the vast majority of cases, will assist in the check of
epidemics by the early reporting of sickness in the family. They ask for
advice as to whether Mary should stay at home because Johnny has a
I rash." The parents are very eager to learn the explanation of the
length of incubation periods regulating the quarantine periods, and are
interested to learn the present-day methods regarding quarantine and
isolation under supervision.
Preschool and Infant Welfare Clinics are held twice monthly here,
and the follow-up work is chiefly done when visiting the homes for other
reasons. Much more should be done but the school work is the major
factor, and I feel that it is better to be thorough in one branch of the
service rather than attempt too many things, some of which only have
to be dropped later as the work expands, as it does in all its branches.
People are becoming more clinic-minded all the time, realizing the
benefits received rather than the disgrace that used to be felt if they
were asked to attend one. Several advanced cases of tuberculosis in our
midst have made it much easier to approach the people in regard to the
care for and the carefulness necessary in this disease.
Goitre is not so prevalent here, but in all instances where the tablets
have been suggested for the children the parents have sighed the slip of
paper and paid the fifteen cents asked for to help cover the cost.
Last June scarlet fever found its way into one family. Also in
November another child became ill, but in each case we were happy to
report no further trouble. In January of this year there was a case of
rubella in the third grade which spread only to a pre-school brother and
a girl who was assisting in the home during the mother's visit to hospital.
The family consisted of six children. I cannot say this of whooping-
cough, unfortunately, as we have had quite a few cases, but all suspicious
coughs are being isolated and I think a severe epidemic will be prevented.
The cases are mild but the weather has been so cold and wet that the
children have not had the chance to recover out-of-doors in the sunshine.
The best way to reach the hearts of the people is to take an interest
in their children, and we have accomplished much. They are proud of
their schools and are extending the courses annually.
Emily G. Allen, R.N.,
DENTAL PROBLEMS OF THE DAY.
To the many expressions of impressions on depressions, as a School
Nurse, I would like to add some observations in regard to the dental
condition of individuals who must neglect the repair of their teeth in
order to have the immediate necessities of life. Such people visit the
dentist only when in extreme pain or when general health is seriously
I have found that dentists are very generous in treating urgent cases
referred to them, but it is impossible for them to treat all the needy ones..
Hence every day one meets in both school and home many cases of
I The dentist says I have five to be extracted and eight to be filled."
I It would cost thirty dollars to fix up another young girl's teeth." These
are examples of the many reports from dentists when children go to them.
When trying to get the consent of a mother to get Mary's tonsils out,
she replied, 11 think her trouble comes from bad teeth rather than her
throat." On looking at the teeth I agreed with the mother. Many
months have elapsed and neither teeth nor tonsils have had attention and
Mary remains a thin anaemic-looking girl.
Practically all prenatal cases among people with a small income need
dental care. We are reminded that they need extra milk in the diet and
foods that give additional vitamins. How are these expectant mothers
to get such " extras " as foods and dental care? Surely pregnancy brings
enough discomforts without the unnecessary suffering that carious teeth
When a doctor examined a child of five, who was acutely ill, he could
find no cause except many bad teeth. The child had not had sufficient
milk and cod liver oil. It has been observed that small children who have
had plenty of milk and cod liver oil have good teeth. But there are
hundreds who cannot provide these for the children.
In school, one sees very few children whose parents pay any attention
to the deciduous teeth. Hence there are scores who have these sources
of infection in their mouths.
It is heart-breaking to inspect the permanent teeth of children. Over
100 of the 911 inspected (under sixteen years of age) have from one to
five or six large cavities. There are likely many small ones besides which
are not easily seen in the school examination. Some forty of this group
have had from one to four of the permanent teeth extracted.
There are only about a dozen in the group who have perfect and
complete sets of teeth. Hundreds need treatment by the dentist for
cleaning, straightening, etc. In answer to " have you seen your dentist
this year ? " one often gets the reply, " No, I haven't had toothache yet."
The famous Sir William Osier once said, | There is not one thing
in preventive medicine that equals mouth hygiene and the preservation
of the teeth." Prevention! That is a heart-breaking word in these days
when so little of it can be practised.
While it. is generally conceded by all doctors and dentists that
neglected teeth causes many ailments, it seems to me to be unkind to tell
people of the dangers of such neglect when they can do nothing about it
themselves. This teaching only adds " fear of losing health " to the many
anxieties they already have. He who has health has hope and he who has
hope has everything.
We so need dental clinics for small municipalities. Here is hoping
we have one soon.
M. A. Twiddy, R.N.,
DISCUSSION GROUPS FOR MOTHERS.
It has been stated that the education of parents can be accomplished
through the schools, by means of the children. Consequently, when in
health education classes, certain facts relating to hygiene are emphasized,
and when in home economics budgeting and food values are studied
minutely, it is often with the hope that these messages will be carried
home to 1 mother and father." To parents this second-hand method of
obtaining a modern education must at times prove embarrassing.
Approaching adult education from the standpoint of health, there are
many problems to be considered. It is difficult for doctors and nurses
to keep up with the fast changing trend of medical science, while for the
" lay " person it is practically impossible to weed out truth from untruth
from magazines and newspapers.
For two years now we have held regular discussion groups for
mothers, and they have proved to be a happy solution for these problems.
Not only are they useful as a method of educating " mother," but also
serve as a means of keeping the nurse well informed. In order to guide
the groups profitably the nurse must gather all the information she
possibly can on the topic for discussion. We organized in this way: A
message was sent home through the school children and through the
Parent-Teachers' Association inviting all mothers interested in a " discussion group I to meet in the nurse's office. The response was fairly
gratifying and the attendance since then has varied from four to twenty-
four, but, in all, about fifty different mothers have availed themselves of
the opportunity to meet and discuss their problems.
The mothers selected from a given list the following topics for
(1.) " The Job of Being a Parent."
(2.) I Cod Liver Oil and Concentrates Now on the Market."
(3.) "Colds—Cause and Prevention."
(4.) "The Power of the Spoken Word." (This meeting was conducted by Mrs. Jennie McDonald, of Cowichan.)
' (5.) I Children's Parties and Christmas Presents."
(6.) I Nutritive Value of Dairy Products." (Address given by Miss
Pepper, of Dominion Department of Agriculture.)
(7.) "Nervous Breakdowns." (A review of the book by that name
written by Dr. Wolfe.)
Each meeting was opened by an address (so far this duty has fallen
on the nurse, as the mothers are backward) followed by questions and
discussion relating to the subject. Sometimes, however, other topics are
introduced into the informal discussions. Connected with the mothers'
group, we have a library of periodicals, namely " Hygeia " and " Parents,"
and the mothers seem grateful for the opportunity of thus broadening
their health knowledge. Now, also, they are asking that the addresses
which were preliminary to each discussion be printed and distributed to
These discussions have entailed a great deal of preparation, but I
feel that it has been well worth the effort, for not only has it been a
method of self-education, but also it has been a very forceful way of
presenting the principles of health education.
Eileen M. Carruthers, R.N.,
INKAMEEP INDIAN RESERVE—OLIVER DISTRICT.
How many of you have an Indian Reserve attached to your district?
And who does not find the work thereon one of the most interesting parts
of your entire programme ?
When I first came to Oliver two years ago, having had no former
experience with Indians, I looked with some few qualms towards the
Reserve. Like the average British Columbian, I had given only a passing
Tooth-brush drill, Inkameep Indian Day School.
thought to the Indian in our midst. Few of us realize that a brief 200
years ago Indians of this Province were monarchs of all they surveyed.
The present year finds the red man closely hemmed in by our complex
machine-age era. How to develop him and fit him for our modern life is
at present a big problem.
In his primitive state the Indian responded to the natural impulses.
He hunted when hungry and loafed when full. Their primitive wants
were few and easily satisfied. The Indian women knew how to care
for hides. From them she made much of the clothing for her family—
clothing that was not only durable for hard wear but fine and beautiful
as well. Shelter was a small worry. The nomadic urge is strong within
the Indian and, though we now have them more or less restricted to the
Reserves, one finds them frequently roaming back and forth, " visiting,"
they call it here. In our efforts to remould the red man, we would do
well to remember that though he buys canned milk, store clothes, cheap
jewellery, and the radio brings modern jazz to his lowly dwelling, his
ancient habits are very much with him. He has really advanced only a
fraction of an inch from his primitive ways.
Dealing with an Indian Reserve from a Public Health Nurse's
standpoint, I find, gives one plenty of opportunity to cope with difficult
problems. I believe we are very fortunate here in having a day school
rather than a residential school. The relationship is closer and one
finds that much of the teaching carries over. Health lessons are necessarily very elemental when one remembers that most of the children
have previously never seen a tooth-brush, a bath-tub was unheard of, and
a balanced diet beyond the limits of imagination.
Very excellent co-operation from the teacher of the school has overcome many difficulties. Finally, each child possessed a tooth-brush and
we practised cleaning our teeth assiduously. Formation of a Junior
Red Cross with an active health committee gained much interest among
the children, Henry, aged eighteen, acting as the solemn chairman of
the meetings. The meetings are held when the nurse visits the schools.
At this time she is a special speaker and stresses some one of the health
rules as the necessity arises. Last term a number of lessons in first aid
were given. In this the pupils showed marked adaptability. The local
Boy Scout leader, who was present at a demonstration of work put on for
school closing exereises, assured me that the Indian children put his
scouts to shame.
Many of tin1 Indians on this Reserve suffer from the eye disease,
Trachoma. The Indian Department specialist on Trachoma, Dr. Wall,
first visited this district about three years ago and diagnosed many
cases. Since that time copper citrate five per cent., supplied by the Department of Indian Affairs, has been used as a preventive treatment.
This measure carried out regularly at the school has shown good results.
Many of the older people suffer from badly impaired vision and some
from blindness, no doubt due to Trachoma.
In visiting the homes I find it most important to establish a friendly
footing. The Indian is slow to accept one as a friend, but, once established, his faith is implicit. My experience has shown demonstration to
be much the best method of teaching. The women, and there are often
several in one household, crowd around and watch every move. Most
of the younger ones are very willing to follow instructions re child care,
but are sometimes dissuaded by their parents and grandparents who
think babies should never cry. The result is difficulty in establishing
anything approaching a regular routine.
The majority of the Indian women keep their infants clean and,
although some still stick to the native mode of dress, many have accepted
the modern method and make quite respectable garments, too. One of
the dirtiest squaws on the Reserve was persuaded to keep her baby
beautifully clean when I sold her a complete second-hand layette for
twenty-five1 cents. She was so proud of those clothes, partly because she
had paid for them, I think.
Illegitimacy is fairly common and does not seem to arouse much
concern. The child is taken into the home and looked upon with as
much favour as any other~ member of the family. The father of one
illegitimate child was known to be a white man. This seemed so appalling tome that I wrote the Indian Agent about the case only to find that
the Department could not do anything about it as the girl was over age
and, as the agent remarked also, 1 unfortunately, this is not by any
means an isolated case in this Province."
The Department of Indian Affairs supplies certain standard drugs
for distribution. Important among these is cod liver oil. Through
the co-operation of the school teacher, cod liver oil has been fed daily
to all children attending school during the winter months of the past
two years. Their health record shows that this has been of great benefit.
I found it very difficult to persuade mothers to feed cod liver oil to
the younger children—mostly because the children showed a distaste
for it and the mothers would not carry on the treatment. This was overcome when we got a supply of malt extract and cod liver oil. Perhaps
the actual content value is not quite so high but one can be quite sure
the children take it. Many of them, toddlers and pre-schools, come
running to the car when the nurse visits asking for " malt, malt." Diets
are poorly balanced and run to meat, fish, and bread principally. Although the Indians on this Reserve raise huge herds of cattle, most of
them like to buy canned milk. Some families have been persuaded to
keep one cow for milking and to feed more milk to the children.
Most of the houses are badly built, run down, overcrowded, and
poorly ventilated. Some of the women are fairly clean housekeepers
but the majority are careless and dirty. One who was especially dirty
acquired a great love for tysol and asked for it continually. " Bad
smell; make clean," she said, and could scarcely be persuaded that her
shack needed a thorough scrubbing. Open windows were under discussion until this winter, when two little girls in different families developed pneumonia. Both families were greatly impressed with results
of fresh air treatment prescribed.
Tuberculosis is an ever-present problem here. The Indians are
fairly well informed about the disease and very frightened of it as it
accounts for a high percentage of deaths. During the summer months
the use of tents and sleeping outdoors is stressed, but winter, with its
crowded quarters and prevalent colds, usually leaves a mark.
One might discuss work of the Reserve on and on indefinitely. I
hope I have touched upon a few points of general interest. The Indian
will, be an ever-present factor in our affairs for years to come. Thanks
to his adaptive and imitative faculties, he himself is making a valiant
effort to adapt himself to our modern parade. Surely our chief aim in
this special branch of our work is to help develop the Indian into a
healthy, respectable, self-supporting citizen.
Rita M. Iahon, R.N.
AN ATTEMPT AT STOCK-TAKING.
Another Nurses' Bulletin; another opportunity to learn of other
nurses' achievements and a stock-taking of one's own district's two
The stock-taking of public health nursing of a district is a bit difficult ; one is not always sure what is profit and what is loss. It is not
possible to add up the forward changes in attitudes toward prevention
of disease and the building up of positive health. Nor can one be sure
of just the amount of prejudice and the lack of understanding of the
health ideals that are still existing in the community, so the compiling
of a list of the concrete advances in this work of necessity leaves out
While one can count the percentage of children in the schools immunized against diphtheria (sixty-four per cent, in these two districts,
plus numbers of pre-school children), it is not possible to tabulate the
harm that may come to the remaining thirty-six per cent, who are not
thus protected from that disease.
The fact that half of the schools are receiving milk for their undernourished, paid for by the School Board, can of a certainty be placed on
the credit side, the value being greatly increased by the willingness and
understanding of the Board in supplying this service.
The iodine tablet treatment supplied by the School Board of eight
schools is resulting in a marked decrease of simple goitres among those
pupils. The other nine schools not given this privilege must be added
to the losses for that.
Tests for vision defects and the acquiring of needed glasses by
a number of pupils, financed by the Parent-Teacher Associations, School
Boards, and other organizations, we gladly mark up. Also the thirty
odd children likewise equipped through the parents' efforts, with distinct
benefit to them all.
But the non-success thus far of any arrangement for much-needed
dental clinics looms large on the debit side. Only a few dozen cases
have been given dental care through societies paying and the kindness
of one dentist in giving one afternoon a week for free work for a few
months. Of course there have been numbers taken care of by the
families, but many still are in need of dental treatment.
The decrease in the percentage of underweights in the schools, on
the whole, in spite of the hard times, can, we feel, be placed with the
gains, although the degree of malnutrition may not be evident for a time.
The requests for well-baby clinics and more diphtheria " toxoid i
clinics we add to the right side, even though the plans have not been
completed for them yet. Also, the eagerness of the mothers of infants
to receive the mothers' advisory letters from the Department of Health.
Realization by many parents of the necessity of the protective foods
in the diets of the family and the more general use of cod liver oil with
the understanding of its properties, is a distinct advance, one feels, while
there is still much to be done there.
The reporting by many of the parents of the symptoms of communicable diseases much Overbalances the failure of some of the others
to do so. To which, we add the spoken appreciation of a Municipal
Council of the health service given, particularly in communicable disease,
although there was a rather prolonged epidemic of mild scarlet fever just
The clouding of the spirit of independence in many, through the
receiving of relief, darkens the "page. It is a direct about-face with some,
a weakening of the morale, worse than many other epidemics, one fears.
In spite of shortened budgets, the lighting and other facilities have
been much improved in some of the schools, though in three schools there
is much overcrowding.
But the I stock " still contains the backing and assistance of the
Department of Health, the proven scientific aids for the prevention of
disease, even aids to improve the salesmanship of these same as refresher
courses for the salesmen. Belief in these " wares " too is a valuable asset.
Mary E. Grierson, R.N.,
"FRESH FIELDS AND PASTURES NEW."
There is always an element of excitement about something new and
unknown, and our anticipation ran -high as our supervisor, one of our
students, and myself, in answer to an invitation received from the residents of Kapoor, started out to investigate the possibilities of adding
this settlement to our already large Cowichan District.
To reach this little-known place we had to travel about twenty miles
from Duncan through Shawnigan before branching off on the unsettled
ten-mile stretch through the Victoria watershed area, along the shores of
Once before we had partially explored this area, but had been repulsed by the many signs promising fines and imprisonment to any who
contaminated or even trespassed on this forbidden land. We had heard
of the " impassable " road, but we found it even better than many roads
we traversed daily in our regular routine of work.
Although there had been a light fall of snow a few days previously
which blanketed the ground, one could easily imagine the beauties of
this virgin forest, through which we travelled, on and on. At last in
the distance we saw great clouds of smoke belching heavenward. As we
reached the crest of a hill, we saw below us a valley in which lay the
object of our quest—Kapoor. This spot, as you may or may not know,
is a small village around a lumber mill, owned partially by Kapoor
Singh, a native of India, and situated in the mountains, between Gold-
stream and Shawnigan Lake.
Leaving our trusty car, we followed a faint path down a long hill
toward the mill. All about us were logged-off b,arren hills, dotted with
unpainted houses, typical of many other logging camps in our district.
We proceeded a little uncertainly until we came across an East Indian,
of the Sikh clan, piling lumber. He directed us with a wave of his arm
to the school. We were secretly pleased with this gesture, for at least
he knew who we were. We guessed that this man must have at one
time lived in some part of our Cowichan area.
Walking along the railway track, we saw upon oui\ right the Union
Jack waving in the breeze. This betokened the school. Up we climbed
and reached the green-painted school-house, where the teacher greeted
us warmly and wanted us to get to work at once among her twenty
pupils. After gathering some necessary information from her we went
on our way to find the official trustee in the mill office. He, in turn,
mistook our initial survey for a professional call and was very anxious
that the work in this district should be undertaken immediately.
This little village has a population of one hundred and seventy-five
people, comprised primarily of whites, East Indians, and Japanese, the
latter two races predominating. The homes are clustered about the mill
in little groups, according to nationality. Our guide, the trustee and
company official, explained to us his attempts to maintain some semblance
of sanitation by insisting that each house be built some distance from its
neighbour. In order to get even this idea across, the danger of fire had
to be used as the excuse. Owing to the mixed population to be found
in most logging centres, with each race maintaining their individual
native customs and each reluctant,to relinquish these for our modern
new-world principles of hygiene and health, the problem of sanitation
becomes a baffling one. This difficulty may only be overcome by education and understanding.
Most of the company business is carried on through Duncan, and it
is from this centre that medical aid is sought. We found that even the
doctor is called only when it is considered absolutely essential. Furthermore, even though the school was established three years ago, the pupils
have never been medically examined. Here is, therefore, a very fertile
field indeed, and we fairly yearned to begin work at once.
After discussing the situation from all angles with the company
official, we found that the nurse from Langford Lake would have only
fourteen miles to travel to reach Kapoor School, while we would have
thirty miles, so we decided to submit the question to our local committee,
with a view to the matter being officially reported to the Provincial
Medical Health Officer for his consideration and decision.
As we departed, after partaking of tea at the home of the trustee,
Ave felt that Avhoever undertakes this field will receive the heartiest
co-operation from the people in Kapoor in solving the many problems
which this most interesting district presents.
H. Kilpatrick, R.N.,
" SOME REFLECTIONS."
" Engineers are prone to talk of the efficiency of modern machines. But no
machine has ever been constructed that is so efficient as man himself. Where can
we find a pump as perfect as the human heart? If the boss treats it right it stays
on the job for more than 600,000 hours, making 4,320 strokes and pumping fifteen
gallons an hour. We have no telegraphic mechanism equal to our nervous system;
no radio so efficient as the voice and the ear; no camera as perfect as the human
eye; no ventilating plant as wonderful as the nose, lungs, and skin; and no electrical switchboard can compare with the spinal cord. Isn't such a marvellous
mechanism worthy of the highest respect and the best care? "—Floyd Parsons.
The physical being of the average man does not obtrude itself upon
his notice, in health. Only pain or discomfort brings it to his attention.
This is, upon merely aesthetic grounds, a very great pity. The consciousness and pride in the perfect order of the human mechanism would, if
present in every person, make for a dignity of thought and a care for
the body which would approximate the perfect health attitude. This
brings up the ideal of the modern public health, which is so practicable
and lends itself so well to education and demonstration.
It is the office of the Public Health Nurse to begin this education.
Necessarily it is slow at first. It takes more steam to start a cold locomotive than to run a moving one along miles of track. Ours is the
struggle to begin this motion, in order that we all may benefit by the
momentum it will one day gain. Alone on our districts we have the
scant satisfaction of knowing that, in our struggle, other nurses meet
with our difficulties. We find that time well spent for education, a
reluctant mother convinced of some sane method is regarded by many
as so much wasted time. We all have found that we have spent time,
teaching, only to find that the person on whom we have spent the time
has little or no comprehension of our aims, or meaning. Nevertheless,
some of our lore always sticks, making further work easier. It is
encouraging also to notice that, judging from writings of earlier nurses
in Public Health, we now meet with a response and an intelligence that
would have seemed miraculous to them.
Beginning with the prenatal and carrying on up to the cold, cold
grave we teach, teach, and teach with the idea of getting every one to
maintain their health and to realize the dignity and responsibility
lappy and well-running bodilv mechanism.
» » » CD nJ
entailed in maintaining a
D. E. Mackenzie, R.N.,
Qualicum Beach, B.C.
FIRST IMPRESSIONS IN REVELSTOKE.
We sometimes hear it said that first impressions are lasting—well,
my first impressions of Revelstoke will not soon be forgotten. As the
old-timers around town are saying, I The worst winter and most snow
since '92." My first impression was snow—and more snow, and now,
almost three months later, it is still snow, and measles.
Revelstoke has more than its share of Nature's grandeur and natural
beauty. Lying in the lovely Columbia Valley, it- is surrounded by lofty
mountains and majestic peaks. WTe are on the very threshold of the
My thoughts on stepping off the train on January 6th were, " What
a fairy-land of snow"—mountains snow-clad, trees snow-laden, and
a flurry of soft feathery flakes falling and floating to a blanket-covered
snowy soft earth. To me, coming from Vancouver where the rain had
almost excelled itself in a recent record-breaking downpour, the snow
was a new experience and rather a pleasant one.
Sometimes we are initiated gradually into our new life and environment, but the elements of Nature descended upon us with vengeance in
this little mountain town, and January, 1935, goes down in history as a
record month with a snow-fall of seventy-two inches in two days, and
about ten feet in the month.
Imagine being a newcomer to the district and ploughing through six
and seven feet of snow making home visits. The people of the town were
most sympathetic in their attempts to assure me I was seeing Revelstoke
at its worst, " but just wait until the spring comes." April is almost
here, and we are still waiting for spring to come and for five feet of
snow to go.
May I take this opportunity of writing a word in appreciation of
the splendid work accomplished by my predecessor, Miss Amy Lee, who
organized the work here. To pioneer in public health is not easy. There
are obstacles to overcome, prejudices to break down, old ideas and customs to abolish, organizing and planning to be done, but Miss Lee has
laid a sure foundation that will not easily be shaken. She has won the
.confidence of the people and has proved to them in a most practical way
the worth of a school health programme.
An enlightened public opinion is needed to make health work in the
schools effective, and the people in Revelstoke are becoming increasingly
| health-minded " and the school nurse is considered just as necessary
now as the school teacher. The health programme in this community
has been almost entirely confined to school work. XFnder the following
headings I will try to give an account of our programme.
Personnel.—One Medical Health Officer, one Public Health Nurse,
one high school (155 pupils), two public schools (520 pupils).
School Plant.—Daily inspection of basements, hand-washing facilities, drinking-water faucets, and toilets.
Health Inspection and Examinations.—A yearly examination by the
School Doctor, and a monthly inspection in each grade to determine the
general cleanliness and health of the children.
During January I weighed, measured, tested eyes, and sent health
reports home to the 520 public school pupils. In February the high
school pupils were weighed, measured, and eyes tested. During the
present measles epidemic a daily inspection is done in each grade, spending the morning in one school and the afternoon in the other public
Follow-up Work.—It is here that the Public Health Nurse has the
best channel through which a contact may be made between the home
and school. It is the responsibility of the parents to have defects corrected, but it is our responsibility to explain to the parents the nature
of the defect and why it should be corrected.
Co-operation between the home and the school is vitally important
in the school health programme. The most effective means of winning
this co-operation is by a home visit. I find defects followed by a personal
visit likely to be remedied far more speedily than those followed up by
only the health report or a telephone call.
During the months of January and February about seventy-five
home visits were made, and I found the mothers always appreciative for
the visit and anxious to discuss the health report of " Johnnie" or
Already ten pupils have had eye defects attended to and are now
wearing glasses. Eight have promised to visit their eye specialists
during the Easter vacation to have their present glasses checked. About
fort^-iive children have visited their dentists in the past two months.
I am hoping in the near future that a medical and dental fund will
be established by the School Board to enable indigent parents to have
Underweights.—In one public school we have six per cent, underweight; these are children more than two pounds below the standard
weight, and in the other school twenty-three per cent, underweight. The
difference in the two schools is very likely due to the large number of
Italian children in one school whose parents are on city or Provincial
relief. These children are weighed monthly and a record-card sent home
showing the gain or loss as the case may be. Each teacher is given a list
of her underweights, and the percentage of underweights in-each grade is
worked out and the list posted. We have keen competition between
the various grades as to which class has the smallest number of underweights. During February eighty-five per cent, of underweights gained
more than one pound.
Milk in the Schools.—About three years ago the local chapters of
the I.O.D.E. and the Women's Auxiliary to the Canadian Legion sponsored the supplying of milk to children not gaining in weight, underweights, children whose parents are on relief, or mothers' pension, and
poor families. Other children wishing to take milk pay 50 cents per
month. At present over one-third of our school children are drinking
milk at recess.
I think this health project is perhaps the most worthwhile activity
carried on in Revelstoke. The results cannot be evaluated in dollars
and cents. In these days of hard times the children are always the
greatest sufferers, and a child underweight starts life handicapped and
may later become a social and economic liability to the community.
Health Education.—Health teaching has become a definite part of
my programme. Every two weeks a health story is given in grades one
to four, and a forty-five minute health lesson in grades five to eight.
We have also commenced tooth-brush drills in the lower grades, and
these have proved very popular as well as instructive and amusing.
In grades five and six we have recently had a poster competition
between the two public schools. I gave a health lesson, " The Human
Machine and Its Fuel," and following this the children worked out their
own ideas for a good dinner poster. The competition was very keen as
to which class and school would produce the best poster.
I have two classes a week in first aid, one in each school to grade
seven boys, and two a week in home nursing and Little Mothers' League
to grade seven girls.
We are conscious of the need for greater education along health and
prevention lines in our community, and our greatest hope lies in the
rising generation. If we can put our gospel of good health and prevention of disease across to our children we have gone far in the promotion
of health practices in our community.
. Communicable Disease.—This community has been remarkably free
from epidemics of any kind for the past ten years. I think there has
been one case of diptheria in three years, consequently the people are
not very enthusiastic about toxoid and prevention of diphtheria. I have
found that the majority of people here have never heard of'toxoid, and
those who have think it is a serum. I have taken every opportunity of
explaining what toxoid is and what it does and it is one of the ambitions
of my life to organize in the near future a toxoid campaign for the immunization of our pre-school and school children. I may say that the
three doctors here are most co-operative and willing to support the
And now comes my sad tale of woe. We are at the present time
at the peak of a measles and German measles epidemic. Having had no
previous measles epidemic here for ten years it was virgin soil for the
spread of this most infectious virus.
We had two or three adult cases of German measles in January,
but not until the middle of February did one case crop up in the
schools. This was in grade one, and was diagnosed by the doctor as
German measles. The contacts from this case were inspected daftly
after seven days, and a brother developed what turned out to be the real
measles. The brother was in a different school and the damage was done
there. For the past three weeks all class-rooms have been inspected daily
and contacts sent home on the seventh day. Having the two kinds it
has been almost impossible to be certain of the incubation periods and
even the doctors have differed as to whether some cases were severe
German measles or a light case of measles. Fortunately the measles
have been of a light nature and so far no complications have developed.
The epidemic has caused tpaite a sensation in town, and many people
still hold the old-fashioned idea that the schools should be closed. It
is discouraging to see the havoc the epidemic has caused in our school
attendance. About ninety per cent, are absent in grades one and two,
and thirty per cent, in the older grades. At the present time there are
160 absent in the two public schools.
With weather conditions so bad the walking is difficult, 135 cases
have been visited. It means miles of plodding through snow and slush
but at the end of a busy day arriving home at six p.m. tired and weary,
it gives a great deal of satisfaction to know that perhaps due to your
words of advice and warning of the dangers of complications, some child
may be saved from mastoiditis, bronchial pneumonia, or defective vision
—yes, it is worth while.
Clinics.—No clinics have been organized in this community, but I
think the time is ripe to start prenatal and well-baby clinics. Oh, for time
to do all the things we would like to do. There is so much to be accomplished and the days slip by so quickly. I have organized a prenatal clinic
and had hoped to hold the first clinic about the middle of March. How-
'ever, owing to the disruption caused by the measles epidemic the opening
has been postponed and we hope to commence in the first week of April.
The hospital has kindly loaned us one of their rooms, and we have about
twenty expectant mothers lined up to attend.
I feel nothing very spectacular in the way of public health is being
done here. We are doing our best, sowing the seeds of good health, prevention and the preservation of health, hoping that some of the seeds are
taking root, and that our Canadian boys and girls will reap the harvest
that will bring new possibilities of health and happiness and efficiency for
As public-health nurses and teachers it is our privilege to help in
applying the knowledge we possess daily in our own lives and to help
forward their application in the lives of those with whom we come in
And so with the hope of spring in our hearts we go forward knowing
that the snotv will go, and measles epidemic will some day burn itself out,
and the triumphs of public health will bear the fruit of human happiness.
Agnes Thom, R.N.,
A SIKH WELL-BABY CLINIC.
There is a Sikh settlement not far from Duncan where there are a
number of native babies. It seemed a fitting time and place to establish
a well-baby clinic. Since there are no other public buildings available,
the primary school-room is used, with the kind permission of the School
Board secretary. The clinic is held aftej? school hours, from three till
At quarter to three the nurse approaches the school, baby-scales
under one arm and a large sheet of cardboard under the other. As. she
walks up the board walk she meets an anxious mother who has been
pacing up and down in front of the school with a seven-month-old babe
in her arms. The mother looks as if she had stepped down from an
Indian picture, with her wide-flowing silk trousers and picturesque sari,
"Oh, nursu, you weigh bibi to-day?" she asks eagerly. Reassuring
her, the nurse enters the school and arranges the scales on the table.
The piece of cardboard she hangs on the wall; on it are pasted brightly-
coloured vegetables and fruits, cut out from magazines. This is the
The little Indian mother has followed and hovers at the door,
chattering in Punjabi with the school children who have gathered to
watch. The nurse asks her to be seated and begins to unwrap the
baby. Two shawls come first, then two rainbow-coloured, hand-knitted
sweaters; next a knitted bonnet with a round pom-pom on top; lastly
long multi-coloured stockings. His outer clothing removed, baby is now
ready and is lifted to the scales, where he howls lustily.
-1 Bas, bas," cries the mother, snapping her fingers above the baby,
as she watches the weights going on. Baby has only gained one ounce
in a week.
What has he been eating? Mother-milk? Anything else? Cow-milk,
some time little bit potato. " Cereal" she does not understand, but
"mush " brings a smile of joy from her. The Chart is brought into use;
she recognizes vegetables by picture if not by name. She is told when
and what to feed her baby and is given a book on infant-feeding. Though
the majority of mothers know only a few words of English, the fathers
can generally speak and read it with ease.
Next comes a mother with a sixteen-month-old baby who has had
nothing but breast-milk since birth, with a few arrow-root biscuits once
in a Avhile. The child can barely sit up by himself and the mother is very
worried. 1 Nursu, bibi sick."
The nurse has a difficult task. She calls to one of the school children.
A little girl, with long glossy black hair and sparkling black eyes, answers
eagerly. There is nothing she likes better than airing her newly acquired
The nurse finds exactly what the child is getting, then tells the
mother exactly what the child should get. " Cod-liver oil" is the most
difficult thing for her to grasp. The little interpreter herself does not
understand. Fortunately the nurse has a small sample bottle of cod
liver oil in her pocket. This is produced, and though the bottle is not
recognized, at least the smell is, and all are smiles once more. The mother
departs happily, and the nurse wonders to herself how many of her
instructions will be carried out. She knows from experience how often
baby is not given his proper food because " he no likee."
And so they come and go. Each day the nurse repeats the same instructions, and though they are not all carried out immediately, eventually the mothers come to realize how important proper diet is. And as
they see their babies gaining under the new regime more than before, so
they tend to do more what they are told.
Time passes quickly and as the last mothers walk down the stairs,
chattering and laughing in their soft native voices, with their toddling
babies clinging to their trousers, the nurse glances out the door to see
the sun sinking behind the near-by hills. She gathers up her cards and
prepares to depart. The clinic is over.
Annie S. Law, R.N.,
WORK IN SAYWARD.
It is with much pleasure that I submit a brief outline of the work in
Sayward. "The work goes on much the same as we are only a very small
family. Visiting schools, child-welfare visits, prenatal and postnatal
visits are the chief things; I do bedside nursing sometimes, and dressings,
etc., and helping out people who cannot get out. Sometimes I can get in
touch with the doctor of the Columbia Coast Mission and can then carry
out treatment till we can get the patient out, or till they are strong
enough to travel to Vancouver if they need further treatment.
During the last few years there have been very few changes. Some
families have gone out owing to the lack of transportation to and from
school, the distance being too great for the small pupils to walk especi-
•ally in the winter. Other pupils have gone out to high school, having
passed their entrance here.
This last winter has broken all records for Sayward. Altogether we
have had over eleven feet of snow. In January it was impossible to get
out because of the snow. Then, owing to the warm winds and rain there
were floods when the river rose. In some places the water went into the
rural mail boxes on the road, over four feet high. Just when the snow
was at its worst, a small child, aged seven years, died. She had a serious
operation in September. She had been home for several weeks, running
around and even took part in the school closing concert at Christmas.
After Christmas she seemed to gradually get weaker and died just after
the heavy snowfall. It took several men six hours to dig a trail a little
over a mile long. The next day several more men and teams broke the
road as far as the cemetery and store about four miles from their home.
So they were able to get the little one buried.
The health of the pupils seems to be very good in Sayward. There
have been no epidemics. So far there have been very few colds in spite
of the bad condition of the weather and roads.
Edith M. Walls, R.N.
There are many subjects that I might mention in connection with my
health work here in Vernon. I have decided to take " Practical Nursing
in the Home " as my topic. I shall attempt to show what I have done in
that line, and mention some of the things that I hope to do.
I have for some years given talks, from time to time, on " Home
Nursing " to groups of high school girls. This year. I am giving a series
of talks to quite a large group of members of the Women's Institute on
" Practical Nursing in the Home." When I have finished these talks I
hope to give similar ones in the Ukranian community hall near here.
I try to make these talks as interesting as possible and listeners are
urged to ask questions as we go along.
These practical nursing talks are outlined as follows:—
First talk: Health in the home. This includes cleanliness, ventilation, sanitation, flies, food, elimination, clothing, care of teeth, rest, recreation, etc.
Second talk: Signs of sickness, as temperature, pulse, respiration,
general appearance, tongue, cough, bowels, urine and how to measure it;
pain, chills, etc.
Third talk: Care of the patient, including cleansing bath, care of
mouth, changing sheets, moving a bed patient, back rest, etc.
Fourth talk: Feeding the sick, which includes preparation of food
for patients on liquid and soft diets.
Fifth talk: Treatments show how to prepare a hot fomentation, how
to give an inhalation, how to make a mustard plaster, a linseed poultice, etc.
Sixth talk: Communicable diseases, method of spread, signs, isolation, care of hands, discharges, linen, etc.
Seventh talk: Emergencies and slight ailments, as poisoning, bleeding, fractures, dislocations, apparent drowning, etc.
Eighth talk: Prenatal and maternity care.
Ninth talk: Infant care.
Tenth talk: Feeding infants, pre-school and school children.
This comprises the outline of these talks which we add to when
On the thirtieth of this month the Women's Institute are holding
their annual " Bird-house " competition in the Scout Hall. In connection with this there are exhibits of drawings, clothing, and woodcraft
entered by the school children. Included in the school' exhibit are health
posters, health books, health projects, and essays on " The Care of the
Baby " by the girls of the Entrance Classes. I am giving a general, practical demonstration on that day, showing substitute appliances that may
be used in any home. This demonstration illustrates part of my talks on
" Practical Nursing in the Home " and will, I hope, be as successful as the
last one that I aave in the Scout Hall.
Elizabeth E. Martin, R.N.
POPULARITY AND THE THREE C'S.
I A man, be the Heavens ever praised, is sufficient for himself. Yet
where ten men are united in love, they are capable of being and doing
what ten thousand would fail to do. Infinite is the help man can yield
| We love our Health Centre and we are proud of it." Such Avere
the words that greeted me when I first arrived in Duncan. Naturally
they made a strong appeal and I could not resist the desire to delve about
for the reason and this is what I discovered.
Cowichan Health Centre has just reached the stately age of 15 years.
Yet when one looks back over the accumulation of records, one realizes
that, like many other Public Health endeavours, it was started by a little
band of workers who struggled against considerable opposition and misunderstanding. They, too, in the early days were confronted with the
problems that confront every pioneering district to-day and yet their
work has grown far beyond the fondest dreams of the original Committee, and at the same time the community now boasts and points with
pride to " Its " Centre.
What are the winning points of this successful endeavour? Let us
consider them only from a very local point of view, and examine what
seem to be the three most important factors of popularity.
First, the Committee. Members are staunch and courageous of character. Undaunted they are, possessing in no ordinary degree the gift of
inspiring all. At the same time they stand 1 united in love "—capable
of being and doing what ten thousand singly would fail. They back up
the work, giving courage and sympathetic understanding to all problems
as they arise. Truly such a little group of health missioners is outstanding—for with high ideals they set out to conquer the unknown and
return victorious to be acclaimed by one and all.
Secondly, co-operation—always co-operation, a spirit of comradeship and good-will existing between the medical, dental, and teaching
profession, besides all the others with whom one comes in contact, a
spirit which has been helpful in establishing that permanency and trust
which makes the Health Centre an integral part of the community.
Thirdly and of equal importance, that instillation, deep into the
hearts of the people of the peeling op confidence. To have the public
feel free at any time to share their troubles and to be assured of a sympathetic and understanding hearing. One's best friend is one that will
serve in time of trouble. " Infinite is the help man can yield to man."
To all the younger nurses, pioneering in virgin territory, let it be
a comfort to you to know that as years roll by (and not so very many
at that) triumph and success awaits your endeavours. Many valiant
attempts prove to be apparent failures. Be not discouraged—foresee the
value of the earliest and always the hardest work—that of laying the
foundation. Here in Cowichan we are now benefiting from the early
struggles, and to-day we meet our people who cannot sing loudly enough
their praises of the work. Thus popularity and its relationship to the
three C's. You too can have all three.
Geraldine Homfray, R.N.
THE PROBLEM OF TEETH IN CHILDREN.
The teeth being formed in utero, are therefore influenced by prenatal conditions, and are influenced unfavourably by all adverse conditions in the first six to eight years of life. When the permanent teeth
are being formed such conditions as rickets or other deficiencies in vitamins or infectious diseases as measles determine whether or not the
child will have a healthy set in later life.
Heredity, of course, plays some part. The most common error into
which parents fall is that they consider deciduous teeth may be neglected,
as they fall out sooner or later. But the presence in the mouth of temporary teeth until the eruption of the permanent teeth is also necessary
for proper development of the permanent teeth, and their proper placement or position in the dental arch. A perfect dental arch certainly
influences well being and appearance.
The teeth being bloodless structures must have proper care expended
on them so that caries may not develop. This care consists in:—
(1.) Properly balanced diet.
(2.) Mechanical care.
(a.) Proper brushing.
(b.) Removal of tartar by the dentist.
When caries develop it is impossible to say what course an infection
will take. It may either be localized or break through the protective
mechanism of the body and give rise to such profound disturbances as
endocarditis, pericarditis, arthritis, and rheumatic fever, etc., through
which, not only life itself, but the efficiency of the individual and his or
her value to society are endangered.
Too, the care of the teeth should be of great concern to bodies controlling education—for a neglected mouth means retardation and waste
of money devoted to education.
No child can devote attention to his school work nor exercise his
mental powers properly when suffering from dental infection. His
behaviour, present or future, may also be influenced by such infections; and, as such, should be of interest to our law-enforcing bodies.
Dorothy E. Tate, R.N.
THE GENERALIZED PUBLIC HEALTH NURSE.
Once again the time has come around for us to do our bit by contributing an article for the yearly issue of the Public Health Nurses'
I have chosen as my subject the Generalized Public Health Nurse,
as I feel that I am qualified to write on this subject.
The generalized public health nurse should know her district with
its peculiarities and potentialities. She must study the different types
of people and work she contacts, gain the support of the communities as
well as the co-operation of all public health and welfare organizations,
both official and voluntary. The work of the public health nurse is certainly neither uninteresting nor dull, as it deals with life itself, for one
must be prepared to be mother confessor to all her flock, as well as carry
out the usual duties attendant on such a position.
This requires a patience and tolerance, only acquired after much
experience. The generalized public health nurse comes in contact with
the family in all its different aspects, both health and social. One very
important factor of this work is the prenatal care and advice. This
phase of the programme is established to protect the mother and to promote the development of a stronger and better race of children—the citizens of the future. This training of mothers is very gladly accepted and
the results are becoming more and more evident as time goes on. With
the help of the Well Baby Clinics, it is gratifying to know that conditions arising from malnutrition and ignorance are gradually becoming
a thing of the past and the child is thus prepared to meet the demands
of school and future life with a much more satisfactory physical and
mental development than would otherwise have been the case.
During the school years one phase of the work that requires unremitting watchfulness is that of communicable diseases. By a little detective work it is generally possible to trace the disease to its source. These
cases, when found, should be isolated, thus preventing them from spreading the disease and causing hardship, not only to parents, but to teachers
and other pupils as well. The general health of the child is carefully
watched and instructions given to the parents when necessary.
In visiting the homes, one often meets problems of an upsetting nature
which a public health nurse will see and recognize as being remedial. By
her interest and sympathy she is able frequently to suggest some means
of help. For instance, one mother living in a rather isolated spot and
being so much alone, got discontented; as a result her general outlook
on life was disturbed. I advised her to attend a sewing class. She did
so and now has a better outlook on life. This is one small example of
the many ways a public health nurse can be of help to her families.
The co-operation of the different societies is of great value and help
to the Public Health Nurse, and again, diplomacy in contact is an
The Public Health Nurse should feel "A friend in need is a friend
indeed." So as we said at the start, the life of a Public Health Nurse
is neither uninteresting nor dull.
Elizabeth Lowther, R.N.,
North Vancouver Heal tit ('nit.
NELSON'S HEALTH PROBLEM.
The present school term has been an eventful one and has demonstrated in many ways to the Nelson public the value of Public Health
We commenced the term under a cloud because of vthe distant
rumblings of poliomyelitis which was gradually creeping our way. As
the disease became prevalent in the State of Washington, the people of
Nelson were notified through the press, that travelling between the Koote-
nays and the State of Washington should be confined to business and that
children should on no account visit in Spokane.
On the eve of school opening (August 31) a case of diphtheria was
reported. The patient returned from a visit to a near-by town and
arrived home with a sore throat. The family was quarantined a few
hours after arrival in Nelson.
The month of September was well over, the weather much cooler, and
onr fear of a poliomyelitis epidemic was subsiding when our first case was
reported (September 24). The patient was a preschool child and medical
attention was not obtained until the damage was done and one limb was
paralysed. Parents thought the child was suffering from rheumatism.
There was general alarm and the public practically demanded a ban.
Members of the medical association met and the Medical Health Officer
closed the two schools which members of the family had been attending.
The city council and school board met with the Medical Health Officer.
Members of both bodies were well aware of the value of preventive work
and a motion to engage three nurses to assist in the supervision of school
health was unanimously passed. The meeting weighed the advantages
and disadvantages of schools remaining open. The medical profession
felt that if schools were closed it would be almost impossible to keep a
check on the situation. If all absentees could be visited by nurses immediately it was likely that medical advice would be obtained in the early
This supposition proved to be a fact in two cases at least. An
absentee was visited on September 27. The nurse, visiting, found the
child irritable and worried looking. Temperature was elevated, pulse
was very rapid. Intestinal upset was present. The mother thought it
quite unnecessary to have medical advice and explained to the nurse that
the child had " Stomach Flu." The nurse however prevailed upon her
to call their doctor. The child was taken to the hospital, a lumbar puncture done and the diagnosis of poliomyelitis confirmed.
On September 29 a child was excluded from school because of a sore
throat and elevated temperature. The home was visited by a nurse
during the early afternoon and swabs were taken. Membrane and typical
odour were present. The mother was advised to call her physician but
refused to do so and was asked to reconsider. She was approached by
the nurse again that evening and finally consented, explaining that a
quarantine would inconvenience them very much. When the doctor
called the membrane had been removed and the throat was in a bleeding
condition. The nose and throat swab were positive but the parents
refused to accept the diagnosis or to co-operate by having the child given
anti-toxin or by observing quarantine regulations. Quarantine was enforced by the Police Department.
With the appearance of diphtheria the public became genuinely
alarmed. Feeling ran high so that it was deemed wise by the Medical
Health Officer to declare a ban (eptember 29-October 9). Schools,
churches, theatre and other meeting places were closed and parents
ordered to keep children in their own yards.
The teachers co-operated in a splendid manner and visited each home
explaining to parents the health service which was at their command and
reported back to the nursing service any cases of illness encountered on
No further cases of either poliomyelitis or diphtheria were reported
during the week of the ban, but because of new cases reported the following week the Medical Health Officer again declared a ban in force which
was in effect until October 26.
During this period much was learned regarding the eccentricities of
human nature. Many of the people who demanded a ban in the first
place wearied under its restrictions. Parents found it difficult to keep
children from congregating. Children living in apartments had nowhere
to play except in the streets. Merchants felt that business was curtailed
and they were therefore " out of pocket." Beer-parlour operators were
particularly bitter and interviewed the council regarding their rights.
Experience taught us that at most it was impossible to foresee the difficulties which might arise when a ban is declared.
It would require considerable space to outline each case but the
following tables will give a picture of the situation.
Nelson Sept. 24
Procter Sept. 25
Nelson Sept. 27
Nelson Oct. 12
Nelson Oct. 17
Nelson Nov. 5
pre-school Left leg paralysed
school no paralysis
The cases of poliomyelitis appeared sporadically. There were no
deaths and only one case where paralysis ensued. All cases received the
serum of blood from immune persons. It was impossible to establish
any source of infection. In no instance was there more than one case in
Dr. Meekison's paper which was sent out by the Department of
Health was invaluable to the nursing service.
Fam. District Case Date Age Remarks
1 Nelson _ 1 Aug. 31 School
2 | „ pre-school carrier ,
3 Sept. 1 adult
4 „ 2 school
2 Nelson 5 „ 29 school
3 Ymir 6 Oct. 13 adult
1 Ymir 7 „ 15 „ died
5 Nelson 8 „ 17 school
11 I 20 school
6 Nelson 9 „ 18 pre-school
12 I 21 adult
7 Ymir 10 „ 18 adult
8 Nelson 13 „ 22 school
There were ten cases of diphtheria in Nelson and three from Ymir.
One death occurred from Ymir, the patient having been ill for some time
before entering the hospital. Contact and cases were carefully interviewed and history taken but here again it was impossible to establish a
satisfactory source of infection. Cases appeared here and there throughout the city. It was believed that the cases were the result of a carrier.
Following the outbreak of poliomyelitis and diphtheria we had an
epidemic of septic sore throat which lasted until the early part of December. There was membrane present in many of the cases and many of the
cases were diphtheria suspects until swab reports could be obtained. The
temperature in most cases was much higher than usually found in
diphtheria (103 °-104°).
January was a comparatively quiet month but with February came
a " Flu " epidemic which has given us much cause for worry because of
the complications—mastoiditis, rheumatism, sinus, arid eye infections.
There have been eight mastoidectomies performed as a result of this
epidemic and on one day 20% of the school population was absent owing
Routine work has suffered rather badly, but we are confident that
with health conditions in schools gradually improving we shall be able
to complete our year's work.
Kathleen Gordon, R.N.
-WITH REFERENCE TO ITS EFFECT
The situation which here demands consideration is not that of the
state of those who are on relief, and the medical care given to them.
They receive this, either upon demand or on the recommendation of the
Public Health Nurse. This care includes all the incidental care any
one might require, maternity service, extraction of teeth, and free medicines. There is, however, another section of the population which is on
low income, in some cases no more than that of the relief standard. To
these, sickness is a major calamity, from a financial point of view.
Naturally they receive required attention from the doctor, regardless of
their ability to pay; but if they, the recipients of this care, have the
independence that demands the payment of bills they hesitate to incur
them when their ability to pay is doubtful. The few dollars that are
needed, to make the quite necessary but not urgent visit to the doctor
or dentist, are so often earmarked for food and clothing that the visit is
never made. Never, until the dark night when little Willie is ill indeed,
when a health visit is no longer in question, prevention is too late, and
an emergency is declared to exist.
Here, when little Willie is so sick, is where the pressure is exerted.
The family ideal of the moral grandeur of never owing goes, goes phut,
in fact. Naturally. The only human and tenable position the family
can take is to get all the care for little Willie that he needs. But when
Willie is recovering, on naps, and cod-liver oil the bills come in; cold
thinking takes the place of emotionalism. They discover that they
would have been better off on relief? They are right. They would.
On low income the man with illness in his home has his choice. He
(a.) Do without medical aid. The nurse will call once and advise
a doctor's care. She can do no more, being unable in every sense of the
word to suggest treatment or medication.
(6.) Call the doctor. Have him do everything that he finds necessary, and run the corollary accounts of nursing and drugs. If he has
the independence that he should he has to pay, for his own self-respect;
but, on low income, most people feel an eventual resentment for these
expenses, when obviously, their neighbours on relief have no such worries.
(c.) Go on relief. This may involve lying to the investigator, and
understating his resources; quitting the small job he has, in order to
qualify. This course gives him absolute security in the event of accident
or illness. Gently and insidiously he begins to believe in Santa Clans,
and the law of equivalent return becomes the myth.
It may be argued that the cause of these people on low income needs
less attention than that of the really poor, and that such people are not
found in great numbers. My contention is, that such people are the
custodians of the morale of this Province. The better off have never
been tried, those on relief have been tried too hard in the economic
struggle. It is the man on low income who shows us the national temper.
In view of this the public health nurse is delighted when anything
towards a general contributory health insurance scheme is advanced.
Such a scheme will be a powerful factor in saving this pioneer country
from decadence, without its proper interval of civilization between these
Beryl McPherson, R.N.,
Coombs, V.I., B.C.
PUBLIC HEALTH IN WESTBANK.
The day previous to the opening of the Schools in Westbank and
Peachland in September, 1934, Dr. Ootmar, our M.H.O., telephoned from
Kelowna across the lake and warned me that we Avould have to watch for
signs and symptoms of poliomyelitis developing. There had been some
cases in Spokane, and with the traffic back and forth across the line we
would be exposed. He instructed me to find out if any of the teachers
or children had visited there during the summer vacation, and if so have
them quarantine themselves for two weeks. On making a tour of all the
schools I found that neither teachers nor pupils had been there, so the
schools were duly opened. Now, Westbank is situated on the west side
of Okanagan Lake. The lake is about 4 miles wide and 85 miles long,
and the only way people can get to Kelowna from Westbank, or vice
versa, is by a ferry that plies between the two places. This ferry runs
every hour, the first one leaving Westbank at 8.30 a.m. and the last at
8.30 p.m. The people of both places have often wondered if a bridge
could not be built across the lake, especially when they arrive two
minutes late for the ferry and have an hour to sit there and contemplate. Well, this same ferry proved to be of great benefit when some
cases of poliomyelitis actually did develop in Kelowna. Dr. Ootmar
enlisted the help of the Provincial Police in checking up on all cars from
across the line. The ferry wharf proved to be an excellent checking
place, as it is a continuation of the main highway. The parents were
advised of the seriousness of the situation, and to keep their children
and themselves away from any homes where there was sickness. Most
of them complied with the doctor's instructions. However, there is
always someone who doesn't understand why they should comply with
these regulations. One Sunday morning a family in Kelowna decided
they would go to Westbank to visit some friends. Now this family had
been in contact with someone who had developed poliomyelitis. Before
night, Dr. Ootmar found out where this family had gone. He telephoned
to the Public Health Nurse, and had her send the family home at once.
The family which they were visiting Avas quarantined for two weeks, as
two of the children were attending school, but fortunately no cases
developed. Dr. Ootmar and the Public Health Nurses kept a strict
vigilance over the district, and through the local papers kept the people
posted on the latest developments, and while they realized the seriousness of the situation, this kept them from getting panicky.
Grace Hill, R.N.,
RAIN OR SHINE?
The weather plays a very important role in the attendance at the
Well-Baby Clinic. Immediately on rising every Tuesday morning the
nurse looks out of the window to see what the weather man intends to
give that day. Heavy rain means a small clinic, probably only mothers
with cars will attend; and if the sun is shining a good attendance is
expected. Where there are four rainy Tuesdays in one month it is very
In 1926 a Well-Baby Clinic was started here. It was first held
monthly, but it was soon discovered that that was not sufficient so it was
held weekly which has been the case ever since. At first just one nurse
was in attendance, but it was soon found that it was almost too much for
her so the school nurse was given permission by her Board to assist each
week. In May, 1931, a preschool clinic held at the same time was inaugurated which demanded another assistant. Now the school nurse is
responsible for the pre-school children and the district nurse for the
babies. A voluntary worker, who is very interested in the work, weighs
the babies, which is a tremendous advantage as the nurse can devote her
time to giving advice.
The members of the local committee take turns in serving tea to the
mothers and arrowroot biscuits to the children. They have assumed this
responsibility ever since the beginning. This gesture of hospitality is
appreciated greatly, especially on a cold day or if the mother has some
distance to walk. Another value of this arrangement is that the members
of the Committee come into direct contact with the work.
The clinic is essentially a weighing station. Any conditions suspected such as feeding problems, rashes, etc., are referred to the family
physician. This has been found to be more satisfactory in an industrial
town of this size, rather than having a medical man in attendance. The
latter was given a trial during the first year. Some of the doctors asked
the mothers to attend the clinic in order to keep check of their child's
weight, thereby helping them to regulate the formulae.
The clinic is held in the Canadian Legion Building which is almost
in the centre of the city. The room is set up each week for clinic, one
end set aside for the babies and the other end for the older children. An
I.O.D.E. organization presented the clinic with baby scales and the school
scales are used for the preschool children. A large table in the centre
of the room, covered with a sheet, is used by the mothers dressing
and undressing their babies. The table method is much preferred with
the majority rather than using their knees. Ordinary wire waste paper
baskets are available to hold the clothes, thus preventing them from
falling on the floor or touching those of their next-door neighbour.
Much interest is shown in the different health posters that decorate
the grey walls. Some of the pictures on the posters are even used to
induce the four-year-old to stand on the scales. The table with health
literature draws the attention of the mothers, many pamphlets pertaining
to other phases of health are taken home for the use of the other members
of the family.
The toys that are supplied for the preschool children to play with
certainly act as a good means of bribery. Mothers often relate stories
to the effect that her small son begged to come to clinic to play with the
toys. In watching the children play the nurse gains some knowledge as
to the mental development. Some children show quite a creative ability.
Imprints of the children's feet are made by means of applying a liquid
preparation to the soles of the feet, then an imprint is made on a piece
of drawing paper. This gives a fair idea as to the condition of the arch.
Before each new term, for the past three years a special pre-school
clinic has been held for those six-year-old children starting school. The
school nurse gives the usual school inspection, thus getting acquainted
with the child. They were weighed and measured and imprints of their
feet taken. The members of the nursing committee serve tea. At the
last clinic three fathers brought their sons, then stayed to listen to the
doctor's informal talk. At each clinic one member of the medical
profession has given a very interesting talk on some health problem,
especially pertaining to the six-year-old child. The stores in town very
kindly loaned sample clothing. Health literature was also distributed.
Some gratification was felt when at the last clinic the majority of
the children had either attended the baby or pre-school clinic. Also the
number of underweights and defects found were much less than that
found at any other clinic. The best record for attendance was attained,
seventy-five percentage of the beginners were present.
A branch of the town clinic is held in the Chinese Mission in Chinatown once a month. The majority of the mothers cannot speak English,
but we talk with them by means of an interpreter. The wife of the
Chinese missionary has kindly consented to act in this capacity. A
number of Chinese posters have been sent from China, all nicely printed
on rice paper. The children are taught health drills to teach them some
of the rules of health. If you want real comedy watch a dozen Chinese
children between the ages of two and six years do the handkerchief drill.
Due to the generosity of one of the local organizations, cod liver oil
was supplied to the families on relief who have babies or children
Each year shows an increase in the attendance at the Well-baby and
Muriel Upshall, R.N.,
MENTAL HEALTH IN OUR SCHOOLS.
Some time ago, when discussing our health programme with a physician he said, " Mental hygiene is being sadly neglected in the schools."
I have thought a great deal about this remark, and have decided that he
We strive to instil good physical habits in the child so that he will
have a good chance to develop a strong, healthy body. We also spend a
great deal of time striving to have physical defects corrected. Are we
doing as much for the mental health of our children?
We often see a teacher giving a great deal of extra instruction to
I Johnny " who does not understand fractions, but, if on the other hand
I Johnny " is one of those pupils who has a good degree of intellectual
capacity, but is shy, retiring, and over-sensitive, and does not mix or
play with the other children, is extra time given to him going to help
him adjust himself to daily life?
Dr. Geo. Davidson, of Brandon Mental Hospital, writes, 1 Most of
our mental disorders are due to bad mental habits, and if these bad habits
are left uncorrected then one sees difficulties setting in during later life."
In summing up the article from which the above is taken he points out
the need of 1st: recognizing mental abnormalities in children; 2nd: in
preventing the development of these abnormalities and correcting them;
3rd: in proper handling of children who already show these abnormalities.
A writer to Mental Hygiene regards fear and speed as two of the
greatest mental health hazards. Fear in a child very often leads to
queer or objectionable conduct. In speaking of speed, Miss E. de V.
Clarke, Supervisor of Mental Hygiene, Toronto, says, " The school supervisors require speed of teachers, they in turn hold the stop-watch, so to
speak, on the child. Educators have assumed that the way to speed in
performance of school work is to force the pupil to hurry—he must learn
things by a certain date, and the child who cannot learn fast enough is
certainly out of luck. A great many times the nervous system of both
child and teacher cracks under the strain." How often we have seen
To have and maintain good mental health in children lies with the
parents and teachers. Most habits are formed before school age, so the
greater responsibility rests with the parents. The teacher should be
able to recognize these habits and correct them. She should also avoid
overstraining the mind of the child. As Public Health Nurses we can
do our part by being the link between the home and school, and smooth
out many a conflict that might arise between mothers and teachers.
P. Charlton, R.N.,
A campaign for immunization in Saanich is conducted along* novel
lines—in that no campaign is attempted. With this community, the
usual drive for vaccination or inoculation is accompanied by a vigorous
counter-drive against them—organized by members of the Anti-Vaccination and Anti-Vivisectionist Leagues, etc. Consequently, it has been
found that the best method of procedure is to work with as little publicity as possible—and as quickly as possible.
Our recent campaign for diphtheria immunization was conducted in
this way. A definite schedule for clinics was arranged, and explanatory
pamphlets issued to every school child. These were signed by the parents
who wished the treatment given and collected as quickly as possible.
The first dose was then given immediately. Clinics were conducted in
all the schools by the Medical Health Officer. The nurse for each school
was present to round up the children and to record doses.
The response was particularly gratifying. Approximately five hundred children—school and pre-school—were immunized. In a few cases
some discomfort was experienced—but none serious. All the children were
checked by the school nurse, home visits being made where necessary.
The Health Department feels that the success of the method is
largely due to general health teaching. Throughout the year the school
nurses introduce the subject of immunization to parents while visting
them to check absentees or illness, etc. The discussion is casual but
informative. A prejudice based on ignorance and fear can often be eliminated by a simple explanation of procedure and purpose. We have found
that the best method of combating anti-vaccinationists is to avoid the
appearance of argument—but to be prepared to offset inaccurate statements by a disinterested presentation of actual figures. Those for
Saanich—compiled by the nurses personally—have been particularly
valuable in these interviews.
M. R. Smith, R.N.,
Saanich Health Centre.
ORGANIZING THE NURSING SERVICES OF A HEALTH UNIT.
In any nursing service where there is more than one nurse in a district, proper organization of the work is important. This organization
should be planned with a view to giving the maximum amount of service
to the district with a minimum amount of overlapping. It is also necessary to plan with a view to giving variety of work, or generalized nursing,
together with adequate off-duty time for the nurses.
Having these objectives in view, the reorganization of the work at
Saanich was undertaken.
A survey of the district over a period of three or four weeks produced
the following data:—
(1.) There are eighteen schools in the district, three of which are
high schools, three large seven-roomed schools, and the remaining ones
from four rooms to one, mostly in the outskirts of the district.
(2.) The larger schools are in one part of the district where the
greater part of the population reside, and so is a seven-roomed high
school. The schools in the outlying districts are as far as 10 and 12
miles from the central ones—a point which had to be considered when
planning a specific and equitable district for each nurse;
.(3.) The ever-present question of bedside nursing had also to be
taken into consideration, and, like all districts, this phase of the work in
Saanich is a variable quantity—running in spurts.
As a consequence, the schedule for nursing and school work was
drawn up as follows, and has, with few exceptions, worked out very
Nurse No. 1|
Nurse No. 2^
Nurse No. 2)
Nurse No. 3(
Nurse No. l) 1 m
n} Tuesday a.m.
Nurse No. 3J J
Nurse No. 1) m
„> Tuesday p.m.
Nurse No. 2( mm
Monday a.m Nurses Nos. 1 and 2
Monday p.m Nurses Nos. 2 and 3
Tuesday a.m....Nurses Nos. 1 and 3
Tuesday p.m....Nurses Nos. 1 and 2
and so on all week.
Nurse No. 3 Monday a.m.
Nurse No. 1 Monday p.m.
Nurse No. 2 Tuesday a.m.
Nurse No. 3 Tuesday p.m.
Nurse No. 3
Nurse No. 1
Nurse No. 2
Nurse No. 3
The school schedule is inflexible, and any nurse not being able to
visit her particular school on the scheduled a.m. or p.m. is substituted by
the nurse in charge.
Notices were sent to each school at the beginning of the term indicating the schedule for the coming year, as follows:—
I Prospect Lake School—Schedule for Visits of School Nurse.—Every
Tuesday a.m. and Friday p.m.
I If the regular nurse is unable to visit, another nurse will make the
I School Nurse."
The nurse gets to the school at 8.45 a.m. to arrange re-entry of pupils
who have been absent, etc., and 1 p.m. for afternoon calls. Arrangements
for M.H.O. examinations are made in advance, and invitations are sent
to parents to attend if desired.
But, you ask, what about the disorganization of this schedule in the
stress of extra nursing? It may seem unreasonable that the one nurse
on call can handle all the emergency calls if she has two or three obstetrical cases to attend. At one time during this year we had five confinement cases on the go, and each nurse was able to handle a case along
with her school-work. It meant that home and school visiting was postponed until the afternoon or next morning, but it was done, and
admirably too, while all emergency calls were handled by the nurse in
The high "schools are visited once a week. All M.H.O. examinations
were done during the first month of the school term. This enables the
school studies to be uninterrupted by medical inspections for the whole
of the term. Sex education talks were given to both boys and girls
immediately following the medical inspection.
It is understood that all emergency calls to both high schools and
elementary schools are answered by either the nurse " on call " or by the
Time off for the nurses is arranged with a view to the convenience
of the nursing schedule as well as to the nurses. Each nurse takes successive week-ends off, as follows: First week and from Friday night to
Sunday night, followed by a week-end on duty, with a p.m. off during
the week as the school schedule permits. The next week-end starts at
noon on Saturday and continues to Sunday night. In this way the
weekly p.m.'s are compensated. Night duty during the week is taken
consecutively turn about, which amounts to one night in three being on
call, or two nights a week.
This off-time schedule is also inflexible, which enables each nurse
to plan ahead for her off-duty time.
Apart from the school schedule, around which this work seems to
revolve, the nurse in charge manages to address public meetings, and
feels gratified to know that all WTomen's Institutes and some of the
Parent-Teachers' Associations have been addressed about the work of
their Health Unit. This is the most effective way of breaking down any
prejudice and of getting to know the people of the district . . . and
doing educational work.
This programme has now been in operation for nearly a year, and
there has been no necessity for changes, which leads to the hope that as
we are able to do more in the district we will be able to fit the extras
into the schedule without disrupting the basic scheme.
Bertha Jenkins, R.N.,
Supervisor, Health Department, Saanich.
PROGRESS OF PUBLIC HEALTH IN KAMLOOPS, 1925-35.
The Kamloops Red Cross Society was responsible for the Public
Health Service being started in the year of 1922. Miss Thorn, the Red
Cross District Nurse, began the first school work in the City of Kamloops.
During this early stage of the pioneering work the nurse spent her time
between bedside nursing and school work. It was then that the foundation was laid for the advancing educational work that is being done
to-day, which is now under the auspices of the School Board and City
Council of Kamloops. >
From all accounts it was very difficult for these early nurses. Later
in 1925 Miss Fisher was in charge. I found an interesting annual report
of hers to which was attached a Dental Survey Report, showing the
deplorable condition of the children's teeth at that time. She states in
her report that:—
Children examined, 731; children with defects, 636, or 87 per cent.;
children with permanent defects, 483, or 66 per cent.
She also says in her appeal to the School Board for a Dental Clinic
(which was never granted) that 1 This work is necessary for the physical
and mental welfare of the children, and will undoubtedly result in
improved general health conditions in the whole community, for children
with healthy mouths are less subject to acute infectious diseases." It
must have been quite a misfortune to the public-health work when Miss
Fisher resigned at the end of her first year of efficient work.
However, she was followed by a most capable and competent nurse,
Miss Janet Campbell. She carried the banner of progress and also laid
many good bricks to the foundation of public-health work. She was able
to gain the confidence of the parents and children and was so able to
break down many old prejudices.
The Bed Cross Well-baby Clinic was established after the war.
Hundreds of mothers have received the skilled advice given at these
clinics. A great deal of credit is due to these nurses who ploughed the
rough places, and built the firm foundation on which it has been possible
to carry on with the progressive work of public health.
The mere fact of the improved condition of dental hygiene will show
what has been done by the education of the parents and children in our
clinics and schools. For instance, the following figures may convey to
your mind the improvement in the dental health of our school children:—
Defective teeth (permanent and temporary) : 1925, 87 per cent.; 1935,
20.70 per cent.
Defective teeth (permanent): 1925, 66 per cent.; 1935, 10.13 per
One can see at a glance what education has done: First, by prevention, the building-up of general health and hygiene; second, by early
Miss Fisher also stated that goitre was very prevalent in 1925.
Goitre in all schools: 1925, 32.5 per cent.; 1935, 10.6 per cent.
This condition has been overcome by the addition of iodine, using
iodine tabloids which are provided by the generosity of the Imperial Order
of Daughters of the Empire. These are given to all children who show
the slightest symptoms of enlarged thyroid glands.
There are no early figures showing the precentage of infected tonsils
and defective vision, but it is interesting to note that we have only 4.57
per cent, of all children needing the preventive operation for the removal
of infeeted tonsils.
Now I would like to dwell on the all-important subject of good vision.
When I took this position in 1927, I was amazed to find the number of
children with defective vision. After many years of talking, persuasion,
and patiently waiting, I am now pleased to say that we only have twenty-
seven children needing glasses, 3 per cent. Last year 60 per cent, of all
defects were corrected.
It has been possible to have many of these defects corrected through
the kindness and skill of our doctors and dentists. Then, too, through
onr Junior Red Cross Society, which was organized in 1929. The first
year we held a bazaar in the Lloyd George School which realized $183.
We sent a baby to the Queen Alexandra Solarium for one year. The
Primrose " Tag Day, and
following year we held a Junior Red Cross
have continued to do so annually since that time. Altogether we have
collected $713.50; and eighty children have benefited from this fund.
Our school population has certainly increased. Pupils: 1925, 731;
The Junior High School was opened in 1929. Since that time it has
been possible to carry out a much more advanced educational programme.
During that year we gave our first toxoid treatment as a prevention of
diphtheria. At that time we immunized 40 per cent, of our public-school
children. We have given this treatment annually since. Now the following percentages of children are protected:—
Lloyd George, 49.78 per cent.; Stuart Wood, 61.40 per cent.; High
School, 40 per cent.; all schools, 49.27 per cent.
We also hold pre-school clinics for the immunizing of this group.
Unfortunately very few parents avail themselves of this opportunity. It
seems so difficult to make them realize that diphtheria is one of " The
Four Horsemen of Death," and "that between 60 to 75 per cent, of the
deaths from diphtheria occur in the age group under five years."—(Dr.
Amyot, North Vancouver.)
Certainly the children are healthier and have fewer defects than when
Miss Fisher made her report ten years ago.
The following comparisons of malnutrition will give an idea of what
the correction of defects has done to improve the physical health of the
Per Cent. Per Cent.
Stuart Wood School 20 19.19
Lloyd George 30 20.20
High School 27 Junior High 14.17
All schools 25 17.85
Surely these figures speak for themselves and the prophecy that Miss
Fisher made, that " The physical and mental welfare of the children will
undoubtedly result in improved general health conditions when these
defects are corrected," has come to pass.
We have had no epidemic this past year or any infectious cases whatsoever. It is now over four years since we had a case of diphtheria in
Kamloops. We are most fortunate in having the support of our Rotary
Club, which supplies our schools with between 400 and 500 quarts of milk
a year for the underweight and children who stay for lunch. Our local
Red Cross Society provided on an average 5,000 quarts of milk to the
homes yearly, also 75 bottles of cod-liver oil.
The public is realizing more and more that in the twentieth century,
medical work is preventive. Thus positive health is offered to all who
will avail themselves of it. It is given freely and willingly and yet so
many pass it by and are content with old ways, traditions, and ideas.
This education is offered from the prenatal stage to High School.
During this school age we Public Health Teachers have such wonderful
opportunities of sharing our knowledge and experience. Especially interesting is it to form the Little Mother League classes and teach these
young girls in Grade VII I. (he true meaning of reproduction, the care
and training of the mother and babe. Indeed, we seem to tread on holy
ground when we come to the threshold of these young minds; as Mr. I ra
Dilworth, of Vancouver, said once: " We must come in great humbleness
and wait with great patience, for we are on the threshold of the greatest
of all mysteries, the human mind/' Yes, indeed, how little we know of
or understand the human mind.
What is the human mind ? 1 It is the voice of the universe made
articulate. It is the voice of the soul." (Lesson help for Teachers.)
Should we then not listen more intently to this voice of the universe,
and keep our minds young and ever advancing so that there is a greater
bond of sympathy between us ? For, as Leonardo da Vinci says: " Learning maketh the soul young, it decreases the bitterness of old age. Gather
then wisdom, gather sweet fare for thine old age. Little knowledge
imparts people with pride, great knowledge imparts humility."
So again we take up our banner of progress and fight not with arms
of war and destruction, but with wisdom, knowledge, and humility, for
the positive health and happiness for all nations.
Olive M. Garrood, R.N.
VICTORIA, B.C. :
Printed by Charles F. Banfiei,!), Printer to the King's Most Excellent Mnjesly.
J the l^ary:;
University of Brins^ - issued by the
PROVINCIAL BOARD OF HEALTH, BRITISH COLUMBIA
Public Health Nurses' Bulletin
MOST of the Public Health Nurses of this Province are familiar
with the letter-head of the Department of Health, on which
comes the yearly request to § send in your article for the Bulletin,
dear Nurse, as soon as possible "; and most of us are also familiar
with the rumpled heads and wracked brains which inevitably follows
this yearly request.
It is therefore a source of continual wonder to me that the articles
which finally appear are so original and well prepared, and proves
conclusively that as we live up to our calling of being able to fashion
things out of nothing when working against terrific odds in the field,
so we also can produce readable articles at the eleventh hour.
The interesting feature about this Bulletin, now that it is compiled, is that it will be available for distribution in time for the various
conventions for which Vancouver is to be host and which we are
being privileged to attend. We have the opportunity through the
Provincial Health Officer, who makes these yearly Refresher Courses
available to each of us, and the benefit we derive from these visits
will be shown in our work as the years go by.
As this volume goes out, therefore, may we echo the words of
our new King when he ascended to the Throne: " May we be worthy
of the heritage that is ours."
TABLE OF CONTENTS.
Hocking, Miss J.—A Saanich Sonnet 3
Allen, Miss E. G.—Ladysmith and District 4
Arnould, Miss J. M.—Demonstration Area 5
Chodat, Miss I.—Coombs and District 7
Claxton, Miss M.—Transportation North of Peace 9
Cunningham, Miss N.—Baby-welfare, Fort St. John 10
Dunn, Miss N. E.—Dental Clinics, Peace District a. 12
Garrood, Miss 0. M.—Correcting Defects, Kamloops 14
Gordon, Miss K.—I An Impossibility becomes a Reality " 16
Gowen, Miss M.—Peachland-Westbank 18
Grierson, Miss M. E.—Mission and Maple Ridge ... 19
Grindon, Mrs. A. F.—" Selling Public Health " 20
Hardy, Miss M.—Control of Communicable Diseases 22
Homfray, Miss G.—Advertising Public Health 23
Jenkins, Miss B.—| Relax " 24
Kilpatrick, Miss H.—| A Day in a Logging Camp "_. 26
Law, Miss A. S.—" Personality in Public Health | si 29
Mahon, Miss R.—" First Aid in the Peace " 30
Martin, Mrs. E.—Dental Work in Vernon 31
Miles, Miss M.—" Tuberculin Tests in a City School " 33
Morris, Miss M.—The Child-guidance Clinic 35
McMillan, Miss I.—| Emancipation of Children's Play-clothes " 37
Seymour, Miss W. E.—Fernie's Progress 38
Smith, Miss M. R.—| Why Nurses go Grey " 39
Tait, Miss C.—Chilliwack Rotary Dental Clinic 40
Tate, Miss D.—| An Open Letter " 42
Thom, Miss A.—Health Pursuits in Revelstoke 44
Thomson, Mrs. B.—Keremeos and District 46
Twiddy, Miss M. A.—" Progress " 47
Upshall, Miss M.—| Mighty Oaks from Little Acorns Grow " 48
Walls, Mrs. E. M.—Sayward 52
Wilkie, Miss D. W.—Esquimalt Rural Nursing Service 52
Yaholnitsky, Mrs. P.—" The District Nurse's ' Soft Job ' " 53
Cull, Dr. J. S.—Health Services under the Larger Unit of Administration 56
A SAANICH SONNET.
Have you seen T>r. Young's little column each month
Of the blessed events in our midst?
Walter Winchell himself with his very best hunch
Couldn't ever foretell such a list!
The old stand-bys are there who produce every year,
Almost all of the Spring's blushing brides,
Though the lads of the Fleet many miles are from here,
They have added their quota besides!
Even people whose youngest are almost through school
Have their name on the baby-list now,
We should visit each one, but with programmes so full
For a time we just couldn't see how.
We started a clinic for pre-schools and babes,
Every month in a hall it was held;
With a Doctor and Nurse, snowy gowns and the scales,
And a rattle for infants who yelled.
Now the first afternoon was all spent on just three,
And the Doctor said, | Waste of my time."
At the second just one—what the Doc said to me!
Well, the next month the number was nine.
Twenty babies and mothers, some sisters and brothers,
A father who carried a twin,
Our last clinic discovered, said they'd bring the others,
Sure the Doctor was almost all in.
Dr. Young's little column so bad doesn't look,
And the blessed events seem more blest,
When we find more than half in the new clinic book,
Its good fun to go after the rest.
Note.—The above was inspired by the true story of a clinic we started in one
part of the District last December. In six months the attendance has increased
from two or three to over twenty.
Saanich Health Dept.
PUBLIC HEALTH, LADYSMITH AND DISTRICT.
This district comprises a rather extensive school programme;
there are nine schools (752 pupils) taken care of and, with the exception of the local high-school pupils (99), the youngsters are all weighed
and inspected each month, weight-cards being given to all pupils
10 years of age and under; this brings in the first five grades. The
local high-school pupils are weighed and inspected twice a year and
as occasion demands.
I find the weight-cards a valuable contact between pupil and
nurse; any constant loss of weight or resistance to gain is found in
this way, and I feel it has much to do with the lessening of colds, as
the old stand-by, cod-liver oil or its equivalent in some form is being
looked upon with a real usefulness; also early and regular bed-time
habits on school nights is stressed as a most important factor in
keeping up the avoirdupois. This system is put up to the pupil for
trial and together we check up the result.
With the exception of the receiving class and new pupils, the
annual medical examination has been discontinued at our local schools,
it being felt that demands were being met by the Public Health Nurse,
in whose responsibility lies the referring to the Medical Health Officer
or private physician of defects noted for correction.
I feel that much can be accomplished with home-school visiting.
The importance and method of the check of contagious diseases can
often be better stressed when entering the home for another reason;
the mother's mind is not so distracted as when fighting a hazard and
she listens with interest, discussing points that have been misunderstood by her.
We were fortunate this year in having dental work done of
which we were sadly in need. Sixty-eight clinics were held to cover
the work of the public school; could this branch become an annual
work, much time and expense would be saved. I think a system of
raising funds towards the cost might be covered in the same way as
the public interest in the school sports fund.
Our Grades V. and VI. girls recently had the honour of bringing
home the shield for the Girls' Choir at the Nanaimo Festival; this
shield has previously been carried by a group for four successive
years. Great credit was due the teacher who trained them, and I feel
she was also assisting in the aid of the health programme, since
without one we cannot have the other.
The six districts taken care of in this territory have from one-
to four-roomed schools, the greatest distance being 16 miles northeast of here. A system of hiring transportation was in vogue when
I came here; this was satisfactory, with the exception of considerable
waste of time, as it meant a wait for either the driver x>r myself when
I had finished at the school, also a double journey was covered.
Later on I purchased a car, the Department making an allowance
towards its upkeep, and I am now using the car full time as satis-
factory work could not be carried on here without means of transportation. I make it a rule as often as possible to call on an absentee
the first day from school.
We are proud of the fact that we have had control of scarlet
fever three times within the past three years, each case not spreading
Well-baby clinics are held twice a month and we have infants
that do us credit. Just now there are twins that chose January of
this year for their birthday, and owing to the long spell of severe
weather I have kept up a Monday morning visit with the scales.
Bobby has already outgrown his shirt and with his shortened sleeves
he greets me with a stretch quite pugilistic; Betty is the dainty
maiden and both are behaving as infants should.
Travelling Tuberculosis Clinics are held three or four times a
year and the response is good from those whom we suggest a check-up;
other clinics are held at intervals.
This district has suffered considerably from the decline in mining
activities during the past few years, but we are hopeful, however,
of some change in conditions with the assistance of a logging company
becoming interested in our locality. This is a most beautiful spot
for scenery and climate.
E. G. Allen, P.H.N.,
PUBLIC-HEALTH WORK IN A DEMONSTRATION AREA.
The first year of public-health work in the Sumas-Matsqui-Abbots-
f ord Demonstration Area has been one of intense interest. It was my
first venture into work of this kind and it was the first public-health
work to be done in the area. In the schools of Matsqui and Sumas
there had been no medical examination of pupils for five years or more.
I arrived in the area only a week after the demonstration had been
begun under Inspector P. H. Sheffield, and my first meeting with the
M.H.O., Dr. McDiarmid, after reporting a case of measles, was not
encouraging, when he stated that there had not been an epidemic of
measles for several years, and if a case or two had appeared in the
district, nothing could prevent its spread.
The first task was to learn the geography of the district, which
comprises 94,644 square miles, exclusive of Huntingdon Village and
Straiton (unorganized territory), giving us both highland and lowland
and many rough, hilly roads to travel. The Inspector took me to the
schools and introduced me to each of the forty-seven class-rooms in
such a way that any fear the children might have had of a School Nurse
was completely dispelled. The attendance at many of the schools was
low, due to an absence of parents and, in some instances, of pupils at
the hop-yards. The hop-yards brought our first problem. A few cases
of measles seemed to have originated there and as the people returned
to their homes cases began to appear in all parts of the district. However, epidemic proportions were reached in only one school. Then
chicken-pox appeared and the odd case of whooping-cough.
One of our principal difficulties has been to educate the public to
the need for isolation of infectious cases. When some children were
sent home from school with chicken-pox or measles, the parents did
not hesitate to take them visiting over the week-end. By addressing
meetings of women in all parts of the area, by explanation, persuasion,
and occasional threats, we managed to convince the public that children
sent home from school with one of the diseases should be kept home.
By Christmas-time the fear of an epidemic seemed to have vanished. At that time we had only a few cases of rubella in the district,
and it appeared that the New Year would see us free from preventable diseases. We had not reckoned with the Christmas festivities,
A few parents seemed unwilling to keep their children home from
the Christmas-tree entertainments and by the middle of January
rubella was rampant. The attendance of pupils at school was greatly
reduced and for a period of two months nearly 25 per cent, of the
teaching staff were away with rubella. During the epidemic twelve
cases of scarlet fever appeared in different areas, necessitating a thorough check-up of all absentees and suspects; 244 visits were made!
Last October a medical examination of 1,485 children was begun
and at the same time Dr. Quinn was engaged to make a dental survey
of the pupils. These examinations have been productive of much good.
The medical examination brought the pupils' defects to the attention
of their parents. The dental survey revealed such an astonishing percentage of defective teeth that a dental clinic became imperative. The
clinic was begun in January. Two dentists at Abbotsford work four
one-half days each week and two dentists at Mission work two one-
half days each week. Because many of the pupils are brought to
their school in buses, it was necessary to convey children to the dental
clinic by means of the same buses. From ten to twelve pupils are
brought in each morning to Abbotsf ord. They are taken to the Inspector's office, where they do school-work, read library books, and otherwise employ their time usefully while awaiting their turn in the
dentist's chair. At Mission five or six pupils are left in each dentist's
office on the mornings when the clinic is operating.
These activities have been received with great appreciation by the
people of the area. Many times parents have said how pleased they
were to know that sanitary conditions have been improved by the
installation of paper towels and toilet-paper, which formerly was supplied to only three or four schools in the whole district. Poor drainage
systems which were contaminating wells have also been promptly
attended to. A number of undernourished children have been supplied with milk and have shown marked improvement. Every day,
by telephone or by letter, requests are made for visits to the homes
of pupils who are ill, and the public seems to be heartily in accord with
the work that is being done. The home-visits are extremely important in an area such as this, where so many families on small holdings
are on relief. Many of them hesitate to call a doctor because of their
inability to pay him. In many cases I have been able to point out
the need for immediate medical attention in critical cases.
Without the friendly assistance and support of the people of the
district the results we have been able to achieve would have been
impossible. The help and co-operation of Inspector Sheffield and
Miss Robertson, of the demonstration staff, have been invaluable and
my work has been considerably simplified by the elimination of four
School Boards. The Women's Institutes, Parent-Teacher Associations, and the Welfare Association have given whole-hearted assistance. The doctors have always been ready with advice and assistance
in emergencies. The hospital staff, under the kindly supervision of
Miss Archibald, have helped in so many ways. The Municipal Councils, too, have given support and assistance that has been invaluable.
Altogether, the help and support that has been forthcoming from the
people of this area have been most encouraging and bring conviction—if that were necessary—that public-health work is certainly
J. M. Arnould.
COOMBS AND DISTRICT.
Coombs, Hilliers, and Errington Districts have been under my
care since August 1st, 1935, but it has not taken me until the present
time to realize that the advice which we were given during our Public
Health Course—namely, | that one must not be discouraged if the
results of one's efforts are slow in coming to notice; that one must be
satisfied to reach a single objective at a time "—is not to be taken
I admit that at times I have been rather downhearted. Parents
have been rather difficult when approached concerning the administration of vaccine or toxoid to their children. My authority in certain
school-nursing matters has been questioned. Criticisms have had to
be dealt with tactfully yet firmly. But I have had very fine co-operation from my local Nursing Committee, and I am not at all discouraged.
I feel that I have gained the confidence of the people in the district,
and am sure that all my efforts to reach the main objective of public-
health nursing are not in vain.
The programme carried on is a generalized one, the most important phase being school-nursing. Each school is visited twice a week,
with a view to checking up on absentees. The teachers have been
co-operative indeed, reporting any rash, headache, or other symptoms
at once. There has been one case of German measles and two of
chicken-pox in the schools, but these have been isolated in time to
prevent any spread of the infection. As the nearest hospital is 30
miles away, and as most of the people in the district are in very hard
circumstances financially, correction of diseased tonsils and adenoids
has been rather difficult to secure. We are very fortunate indeed to
have the services of a dentist in the district twice a month, and it is
most encouraging to find parents doing their best to afford dental
treatment for their children. The Women's Institute has been very
helpful in supplying suitable school clothing for the children of larger
families. A Little Mothers' League branch has been formed here
and all school-girls over 10 years of age have -attended the classes.
The mothers have been very appreciative of this service for their girls.
The Little Mothers, in their turn, have shown deep interest and willingness to learn | How to save the babies." The boys, of course,
must not be left out, so I have started to take firsi>aid classes with
them in connection with the Canadian Junior Red Cross branches here.
All the school-children are weighed and examined once a month, particular stress being laid on regular gaining of weight. \ The poverty
of the district, along with the ignorance of mothers in matters of diet
and good home-management, is greatly to blame for several cases of
malnutrition. However, I am succeeding in making the children
" weight-conscious," and this, with the addition of a few helpful hints
to parents and the use of current health-literature, is proving successful in clearing up the condition.
Pre-school children and infants are visited once a month and
examined. It is one of my chief ambitions to start a pre-school and
infant clinic here. But several factors appear to prevent me from
carrying on. It is about 12 miles from one end of the district to the
other. The only means of transportation is by car, and cars are so
few and far between and volunteers are so scarce that it is impossible
for mothers to bring their small children to a central clinic. But I am
doing the next best thing. I am starting a weighing-station in each
of the three districts, once a month. The first one we have just had
proved quite successful. The idea is being met with much favour
from parents. The prenatal work is being carried on by home-visiting.
I have several things in view for the coming year. Perhaps I
may be able to go ahead with the idea of a pre-school and infant clinic.
Certainly I am not going to give it up as a hopeless business. I would/
like to take classes in home-nursing and hygiene. All the school-,
children are anxious to have instruction in first-aid to the injured,
and they shall have it. I would like to meet with parents, perhaps
once a month, to discuss health matters of common interest. There
is much to be done, and I am full of hopes that, in the coming months,
my programme may become more and more complete. I am sincerely
thankful for the wonderful encouragement and help I have had from
Dr. Young, for, without that, the way would have been much more
So again I say I am not discouraged or yet disappointed! If the
future of public-health nursing in this district holds as much oppor-
tunity as the past has revealed, all will be well and our objectives will
certainly be reached!
TRANSPORTATION NORTH OF THE PEACE.
The means of transportation for the Public Health Nurse has
always, I believe, been a bit of a problem, especially in a rural district.
The question is how to get the nurse conveyed to and from her
work, be it patients, schools, clinics, etc., with the least possible expenditure of money, of her time, and of her energy.
There are, of course, many ways she may travel—from aeroplane
to snow-shoes—but not all equally practicable. The means of transportation has to be suitable to local conditions, and usually the cost
of maintenance is of vital importance.
If it is financially possible, of course, a small car is the ideal;
that is, when climatic and road conditions are equally possible.
I have now worked north of the Peace River for five years, and
have travelled to my patients and to very scattered schools, etc., in
very many different ways.
At first there was the old Ford car, lent to the nurse 1 for the
duration " (of the car!). | Eliza " was a faithful old car, even if not
much to look at. She certainly lacked many things that the average
car is expected to possess; but she had a wonderful engine (so every
one said) and a very willing spirit, and altogether a nice disposition.
Many a time she was left in a mud-hole or astride a stump while I
journeyed on to my patient on foot; but she was useful on the roads
and saved much time. The horse was used for the trails and more
difficult trips, and during the many months of the year when | Eliza "
was snowed up or laid off on account of mud. Of course, she was an
expense to run, with gasoline at 50 cents a gallon; very shaky and
bumpy to ride in; also draughty after the glass in her wind-shield
was bumped out, and dreadfully noisy, but there were many regrets
when she finally gave up the ghost. Her engine now saws wood in
Fort St. John, while her body, converted into a sort of buggy, is pulled
around by horses! How the mighty have fallen!
After the demise of the car I stayed steadily with the saddle-horse,
varied by " Shank's Mare," except when I was fetched to a patient,
when I travelled in a diversity of rigs—from a stone-boat to a dog-
sleigh, including a hay-rack, a grain-box wagon, a home-made cutter,
a comfortable heated caboose, a bob-sleigh, and many others.
Generally speaking, the roads have improved in the last few years,
making transportation easier; but there are still parts of my district
almost impossible to get at, except in winter, on account of the
muskegs. The steep hills with their winding, precipitous roads pre-
sent a very real obstacle to easy and safe travelling, especially after
a Chinook, when the surface becomes glare-ice. Taking a patient to
a hospital over such a hill is quite a difficult procedure and requires
At one time, transporting an old lady with a dislocated shoulder,
we made a safe journey down an icy hill by several men going ahead
early in the morning with picks and cutting a groove in the ice to
take the sleigh runners at the most dangerous points, while another
man riding a steady sharp-shod horse was hitched on behind the sleigh
to act as an anchor and hold it from swinging around. It was rather
a perilous ride, but, fortunately, the patient was the least concerned
of the party, and we reached the bottom safely and thankful. The hill
on the south bank of the river was less icy and more easily navigated.
Riding horseback when the temperature is very far below zero
is a cold business, and then, if time permits, I prefer to walk.
At present I am considering training my two dogs to pull me on a
light toboggan. With such a small team I could not expect to go far
or over bad trails, but they might manage my hundred pounds on good
trails, and it would be decidedly warmer than perched up on a horse.
Of all the many ways I have travelled to visit a patient, perhaps
the most unusual (and undignified) was on hands and knees.
Hearing that there was a sick child on the other side of the lake,
1 left my unshod horse at the house I was visiting; I proceeded to
walk the odd half-mile or so across the ice, as advised, instead of going
2 or 3 miles around. For some little way out from the shore the ice
was comfortably covered with snow, but out in the wind-swept centre
it was plain well-polished ice and I found myself sitting down suddenly
every few yards. Finally, in desperation, I took to my hands and
knees and crawled across the lake nearly to my patient's door.
Surely there are many ways for a nurse to travel her district!
Muriel Claxton, R.N.,
Cecil Lake, B.C.
BABY-WELFARE, FORT ST. JOHN.
Baby-welfare work has its basic principles that apply in any
conditions, but which must be adjusted to the" local surroundings.
This has been impressed upon me in this field of work here in Fort
Fort St. John, in the Peace River Block, is what might be called
one of the last pioneering districts. This area is sparsely populated,
with log cabins miles apart. Most of the inhabitants are farmers
who left their land in the Prairies to try to make a living in this new
country. The average length of their residence here is about four
years. Needless to say, the homesteads are not very well developed
and the farmers are far from rich. Fort St. John, consisting of a
row of false-fronted stores, log hotel, post-office, and a few dwellings,
is the centre of this district north of the Peace River.
We are fortunate in having two doctors, one a resident physician
and the other the Indian Agent, and a very well-equipped Roman
Catholic hospital. The doctors visit the outlying districts only in a
case of emergency, and the people, because of the long distances, do
not come in for medical attention. We are trying to bridge this gap
through the efforts of the Peace River Health Unit. Baby-welfare
work is an important branch of this programme.
Owing to the fact that these homes are scattered and travelling
conditions are poor—horses being used many months of the year—it is
impossible to visit all the babies each month; thus the establishment
of baby clinics was imperative. The Women's Institutes of the various districts proved a great help in the organization of this work.
They were appealed to and took up this work eagerly and as one of
their projects. This enthusiasm or community spirit, by the way,
seems to be the main characteristic of these people. On this trait
much of the success of the clinics depends. The farmers will go miles
to the pie social; any community event, however simple, seems to have
a great attraction for them.
As it was not convenient for the doctor (who> was to attend these
clinics) to leave Fort St. John, the clinics had to be started as weighing-
stations. It is hoped that a doctor will be in attendance at future
clinics when the snow is gone and the trips to the outlying districts
can be made in one day instead of several.
The day that the first clinic was held the thermometer registered
25 degrees below zero. Luckily, this was warmer than it had been
for several weeks, when it had been ranging between 40 and 60 below
zero. Even in this cold weather the mothers and children bundled up
and came by the cutterf ul to the church hall where the clinic was held.
The routine of the clinic is much like that of any other baby clinic,
with its weighings, measurings, and advice. The value of cod-liver
oil was preached and this food was dispensed to babies where it was
impossible for the families to provide it. Orange and tomato juice
were spoken of, but as oranges and tomatoes are unobtainable here
in the winter, and in season are so expensive, turnip-juice has to take
the place of these in many cases. Canned juices are too highly priced
for general use.
The babies are, on the whole, very healthy, and mothers are
healthy from an outdoor and thus more normal life. The babies are
given a good start in the prenatal period and are helped through the
first months by breast-feeding. Isolation cuts down the danger of
infectious disease tremendously. To reduce this danger to its minimum, however, the idea of vaccination and toxoid inoculation is being
introduced. The vaccination-work has started and toxoiding is being
planned for the near future.
In regard to pre-school work, much of the time is spent on food
problems. The families in many cases do not realize the importance
of a properly balanced diet for the children. For example, it will take
much work to teach them that vegetables should be grown in large
enough quantities to be available throughout the winter. The defects
found in this group, such as tonsils and teeth, will, we hope, be taken
care of in the various school clinics.
The Health Unit has been functioning comparatively few months
and infant-welfare work is just being established in this northern
area. Since development in every line of community education is
important, not only to the community itself, but also to the firm foundation of the unit, infant-welfare work as a branch of health education
is not to be ignored in this district, where a great deal of work must
be done to bring the ideas of preventive medicine to the people's minds.
Norah Cunningham, R.N.,
Fort St. John, B.C.
ON ORGANIZING DENTAL CLINICS IN THE PEACE RIVER
A phone-bell broke the silence on one of Victoria's glorious August
mornings in the middle of my summer vacation. Dr. Plenderleith,
Business Administrator of the new Peace River Health Unit and Official Trustee of the district, wished to see me at his office at the Department of Education. Orders were to return to duty and organize dental
clinics throughout the Peace River Block.
Two dentists were coming from the Coast for two months' duty.
There are children scattered over a country that sadly lacks communication; perhaps one rural mail weekly and one phone in a district
which must serve a very wide territory; transportation is always
difficult; some of the districts and people I knew well, of others I had
had only a bird's-eye view from passing in a car; every child must see
the dentist and only two months in which to do the work-—such were
the thoughts that went through my head.
It was to the women of the Block that I turned for help. We are
fortunate in having many well-organized Women's Institutes and other
interested groups of citizens. They are to be congratulated on the
splendid way they helped, not only by devoted service, but by the
money collected in voluntary donations of 25 cents given to defray
The southern districts of the Block were zoned into five centres
and we worked in empty shops, hotel lobbies, and schools, etc. Committees of women with their conveners were arranged for. Three
members were on duty all day. They relieved each other, one member
staying on till her relief knew how to do her job. One woman was
secretary, another looked after the sterilizing and the instruments,
and the third after the wants of the dentist and children. They also
arranged that the staff was housed and fed. All equipment was
brought from Vancouver. The nurse in "charge had to see that the
clinic was set up and that supplies were on hand, including water,
which is always a problem in this district, and also to supervise the
various work being done by the women each day. She must also see
that the children had transportation, and in many cases go after them
herself. I found that my Chevrolet roadster would manage fourteen
children with a little scientific packing in the rumble-seat. The programme for the next day had to be gone over to see that all would
Dr. Coghlan and Dr. Currie, our two overworked dentists, were
marvellous with the children, many of whom had never seen a dentist
and who were not, at their first sight of the man with his instruments,
very much in love with him. However, they always left good friends,
and in some of the difficult cases with an odd dime. There was only
one child in the entire area that the dentists were unable to work on.
The following story was heard one day: Dr. Coghlan, who was
working on a badly decayed 6-year molar of a rather nervous 8-year-
old boy, said: i Now I am going to work in that nice little nest and
drive out all the little bugs." " Oh," replied the child, " then I can
run away in the nurse's big car " (it happened to be Dr. Cull's Ford
V-8—his idea of a big car), | so they won't get in again."
It is of interest to note that the children of some of the districts
had very bad teeth, and yet in some of the most isolated spots the
teeth of the children were found to be in very good condition. Chewing on hard moose-meat may have something to do with having good
teeth. It is thought that some chemical in the water may account for
the bad teeth in certain areas.
The work in the northern district was done at the schools, about
the same amount of work being covered in both north and south areas.
I think that the conservation of the strength of and the nervous strain
on the dentist should be thought about. Sleeping in strange beds
every night, setting up and unpacking the clinic, and miles of travelling
over bad roads, often after eight hours of hard work, should be carefully thought of by the organizing head.
In our most isolated places Mahomet had to go to the mountain.
School districts nesting in the fertile valleys of the Peace River and
surrounded by foot-hills were visited by boat. With Dr. Cull, Medical
Health Officer, dentist, nurse, the school-children's examinations and
dental work were done at the same time. Space does not permit me
to go into the details of this very interesting trip.
Kelly Lake, outside of the Block, was reached by motoring 70
miles through Alberta in the snow, the party consisting of Dr. Cull,
the dentist, and the nurse. It was finished up with a 10-mile drive
over muskeg in a wagon that possessed no springs. We arrived at
10 p.m. at the home of Mrs. Ward, graduate of St. Michael's Hospital,
Toronto. Mrs. Ward is doing our school-work there and her husband
is the school-teacher. Unfortunately, the wire announcing our arrival
had not been delivered. The house was in darkness when we arrived,
and most women who had a home consisting of one room would have
been quite upset had they to provide extra sleeping accommodation
for one woman and three men. Not so Mrs. Ward—she was kindness
itself, and soon had hot coffee and a lovely meal set before us. Bedrolls were made ready and we were happy and warm and soon to sleep.
I would like my readers to meet Mrs. Ward, who is doing such marvellous work among the half-breeds and Indians. She is the only white
woman in that particular area, but keeps the future of a new country
always Before her and sees the beauty of Nature and good in everything; a somewhat difficult philosophy to attain in a hard pioneering
country conquering the last trails of the North-west.
The urgent need of this work to be, done was well known to Dr.
Young, Provincial Health Officer, the situation having been presented
to him professionally, privately, and by an interested public. We have
him to thank for making this great work possible.
The results of the clinic are many, and the good work can already
(1.) This year there has been a marked improvement in the
attendance of the school-children, this fact being brought to my attention by the teachers themselves.
(2.) The children are taking more interest in the care of their
(3.) The nurses have not to contend with the child crying with
toothache, miles from help in 40-below-zero weather and snow-drifted
(4.) The people feel that something, to the most quite beyond
their reach, was accomplished by the dental clinics for the children.
(5.) It made a pathway for the staff of the Peace River Health
Unit to carry out prevention and health to greater goals.
N. E. Dunn, R.N.,
Supervisor of Nursing, Peace River Health Unit,
SOME WAYS AND MEANS OF CORRECTING PHYSICAL
DEFECTS AMONG THE SCHOOL-CHILDREN
After writing so many articles for our Public Health Bulletin,
one finds it difficult to continue annually with something of interest.
However, I will tell you something of what we are trying to do to
reduce our physical defects. Most of the parents who can afford to
have these defects corrected now take the necessary measures. They
are realizing, as never before, the far-reaching effects of the neglect
of defective tonsils, teeth, vision, etc.
Six years ago I organized a Primrose Tag Day, the proceeds of
which were used for our Dental and Medical Fund. This fund had
been used for the purpose of having defects corrected, of children
whose parents have found it impossible to do so owing to unemployment. We formed an advisory committee to look after the finances,
also to whom I could refer names of children needing treatment. My
Some babies attending Well-baby Clinic at Kamloops.
committee investigates every case most carefully. The children from
the Lloyd George and Junior High Schools have assisted on our Tag
Days; also we have had donations given to us, amounting to $100,
roughly speaking. Altogether we have collected for this fund $788.71
Some mothers and babies attending Well-baby Clinic at Kamloops.
and have given assistance to ninety-eight children. Most of the
defects corrected have been defective teeth and vision. This year
alone we have corrected 64 .per cent, of the defects. In 1925, 66 per
cent, of the school-children had defective permanent teeth; in 1936
this was reduced to 10 per cent. Our school population is just over
1,000 and there are only ten children who need glasses. Most of these
children have parents who can afford to buy them. Some day I hope
we shall have 100 per cent, good vision.
In 1925, 32 per cent, of the children had goitre; in 1936 this was
reduced to 5 per cent. For several years the Imperial Order of the
Daughters of the Empire have provided us with iodine tabloids for all
children showing any sign of goitre. I am pleased to find that this
year twenty-five of our high-school pupils have shown very marked
improvement, owing to the continued treatment which they have
received during the past five years. Toxoid treatment has been given
continuously since 1929 to the school-children. We have 62 per cent,
of our children protected from diphtheria, and also hold a pre-school
clinic and usually treat twenty children annually.
It is quite a grief to me that parents do not realize the benefits
that are offered them free of charge. However, it is only by education that we can hope to build the future health of our race.
Olive M. Garrood, R.N.
| AN IMPOSSIBILITY BECOMES A REALITY."
I think that I am just beginning to realize how much planning and
thinking and talking and scheming is necessary before anything really
worth while is accomplished. So many things around us which are
functioning smoothly in our day, things which we take for granted
now, have taken hours of careful study, and have had very perilous
trips through the sea of public opinion.
It is over three years ago that we first mentioned to the people
of Nelson the necessity of a pre-school and school dental clinic. Fully
realizing ourselves the appalling dental conditions which existed in
our community, we tried to convey to the public the need of dental
work and to interest people in a clinic, the purpose of which would be:
(1) Education of parents and children as to the need of dental work;
(2) operative work for children of the indigent and near-indigent
However, a dental clinic was an impossibility. It was not just
that we sensed the fact, but we were definitely told that it was.
" It would cost too much." " It couldn't be organized so that it would
work." " A dental survey had been done before and nothing was
accomplished as a result of it."
And so each year we talked and planned and schemed. The need
of dental work was becoming greater as the period of. depression
lengthened. The dentists co-operated to the best of their ability, but
there seemed little to offer except extractions. Many of the children
had so many teeth extracted that they were unable to masticate their
food properly. There were so many abscessed teeth and more than
a few cases of acute rheumatism, which our doctors told us were due
to infections of the mouth. There were so many swollen painful faces
and so many notes from parents explaining that children were absent
from school on account of toothache.
Dr. Young brought a ray of hope to our midst when he visited
us last June and addressed a very representative meeting, explaining to those present the need of dental work and offering material
When the fall term commenced we felt that it would be wise to
concentrate all of the time which we could spare from routine work
on the organization of a dental clinic. We talked to the Women's
Institute, the Gyros, and the School Board. Our first real assistance
came from the Nelson Women's Institute, when early in November they
voted money for the purpose of carrying on a dental survey.
Dr. Walley, a local dentist, was appointed to do the examinations,
and it was one of the most interesting and conscientiously done pieces
of work I have ever seen. The children were carefully examined and
findings charted on the dental charts provided by the Department of
Health. When the examinations were completed we heaved a sigh
of relief, feeling that our work was nearly over.
However, we found ourselves faced with the problem of compiling
a statistical report which would convey something to our public, and
we found that the hours spent on the statistical end of the survey
almost outnumbered the hours spent in actual examination.
We were not the least surprised at the results obtained. Doctors,
dentists, and Public Health Nurses the Province over realize the
appalling need for dental work. The public, however, was surprised.
On the whole, people were aroused and genuinely interested. The
local press devoted considerable space to the printing of statistical
reports. Parents received cards with tooth-defects charted.
The School Board members became interested, and after the
matter was discussed from every angle they voted that $1,200 be
included in the estimates for the purpose of organizing and carrying
on a dental clinic.
The Provincial Board of Health obtained the sum of $306 per year
from the Department of Education toward the salary of a dentist
and donated the sum of $1,000.
We are planning to commence work this fall. A committee has
been chosen to obtain equipment and work out a policy for our dental
In reviewing the situation, it is gratifying to note that a dental
clinic which seemed well-nigh an impossibility a short time ago is
now well on its way to becoming a reality.
Four months have passed since I was transferred to the Peachland-
Westbank District. In that time I feel that I have learned something
of the people, their needs, living conditions, educational background,
and religious doctrines.
A generalized nursing service is required, so the many phases
of the work must be considered and developed, each as an integral
part of a public-health programme adapted to the needs of this
Prenatal instruction forms a good foundation for future health-
teaching. In most cases the patient is confined in hospital at Kelowna,
but some infants are born at home.
Infant-welfare and pre-school teaching is well received. Most
of the mothers are anxious for advice and willingly bring their children
to weighing-stations. This month we hope to have Dr. Ootmar, of
Kelowna, with us at a well-baby clinic in Westbank.
With the splendid co-operation of the teachers the school-work
is well begun, but there is yet much to do. Simple goitre is very
prevalent amongst the school-children and with the consent of the
parents we hope soon to give preventive iodine at school. Plans, too,
are under way'to form branches of the Junior Red Cross this fall.
When Dr. Lamb and Dr. Kincade visited our district during the
first week in May, 155 of the 179 school-children were given the tuberculin test. Ten showed local reaction after the first dose and three
after the second. Five of the total were Indians. At this time
thirty-two pre-school children were tested and all found to be negative. Of the twenty-three young adults, including teachers, twelve
showed positive reactions. In the near future Dr. Kincade plans to
follow up this test with physical and X-ray examinations of those
reacting to the tuberculin test. This survey has stimulated a community interest in the present campaign against tuberculosis.
Bedside-nursing is necessary in a number of cases. Very often
through this branch of the work interest is created in the nursing
programme and those who were at one time antagonistic become loyal
supporters of the nursing service.
First aid is frequently required, as we have no resident doctor
in Westbank and the hourly day ferry service to Kelowna is discontinued at night.
The Indian reserve presents problems of its own. Superstition,
old Indian customs, and a little knowledge of modern theories present
rather serious difficulties. As an example, there is the Indian girl
who had heard there were people ill at Westbank. When I visited
her home she asked if every one was well, for she said: " You might
bring the germs to us." An Indian lad with lobar pneumonia and a
history of tuberculosis was seriously ill and refused to go to hospital,
so was of necessity nursed on a very draughty floor. Yet the younger
generation is beginning to accept a higher standard of health and will
seek advice and co-operate to a certain extent. Tuberculosis is the
greatest problem of the reserve. Those suffering from the disease
are undoubtedly infecting others. Yet what is to be done?
Sanitation, the disposal of refuse, safeguarding the milk-supply,
etc., are vital problems of this rural area.
In Westbank and Peachland the general attitude towards public
health is good. A splendid foundation has been laid by nurses who
were here in previous years. With the hearty co-operation of physicians, teachers, members of the local Board, and other organizations,
we hope to progress steadily, although slowly at times, towards our
goal of good health for all.
Mary Gowen, B.Sc.
MISSION AND MAPLE RIDGE DISTRICTS.
The I mills of the gods " seem to be grinding a little less slowly.
One wonders how much faster public-health projects would be carried
out if the I times " were as good as in the 1920's—with public interest
aroused as it is to-day. Difficult times seem to be necessary to impress
people in general—those who are impressed—with the advantages and
need of preventive and scientific measures in the building of positive
Undoubtedly there is keener health-consciousness among the laity
than there was ten years ago. There is also a greater appreciation
of the authorized services available to the public and an increasing
demand for them.
The information on health measures that has been given to people
by press, air, across platforms, and in the homes is reaping a measure
of harvest. In spite of the number on relief budgets and the larger
number on small wages, there are fewer underweight children than
there were before the " depression." Also there are in this field a
smaller percentage of pupils absent from school because of illness
other than communicable diseases or accidents.
As an example of public awareness, many have remarked at
Father and Son banquets, i in almost every case the son was the
better man of the two " (physically). They gave the credit to improved athletics and the greater attention to diet and hygiene, by
which the sons have benefited. And, again, the very few times one
hears of convulsions during baby's teething period these days as compared to those of mother's day, and the almost universal use of
cod-liver oil for babies instead of teething-powders. While one less
seldom hears that " Johnny's father and uncles had weak eyes or
bronchitis " given as a reason for neglecting Johnny's need of glasses
or medical care.
These districts have had rapid growth in school attendance.
There has been an increase from 1,700 pupils to 2,400 in the past
three or four years in the nineteen schools in an area of about 240
square miles of occupied land. In addition to the natural growth in
receiving classes, many have come from the big city and the Prairie
Provinces to our fair valley.
Unfortunately, the past winter's routine health-work has been
hampered by communicable diseases, chiefly rubella and influenza, but
with one good result: many people realize and state that there should
be two Public Health Nurses here. This good luck, I really believe,
may come in the near future.
There were " repeat" diphtheria-toxoid clinics in the one large
centre which were well patronized. There have been inquiries for
others as well.
Anti-goitre tablets are still being given to the pupils up to the
sixth grade in eight schools. These are supplied by the School Board.
Very few cases of enlarged goitre are found in these schools. Milk is
also supplied by the Board to under-privileged children in these
In addition to the four regular chest clinics held here by Dr. Lamb
annually, a tuberculin-test survey is being conducted at present by
this Travelling Medical Health Officer among the Japanese. There
have been seven | new " active cases among their young men in the
past eighteen months. The hope is that further clinics will soon be
held for the rest of the population. These surveys are a great advance
in preventive medicine.
There is also need for the application of mental-hygiene principles
in our schools, where large numbers of children are almost surely
going to find their social adjustments difficult in the coming years.
We hope to do something along this line in the near future.
Mission and Haney.
I SELLING PUBLIC HEALTH " IN THE KELOWNA
The problem confronting every Public Health Nurse working in a
rural area is that of " reaching " her public and placing her wares
before them so successfully that they will co-operate with interest in
her efforts to develop a public-health consciousness.
I will endeavour to present as briefly as possible some educational
methods used to attack this problem in the Kelowna rural districts,
a farming area of scattered communities of some 3,600 people,
embracing sixteen different nationalities.
The continuous health education of the individual by personal
contact in the home and school is, of course, second nature to the
Public Health Nurse. Personal contacts in clinics also come in this
category, but the more intimate personal relation established by the
home-visit has been found invaluable, because parents will have con-
fidence in and listen to some one they know personally who is obviously
interested in the welfare of themselves and their children.
Education of the public in the mass has been attempted by means
of lectures given to many different types of organizations and gatherings—by health exhibits, by health talks in the schools, and by the
wide and free distribution of suitable health literature.
The annual School Health Cup competition staged between ten
rural schools has been an educational force of a somewhat different
nature, arousing keen interest among school trustees, teachers, parents,
and children in the health conditions in their own schools. The graded
results, embracing every phase of personal hygiene, school sanitation,
interest in and response to health education, are fully written up by
the School Nurse in an annual topical report, in which she also endeavours to present in an educative and interesting manner every phase
of public-health-nursing activity carried on in the communities and
This report (which has grown through the years to a mimeographed booklet of some twenty-one pages) is sent to representative
school trustees and other key people in the districts, and is discussed at the annual meeting of the Kelowna Rural Schools Health
Personal interest in child-welfare work has been aroused locally
by enlisting the aid of Women's Institutes and other interested persons
in the organization and operation of well-baby and pre-school clinics.
Clinic work in general has been a prominent feature of the development of the educative, preventive, and curative programme of public-
health nursing in the rural areas, as the summary of results at the
end of this article will show. All clinics are attended by the Public
Health Nurse; those of a preventive nature and well-baby clinics by
the district Medical Health Officer. Such clinics held in their own
districts are an effective means of coming into personal touch with
rural residents. Well-baby clinics especially, where refreshments are
served by the Women's Institutes, are really pleasant social and educational gatherings.
Results of Health Education.—The result of seven years of intensive personal and mass health education has been seen in the response
of parents and teachers to requests from the Health Service for consent to active immunization of school and pre-school children against
scarlet fever, diphtheria, and smallpox; to goitre treatment in the
schools, and, most recently, to tuberculin-testing of school-children.
Too much appreciation cannot be given to those teachers in the rural
schools who have placed before their classes the need for such protective treatments, and have themselves administered iodine for simple
goitre prophylaxis, standing behind the Health Service with valuable
moral support in their own school-rooms. The teachers have also
impressed continually upon the children under their care the need for
personal hygiene, and brought before their School Boards the need for
necessary improvements in school sanitation pointed out by the School
Some of the practical results of health education may be summarized as follows:—
(1.) Ninety per cent, of 700 rural school-children in ten rural
school districts actively immunized against diphtheria, or Schick
negative; 50 per cent, of 380 pre-school children on register actively
immunized against diphtheria.
(2.) Eighty-eight per cent, of rural school-children vaccinated
against smallpox; 48 per cent, of 380 pre-school children on register
vaccinated against smallpox.
(3.) Simple goitre reduced in three years in the schools from 66
per cent, to 25 per cent., due to the administration of iodine by the
teachers with the consent of parents.
(4.) Ninety-six per cent, of 736 school-children tested with the
tuberculin test with the consent of parents.
(5.) Gradual improvement in school hygiene and sanitation as
shown by the increasing percentage of points gained yearly by individual schools in the School Health Cup competition. In 1932 the
lowest school gained 54.4 per cent, of possible maximum; in 1935 the
same school averaged 75 per cent, of a possible grading of 1,200 points.
(6.) One hundred and thirty-two rural well-baby and pre-school
clinics, sponsored by Women's Institutes, at which 876 children made
(7.) Four hundred and eighty-nine free clinics of various types,
preventive and curative, at which 3,691 adults, school-children, preschool children, and infants made 8,526 attendances.
On consideration of the above summary of results, it would seem
that methods used to § sell public health " to residents of the Kelowna
rural districts during the past seven years have resulted in a greatly
increased interest in and understanding of public-health aims and
Anne F. Grindon, R.N.,
Kelowna Health Unit.
CONTROL OF COMMUNICABLE DISEASES.
Last May two cases of chicken-pox from one family developed in
two class-rooms of Grade I. and two pupils. Previously, when this
happened, I inspected classes frequently, excluding any further cases
which developed on school-days, and, if I could not contact the parents,
hoped that nothing would happen over the week-end. This time,
however, I expected the contacts of these cases to develop the disease
on days which included Thursday, a school-sports day; Friday, the
May Day Festival; Saturday, the children's ball; and the Sunday.
There were seventy-five contacts and it was a big task to notify the
parents of those children personally. I decided to make use of the
mimeograph equipment at the school and notified the parents by forms
which were delivered by the children who were contacts. Eight cases
of chicken-pox developed during the holiday, but each one was recognized in the initial stages and no other cases developed from contact
with those eight cases. Instead of being alarmed, parents were
extremely co-operative and pleased that they had discovered the
disease at the first symptom and that they had prevented other children from contracting it.
Since then I have distributed mimeographed information occasionally, stating what diseases are likely to occur, describing the
symptoms, and giving instruction about the procedure if anything
develops. Parents are always notified if there is known contact at
school or anywhere else, and if a family contact is excluded, the
mimeographed form is also given as 'part of the instruction at the
home-visit for further reference.
After a year's experience with this method I find that parents are
grasping knowledge of the diseases and are co-operating splendidly.
Class-room inspections, etc., are continued, but are not as profitable
It is gratifying to have parents realize that a cold may be the
beginning of a communicable disease and to have their co-operation at
that stage in the development of, for example, measles. I now consider these forms an indispensable part of the education and control
of communicable diseases.
School Nurse, West Vancouver, B.C.
ADVERTISING—A PUBLIC-HEALTH NECESSITY.
In speaking of advertising public health, let us dwell for a moment
on the word | advertise." What does it mean? According to a text
on I Modern Business," advertising is an announcement to the world,
telling the people what it has to offer. It is an invitation to get
acquainted. If it is successful it is a contact that opens the way to
permanent friendship, for it radiates friendly fellow-feeling.
Let us apply this to public health. By means of advertising it,
we are giving the public an opportunity to be better acquainted with
our work, we are making contacts, we are paving the way to permanent friendships, and we are radiating friendly fellow-feeling.
One can readily see why people, being acquainted with any particular type of work, and therefore possessed of a greater understanding of its value, will rally to the cause. Equipped with knowledge
of public health, people will put forth a good deal more effort mentally
and physically to support it, and it is that added support that we
are striving for.
Advertising is a form of education. In all phases of life the
task of education must go on year after year—repeating the same
processes. For instance, the multiplication table may not change, but
there is always an army of new pupils who need to learn it, and sometimes an army of old pupils who have forgotten it and need to learn
it again. Repetition is necessary to assure a permanent place in the
memory. Every Public Health Nurse knows how very true this is.
In health it is necessary to repeat the same lesson over and over again.
If we advertise the lesson we are employing only one more way of
putting it across and forming a permanent place in the mind of
Again, advertising is a tremendous force in the life of a people.
It is a vital factor in the building-up of any enterprise. Look, for
instance, at magazines, newspapers, sign-posters, neon lights. A manufacturer cannot afford to let the public forget his products for one
moment. So it is with public health. One must constantly strive
to keep the value of this work ever before the public eye.
Moreover, advertising is a force made to overcome barriers of
inertia. By this one does not mean that we are displeased with
health conditions in our Province. Far from it, but in almost any
work there is room for improvement and any effort put forth to
further this improvement is of great value. By advertising public
health we can mould public opinion by changing old habits and beliefs,
by planting new ones, and by overcoming prejudices, and hence lay
the foundations for a healthier future.
We are the lights of public health. Let us not hide our lights
Geraldine Homfray, B.A.Sc, R.N.
In this accelerated day of hectic dashing back and forth from
case to case, from school to school, from confinement to confinement,
from rubella case to rubella contact, the art of relaxation is almost
lost. It is typical of human nature that sight is lost of the things
most needed and which are closest to hand. Relaxation is one of
these near-by remedies—and how we need to make use of it!
While physical relaxation is a matter of will-power, a matter
of just stopping occasionally to get some extra sleep, mental relaxation seems to be more elusive, and to a group of nurses it seems
hardly necessary for me to emphasize the value of this capacity for
which most of us long and which few have achieved.
In my humble opinion, however, the ideal way to relax is to have
outside interests—anything that will take us away from nursing and
things that " pertain thereto "—either a Hubby or a Hobby! I have
not tried the former, but I can certainly vouch for the benefits and
pleasures of the latter.
A hobby, so I have found, is a path by which one may wander
to green fields far removed from the sick and their troubles; where
for hours at a stretch one can create fascinating objects out of
materials, and exhibit them later for the pleasures of others. For
instance, take china-painting, photography, drawing, etching, gardening, leather, wood or copper work—any of them will lead you off
into another world of enjoyment entirely apart from the nursing
sphere. A change is as good as a rest, so they say!
These side-lines, or lanes, lead to the development of unthought-of
talents, and are not to be compared with various forms of exercise
and sports, such as horseback riding, tennis, etc., that lead to nothing
but physical prowess. Not that exercise is being condemned in this
article—far from it; but it is being contrasted by the satisfaction
which a creative urge produces and the tangible results which ensue.
After all, it is an achievement to be able to produce unusual gifts
for various members of the family at Christmas-time, and the
emergency gifts for Aunt Susie's birthday or sister's wedding!
Being a group of nurses—and women—I don't suppose many
of you have ever considered photography as an outlet; and yet it is
true that most of the outstanding work on exhibition in photographic
salons is the work of women.
This particular hobby is one of the most fascinating escapes
from Mrs. Jones and her family troubles. To shut oneself up in a
dark room and watch the miracle of a picture develop before one's
eyes is really a thrill. Besides which, when the world and everything
in it is viewed with the one idea of getting interesting pictures out
of it, it is surprising what one sees! Then, too, the casual snapshot
of a scenic spot will produce a pictorial effect suitable for exhibition
if the right portion is picked out and enlarged—the enlarging process
being the most intriguing phase of the whole art. One could go on
indefinitely with the latent possibilities of this particular hobby,
especially when the secrets of colour effects and filters, shadows and
angles, worm's-eye and bird's-eye views are explored.
The value of china-painting is more self-evident because all
women have a sneaky regard for nice china, and the pride of being
able to exhibit china of one's own painting at any tea-party is quite
Drawing and etching too. No, it's no use saying, 11 never
could draw a straight line at school," because you really don't know
what you can do until you try. I have proved that theory over and
over again, even to drawing and painting!
And so I leave the subject for your consideration. By all means
dig up something different to do in your spare time that will take
you far enough away from nursing or social-service work and give
you a new zest with which to attack your evening's activities.
Saanich Health Dept.
" A DAY IN A LOGGING CAMP."
Tuesday comes around again and preparations are made to pay
the weekly visit to the logging camp across the lake. Having filled
my nursing-bag with all manner of things, I also arm myself, on
clinic days, with those cumbersome baby-scales—frame, tray and all.
The first problem is to persuade the worthy boatman to be ready
to start on time. Having located this elusive person, we repair to
the launch, which is probably tied up at the store float. We then
go aboard hoping that the engine will start ,and, what is more
important, will keep going until we have covered the 7 miles up and
across the lake.
Camp Six, Cowichan Lake. View 1.
We start our journey and, if the weather is calm, one can settle
down to enjoy the scenery for about an hour. The lake, which lies
east and west, Is about 18 miles from Duncan, on Vancouver Island,
and runs for about 22 miles. From the water's edge the mountains
soar high above. Numerous bare patches, where other logging camps
have been located, show up on all sides. Away in the distance, snowcapped mountain-tops are clearly visible against the sky.
Slowly we chug up the lake, passing the big lumber-mill on our
right, until we pass between two tiny islands, and there in front lies
Camp Six. The accompanying snapshots may give some idea of
the setting. The general impression is of a collection of many
weather-beaten frame buildings clustered about the narrow shore,
with numerous float-houses oozing out over the lake.
Here in this restricted area live about ninety families, with about
200 men working in the woods several miles from camp. The houses,
which are typically lumber-camp abodes, are dotted here, there, and
everywhere. The office, store, and cook-house, as well as numerous
bunk-houses and homes, are built on floats which must be hauled in
or out as the lake rises or recedes. Woe betide the dwellers if they
neglect to push their homes out as the water falls, for they must then
maintain their existence at a most uncomfortable angle. Furniture,
dishes, and even the linoleum on the floor will slide. Such homes
are delightful in summer, but when the winter winds come the sensations are not at all pleasant, for, even after getting back along the
floating walk to dry land, one continues to feel that monotonous
motion of a water-tossed boat.
Camp Six, Cowichan Lake. View 2.
The first objective is the one-roomed school set in its | playground I between the many stumps. The thirty-five children are
examined monthly or more often if necessary, and informal health
talks are given. They are encouraged to show any ailments to the
nurse, and all of these, even to the most infinitesimal scratch, are
The order of the day then is to visit any school absentees in their
homes. If it is thought necessary, the cases are referred to the doctor,
who pays a regular visit to the camp on Tuesday afternoon. After
this it is usually time for lunch and this may be procured in the
Every two weeks, from 1.30 to 3 p.m., a well-baby clinic is held
in the home of the school-teacher. Here the babies are weighed
and advice is given on general care and diet. On the alternate
Tuesdays, or after the clinic is concluded, the afternoon is spent in
making more home-visits. Such calls will include prenatal or postnatal work, infant or pre-school care, tuberculosis instruction, or,
in reality, anything or everything that can be done tb further our
programme of health education.
Sometimes there is the difficulty of language, for it is quite a
cosmopolitan community, with Finns, Swedish, and Mid-European
peoples predominating among our 1 new Canadians." This, however,
is overcome by object-lessons or patient explanations, or, if these fail,
an interpreter may be located.
Camp Six, Cowichan Lake. View 3.
All are very anxious to learn, particularly if the subject is the
care of the new baby. This seems tangible to them, and such instruction forms a solid footing for a further entrance into the family
for some other reason.
After a busy day of winding in and out by the very numerous
footpaths and of walking § the ties," supper is enjoyed. The evening
is spent in visiting about until the doctor is ready for the return
journey—probably about 8 or 9 p.m.
With many a joke about the faulty boats, we climb aboard and
are carried down the dark lake until we see around the point the
welcome lights of the mill and the homes of Youbou.
Heather Kilpatrick, B.A., B.A.Sc, R.N.,
PERSONALITY IN PUBLIC HEALTH."
What do we mean by the term | personality " ? The dictionary
defines the word as | personal existence or identity " or i distinctive
personal character." We all know that neither of these definitions
is adequate. | Personality " includes these and many more shades
of meaning indefinable in even the best of dictionaries. It embodies
our character and inherited mental make-up and is influenced by
our every-day environment. The reaction of people we meet is their
reaction to our personality.
How important, then, is the development of an attractive personality in our daily life, but how much more is it in public health.
For public-health workers, be they doctors, nurses, or teachers, are
virtually meeting the public constantly. The words " public health "
embody this very thought; for it is the public to whom health is
brought and taught every hour of the day or night, whenever the
It is therefore absolutely essential that all contacts with the
public should be pleasant and should be forerunners of further
contacts. A pleasing personality creates a good impression. Such
a one will be asked again and again for advice and will be sought
out on many occasions.
A person who will make a good impression on the public does
not mean a person who has a great flow of small talk. The ability
to talk well is very useful, but it should be used with discrimination.
A good talker is not uncommon, but a good listener is a much rarer
person. Most people want to talk, but few want to listen. Perhaps
if public-health workers would keep this as their motto they would
achieve far more as regards their contacts in their work.
Character also comes with personality. A person may be charming to meet, but unless one feels that there is character behind that
charm, one soon forgets or grows tired of that person. The public
will have no confidence in a weak personality, no matter how charming. People want to feel the strength of will and purpose that should
be found in a person to whom they will listen and obey.
Trustworthiness is the very backbone and foundation of personality. If a person is consistently reliable, mediocre work may be
forgiven. Deception may seem the easier way out of a difficulty,
but, applying an old tag, f You may deceive some of the people all
of the time, and all of the people some of the time, but you cannot
deceive all of the people all of the time "; so why not save any trouble
and be truthful always.
Were a personality to include all these—charm, character, trustworthiness—workers in public health would gain the confidence,
friendship, and co-operation of their people far more easily and
quickly than by any other means.
Annie S. Law, B.A., B.A.Sc, R.N.
i MY FIRST FIRST AID IN THE PEACE RIVER
Early September saw the establishment of our Health Unit here.
I had only been at Pouce Coupe (I was staying there temporarily
until I would be able to get to my own district over a river from
which the bridges had been washed out) when I was asked to make
a quick inspection for contagion over six schools within a radius of
25 miles. Aside from a general sense of direction, I had a very hazy
idea of where these schools were, and at that time also I had very
little idea of what muddy Peace River roads are really like. So I
packed up my little kit and set out on what was booked for a two-day
I shall spare you the details of the journey—that is not what
I really set out to write about. Suffice it to say that I have found
out after six months here that difficulties of travel and road conditions
are the most popular topics of conversation. Everybody always has
one better to tell, and I stored up a few treasures of anecdotes of that,
my first trip of any length, that still make material for a brilliant
participation in any bout of this nature.
On the second afternoon out, about 3 p.m., I arrived at and
inspected the last school on my list. Duties over and school dismissed,
the teacher and I sat chatting over her desk. She wanted to know
all about the new Health Service, and I was especially interested
to find out the best road—if any best road existed-—back to town.
Glancing at her casually as we conversed, I suddenly saw a huge
black spider enter her ear. Controlling an exclamation of horror,
I asked her to sit still for a minute and let me have a look at her ear.
I thought she might become frightened if I mentioned spider, so she
sat there rather cool and astonished-looking while I peered into her
ear. Only one wee bit of a black spider leg was visible! All the
rest of Mr. Spider was already well out of sight within the ear.
"Now," I thought, "What shall I do; what can I do?—Why,
my flashlight! " I am sure the inspiration came filtering through
a few years of time from those first-aid classes back in U.B.C. How
was it? Oh, yes. " If an insect is known to be in the auditory
passage, flashing a light at the external ear will cause him to back
Quickly I ran out to the car, thanking my lucky stars for the
brand-new flashlight with which it was equipped. I explained to the
little teacher, who still seemed rather amazed at the proceedings, but
who was a real brick, what it was all about and we settled ourselves
as comfortably as possible for a session of flashing. Mr. Spider
paid no attention whatever. The little teacher said she could not
feel him there at all, and I began to wonder if his entrance into her
ear had been an optical illusion of mine. All I could see was a tiny
fraction of what resembled a spider's leg. Flash on, flash off; flash
on, flash off. What else could one do? Should I fill the ear with
olive-oil and chance it floating out? No; I was sure this light-
flashing would work eventually.
We tried to carry on a conversation and found it hard to keep off
the subject of spiders in ears! I wonder if she realized what might
happen if the insect wouldn't come out. Suddenly I saw the leg
wriggle, and Miss C. said: " Oh, I can feel him wriggle. Gee, he
feels funny." I was glad to find her such a composed young lady.
We had been carrying on proceedings already for fully forty minutes
and it must have been a nervous strain for her.
Flashing continued for about twenty minutes more, with the leg
continuing to wriggle provokingly. We were sure he was trying
to wriggle back through the waxy entrance. Two legs appeared, and
finally Mr. Spider himself, with a great rush, very subdued and waxy
looking, and in an immense hurry to find other cover. I picked him
off her outer ear in great glee. Nothing has ever given me greater
satisfaction, and as a result of this little experience I am more than
ever interested in first-aid measures.
I find many people have pet tricks all their own. Often valuable
hints can be picked up. Even our Medical Director of the Unit has
some seemingly rather odd theories re first aid. Just the other day
he told me of a way to control severe nose-bleed when all other
measures fail, with the use of a small piece of salt pork in the bleeding
nostril. Now, who is going to try that one out?
Rita Mahon, R.N.,
Peace River Health Unit, Dawson Creek, B.C.
DENTAL WORK IN VERNON SCHOOLS.
One of the greatest achievements in public-health work in this
district has been the improved mouth conditions of our school-children.
We have here as fine a condition of good mouth hygiene and corrected
dental defects, I am sure, as you will find in any school in the Province.
It has taken several years to achieve this; but if this standard
can be maintained in the years to follow, I shall be satisfied with this
phase of our public-health work here.
Our dental programme is a simple and, I think, a sound one,
and if administered properly, one that can be carried on for an
indefinite number of years. This is how we started it.
The School Nurse in her reinspection of school-children found
an appalling lack of interest among some of those parents who could
afford to pay for their children's dental work, and also revealed that
there were many dental defects among the children of indigents who
would never be able to have this work done, or probably not until it
was too late to do much good. This condition was persistently
brought to the attention of the parents of those children who, we
felt, could pay for this work, but something had to be done for the
teeth of the indigent child. This was before the days of Government
I have always objected to raising money for this sort of work
from proceeds of Tag Days, concerts, etc., as the publicity given to
it in such cases would probably have swamped us with requests for
assistance from many undeserving cases.
We wanted to start a dental fund, not anything spectacular, but
rather in a small way, and gradually build it into something permanent, so we appealed to our faithful friend, the Vernon Women's
Institute. Just at this time some Red Cross nursing classes were
being held in the Province under the auspices of the Women's Institute.
Part of the proceeds from these classes were to go to the Canadian
Red Cross Society and the remainder to the Women's Institute. When
the classes were finished and the proceeds distributed to the two
societies, the Women's Institute here added to their share of the
proceeds to make up the sum of $25 and sent it to me for our dental
work. It was not a large sum, but it formed the nucleus of our dental
fund. Some of our benefit societies and service clubs were interested
and they too sent donations when appealed to for funds. This system
continued for a couple of years. Then our School Board, recognizing
the value of the work that was being done, included a sum of money
for dental work in their estimates each year. It was not necessary
to appeal for any more funds as the School Board still carry on this
work as part of their yearly expenses. For the past few years this
money from the School Board, together with the Provincial grant
for dental work, constitutes our permanent dental fund.
So much for the financial side; now for the children. This
service takes care of needy cases and assists with others when we
think it necessary, and applies only to pupils in the elementary grades.
We started with the receiving classes and the entrance classes, the
beginning and end of our elementary grades here, and gradually
continued our work toward the intermediate grades, until now we
are able to include all the elementary grades during the year.
We pay particular attention to permanent teeth and mouth
hygiene, and we try to do as much as we can each year with a certain
sum of money, always keeping some in reserve for emergencies.
That is, we bulk the money and estimate the amount of work to be
done each year, usually about seventy-five or eighty children.
This work is divided among our four dentists, and it is done
impartially, regardless of age, nationality, or length of residence in
the district. The only stipulation is that we must be sure that they
are really needy cases and would not be able to have the work done
in any other way.
This part of the work I take care of, and I find it difficult many
times to decide just where to draw the line. I also make the first
The work is done as quietly and tactfully as possible. There is
no public clinic; in fact, we do not call it a clinic at all. Too much
publicity would ruin the spirit of our work, and might also lead to
some unpleasant controversies as to whether cases are needy or otherwise.
But I wish to mention our local dentists, without whose hearty
co-operation this work would have been impossible. They are doing
a wonderful work—underpaid it is true; but nevertheless doing it
well, and in this way making a wonderful contribution to the future
health of a great number of our young Canadians. I am deeply
grateful for their loyalty and support and thank them most sincerely
for the many hours of free dental work that they have given to our
Elizabeth E. Martin, R.N.
| TUBERCULIN TESTS IN A CITY SCHOOL."
We have just completed tuberculin tests of 1,700 children and
young adults in the City of Kelowna and the rural district. This
was carried on by Dr. A. S. Lamb and Dr. G. F. Kincade, Travelling
Medical Health Officers, assisted by Miss J. Peters, R.N., and Miss
E. Pease, R.N. Since this is the first district in the Interior to be
surveyed in this way, I felt that it might be of interest to other
Public Health Nurses, who might be called on to organize a clinic,
to have a brief outline of our trials and triumphs here.
In the first place, publicity is of prime importance. We sent
detailed notices home to the parents about six weeks before the tests
were scheduled. We had an explanation of the test in local papers
and mimeographed notices of the same were sent to each home with
separate consent-slips. If at all possible, I would suggest that you
have a letter written by the doctor carrying on the test, pointing
out again the difference between tuberculosis infection and tuberculosis disease, these to be given to all children whose reactions were
Dr. Ootmar and Mrs. Grindon arranged the schedule for the
tests in the city schools as well as those in the district. I have no
doubt that this was probably the hardest work in connection with
our preparation for the clinic. To have the schedule so arranged
that the doctors were not at three places at once or completely out
of work was quite an accomplishment. Each child must be inspected
forty-eight hours after the first dose; all the children who were
negative at this inspection receive a second dose of tuberculin, and
they are again inspected forty-eight hours after the second dose.
That means that the doctors must visit the school three times at
two-day intervals, and if you have ten or twelve schools to be included
Tuberculin-testing at East Kelowna School.
you will realize the complexity of the schedule. Seventeen hundred
children and young adults were tested and positive reactors were
X-rayed and had chest examinations in three weeks' time.
If your district is to be the next " victim," try to allow yourself
six weeks for preparation and publicity. Sorting and listing the
names from consent-slips took three times as much nme as the actual
testing. As to the test itself, the two doctors and two nurses were
such adepts that it took all my time to keep enough children in line
to keep the doctors busy. Fortunately, this and keeping the records
is all that is expected of you. To give you an idea of the speed with
which the doctors and nurses worked, they gave the first test to
394 children in two and one-half hours. It might save you a good
deal of time and energy if you have one list according to age groups
as well as one according to grades, as I did. A duplicate copy would
not be amiss, one for yourself and one for the doctor to keep; otherwise the doctor will borrow yours.
The following statistical report is complete for the actual testing,
but to date I have not the reports on chest examination or X-ray.
Eighty per cent, of school-children in rural and city schools were
Pos. 1 '•
Tot. Pos 1
% Pos ---
(1.) Total children tested of that age.
(2.) Positive 1: Positive after one dose.
(3.) Positive 2: Positive after two doses.
THE CHILD-GUIDANCE CLINIC.
The first " child-guidance clinic" in Nanaimo was held in
November, 1935. Suitable clinic-rooms were obtained from the
United Church and consist of three separate medium-sized rooms
which are upstairs in the Sunday-school hall. These rooms are quiet,
well heated and lighted, and are ideal for such a clinic. It is necessary to have the three separate rooms because one room is used for
the physical examinations, one for the psychometric tests, and the
other room for Dr. Crease's consultations with the patient, parents,
or relatives, as the case may be.
The first task in connection with the clinic is to decide upon the
patients, who may be referred to the clinic by the supervisor of the
schools, Mr. Tow£ll, or by the teachers, doctors, Public Health Nurses,
or by the welfare-worker, Miss McCrae. The patient may be a young
boy who does not mix well with the other children and who probably
has some nervous habits, such as biting his nails, sucking his fingers,
or stuttering; or perhaps another child has been stealing for no
visible reason at all; or the child may be a sexual pervert. These
are a few examples of the cases which are referred to the clinic.
After the patients have been decided upon for the clinic, either
Miss McCrae or the Public Health Nurse takes a social history of
the case. The social history is made up of the family's understanding of the clinic; the personal history, including the development,
health, habits, school-work, and personality of the patient; the family
history, and an account of the home and home conditions. An
explanation of the clinic is given to the patient and the parents are
asked to accompany the patient to the clinic. Besides this history,
Mr. Towell has prepared a | personality rating test" to be used for
these children. It is filled in by the child's teachers and attached to
his social history. The personality rating test is made up in three
main headings: First, attitude towards school-work; second, dispositional traits; third, social traits.
The clinic is held the first Wednesday of every month. Shortly
before 9 o'clock on the specified day Dr. Crease, Psychiatrist; Miss
Kilburn, Social Worker; and the nurse arrive and the clinic starts.
The appointments have been made as follows; Two patients for
9 o'clock, one for 10.30, and the remainder for 2 o'clock. Six patients
make a very full day. Dr. Crease and Miss Kilburn read the social
histories and meanwhile the nurse arranges the necessary equipment
for the rooms and sets up physical-examination room.
In the physical-examination room there is a large oak table, of
which Dr. Crease is very proud. This table is most compact and
was made in the Occupational Therapy Department of the Mental
Hospital. It is used as an examining-table and in it there is sufficient
room to store the writing material, pillows, sheets, instruments, etc.
The nurse assists Dr. Crease when he examines the patient's eyes,
ears, nose, throat, heart, lungs, takes the blood-pressure, performs
the Babinski test; any laboratory tests or X-rays are done at the
hospital later. The weights and measurements are recorded. During
the physical examination Dr. Crease keenly observes the case for any
abnormalities (such as speech difficulties) and nervous habits. He
talks with the patient and makes him feel at ease, thus gaining his
confidence. This examination takes approximately one-half hour.
In a fairly large percentage of cases Dr. Crease finds abnormal
physical conditions which may account for the patient's behaviour
and problems. A case of haemoplegia was found at one clinic which
had existed for many years and explained the child's behaviour and
the great difficulty under which he had been labouring.
While the physical examination is being done Miss Kilburn is
studying the history and is now ready for the patient, who is taken
into the room where the psychometric or intelligence tests are given.
During the administration of these tests Miss Kilburn observes the
patient's behaviour and how he attacks problems.
While Miss Kilburn is giving the psychometric tests Dr. Crease
interviews the patient's parents separately and together. At the
completion of the psychometric tests, which take approximately one-
half hour, Dr. Crease then interviews the patient.
Later Dr. Crease and Miss Kilburn review the history, the results
of the medical examination and the psychometric tests. The problems
which are found are discussed and a plan is formulated for the
patient's future regarding medical treatment, school, social life, and
living conditions. The parents are again consulted and the patient's
condition is explained to them, also the type of treatment he should
receive. The parents and patients are most co-operative and these
heart-to-heart talks with Dr. Crease do a great deal. They co-operate
with him to the best of their ability, and in many cases where the
child is being over-protected these talks with the parents have done
much for the child.
The clinic day comes to an end at 4.30 or 5 o'clock. Dr. Crease
and his associates and the Public Health Nurses gather around the
table and the findings are explained, the case discussed, and the
treatment to be followed is outlined. The Public Health Nurses
report on the progress of the former patients.
Last but not least, the valuable co-operation of Miss McCrae,
Mr. Towell, the teachers, parents, and doctors make it possible to
have a clinic such as this, and we are hoping that by starting with
the children in the preventive work in mental hygiene we will have
a stronger race, both mentally and physically.
I EMANCIPATION OF CHILDREN'S PLAY-CLOTHES,"
Sweet-pea Festival, July 1st, 1936. To all residents of Duncan
and the Cowichan District this means a showing of the finest sweet-
pea blooms one can grow. In connection with this display a parade
is held and what adult or child does not thrill to a parade.
The Health Centre received an invitation to enter a float again
this year. This request brought forth the question of: What can we
put on that will emphasize a health project as well as being colourful?
Finally it was decided to call the float, | Emancipation of children's
play-clothes in the past 100 years."
Having decided on the name of the float, it remained to collect
the necessary material with which to work.
First of all, we needed to have a truck promised, so the owner
of a local garage was approached and he was only too pleased to
offer the use of a suitable car.
The next problem was: Could accurate information be obtained
regarding children's dress of a hundred years ago? A letter was
written to the Provincial Library telling of our project. In a few
days we received a volume illustrating children's costumes since 1775.
The necessary information being obtained, it remained to find
children who would be suitable. The teacher of the junior school
came to our assistance by selecting seven of her pupils, the children
being overjoyed to participate. In fact, it required great tact and
diplomacy on the part of the teacher to decide who should enter.
A follow-up visit was then paid to the home to see if the parents
were willing for the children to appear on the float, and it was a
pleasure to discover that they were as keen as the little ones and all
offered to make the costumes; even the fathers offered to assist with
decorating the truck.
The children will be dressed in the following costumes: Bathing-
suit of 1835 made of heavy striped cotton, high at the neck and well
below the knees, will be worn by one of the children who will be standing beside Master 1936. This young man will feature a pair of
swim-trunks and a good coat of tan. A second couple will be boys in
play-suits. The boy of 100 years ago will wear long tight trousers,
a frilly shirtwaist, bright jacket, and a bowler hat, showing a marked
contrast to the play-suits of to-day. 1936 will be wearing shorts, a
polo shirt, and sandals. A third group of three girls will feature,
individually, one 1936 in a gingham sun-suit standing between the
other two, who will be attired in the mode of 1835. This will consist
of a high frilly-necked long-sleeved dress and long pantalettes topped
by a large hat tied with ribbons.
With this little band of children we hope to convey to the public
how healthy and unrestricted the children's dress of to-day is as
compared with that of 1835.
Isabel McMillan, R.N.
If change makes for progress, then in the last year we have
surely progressed. We now work under a Commissionership, which
eliminates School Boards, City Council, and all the rest of the usual
city machinery. We also have a new School Inspector, a new principal, several new staff members, and a new Medical Health Officer; so
there has been considerable readjusting to do.
Fernie, as the world knows, is no longer a thriving mining centre,
but we are still a centre of population, with all the usual problems to
face. On the whole, we did fairly well in regard to health until
influenza hit us this spring at the end of a month of sub-zero weather,
which had sapped our vitality. The month of March ended with 10°
below zero, but, in spite of depression, weather, and 1 King Flu," our
children are in good form, with fewer underweights than in the years
of plenty. Skin-diseases are very rare and, beyond a few cases of
mumps and measles, we have enjoyed splendid health.
I still have a vision of giving health service to all the small schools
in the East Kootenay District, and it has been a joy to realize that
Mr. Brown, our Public Schools Inspector, shares that vision.
When the September term commences we shall have installed
Junior Red Cross in our class-rooms, and I am looking forward to
helping the teachers get things in running-order. We shall also have
re-established our Home Economics and Manual Training Departments by that time, so I really think we may proudly say that we have
progressed in spite of obstacles, even, perhaps, because of them.
Winifred E. Seymour, R.N.,
Provincial Public Health Nurse, Fernie, B.C.
I WHY NURSES GO GREY.
Well, you certainly have a queer method of quarantining people.
I don't see how you expect to keep it from spreading. . . .
What! Peggy can go to school while Elenor has it? Well, that
wasn't the way we used to treat it when I was in training (about
twenty years ago). We considered it just as contagious as anything
else. You don't think a basin of lysol is necessary? Well, when I
was nursing we used it—and we never had any cross-infection. . . .
Well, I can tell you right how I don't see what earthly use the
Health Department is—the way children are allowed to run around
the streets spreading infection. What children? Well, I'm not saying. / don't want to make trouble. Why didn't I phone you when
I saw them? Well, I'm not mean enough to tattle on my neighbours.
You can't do anything about it now? Well, something ought to be
done. I keep my children in—you know that. . . .
Yes, certainly. Anything you say, Nurse. Now Billy, mind
what the nurse has said. You're to stay in for a week—even if you
don't feel sick. No playing with the other boys. You see how carefully she washes her hands before leaving? That's why she never
gets these things. . . .
And I said—well, there is something wrong somewhere when
these people are allowed out so soon after. There they were—peeling
all over—shedding large patches of skin every time they walked across
the room. Did they have a doctor? Why, no; they weren't sick
enough. How did they know iL was rubella? Well, my friend was a
nurse once. Who were they ? Well, now, I don't know that my friend
would want the name given. The Health Officer wpuld be interested
to see them? Well, no doubt; but I don't care to cause my friend
any trouble. . . .
I just called up to ask if I can let her out of the darkened room
now. lean? But are you sure it's safe? Well, I want to be careful.
And you said her sister could go to school. Well, I'm keeping her
right in except when she's there—just to be on the safe side. We
didn't let them out at all back on the Prairies. . . .
Why should my son stay home? He's perfectly healthy even if
he was playing with Frank yesterday. I'm sure he won't get it.
Well, it's a pity that we can't even send our children to school
when they're perfectly healthy. What do we pay our taxes for,
anyway? . . .
She said I had no business letting them out to play. And I said
the nurse told me I could. They don't have to stay in for twelve
days. That shut her up pretty quickly. . . .
And she said she had never heard of anything so ridiculous.
Keeping that child home. Why don't they keep the whole class home?
She lives right next door and was playing with her that afternoon?
Well, I'd hate to have my neighbours come down with anything.
I suppose you'd quarantine us, then! . . .
Hello, is that the Health Department? Well, I just wanted to
let you know that my neighbour's child is down at the beach—and her
sister has rubella. What! She is allowed out until next week? Well,
I never heard of such a thing. . . .
Well, I didn't phone you because we've had enough of the Health
Department. They wouldn't let us sell any milk when the doctor
thought Jackie had scarlet fever. Our milk is our bread and butter
and it's too bad we can't be let alone. No, Vincent has never had it.
What! He'll have to stay home? But he isn't getting along very
well at school. It will just put him back some more if he has to miss
a week. He never takes things, anyway. Well, it certainly seems
a shame. I don't believe Jackie had it, anyway. . . .
Well, you were right, Nurse. She came down with it on the
exact day you said she might. It certainly is wonderful the way they
do things nowadays. . . .
And he said that if he wanted to make an issue of it they couldn't
keep his child away from school. The Health Officer was crazy,
anyway. He told him so to his face. . . .
What! No placard? And the rest of us can go out until next
week? Isn't that fine now! . . .
And he has had to miss nearly two weeks of school—all for
nothing. I told you he wouldn't get it. I build him up and keep
him strong and healthy. He never gets these diseases the other children get. . . .
Well, thank you very much, Nurse, I'm sure. It's nice to know
that you are always there to look after the children. . . .
Dear Teacher,—I am sorry Alfred had to stay home yesterday;
he had a bad headache and felt dizzy. I am sending him this morning
as he seems all right and he eats well, but I suppose if there are any
germs floating around he would be in a condition to catch them.
I think a great mistake is made in letting the children go back to
school so soon after they have had these infectious diseases, and also
letting other children in the family go to school while it is in the
house. . . .
M. R. Smith,
THE CHILLIWACK ROTARY DENTAL CLINIC.
During the school-year of 1935-36 three new and important links
were forged in the chain of Chilliwack's health and welfare programme.
First, in November the Provincial Child-guidance Clinic was
organized; later a permanent social-service worker was engaged,
with headquarters in the City of Chilliwack, but who works in the
surrounding area as well. Last, but not least, the formation and
development of the Chilliwack Rotary Dental Clinic, with a construc-
tive educational and remedial programme which we hope will in time
be purely preventive and educational.
In the fall of 1935 the Chilliwack Rotarians, having decided upon
a dental clinic as their service-work, organized this clinic. And a
service it is in the true sense of the word, involving much effort and
work, a great deal of planning, and needing a fine spirit of co-operation in spite of handicaps.
Previously the number of dental defects were appalling and
remedial measures inadequate. True, some of the parents took care
of these problems regularly, but the majority could not and did not
take any action. It was very discouraging, month after month, to
inspect these children and find, instead of improvements, a few more
defects each time.
A dental survey was made in both the city and municipality. Out
of 1,536 children examined, 1,368 or 89 per cent, were found to have
dental defects. The whole cost of the work needed was estimated
at $7,480.25 on a reduced basis of from one-quarter to one-half of the
Due to the extent of the work required and with the object of
giving dental care to as many pupils as possible, it was decided that
the clinic would function for all public school-children at a reduced
cost, and that those who could pay should do so, while an instalment
scale should be worked out for those who could not pay in full; those
who could not pay after due investigation to be taken care of by the
clinic. These are of course numerous.
The Women's Institutes were asked to co-operate with the dental
clinic and form committees for the purposes of investigating cases
where there was any doubt about financial conditions and abili^.
to pay. | no
The people who can pay in full or in part have the right to given
their own dentist, while for free cases the committee feels name;
distribute the work equally amongst all the dentists. <mt, that
After the survey was made " consent-slips " were souple, half
the parents, stating the work needed and the estimated The latter
children took these slips home and were requested to brnrpatient with
signed by parent or guardian, with the necessary monr. A message
any explanations the parents wished to make. Therpital.
returned were handed to a certain member of the 7. Holiday. The
mittee, who with another member went over them ar bound to a chair,
findings at the next meeting of the Executive, whereto. It cheers her
or arrangements made for investigating, etc.
Tuesday and Thursday mornings are set ay ticking the names
for clinic work. . _ *s a boy who had been
Transportation for municipal s«Ms better, but is inspected and
problem, which will require so;ehool. There are several other calls
reopen in the fall.
The clinic has been operrn, when one boy with chicken-pox say?
its record is a splendid o chers the day before. These other bo:-''*
■ ■■■■■ -'.
cost of approximately $700. Largely due to the influence and activities of the clinic, however, we know that about 100 other pupils have
had their teeth attended to privately, which also fulfils our aim—care
of dental defects in our school population.
When the clinic was opened the sum of money which the Executive
Committee had on hand was about $23. Splendid co-operation was
received from Dr. Young, whose financial assistance of $350, as well
as paying of the cost of the original survey done in November, formed
the foundation upon which our Chilliwack Rotary Dental Clinic is
The activities of the clinic will be carried on until about the middle
of June, and what money remains after running expenses have been
paid will be donated to other good work.
The Executive Committee have several plans for an educational
programme, beginning with the fall term. Posters, literature, and
X-ray films of defective teeth and gums, etc., are to be shown in the
Health and Baby Clinic rooms during the days of the annual fair.
Later on, radio talks and lectures will be given by the various dentists
to Women's Institutes and Parent-Teacher Associations. While, of
course, continuous education will be carried on in the homes by the
Our success depends on the educated individual and it is only
through his or her co-operation and understanding of the work can
the permanency of the Chilliwack Rotary Dental Clinic be assured.
Claire Tait, P.H.N.
I AN OPEN LETTER."
letting otht Vera,—You have often asked how I spend my days, so here
house. . .
Royal Oak P.O.,
Saanich, B.C., May, 1936.
The phone rings and I answer: " Hello. Yes, this is one
speaking. You would like me to call at Mrs. Mortimer's,
', give general care and report her condition to you later
THE CHIr*n£s frequently in the morning; often just as we are
■ with a cod-liver-oil can in one hand and a bag in
During the scnc)00k; tucked under one arm.)
were forged m the i.cum scnooi jn time to see several teachers before
gramme. vS# Miss Rockwell, the Primary Grade teacher,
First, m November the -t-othing. A new pupil has arrived and
organized; later a permanent socia;se weH-ordered class-room. He
with headquarters in the City of ChilUawn to J the more pr0nounced
surrounding area as well. Last, but ikvery good; reading and oral
development of the Chilliwack Rotary Dendecide that his mother might
consent to an examination by a psychiatrist at the child-guidance
clinic. This will mean a visit within a day or two to make
In Grade IV. the teacher reports the absence of a child who
misses about a week every month with a cold or upset stomach. I have
visited the mother time and again, making inquiries and offering suggestions. So far I cannot see that I've accomplished one thing.
The principal hands me a note from a parent which reads: " Nora
needs a new scribbler and art pencil. Would the school please provide
them? " I know the circumstances of the family well enough to know
that 15 cents in school supplies means a bottle of milk less at home.
Nora will receive a book and pencil.
For the next half-hour children come to my office to have cuts
dressed; while others come for readmission certificates after being
away from school. In the meantime a list is made of the absentees
in each room, and fortunately it isn't such a formidable one to-day.
I make a call on Mrs. Mortimer, who lives only a few blocks away
from the school, and spend an hour carrying out the doctor's orders.
The first visit is always the longest, because one never knows where
to find towels, soap, basin, or clean linen!
My next call is to a little girl named Patsy Jefferson, because a
neighbour has reported that the child has brown, ring-like sores over
her neck. Fortunately, Patsy is playing in the front of her home
with Jimmy, whom I know. While I am talking to them, Mrs. Jefferson comes out and tells me all about her little girl while I try to
sandwich in. I hope when I go back in two days that there will be
About 10.30 I telephone to the office to see if there are any calls.
Sure enough; Mrs. Lehane would like to see a nurse. There is no
address; I am to get that from the postmaster; and no reason given
for the visit. The postmaster knows three families by that name;
one wouldn't have anything to do with the Health Department, that
eliminates them for the time being; another is an elderly couple, half
a mile north; the other is a family with four children. The latter
is the right one. I cannot do anything when I arrive. A patient with
a high temperature and abdominal pain needs a doctor. A message
comes later saying Dr. Jones has sent Reynold to hospital.
On the way home for dinner I drop in to see Mrs. Holiday. The
dear old lady was held up two nights ago, gagged and bound to a chair.
She has some bad bruises and cuts that we attend to. It cheers her
up to have company.
Referring to the absentee list again, I enjoy ticking the names
off as I make the rounds. First this afternoon is a boy who had been
away for three days with a cold. He is better, but is inspected and
given a certificate to return to school. There are several other calls
made for a similar reason.
I am in difficulty, though, when one boy with chicken-pox says
he has been playing with others the day before. These other bo: •"'
mothers cannot see why their children should be allowed to go to
school for a while, then be kept at home for a given period. I am in
disfavour up and down the street.
Then there is Myrtle Ross, a stenographer, who has rubella.
I nearly always ask these people where they think they might have
been exposed to infection. It's very interesting to hear some of the
tales. Myrtle thought she had contracted the infection from a girl
with whom she works. I was a bit doubtful. During our conversation she tells me about a party she had attended. Three of the boys
had rubella the next day. One was her friend. She hadn't seen-
him for six months, so I don't expect she would stay ten feet away
from him. It was eighteen days after this party that Myrtle had
About 3.30 every Tuesday and Friday I give Mrs. Saunders a
hypo. She always offers me a cup of tea. It's one of the things I look
forward to these days.
Mrs. Pearson is my last visit. She is a prenatal and expects to
be confined at home. Just as likely as not she will have her baby
to-night. Am I glad I'm not on duty? It won't be my night that
is going to be disturbed.
I am certainly tired so will end my letter right here.
HEALTH PURSUITS IN REVELSTOKE.
Once again time to write an article for the Nurses' Bulletin.
We say, | Time flies—alas; ah, no, time stays, 'tis us who go."
Last year, being a newcomer to the Public Health staff, my article
was " First Impressions in Revelstoke "; now, after fourteen months
in the work, my thoughts turn to a review of the past year.
A retrospective view, although somewhat disappointing, in that
we have not seen the realization of all our dreams, is, nevertheless,
necessary in our work and proves a stimulus to strive for greater
Our thoughts turn back to our ambitious hopes, fresh enthusiasm,
high ideals, our altruism, and we ask ourselves, | What have we accomplished? Have I given my best? Has my work been worthy of the
trust that has been placed in me by our beloved Chief, Dr. H. E.
The following will be something of what we have tried to do in
this little town on the threshold of our great Canadian Rockies:—
Pre-school Clinic.—This was started for the first time in Revelstoke last June. We sent a written invitation to mothers with children
starting school in the fall. We explained the nature of the clinic,
rhich was to be held two afternoons in the week. The response was
marvellous, and we had a 100-per-cent. attendance. The clinic was
held in a class-room in one of our public schools. The children were
weighed and measured, examined for defects, and a friendly contact
made with the child before he or she started to school. I gave a talk
to the mothers, " Is your child ready for school," and later distributed
a few hundred copies of health literature. The few defects we
found were in each case corrected before the child came to school in
School-work.—My work is mostly in the schools. We have a
total enrolment of 650 in the public and high schools. During the
past year there has been a very marked improvement in the health
of our children and we are proud of our record. Last year our percentage of underweights in the public schools was 39 per cent., as
compared to 5 per cent, at the present, a decrease of 87 per cent.
In the high school it was 18.5 per cent., as compared to 7 per cent,
this year. I believe this is about the lowest percentage for underweights in the schools of British Columbia.
There may be several reasons for this marked decrease, but I
believe the drinking of milk in the schools and cocoa at lunch-time
(in the winter months) has to some considerable degree helped.
Another reason may be that over 50 per cent, of our children take cod-
liver oil during the winter months. There has also been a very fine
co-operation from the parents in having physical defects corrected,
because undoubtedly these defects were handicapping the health and
progress of the child.
Correction of Defects.—This has been my " pet hobby " for the
past year and the results have been well worth while. In the three
schools there has been a 67-per-cent. decrease in dental defects alone.
At the present time the dental defects in the public schools is 17 per
cent, and in the high school 13.5 per cent. The greatest gain, however,
has been in the numbers of corrected eye-defects. Seventy children
have received glasses or change of old lens in the past year. We have
only two cases in our schools up to date with uncorrected eye-defects,
and both these will be seen by the eye specialist this summer. Thirty-
eight children had their tonsils removed, with several lined up for
Perhaps we are more fortunate here than many communities, in
that few of our families are on city or Provincial relief. We are a
railroad town and medical care is provided for the C.P.R. families.
However, we had about seventy-five children with physical defects
whose parents were unable to pay for treatment. It was to assist
these cases that we organized the Medical and Dental Fund.
Medical and Dental Fund.—A committee was formed of five
public-spirited and health-minded citizens. Meetings were held,
articles published in the paper, and letters sent out to every organization in town soliciting their interest and co-operation. I was
asked to give talks explaining this project to some of the organizations. Donations came in and very soon we had $125 in the treasury.
Thus our Medical and Dental Fund was launched. A month later we
raffled a cedar chest made by a boy in the relief camp and this brought
us in another $125. The children sold the tickets and we gave prizes
to the two boys and two girls selling the most tickets. How they
worked! The whole town and even the surrounding territory was
canvassed and 625 tickets were sold. . With $250 in the treasury we
were able to send sixty children for dental work and purchased glasses
for three children suffering from defective vision. We plan to hold
a Tag Day early in June to raise money for this fund.
Vaccination Drive.—In checking over the number of pupils vaccinated in our schools early in April, I was surprised to find only about
10 per cent, vaccinated in the public schools and 41 per cent, in the
high school. This seemed to me to be a serious state of affairs, so I
decided to talk | vaccination."
First a talk on vaccination and smallpox was given in each grade
and the seriousness of smallpox was impressed upon the children.
Then a letter was drawn up, mimeographed, and about 500 were sent
into the homes. An article was also published in the weekly paper
and some follow-up work done by home-visiting. The response was
marvellous and in the Easter holidays 385 children were vaccinated,
and this total does not include the pre-school children who were done.
Now our percentage of vaccinated children is 92 per cent, in one school
and 85 per cent, in the other, with several promising to be done in
the summer holidays. This is, I think, a practical demonstration of
what can be accomplished as a result of a little educational work.
We hope now to start on a 1 toxoid-campaign " and it will be
extremely gratifying if this goes over as well.
And so we have taken stock and feel our balance-sheet does show
some favourable gains. Ours is not a material gain and we know
that the human asset exceeds in value by five times the amount of the
value of material assets in our country.
The most valuable form of ivealth is not money but human life.
Its conservation should be our greatest objective and our first concern.
It has been said that the " wealth of the nation lies in the health of the
children," and as Public Health Nurses it is our privilege to be " crusaders " in this great public-health movement.
Agnes Thom, R.N.
KEREMEOS AND DISTRICT.
Having spent the greater part of my nursing-life in institutions
and three years in army routine, I find that I cannot work to accomplish anything without a definite plan. I therefore have a definite
schedule which I follow all week, leaving margins each day for
emergencies. In the course of my work I attend all minor cases
for those on relief, but send all others to a physician. Briefly, the
schedule is this:—
Monday.—Keremeos School and all things that come up in connection therewith.
Tuesday.—Pre-school and prenatal work.
Wednesday.-—Cawston School in the morning and Hedley Indian
School in the afternoon.
Thursday.—Odd jobs and Chopaka Indian Reserve every other
Friday.—Keremeos School and doctor's consultations at my
Saturday.—School-visits in the morning; off in the afternoon,
except for emergencies.
The district is scattered, but I carry on the usual educational
programme as opportunity and time permits.
(Mrs.) B. Thomson.
Progress may suggest that we are travelling somewhere on a
highway or advancing towards better conditions. Are we, in public-
health work, just going on through space towards our objectives or
are we keeping carefully to the highway leading to the goal? Sometimes I feel that I am in space or on a detour of difficulties, but have
never felt that I have altogether stalled on the way. There have been
upgrades too, but even then progress has been maintained, though
extra effort has been needed to get over the top.
Our ideal in public-health work, that of producing a health-
conscious community of people all working towards the prevention
of disease, may be said to be our goal, and what are we as nurses
doing to bring about this happy condition? We are just one link in
the chain, but are we doing our best to keep that link as strong as
Progress in some cases is measured by advancement in miles
covered in a given time. Schools have a progress record for each
student as success in examinations is achieved, but attainments in
public-health work can hardly be measured in either of these ways.
If the incidence of infectious diseases may be used as a measurement,
we in Penticton may have reason to consider we have advanced, for
the attendance at school has been continuously good throughout the
year. I think that the school attendance may be taken as a good
index to the incidence of disease in the community. I find, too, that
parents are becoming more and more co-operative in isolating infectious cases and feel that the success in controlling communicable diseases is largely due to this co-operation. People are becoming more
health-conscious not only in the home, but towards the whole com-
munity. Thus our health-teaching in the school and home may be
Through the co-operation of each of the doctors, several clinics
were held for immunization against diphtheria. Some 325 children
received the treatment and it is gratifying to know that many of the
large families have received this protection.
Neighbouring communities have been asking about having the
services of a nurse and we are hoping to be able to extend the service
to them in the not-too-distant future. I feel our demonstration
here has been satisfactory and the effort is being appreciated when
people wish the service extended.
Yes, we have progressed. How much?
M. A. Twiddy, R.N.,
Public Health Nurse, Penticton, B.C.
i MIGHTY OAKS FROM LITTLE ACORNS GROW."
Partly from a misunderstanding, the idea for a Civic Health
Week was created; and partly through a printer's error, Health Week
became an "annual" event.
Such is Fate; and surely a kindly Fate sat as chairman of the
Nanaimo Civic Health Week Committee, for from the time that the
idea was created in the first week of September until its successful culmination on the eighth of November, plans and programmes
seemed to form themselves and to progress magically to fulfilment.
It must have been Fate that made it possible to hold the first Child-
guidance clinic in Nanaimo during Health Week; it must have been
Fate that arranged for the Provincial Chest Clinic to be held that
week; Fate again must have been responsible for the arrangements
which brought Dr. Harry Cassidy to Nanaimo then. However, the
fact that Fate had a very active and enthusiastic committee, and that
the public are always keenly interested in anything pertaining to
health, were in no small measure responsible for the success of
Nanaimo's First Annual Health Week.
One week before the Health Week the city was peppered with
little yellow stickers, which demanded of the people in general, " Are
you A 1 ? " and announcing that November 1st to November 8th was
to be a Civic Health Week. (This idea was very good indeed, but
unfortunately the glue was on the wrong side and by the following
morning the rain had washed most of them off.)
On the same day the Art Department of the High School Centre
issued forty large yellow health posters, which were placed prominently in forty store windows on Commercial Street, along with a
special health display and a | slogan." These slogans created a great
deal of interest, as each slogan related the goods displayed in the
window to health. For instance, a beauty " shoppe " featured sham-
poos, and had as its slogan, " Head First—to Health." A hardware
store exhibiting enamel pots and pans which were filled with fresh
vegetables had as a slogan, "Health in a Pot." A jeweller's store
featuring alarm-clocks had the well-known adage, " Early to Bed and
Early to Rise, etc." While one enterprising bank had selected the
slogan, I It Takes Health to Earn Wealth." A battery and auto
supply shop used the following: 1 To Check Your Battery See Us—To
Check Your Health See Your Doctor."
From November 1st to November 8th the days were filled with
health events and Health Week became the " talk of the town."
I Man Against Microbe," a movie made available through the
Metropolitan Life Insurance Company, was shown, along with the
regular feature at the Capitol Theatre on November 1st and November 2nd. A Vaccination Clinic was held on Monday, November 4th,
Demonstration for Health Week at Nanaimo.
and Dr. Drysdale, M.H.O., vaccinated all children who wished to be
done and who had the consent of their parents. The evening of the'
same day Dr. Harry Cassidy addressed a meeting of the Parent-
Teacher Association on 1 Health Insurance." On Tuesday the regular
weekly Baby and Pre-school Clinic was held in the clinic rooms at the
Legion Hall. On Wednesday Dr. Crease held the first Child-guidance
Clinic and on Thursday Dr. Kincaid conducted the Provincial Chest
Clinic at the hospital.
Throughout the week special articles on health topics appeared
daily in the two local newspapers. The first article came out simultaneously with the release of the little yellow stickers and was contributed by Mr. A. S. Towell, Supervisor of Nanaimo Schools, who
explained the great existing need for health education and the objectives of the forthcoming Health Week. The second, contributed by
Mrs. T. A. Barnard, President of the Provincial Parent-Teachers'
Association, gave the hearty support of that body to " the group of
public-spirited citizens sponsoring Civic Health Week." Other press
contributions were: " The Place of the St. John Ambulance Association in Health-work "; | Public Health and Engineering," by the City
Engineer, Mr. A. G. Graham; " Mine-rescue Work," by Mr. Geo.
O'Brien, Mine Inspector; " Laboratory and Its. Contribution to the
City," by Mr. G. Darling^; " Books on Health," by Dr. Helen Stewart;
I Immunization," by Dr. W. F. Drysdale; " Dealing in Futures," contributed by Dr. Amyot.
Besides these, there were of course many news items regarding
the activities in progress each day; also two or three editorials, and
one full-page advertisement, from which blazed forth the announcement that this was to be Nanaimo's " First Annual Health Week."
By the Friday of Health Week Nanaimo's citizens had become
literally saturated with health information and had become thoroughly
" health-minded," so that it was not surprising to find that on Friday
afternoon the streets were filled with men, women, and children bound
for the Pygmy Pavilion, where the final demonstration was to be held.
It would require a large volume to describe minutely the various
exhibits and programmes of the afternoon and evening, but the following remarks overheard as the spectators viewed the exhibits are
" My teeth are awfully soft; the dentist says it isn't much use
filling them any more; and do you mean to say that if all my life
I had eaten those vegetables, and drunk that much milk—and taken
cod-liver oil—and if my mother had done the same before I was born
that I'd have had good teeth to-day? Well! Well! "
I Oh, isn't it just the sweetest thing, the little bed, and the little
bath; and look at the little baby clothes all laid out to warm—baby
clothes are so simple nowadays, aren't they? "
| Bugs! Bugs! Are those little mites down in the microscope
really the germs that cause a person to have T.B.? "
" So that's how they give a patient a bath in bed—well, I guess
it's all in knowing how to go about it. You know if I had only known
how to do that when our Mary was down with the fever. . . ."
" Yes, I have read of pulmotors; they use them to resuscitate
the drowned . . . and in cases of suffocation, you say. Well, it is
good to know that there is one in town."
■ All these fancy fixings are good for nought; give them a plateful
of plain ordinary food and a sweet—but still, if I fussed and fixed
a little for our Martie, maybe she'd take to her food better. . . .
Why! that's just tapioca pudding, but it looks so tempting the way
At the far end of the hall the wall was brilliant with about 400
health posters, made by the pupils of Grades IV., V., and VI.; prizes
for the best of these were donated by the Malaspina Chapter, I.O.D.E.
These of course were a source of great interest to proud parents and
The remaining side of the building, which measured about 60 feet,
was devoted to the book exhibit, beautiful new volumes donated for
exhibition purposes by Dr. Helen Stewart. It was a colourful display—brightly coloured health posters in the background, with a
central poster which stood 6 feet high. This depicted the " Tree
of Knowledge," and from each branch, representing a different branch
of medical science, an orange streamer led to a small table on which
books related to that subject were listed and displayed.
Demonstration for Health Week at Nanaimo.
The programme itse'lf was unusual, in that it took the form of a
drama in black and white. Two very, very ideal children dramatized
the health habits performed during a very, very ideal day. The hit
of the evening occurred when the very, very ideal boy choked and
sputtered when he cleaned his teeth, and then wiped his mouth on
the sleeve of his shirt. This play was followed by an exhibition of
folk-dancing by a class of high-school girls, and an exhibition of tumbling, physical exercises, and pyramiding by the high-school boys.
In addition to this, the audience was very much interested in a
demonstration of mine-rescue work given by the Inspector of Mines
and the man in charge of the Dominion mine-rescue station here.
It is marvellous that such an extensive health educational demonstration, the success of which depended on the splendid co-operation
of at least fifteen local organizations, forty or fifty local merchants,
two newspapers, the University of British Columbia, and of course
the Provincial Department of Health, should have evolved from the
simple idea to have a small display of health literature and books.
Mrs. Walls reports very little change in Sayward, except for a
few cases of chicken-pox and influenza. The district is a healthy
one apparently, because the school attendance is good, even though
financial conditions are as poor there as elsewhere.
The dentist made a visit during the summer, when quite a lot
of dental work was accomplished, which is gratifying.
ESQUIMALT RURAL NURSING SERVICE.
In a rural area, unlike that of a city district, the more pressing
needs of the family as a unit must be met. Bedside-nursing has not
been the primary consideration, nor too much emphasis is placed
upon school when it has been desirable to get into the homes.
The nurse has carefully considered her words for the sake of her
organization, the public, and herself. In addition, attention has been
paid to the keeping of case records, family folders, and a suitable
filing system. With regard to the statistical monthly report, progress
may be shown by comparing the previous month and the same month
of the preceding year. With the statistical yearly report there may
be appraisal and evaluation. A periodic report often provides stimulation and interest. Through such statistical material it may be
possible to get community or legislative action to remedy conditions—as, for example, our most recent contribution to State Health
Group conferences have been undertaken with trained and competent speakers sponsored through the Parent-Teacher Associations
and Women's Institutes for the public. We welcome all such conferences for nurses with doctors sponsored through the Provincial Board
of Health. Already much interest has been shown by the staff of the
Jubilee Hospital somewhat in the nature of " follow-in " as well as
I follow-out I work.
In the schools an attempt has been made to stress the avoidance
of fatigue and overstrain in the adolescent, to induce healthy living
in the school generally by co-ordinating health with economics in
preparation of school lunches, and to increase the attendance by allowing a child to attend school during the incubation of a disease.
A pre-school programme has been attempted during the summer,
mainly to detect and correct defects and to immunize the child against
specific diseases before he enters school. The pre-school years of
life being the most precarious, it would thus seem that a " summer
round-up " is urgently needed. In our infant-welfare programme we
stress the desirability of breast-feeding, and where artificial feeding
must be resorted to we advise raising the standard of milk by pasteurization and special care in handling same. We also urge the early
registration of all prenatals.
Sand-pile at Happy Valley School.
The effect of the depression has been particularly noticeable in
our district. The majority of our people are on relief and the effect
of undernourishment on mentality and teeth entrenches the Public
Facilities for travelling cannot be met in this scattered district
without the co-operation of the nurse; transportation must therefore
be considered. Victoria being 8 miles away, and there being no doctor
closer than that, our educational programme must often be suspended.
By meeting the people and attending their committee meetings,
by assisting in their discussions, helping to advise them in some of
their local problems, the nurse must surely benefit, and by concerted
effort the aims of our service will be fulfilled.
Dora W. Wilkie, R.N.
i THE DISTRICT NURSE'S ' SOFT JOB.' g
It has been said that the District Nurse has a " soft job " running
around in her brand-new car. While the work is extremely interesting, I am going to try to show that it is no § soft job."
In this western district of the Peace River Health Unit the nearest
hospital and doctor are 25 miles away from the nurse's headquarters.
Roads are poorly built and travel by car is difficult at all times.
In summer we have to contend with mud and in winter with snow
and ice. Sometimes the distances which need to be travelled are
very far and the hours of duty very long.
Any one who has been in this country in the winter knows what
it is to drive a car in snow which is 2 or 3 feet deep on the level.
Chinook winds can alter the snow-covered roads into lakes of water
and later into veritable glaciers. It is in such times that we seemingly
get emergency calls.
It was on such a morning that I planned on taking a day off.
No sooner had I begun planning what I was going to do at home when
there came a rap at the door and a messenger came with, | Nurse,
there is a call from Valley; a boy is very sick and they want
you over there right away."
You start up the faithful car and travel 11 miles over snow and
ice. Guarded by a " lucky star," you arrive there safely. You find
" Tommy " with a rapid pulse, a high temperature, and a very sore
and tender right side. The mother is alone with her four children,
the father being away to " town," some 40 miles distant. Between
the mother and myself we decide that the sooner we can get " Tommy "
to a doctor the better. We leave the other children, the eldest of
which is 12 and the youngest 6, in charge of the place to make out
as best they can and also to milk and feed the cow until the parents
return. We phone the father and tell him we are coming.
We start out about noon and manage to make fair headway for
about 15 miles, when all at once the car refuses to go up a small hill.
We leave " Tommy " in the car and get out to find we have a flat tire.
| Tommy's " mother is rather adept with tools, and between us we
take off the offending wheel and put on another. Everything is once
more in order and we start off again. After zig-zagging through the
snow for the next 20 miles, we arrived at the hospital at 4 p.m., where
the anxious father is waiting. The doctor diagnoses appendicitis and
decides to operate immediately.
The parents remain in the hospital, and after lunch I start back
on my lonely trip to headquarters. I arrive home some three hours
later and plan on having a day off some other time.
A month later, at 4 a.m., the whole house is disturbed with rapping
and loud talking, and I leap out of bed and run downstairs to answer
the call. By this time the head of the house has admitted three young
men, the youngest of which is the " patient."
I Sammy " has had an awful attack of appendicitis and should
be taken to the hospital right away. " Sammy " does not appear to
be ill and seems to be enjoying his " appendicitis." I ask him to
undress and put him to bed. I take his temperature and pulse and
find both normal. I press on his side and abdomen, and although he
says it hurts, the expression on his face seems to belie his statement.
I decide not to take any chances, so prepare to take i Sammy " to
a doctor as soon as dawn appears. We have our breakfast at 7 and
I Sammy " is much displeased because I thought it best for him not
to eat. We start off at 9, and after having some difficulty with the
snow we arrive at a post-office and little store which is about half-way
to | town " and hospital. Here the father is waiting with a girl who
has been very sick; she, too, apparently has | appendicitis." I take
her in my car, too, and the father rides behind in the rumble-seat.
We arrive at the doctor's office about noon.
The doctor examines the girl and finds acute appendicitis and
sends her up to the hospital for immediate operation.
He puts I Sammy " on the table and examines him. He finds
there is " not a thing wrong with him." 1 Sammy " is rather disappointed and still declares that he was sick and says he is very
We leave the doctor's office and go to a cafe for lunch before we
start for home. The aroma of the eats in the cafe causes " Sammy "
to forget his appendicitis and he eats a full meal of hamburger steak
and I all trimmings." On the way home " Sammy " confesses that he
was at a birthday party the day before and had 1 eaten too much
birthday cake, got a bellyache, and vomited."
In a district like this, where the doctor is so far away, the nurse
comes in contact with many interesting and difficult cases. During
threshing season there will be those who get their hands and fingers
cut in the threshing-machine; during hunting season they still
make mistakes and get shot; children will get burned and scalded in
the most unusual ways; expectant mothers will doggedly stay at home
and refuse to go to a hospital and the nurse is expected to race the
" stork " to the home.
This kind of work, besides the regular routine of school-work,
prenatal and child-welfare work, makes the nurse's work very interesting, but far from a 1 soft job."
Pauline Yaholnitsky, R.N.,
We have the pleasure of publishing a full account of what can
be done under a full-time Health Unit. The Peace River District was
opened as a Health Unit with a full staff under Dr. J. S. Cull, D.P.H.,
and a staff of six nurses. During the summer two dentists examined
and treated every child in the district. The account is a full review
of an organized Health Unit, beginning as a complete Unit, and
contains information for the public that will give them a resume of
how organization, followed by administration through the agency of
a trained staff, can produce results.
Provincial Board of Health.
HEALTH SERVICES UNDER THE LARGER UNIT
By Dr. J. S. Cull, Director, Peace River Health Unit.
To obtain the proper perspective of the health services of the
Peace River Health Unit in this Larger Unit of Administration and
to appreciate the benefits accruing therefrom, it is advisable, I think,
to give a brief resume of conditions as they existed previous to 1934-35.
At that time there were two part-time Medical Health Officers
acting as School Health Inspectors, one north of the Peace River and
the other south. These physicians visited the schools once a year
and examined the pupils, sometimes rather hurriedly, and in the great
majority of cases without the parents being invited to be present for
the examinations of their children. Where defects were found notes
were sent home to the parents, but little or no follow-up work was
done to stress the importance of early remedial treatment. As a
result, really very little actual medical service was brought to the
child except where the conditions found were particularly pressing.
Dental attention for the school-child was a thing almost unknown
until the summer of 1934, when a service of this nature was rendered
to certain sections of the district. The reports of the School Health
Inspectors regarding the school buildings, equipment, environs, sanitary arrangements, etc., were forwarded to the various School Boards,
but owing to the lack of co-operation from these the improvements
that were made, based on the Inspector's recommendations, were
few and far between.
The weakness of the system lay in two directions: First, in the
traditional lack of co-operation from rural School Boards; and,
secondly, in the employment of part-time School Health Inspectors.
The first has been most successfully remedied by the consolidation
scheme under the Official Trusteeship of Dr. Wm. Plenderleith, while
the second has been corrected by the installation of the Health Unit.
It might be interesting to state briefly why the old system of health
supervision has fallen down—because there has been no one continuously on the job to carry out those measures which are necessary
to prevent illness and death, those in charge have often not received
the necessary training and they do not have the time to devote to
public health with their other duties. It is constantly found that
the Health Officer who is paid very little for his services is necessarily
obliged to devote, his time to the practice of his profession in order
to make a living. He consequently pays little attention to public
health. It does not pay him to do so. If he were a full-time Health
Officer his entire time and energy would be devoted to the prevention
of disease in his community. It is not the part-time Health Officer
who is at fault, but the now-antiquated system.
After the consolidation scheme had been in effect in this district
for one school-year, a considerable sum of money had been saved in
the operation of the schools and was set aside for health purposes.
This, together with a grant from the Rockefeller Foundation and the
Provincial Board of Health, was instrumental in bringing into being
the present full-time Health Unit. If the above saving had not been
made by the consolidation of school districts, it is doubtful if the
school and pre-school children here would ever have enjoyed the
health services which are at the present time being presented to them.
The actual organization of the Health Unit took place during
the summer of 1935 and the staff started work on September 1st, 1935.
The personnel of the Unit consists of a full-time Director, who is
Health Officer and School Medical Inspector for the Peace River
District; four full-time Public Health Nurses who carry out a generalized public-health nursing programme, including school-nursing.
No routine bedside-nursing is carried on by the Health Unit staff.
In addition to the above, there are three part-time co-operating nurses,
located in the more isolated parts of the district, who take charge of
the school-nursing in these areas. The full-time personnel co-operate
with these other nurses in an attempt to give as full a nursing service
as possible to the people and children of these more distant parts.
The population served is estimated as 9,000, with 1,400 school-children
and approximately 1,000 pre-school children.
All full-time members of the staff have Unit cars for summer
travel and arrangements are made for the use of teams and drivers
for winter travel.
These members have all received training in public health, as
has also one of the co-operating nurses.
To the best of my knowledge, this is the only Health Unit in
Canada operating under the dual head of the Departments of Education and Health. This is, without doubt, the ideal system, for, after
all, health and education are really inseparable—each being necessary
to complete the other.
The actual work of the Unit began under most auspicious circumstances. Two full-time dentists were appointed for two months
and almost the full time of the staff was taken up during September
and October with the organization and operation of dental clinics.
This service was free to school and pre-school children and did not
apply only to those school districts under consolidation, for arrangements were made with the other School Boards and eventually all the
children of the Peace River District were given the opportunity of
having complete and thorough dental treatment by a competent dentist.
Nothing of this nature applying to the whole district had ever occurred
before, and you may well imagine the benefits resulting therefrom.
The continued neglect of dental attention in this part of the Province
had caused the loss of many six-year permanent molars and a very
serious condition of abscesses from badly decayed temporary teeth.
The neglect and loss of the six-year molars we found in a large degree
to be due to the ignorance of the parents to recognize these to be
permanent teeth. Many deciduous teeth had been extracted from
three to five years before they were replaced by permanent ones,
causing lack of development in the jaw-bones, and resulting in irregularity of the permanent teeth and, in some cases, facial distortion.
In former years absence from school because of i toothache was
quite common, but this year many of the teachers have been remarking
with enthusiasm on the improved attendance.
Below is listed a general summary of the work that was done
during the two months that the dental clinics were held. These
clinics are to be an annual event and they alone will ensure a marked
improvement in the general health of the children.
South of the Peace River
Number transported by Unit personnel, 250; males treated, 522;
females treated, 483.
The District Nurse makes periodic visits to her schools and
examines the children, weighs and measures them, and always is alert
for the presence of communicable disease. If a child is found to need
medical attention, the Health Inspector is acquainted with the fact
either at once or at the time of the regular medical examinations.
If the parents are on relief and they are not in a financial condition
to pay for the treatment considered necessary, use can be made of
a fund which has been set aside under the consolidation scheme to
assist cases of this kind; the parents in these cases usually paying
50 per cent, of the cost of the treatment. The 50 per cent, of the
cost may be given in wood, ice, janitor-work, or other school services
that may be required.
It is expected that arrangements will be completed this summer
whereby those children suffering from diseased tonsils and adenoids
will be able to have surgical attention.
Where glasses are urgently needed for the preservation of the
pupil's eyesight and the parents are unable to pay, the Consolidated
Fund is again made use of.
Preventive treatment, such as vaccination, inoculation against
diphtheria and scarlet fever, iodine tablets or tincture, etc., are available for all school-children desiring them.
'I would like to quote from the article on "Health" by Miss
Dorothy Johnson (B.C. Teacher, April, 1936) : 1 Health-teaching
should be directed at the parent; medical examinations are often
hasty and recommendations are not followed up." I quite agree with
her, but would like to say that these criticisms do not apply in this
district and should not where any full-time Health Unit is established.
We make a particular point of inviting the parents to be present at
the time when their children are examined, as this makes an excellent
occasion on which to discuss and talk over many health matters, and
to advise the parent directly in regard to the care of his or her child.
A considerable length of time is spent on the examination of
each child and we feel that we get better results in this way than by
just making a hasty examination. It is one of the duties of the
District Nurse to follow up any recommendations that are made at
this time and to strive continually to show the value of these. I quite
agree that much of the value of the medical examination would be
lost if this work were not done.
Below are listed some of the figures taken from the Statistical
Report ended December, 1935:—
Visits to schools 340
Physical examinations 514
Average per cent, of parents present 63
Children inspected by nurses 2,722
Notes to parents 66
Home-school visits •_ 203
Quick inspections for contagion 763
Examined at office r: 62
Class-room talks 123
Consultations with school officials 248
This brings me to the school building itself. In this connection
I may say that the buildings in this area are inspected from a health
standpoint. Where poor or improper lighting is found, or different-
sized desks are required, poor ventilation, or poor heating exists,
a report is forwarded to the office of the Official Trustee stating the
facts of the case.
Under the old system- one could have sent reports indefinitely
to the School Boards and little or no action would have resulted.
But now things are different, and in this Larger Unit of Administration I action " is the word of the day. When a report is forwarded
the defect or condition is remedied in very short order.
As a result of this the supply of drinking-water, toilet facilities,
cloak-room facilities, lighting, heating, and ventilation have all been
markedly improved. In the majority of schools in this district the
desks are fixed to strips rather than to the floor. Thus they can
all Jbe moved over to one side of the room, and this tends to overcome
the criticism of lack of space during a physical-education period.
When one realizes that all these changes and improvements and
increased health services have come about as a result of the adoption
of the Larger Unit of Administration, one cannot be other than in
favour of such a system. Little or nothing of this nature existed
before, and I doubt if anything of a similar nature could be brought
about in rural districts without the adoption of a similar consolidation scheme. It is a pleasure to work under such a system, and as
the months go by and we see the improvement being wrought in the
health of the children, I feel that the Department of Education is
to be complimented for the introduction of such a plan, and I trust
that the benefits of the larger-unit system will be extended to other
Some general statistics follow. These are from the Statistical
Report ended December 31st, 1935, after four months of operation:—
Hours on duty 3,474
Average daily hours on duty 8
Visitors to office 236
Phone calls received 99
Phone calls sent 74
Letters received 226
Letters sent 229
Investigations for contagion 41
Home-visits re contagion _•__ 32
Home-visits to T.B. suspects 9
Prenatal visits 66
Infant-welfare visits 146
Infants examined 20
Pre-school visits 120
Pre-school examinations 35
Number transported, other than for dental
Nuisance complaints investigated 10
Water samples taken i_ 3
Inspections of water-supply 12
Miscellaneous visits 354
Investigations made 19
Social-welfare visits 59
First aid given 22
Meetings attended 32
Meetings addressed 1 23
Individual health talks 333
Pieces of public-health literature distributed 261
fhe University of-British Coiumfeia
ISSUED BY THE
PROVINCIAL BOARD OF HEALTH, BRITISH COLUMBIA
Public Health Nurses' Bulletin
Parliament Buildings, Victoria, B.C.
Looking through the accompanying pages, one is struck by the
improvement in type and style of articles submitted in comparison
with those sent in for previous bulletins; perhaps the fact that we
are all one year older, and consequently that much more familiar with
local problems, is responsible. Whatever it is, here we are again
showing definite progress all along the way.
One could wish for more photographs to brighten up the tedium
of the printed page, and we hereby make the humble suggestion that
next year's articles be relieved by some interesting illustrations which
could be provided for by keeping the Bulletin in mind when an
unusual or unique circumstance arises during the year. Are we not
all children still when it comes to looking through a magazine—first
at the pictures and then at the articles ?
TABLE OF CONTENTS.
Allen, Miss E. G.—The Neglected Age 5
Arnould, Miss J. M.—Matsqui-Sumas-Abbotsford Demonstration Area 5
Barbaree, Miss F.—Ski-ing . 8
Campbell, M. A.—Public Health 9
Crafter, Miss L. W. V.—Victorian Order of Nurses 10
Creelman, Miss L.—Revelstoke Reflections j£ 11
Dunn, Miss N. E.—Consolidation of Schools 14
Garrood, Miss 0. M.—Public Health Nurses and Education 17
Gordon, Miss K. M.—An Impossibility becomes a Success 18
Grierson, Miss M. E.—Maple Ridge and Mission Districts 20
Grindon, Mrs. A. P.—The Value of an Annual School Health Cup Competition 21
Jenkins, Miss B.—An Objective . 24
Kerr, Miss M. E.—Curious Superstitions and Beliefs |||| 27
Kilpatrick, Miss H.—What do you really do? 29
Law, Miss A. F.--Just One Call 31
Mahon, Miss R. M.—Problems of Disease-prevention 32
Malkin, Miss L.—Justification for the Appointment of a Social Worker to
complete the Health and Education Programme in the Peace River
District, B.C 34
Martin, Mrs. E.—Vernon 36
Miles, Miss M. C.—Time is Money—Absentees I 37
Moody, Miss E.-—-^Chilliwack 41
Morris, Miss M.—Generalized Nursing System 1 42
McMillan, Miss I.—Day before Christmas 43
Putnam, Miss M.—Public Health Activities Nanaimo Indian Reservation 45
Seymour, Miss W. E.—A City under a Commissionership 46
Tait, Miss C—The Kin Kiddy Camp 47
Thomson, Mrs. B.—News Letter from Keremeos 49
Twiddy, Miss M. A.—Preventive Nursing 50
Walls, Mrs. E. M.—Sayward 51
Wilkie, Miss D.—Notes of an Esquimalt Rural Nurse 51
Yaholnitsky, Mrs. P.—Toxoid and Vaccination Clinics ._'. 53
THE NEGLECTED AGE.
Arriving here on February 15th, 1932, I am nearing the close of
my fifth year in this district. The work has proved particularly interesting and the public appreciative.
School-work demands a major portion of the Public Health Nurse's
time here, both in the buildings and home-visiting; and now the Comox
Logging Co. has started operations in the local town, it has greatly
increased the school population, necessitating nine teachers to take
care of the eight grades in the public school (we have not yet a junior-
high system). There are four teachers at the high school, a home-
economics department, manual-training instruction, and Mr. Bouchard
takes care of the physical education. Five years ago there were but
seven teachers for the first eight grades, three at the high school, and
a manual-training instructor.
Not only has the population increased, but tuberculosis clinics
have also gone apace, and instead of two or three visits annually, we
are having the service every second Wednesday.
There is still a branch of the work of physical welfare that is
neglected—the pre-school age. I include these little ones at my welfare clinics for the infants, but they take more or less of a secondary
place, and I feel that so much could and should be done for them in
preparing for their future and for school. When given a little praise
and persuasion I find them quite easy to reason with and very trusting.
There are many here that are growing up around me so much so that
they look upon me as a 1 safety-zone." There has been only one child
so far to whom I could not give the second dose of tuberculin. He has
a tremendously strong will for his four years and we resorted to the
aid of his daddy; when the child was asleep it seemed easier to handle
the situation and was successful.
In conclusion, I would like to submit a programme that I feel
would be another step in advance and apropos in getting the little ones
of the freedom age to take their place in life as healthy citizens—a
monthly or bi-monthly clinic where they could be encouraged in the
habits of using toothbrush and handkerchief in the form of drills,
taught to gargle, to use the thermometer, encouraged in habits of
tidiness, and in doing things for themselves. Weighing would help in
regard to diet that is best for them, and teeth and tonsils would receive
earlier attention. Furthermore, quite often contagious disease is innocently started and (or) spread by these small people because it is not
discovered at the onset.
E. G. Allen, P.H.N.,
MATSQUI-SUMAS-ABBOTSFORD DEMONSTRATION AREA.
Our last year's report dealt with the initiation of the health-work
in this district. This year we are able to show definitely the effects.
Thanks to the Provincial Board of Health, the majority of the
children have had their teeth attended to and there is already marked
improvement in the health of many, most noticeable being the decrease
in swollen submaxillary glands.
It is now a pleasure to visit the schools and see the majority of
the hands go up when the children are asked if they have cleaned their
teeth. It does not seem possible that a short time ago many had never
had a toothbrush, and, needless to say, it took weeks for some of them
to acquire the regular habit of using them. Only the newcomers are
the offenders now. For a while last fall it looked as though we were
being swamped with Mennonites. Another school had to be opened
in the Poplar area, where nature does not provide rich soil. Large
families have been attracted to this district from Saskatchewan and
other Prairie Provinces, seeking small homesteads or cheap land.
Many are now in need, and in some cases emergency relief has
been given. With lack of water and crowded quarters, there was
an increase in skin-diseases, necessitating frequent exclusions from
school and home visits.
In August all the children from the most distant school were transported to the dental clinic in the nurse's car. Two or three children
or less, depending on the work to be done, were brought in to each
dentist. None had to be persuaded to go, as they all looked forward
to the trip to Abbotsford. One little Japanese counted his carious
teeth and figured on a trip for each cavity. He was quite disappointed
when he was finished in one morning!
The need for proper diet and careful cleansing of the teeth and
regular visits to the dentist in the future has been constantly stressed.
Many now take milk who never took it before. Alas, some have begun
too late—one girl of 14 especially, regrets, after losing most of her
teeth, that she never drank milk until last year. In a dairy country
such as this it is a tragedy to see how many people do not realize that
milk is such a necessary food.
Not long -ago, I felt rewarded after having visited a home previously about their milk-supply, also about Benny's tonsils, to find that
they had purchased a cow first with their hop-picking earnings, and
now the family has a supply of milk, where previously 1 quart of milk
served ten, including two babies under 1 year of age.
Quite a number of children have had their tonsils removed, and
many more intend to in the near future.
Thanks to the members and staff of the Crippled Children's Hospital, several of our school-children have had treatment, and the
benefits they have received has made their lengthy stay well worth
One of the present problems is that of obtaining glasses for
children on relief, but we hope, before long, to see the way clear to
procure them for the most urgent cases.
In many cases of defective vision, the parents, after having a
home visit, saw the necessity for glasses and promptly bought them.
In others, it was only after showing the parents that their child's
vision had failed during the year following the doctor's examination
that they realized the need for prompt attention.
In September a talk was given in each school district about goitre-
prevention, and over 800 children sent in their dimes, nickels, and
pennies. What a task it was collecting the money, and, later, distributing the iodine tablets!
For the first few weeks in September we were free from infectious
diseases. It was too good to last. One morning a phone message
came in saying that a child had died from poliomyelitis on Matsqui
Prairie. So two weeks were spent checking thoroughly all absentees.
There were many away due to the fear of a further outbreak, but,
fortunately, no other cases appeared. The odd case of scarlet fever
here and there meant that the ceaseless vigil had to be continued.
In October the area suffered a sad loss in the passing of our
beloved Director of Education, Mr. P. H. Sheffield. For several weeks
new demands were made on the already crowded programme, but it
was not long before a new Director was appointed, and we are most
fortunate in having Dr. Wm. Plenderleith, who organized the Peace
River Block. Under his direction a health unit is shortly to be established, and we can look forward to an extensive immunization programme, and many other necessary activities, as yet only visualized,
but not realized.
With all the schools now affiliated with the Junior Red Cross and
the new curriculum stressing health, the children are rapidly becoming
health-conscious, and, looking back, one can see a marked improvement
in the personal hygiene. The parents show increased co-operation by
the prompt reporting of infectious diseases and requests for visits
when in doubt as to what is wrong with their children.
With the new Philip Sheffield Memorial Auditorium recently
opened and a gymnasium constantly in use, under the able direction
of Mr. Paul Kozoolin, not only children but many adults are taking
an active part in physical education. We are looking forward to the
future, which holds much in store for those who wish to avail themselves of all the Department of Education has to offer.
Onward little soldiers,
Marching on to wealth,
All our young school-children
Know the rules of health.
Onward then ye people,
This shall be your song,
" Health | is now our motto,
Join our happy throng.
J. Maryon Arnould, P.H.N.,
Abbotsf ord, B.C.
The wonder of wonders that surprised all of Duncan was to see
the staff of the Cowichan Health Centre venturing forth to enjoy the
winter sport of ski-ing. When ever did any one expect to have sufficient snow on the island to allow for this exhilarating sport? With
the old adage foremost in our minds, that | all work and no play makes
Jack a dull boy," we attempt to keep abreast of the times by trying
our hand at all fashionable sports, for at the present time ski-ing is
commanding world-wide attention. Nor does one wonder at this,
having experienced even a little of the thrills of skimming through
To experience the feeling of swooping down the hills, the wind
against your face and the sound of crunching snow under your skis,
is terribly exciting. After a small amount of practice one almost feels
Many will be the falls.
like a ship breasting the waves or a bird flying against a breeze. Now,
if any one had spoken of ski-ing in these terms the first day I tried,
I am quite sure that I should have described it as more like feeling
like an elephant on skates than a floating cloud. However, after the
first clumsiness is past, practice makes perfect and soon a love of the
thrill is developed.
The approved advice to beginners is as follows: Learn to fall,
as many will be the skids and the rough spots and the crossed skis
that will upset your equilibrium, and many will be the bruises and
scratches acquired through your first endeavour. The main point to
remember is to remain elastic and to make your knees act as springs
to your body to absorb the shocks which might otherwise upset you.
The position taken is knees slightly bent, one foot in front of the
other and skis together. Hold your body upright and watch the
ground in front of you, adjusting your balance to suit the contour
of the ground. As you gain confidence in yourself, refuse to fall.
Remain determined to stay on your feet until you are actually thrown
to the ground. To slacken your speed, point the tips of the skis
together and push the backs of them outwards.
According to C. Falcon, this is the correct way for a beginner
to start along the happy way of successful ski-ing. We have tried it
and found that, with this expert advice and a little practice, our runs
became each time a little less clumsy and a little more perfect. The
back yard, the hill behind the house, the country roads, or the rolling
fields are splendid places to explore on skis. Try running, jumping,
or ski-joring for thrills. Ski-joring is accomplished nowadays by
being towed behind a car along smooth and well-packed roads at
20 miles per hour.
Nothing, I am sure, will afford you more good exercise or more
howls of laughter than this pastime. We enjoy it and wish you the
best of luck in your first ski-jump.
Florence Barbaree, B.A.Sc, R.N.,
Cowichan Health Centre, Duncan, B.C.
This winter I was one of the few privileged students who were
permitted an insight into the "more advanced fields of nursing service.
For two weeks, in weather ranging from fitful and watery sunshine to
near freezing temperatures, I accompanied one of the three Saanich
nurses and visited homes representative of nearly every type of person—homes graduating from mere one-room, hot, overcrowded shacks
to little smug stucco bungalows.
Tired and fretful mothers, discouraged and beaten by economic
circumstances beyond their ken, relaxed and brightened a little as the
nurse stepped through the door. No trouble was too long for the nurse
to listen to. Willingly she looked at the whimpering baby's rash,
peered down the next toddler's throat, and discussed the disadvantages
of rheumatism with the grandmother.
Into the schools I went and watched shy little girls and tousled-
headed boys extend their grubby hands and open their mouths to display none too clean teeth for routine inspection. Suspicion of scarlet
fever at that time intensified the examination of all school-children's
throats; with the teachers' ready co-operation, records of absentees
were made and subsequent home visits followed.
I Back-stage " glimpses were obtained upon frequent visits to
the central office at Royal Oak. Here could be observed the machinery
that set this particular Public Health Unit in motion. All day numerous phone calls appealing for help were answered by a speeding busy
But as interesting and instructive this part may be, I frankly
admit I was more intrigued by the social-service side of the department. To be able to go behind the scenes and see at hand their
hopes, fears, successes, and losses was an experience that I shall not
M. A. Campbell,
Provincial Royal Jubilee Hospital, Victoria, B.C.
(Editor's Note.—Students from the Provincial Royal Jubilee
Hospital spent periods of two weeks with the nurses at Saanich Health
VICTORIAN ORDER OF NURSES.
The work of the Oliver, Osoyoos, and Okanagan Falls branch of
the Victorian Order of Nurses is as comprehensive a branch of the
public-health service as one nurse is able to make it, in that it includes
school-work, pre-school and infant-welfare work, bedside-nursing, as
well as the care of one Indian reserve.
Perhaps a short account of the work among the Inkameep Indians
would be of interest to some. One day a week is devoted to the
reserve, and only strictly necessary bedside calls are made in the
rest of the district that day. After travelling over the very rough
road across the reserve, the first place of call is always the Indian
day-school. There are usually from twelve to fourteen children
present, ranging in age from 5 to 17 years old. These are all given
a preventive treatment for trachoma, a disease which was previously
very prevalent in this reserve, but is now well under control. They
are also weighed once each month, and each day the teacher gives
every child a dose of cod-liver oil, supplied by the Indian Department,
and sees that they wash their hands and clean their teeth before school
Due to the eo-operation of the teacher, there is an excellent health
programme carried on in the school, and the children run a flourishing
branch of the Junior Red Cross. Occasionally the nurse is invited
to attend their meetings and speak to them.
Before leaving the school the teacher reports any sickness among
the adult population that has come to his notice, and then the Old
Chief's home is always the next place of call. The Old Chief is well
over 80, but still in complete possession of all his faculties. It is due
to his efforts that this reserve has a school and a nurse, and he is
still very much the chief of the tribe, though his son does most of the
actual business for him nowadays. His English is, perhaps, a little
difficult to understand, and his wife, a bent old lady of much his own
age, speaks no English at all.
After these two regular calls have been made various other houses
on the reserve are visited. The nurse is always made welcome, and
often consulted on a variety of subjects, and even a friendly talk on
matters outside health is important. Each house must be visited in
turn or the inmates feel neglected, and the friendliness between the
Indians and their nurse is the greatest help and power for good she
has; without it very little could be done in time of illness. Contrary
to the general opinion, many Indian homes are quite clean and well
kept, and the nurse is often aware that they have had an extra brush-up
on the day she is expected. The Indians are usually eager to report
any illness and will follow instructions as carefully as most white
On the whole, the work on this reserve is most interesting and
well worth the time given to it. The tribe is, for the most part,
remarkably healthy, and tuberculosis, such a scourge on other reserves,
is rare among the Inkameep Indians.
L. W. V. Crafter,
After five short months as the Public Health Nurse in Revelstoke,
it is time to pause for a few moments to reflect on the work which has
been accomplished and on the plans for the future.
Before assigning my reflections to paper let me take this opportunity to write a few words of appreciation of the splendid work of
my predecessors, Miss Amy Lee, who so ably laid the foundations of a
school-health service, and Miss Agnes Thorn, now Mrs. Ingley, who
continued and expanded this programme. When I realize the great
amount of work which was accomplished by these nurses I feel very
humble as I review the past months. And yet I recall the excellent
advice we were given as students—| Go slowly and be satisfied to reach
a single objective at a time."
The work in the schools occupies the greatest share of the nurse's
time. There are two public schools and a high school, with a total
enrolment of 640. In September the pupils were weighed, measured,
and inspected for dental defects, poor vision, posture, and general
cleanliness, and health reports were sent to the parents. A monthly
inspection is made in each class-room to check on cleanliness and health
and to encourage correction of defects. Rather than follow each
inspection with a health lesson, after consultation with the teachers
a time-table was arranged so that the nurse takes a lesson in each
class-room every two weeks. At the teacher's request some definite
subject is taken, otherwise health rules are stressed by means of stories
and pictures in the lower grades, and in the upper grades some topic
relating to public health is generally chosen. In November we had a
cleanliness campaign in the lower grades in each school. The children
were very interested in marking their charts, and at the end of the
period a prize was awarded to the class-room which showed the
greatest improvement. The teachers all agreed on the effectiveness
of the campaign.
First aid is taken with the boys of Grades VII. and VIII., and
home-nursing with the girls. They are very enthusiastic about these
classes and the certificate awarded to the successful first-aiders is
greatly prized. In referring to the home-nursing classes, the mothers
often remark: "We had nothing like that when we went to school
and I am certainly glad my girl has such an opportunity to learn."
Thus one is amply rewarded for any extra time given to these classes.
So far we have been very free from communicable diseases; three
cases of chicken-pox and six of mumps being our record since September. Although there was a general epidemic of measles in Revelstoke
just two years ago, there are many who have not had this disease, and
our fear has been 1 measles " as we read of the number and oftimes
seriousness of the cases in some parts of the Province. However,
since we have had two cases of measles in our town, one a pre-school
child who had been in Vancouver and another who was.a visitor for
the holidays, without any one contracting from them, we are now
resting somewhat easier, but at the same time always watchful. At
present we are in the midst of a mild 'flu epidemic and most are heeding the warning—to stay at home and keep warm if not feeling well.
During the past week our average daily attendance has been less than
75 per cent., but we are hopeful for a return to normal very soon.
One hundred pupils have milk every morning recess. The majority
pay for the milk, but those who are underweight and cannot afford to
buy receive milk free. The Milk Fund is supported by the I.O.D.E.
and the Women's Auxiliary to the Canadian Legion. Every child
taking milk has made a monthly gain in weight, and there is
many a happy smile when weighing-day comes and 1 Mary" and
I Johnny " find that they need no longer be on the list of underweights.
Four of the teachers have become quite enthusiastic over the
organization of a Canadian Junior Red Cross Branch in their classrooms. Until the present there have been no branch organizations in
Revelstoke and we are looking forward to still further developments.
One really worth-while accomplishment was the administration
of toxoid to approximately 200 children—school, pre-school, and
infants. Except for a few private cases, this was the first time
toxoid has been given here and we were very pleased with the response.
The very willing co-operation of the doctors was given and each held
a clinic. An article was published in the local paper regarding the
value of diphtheria-prevention, and notices were sent to all parents
of children under 11 years of age. The great majority of these were
returned with their consent to have the toxoid given. One notice
was returned with the terse remark: 11 don't see any reason in having
this toxoid until there is a case of diphtheria in our town." Fortunately there are few parents who are so ignorant of modern public
health. We hope to have other clinics in the fall and thus, before long,
make diphtheria an impossibility in Revelstoke.
In connection with the school programme the value of the
follow-up work cannot be too greatly stressed. The home visit completes the link between the parent, the child, the teacher, and the nurse.
Most parents are eager to discuss the health of their children and are
very co-operative in attending to correction of defects. Many a misunderstanding is cleared by the home visit, with the result that the
parent realizes that the best is being done for his child.
To date the work with the pre-school children has been through
the home visit. Sometimes the chance visit to the home of a school-
child is the one of most value. For example, when making such a call
one day it was noticed that a little 4-year-old had a very definite squint.
The mother also had this defect. When it was mentioned that this
could be corrected in the child, the mother replied that she understood
it to be hereditary and she had been told by a neighbour that nothing
could be done. Fortunately she was a very co-operative parent, and
the next time I saw the little girl she had been fitted with glasses.
She was indeed a grateful mother, who had merely followed the advice
given on a chance visit.
The infant-work is really my | chief delight." It is being carried
out on a very small scale, but from small beginnings I have hopes of
great developments. A list of all births is obtained from the hospital
each month. For the out-of-town mothers a notice is sent for postnatal letters. Those who live in town are visited regularly, and they
soon look forward to the Saturday-morning visit of the nurse with
her scales, which tell how much baby has gained. Usually the mother
has a question ready regarding the health and care of her baby, and
then one feels indeed that some service has been given.
So far a pre-natal clinic has not been organized. It has appeared
to be more practical to carry on this work through the home visit alone.
Perhaps in the future such a clinic may be feasible.
And now to future plans. First is a more complete immunization
programme. A very successful vaccination campaign was held last
spring, but still there are many in the public schools and 45 per cent,
of the high-school pupils who have not been protected against smallpox.
We are planning now for a clinic to be held after Easter and are
hopeful that, many of the above-mentioned pupils, as well as many
of the pre-school children, will come for vaccination.
Next is the organization of a weighing-station for the infant and
pre-school groups. All public-health workers realize the need for
service to this group, for it is here that a good foundation is laid for
future health. Just as soon as our blizzards have been forgotten for
another season I hope to have the first of monthly § weighing-days."
Even if these do not appear very popular at first I shall not be discouraged, because I believe that in time more and more mothers will
avail themselves of the opportunity of visiting this station monthly
to have their babies weighed and checked for defects, and to obtain
literature and advice regarding diet, habit formation, and the countless
every-day problems which worry and perplex the young mother who is
seeking the best in health for her child.
The third of my future objectives is perhaps only a dream, but
none the less a very practical dream. It is the hope that some day
the half-dozen or more rural schools which are in the outlying districts
of Revelstoke may have the services of the Public Health Nurse. There
is a real need in these small places and an additional.great opportunity
for public-health teaching.
When the time rolls around again and Dr. Young, without whose
kindly advice and encouragement my way would have been less easy,
asks for another contribution to the Bulletin, I hope that my plans
will have materialized. Much has been learned by a very short experience in the field; but, oh! how much more there is to learn and how
much to do!
Lyle Creelman, B.-A.Sc, R.N.,
CONSOLIDATION OF SCHOOLS.
From a Nurse's Point of View.
Six years ago, in 1931, under the auspices of the Provincial Health
Officer, Dr. Young, the Department of Education, and the Red Cross,
a Public Health Nurse was stationed in the Sunset Prairie District of
the Peace River Block.
The vastness of this territory of scattered pioneer settlements,
with weather and road conditions quite beyond description and the
remoteness of the part-time Medical Health Officer from the large
majority of settlers, constituted real problems to the nurse in this
area. The greatest difficulty, however, which had to be met and
overcome was that of the co-ordination of medical work in the schools.
There was little or no co-operation with the nurse by parents, teachers,-
or local School Boards, and in an area of some 500 square miles,
wherein no general agreement for systematic health-work could be
reached, satisfactory results were obtained slowly and with the greatest difficulty.
In some schools ventilation was of the worst kind; in others no
adequate washing facilities could be obtained. Drinking-water was
frequently of the most unwholesome kind, such as could be procured
from a near-by slough, and the common drinking-cup was in general use.
On the appointment in 1934 of Dr. W. A. Plenderleith as Inspector
of Schools for the Peace River Block, a plan for the consolidation of a
majority of the school districts in this inspectorate was successfully
launched with a view to increasing efficiency in school government and
the bringing about of other much-needed reforms.
Looked at from the purely educational point of view, the scheme
was of the first importance. Local School Boards were often controlled by inexperienced and inefficient men.
This problem was solved after much preliminary opposition by
dissolving most of the local School Boards in the area where the
Government had in any case been bearing, roughly, 90 per cent, of
the financial burden of school administration. Inspector Plenderleith
became Official Trustee for the consolidated area, with full authority
for all school expenditures and for appointment of teachers. An Official Correspondent was nominated in each school district so that the
Inspector could remain in touch with the needs of each school, and
could, through this means, receive suggestions from any one who had
grievances to air or improvements to put forward.
Before consolidation the school taxes were unevenly divided in
the inspectorate—some school districts paying as much as 25 mills,
while others paid as little as 1.3 mills. These inequalities could not
at that time be avoided on account of the great differences between
built-up developed areas and those still in a pioneering condition.
The plan of consolidation effected a cure by making possible one mill
rate for the whole inspectorate. Thus improvements in school conditions from all angles have been very happily brought about throughout
A marked decrease in taxation for those under the scheme of
consolidation was a welcome feature in many districts, the actual
cash saving during 1934-35-36 having been $4,315.70.
Needless to say, the plan did not at first receive the support which
later brought nearly every school district under the scheme. In the
first place, a strong protest was made through the local press and
by locally organized 1 protest meetings." Much was heard of the
dictatorial methods of consolidation which centralized authority in
one person and undermined democratic government in school matters,
imperilled personal freedom, and thereby destroyed personal interest.
With indefatigable effort, however, Dr. Plenderleith set out to meet
all objections, attending innumerable meetings throughout the territory for the purpose of explaining the chief points of the plan—namely,
decrease in taxation and increase in efficiency and equipment of
schools. With the promises given that no reasonable request made by
any School Board would be turned down, and with the better understanding of the scheme, the opposition lost its bitterness and prepared
to give the plan a fair trial. The result has been remarkable, and
to-day all but two of the school districts, whose financial status gave
them the privilege of voting for or against consolidation, have entered
into the scheme of their own free will.
In addition to the advantages shown in the economic and administrative departments, consolidation has made possible the organization
of a complete school medical service in the Peace River Block. In 1935,
a little over a year after Dr. Plenderleith's appointment, a Health
Unit was formed under the control of a full-time doctor as Medical
Health Officer with four full-time and three part-time nurses. An efficient plan was evolved for health-work in every district under
Every school under the scheme now has a uniform programme
of school hygiene, the main features being as follows:—
(1.) Toxoiding and vaccination for all children are now being
carried on even in remote areas.
(2.) A programme incorporating baby and pre-school welfare has
been organized; prenatal and postnatal work has been started.
(3.) Two dental clinics have been held, each of which covered the
(4.) Eye-glasses have been provided for many for whom this
would have been impossible were it not for the assistance given under
the scheme for consolidation.
(5.) Addresses and lectures have been given by the staff to many
(6.) Adequate nutrition has been aided in special cases by cod-
liver oil provided through the Department of Health.
Two modern rural schools have been built with every consideration to proper lighting, ventilation, and sanitation. In passing, it may
be of interest to my readers to know of a good scheme for the even
heating of rural schools in the coldest of weather which any local
carpenter can effect at a cost of about $25. A cold-air draught is
brought in under a jacket heater and a ventilator controlled by pulleys
is placed in the roof. The blue-print plans can be had on application
to the Department of Health, Victoria, B.C.
Other improvements included papering and kalsomining of walls
and ceilings in ten schools; reflooring of six schools; repainting of
schools; purchase of additional grounds for two schools; fencing and
clearing grounds of seven schools; purchase of sanitary paper towels,
towel-containers, toilet-paper and toilet-paper holders for thirty-two
schools; purchase of water-coolers and sanitary drinking-fountains
for forty-six schools; purchase of new stoves for eleven schools; and
installation of electric lights in two schools.
Difficulties remaining are mainly geographical. The enormous
area to be covered over the worst of roads in both summer and winter,
and the very frequent inaccessibility of whole areas due to weather
conditions, piling drifts of snow, gumbo mud or flooded muskeg,
make work very severe and exacting. To keep strictly to one's programme is often impossible. In certain instances, therefore, our
outposts are left untouched excepting for an annual visit of doctor
and nurse. Other difficulties are not uncommonly met with in maintaining co-operation of parents in the observance of quarantine and
in the encouragement of health principles in the home. One could
wish that more home visits could be made by the nurses, but again
the difficulties of accessibility and the scattered nature of the whole
settlement make this far from easy.
With the sympathetic help of the former Director, Dr. J. S. Cull,
and of his successor, Dr. J. M. Hershey, and with the excellent co-operation of the nurses themselves, our difficulties have been minimized, and
what might otherwise prove to be an impossible burden physically
and mentally has become a duty cheerfully carried out.
N. E. Dunn, M.B.E.,
Supervisor of Nursing, Peace River Health Unit.
PUBLIC HEALTH NURSES AND EDUCATION.
My dictionary tells me that the word " educate " means " to bring
up (the child), to train, to bring out, and develop, mentally and
morally." We note here that only the child is mentioned, what, then,
of the adult? Do we as Public Health Nurses educate our adults
and children as we should? Surely there is much to be done. Our
time is so taken up by the common round of routine in our schools,
controlling infectious diseases, etc., that often we lack time and
opportunity to train our large family, the public. There are many
ways. Let us consider some of them and the subjects we could
present for discussion.
First, the school-child, by the teaching of positive health in all
grades. Our new school curriculum certainly has made a big stride
forward in the teaching of health. We nurses should not be held
responsible, but should supplement the teaching of this most important of subjects from the public-health point of view.
Secondly, more should be done for our junior and senior high-
school students. Here we should teach home-nursing and child-care.
The boys also should have the same opportunities, especially home-
nursing. This could be done effectively through the Boy Scouts'
Association. The boys can then earn their Missioner's Badge, the
girls, Junior Red Cross certificates, and Girl Guides, their badges.
I am glad to note that the new course of studies is making it compulsory for these subjects to be taught. I have been giving these
courses for several years and always have very keenly interested
students. Also the question of sex education should be taught in
Grades VIII. and IX. Personally, I have never had any difficulty
in teaching this subject as I have had splendid co-operation from
my principal and the parents. I have used the following books with
success: I Growing Up," by Karl de Schweinitz; The | Three Gifts
of Life," by Nellie M. Smith, A.M. Other groups can be formed,
such as youth clubs for older girls and boys of high-school age, also
for business girls.
At these groups we discuss: Home-nursing; child-care; sex
education; mental hygiene.
Thirdly, we come to the much-neglected adult group. On the
Continent and in England much has been done for adult education
for several years. Alberta and other Provinces, of Canada have
been doing splendid work through extension courses from their universities. Last year the extension department of U.B.C. started a
course of lectures for adults, and are continuing them this year. In
connection with them, study groups have been formed in Kamloops,
thereby a greater interest is created by the adults themselves.
The following are our study groups: (1) Economics; (2) current
history; (3.) modern literature; (4) science of public health; (5)
The last three groups hold for me the greatest interest. Our
Shakespearian group has derived immense value from our studies
from the works of the greatest mind in English literature; but
there—this particular subject may not interest many of my readers.
As a Public Health Nurse, I feel we all should have definite interests
and hobbies outside of our profession. Surely with added interests
we should be enriched, thereby making us of greater value to our
communities. Now to our science-study group. We have several
women very interested in the various angles of this most important
science of public health. I am fortunate in having articles dealing
with the many phases of public health. These are generously provided by our Department of Health. We read and discuss them at
length. I find this group keenly alive to the value of these studies.
They wish me to express their appreciation to Dr. H. E. Young for
The groups have studied and discussed with interest | The New
Health Curriculum in the Schools," by Dr. H. B. King. Other subjects we are discussing are: Mental hygiene; sex education for the
adult and the child; the pre-school child; child psychology; and
many others. There is such a wide field to cover. Then we have
the young, keen mind of the student-nurse in our hospitals. There
should be found the opportunity of giving public-health lectures. I
find them willing to absorb new ideas. Another good method is to
write and produce short plays illustrating one's teaching. These I
have presented from time to time to our parents at the end of the
school term. I am producing | An Ounce of Prevention " next June,
using some of my students for the cast.
I have tried to point out a few means of extending education in
public health. Of course there are many more. We all have our
own ways of developing and teaching, and yet we can all help each
other by the exchange of ideas. Education should be the keystone
of our work.
v " Learning maketh the soul young, it decreases the bitterness
of old age. Gather then wisdom, gather sweet fare for thine old
age."—Leonardo da Vinci.
Olive M. Garrood, R.N.,
AN IMPOSSIBILITY BECOMES A SUCCESS.
A few years ago the establishment of a dental clinic in Nelson
was considered an impossibility. Last year I recounted some of the
difficulties we met with in laying the foundation for such a clinic.
I should like now to report progress in our new undertaking.
Early last June the School Board appointed three of its members
to act as a Dental Committee. Arrangements for financing the
scheme had already been completed as outlined in my last article.
A preliminary survey had been made by Dr. Walley, and it was the
task of this committee, working in collaboration with Dr. Walley and
myself, to work out details and submit its recommendations to the
Board. The plan decided upon was as follows:—
(1.) That we have a semi-mobile type of clinic, which could be
transferred easily from school to school and could later be mounted
on a trailer and used as a mobile clinic to serve outlying districts.
(2.) That necessary changes be made in the three schools to
accommodate such a clinic.
(3.) That, as a beginning, we should carry on an educational
programme for all school-children, and examine and report dental
defects in all children attending our public schools.
(4.) That we would provide free dental care to all children—
(a.) Whose mothers were receiving mothers' pensions:
(&.) Whose families were on relief:
(c.) Who came from homes where the average income was
less than $15 per month per person.
These recommendations were accepted, and Dr. Walley was
appointed by the School Board to act as half-time dentist. A secondhand dental chair was purchased, together with a second-hand cabinet,
bracket table, hand-piece and motor,' sterilizer • table, and rubber
floor-mat. The sterilizer and all instruments were new. The necessary plumbing and electrical changes were made in the schools.
Dental records from other centres were studied and a form designed
that would best meet our needs.
The last piece of equipment arrived on the day that school opened
in September, and on the next day we started our examinations.
Out of 460 children attending the Central School, we found 96 per
cent, suffering from dental defects. Dr. Walley gave dental talks in
all rooms of the school, and by the time the examinations were finished many requests for free treatment had been received. These
were referred to the Dental Committee for approval, and almost
every one of the 137 submitted proved eligible. Monthly letters on
I Dental Care " were mimeographed, and the first of the series were
sent out at the end of September, in the hopes that the parents of
children not eligible for free treatment might be stimulated into
taking their children to their family dentist.
Knowing that it would be impossible to complete all the work
requested, we concentrated on Grades I. and II. of the Central School,
and on the two upper grades, so that next year we would have a good
start both in Central School and in Junior High. Thirty-five pupils
had dental work completed at our clinic, the average treatment for
each child being nine 20-minute appointments. One hundred and
seventeen pupils returned cards signed by family dentists, which with
the 4 per cent, already found free from defects brought the number of
children with well-cared-for mouths up to 39 per cent. Cards signed
by family dentists are still coming in, and we feel that the percentage
will be much higher by the end of this term.
On November 19th we moved our clinic to the Hume School.
It required barely half an hour to dismantle our equipment and get
it ready for the transfer, and even less to set it up again in its new
quarters. Two hundred and fifty children were examined, and there
were ninety-eight requests for free work. Twenty-two cases were
completed by the clinic and eighteen cards signed by family dentists
were turned in. The work was somewhat hindered by the Christmas
examinations, and many children who were examined at that time
are having their teeth attended to by family dentist now.
On January 15th we moved to the Junior High School. Three
hundred and fifty children were examined, and up to the present
(February 1st) we have had fifty-five requests for free treatments
and have had fourteen cards returned signed by family dentists.
The majority of the children are still to be heard from.
A certain amount of emergency work has been done in all schools,
both for clinic cases and for children who are under the care of a
family dentist. For the latter, a temporary dressing was put in
and the child advised to visit his own dentist after school-hours. In
this way we feel that we have saved the children a considerable loss
The dentists of the town have voiced their approval of our plan.
The parents have proven both interested and co-operative. Dental
health in the schools is improving steadily, and we hope in time to
extend our service to both pre-school children and those living in
outlying districts. In fact, we feel that, in spite of the gloomy forebodings of some of our well-wishers, we have made our 1 impossibility " not only a reality, but an unqualified success.
Kathleen M. Gordon, R.N.,
MAPLE RIDGE AND MISSION DISTRICTS.
The homely old i saw," | You can lead a horse to water, but
you can't make him drink," is somewhat illustrative of the persuasion
necessary for the carrying-out of public-health principles by the individuals in a district.
It is most encouraging that the persuasion need not be as prolonged or insistent as formerly and that results are more satisfactory.
The majority still need leading, while some refuse to drink of
the essentials of health hygiene and care, and some go to inferior
"springs" of health knowledge. An increasing number are glad
to be led, however, and are anxious to partake of the most scientific
The attitude of most of the parents toward the new curriculum
in the schools is an example of this. Many are very pleased indeed
that their children are being taught nature, science, and health so
much more basically and comprehensively. Seldom does one hear
now of the complete efficacy of the three R's from parents.
The 1 powers that be " are endeavouring to supply at least some
of the new equipment necessary to carry on the new programme.
Some of them are deeply interested.
The earnestness and the endeavour of most of the sixty-six
teachers to carry out the new projects is a source of amazement to
me. Many have spent their own money for books or articles that
would aid them in teaching the subject more efficiently. Great praise
is due to these men and women for their very large contribution to
the world's progress.
Knowledge of the injurious effects of dental caries, infected
tonsils, defective vision, etc., is being gained by more people; also
the definite need of a full and balanced diet and proper rest, as evidenced by the decided drop in the number of underweights among
The T.B. Survey with the tuberculin-testing of 594 Japanese
children by Dr. Lamb and Miss Peters last year has been a productive
element in preventive education. Many are anxiously awaiting the
early return of Dr. Lamb for the complete survey of all the children
in the schools.
Of the 594 receiving the tests, 16.3 per cent., or ninety-seven,
had a positive reaction, eighty-eight with the first dose and nine with
the second dose. All of them with their parents were X-rayed and
examined. Twenty-two of them, including five adults, were to be
kept under observation and rechecked. One of the adults and three
of the children were- put on the | cure." Those on the " cure " have
been faithful to their regime and examination six months after
showed that they had improved.
The survey has also stimulated interest in the clinics among
some of the older Japanese, a number attending the Tuberculosis
Clinic in Vancouver, resulting in two more | new " cases being dis^
covered and hospitalized and two others under observation.
. Dr. Lamb's six regular clinics held here last year had much
larger attendance than previous ones. Four new cases were disclosed and a number of old cases pronounced progressing favourably.
The discussion of a Public Health Nurse for each district here
has become official, and the hopes are higher for the time to organize
for and hold more toxoid and vaccination clinics, also for well-baby
and pre-school clinics and prenatal welfare—more time to go into
the homes to give information that will assist them in building and
safeguarding their health and usefulness.
Mary E. Grierson, R.N.
THE VALUE OF AN ANNUAL SCHOOL HEALTH CUP
It is always difficult to arouse interest in new and progressive
ideas of health and sanitation in rural farming districts, where
things move slowly, and so often the old saying is quoted, 1 What
was good enough for my father is good enough for me."
There is even opposition to the teaching of new ideas shown by
some parents, as, for example, when one of our teachers received
this letter from an indignant Italian father: " You got no business
tell Antonio brusha da teeth! I never brusha da teeth, got good
teeth. My sister brusha da teeth, wear them out. They all come
out. You teacha Antonio read, write, not what he should do at
This true-incident also brings to mind that tale of the sturdy
Scotch farmer, who literally | floored " the Health Nurse by doubling
up a brawny forearm, saying scornfully: " All this clack aboot vitamins ! Look at ma muscle, and I niver had a vitamin in ma life! "
I shall always remember the early days of rural health organization in my district, and tackling this very problem of health education
with an old gentleman who had been a much-esteemed school trustee
for many years. He did not believe in | This new-fangled idea of
having a school nurse; they never had them in his time, and look at
him! " We threshed the matter out in the middle of a ploughed field
one lovely spring day. He sat on his horse-drawn disk harrows,
smoking a pipe, and I stood over my shoe-tops in soft wet soil and
thus discussed this important .matter of Health education. After a
long argument he was won over to the idea of " Giving the nursing
a trial," and so the first step forward was made in that district, where
now the Health Nurse and her teachings is accepted as a matter of
With nine other Rural School Boards to be convinced in like
manner of the value of new ideas in school-health work, it was necessary to think of some project which would arouse the personal interest
of both School Boards and scholars; stimulate a healthy spirit of
competition between school districts, and show how much progress
had been made from year to year. A school health cup competition
seemed the ideal plan, and when the cup was donated by the District
School and Medical Health Officer interest soon began to grow among
children, teachers, and school trustees.
Much thought was given by the School Nurse as to the points
upon which the competition should be based. It was necessary to
evolve a plan which would bear directly on all aspects of school sanitation and health education, as these phases of school hygiene affected
school trustees, teachers, children, parents, and janitors. It was also
necessary to plan a schedule which would be equally fair to every
child and School Board working in the different types of schools.
This was indeed a problem, but finally the following schedule with
thirteen main sections was drawn up; each section divided into
about ten subsections, for which a rating of 100 points was given.
A copy was given to all School Boards, teachers, and janitors, as
Section I. Cleanliness of children (general),
7 subsections 100
Cleanliness of children (teeth) 100
Section II. Hygiene of the school-room, 8 subsections 100
Section III. Sanitary condition of the toilets,
9 subsections 100
Section IV. Facilities for drinking-water, 7
subsections I 100
Section V. Hand-washing facilities, 7 subsections ! 100
Section VI. Heating and ventilation of the
school-room, 9 subsections 100
Section VII. Lighting of the school-room, 7
Section VIII. Provision for school lunch, 6
Section IX. Equipment of the playground,
10 subsections 100
Section X. Sanitary condition of the playground, 6 subsections 100
Section XI. Response to health education:—
Consents to goitre treatment (percentage of pupils) 100
Consents to toxoid immunization
(percentage of pupils) 1 100
Consents to vaccination against
smallpox (percentage of pupils) 100
Consents to tuberculin test (percentage of pupils) 100
Section XII. Results of health education:—
(a.) Taking goitre treatment (percentage
of those giving consent) 100
Immunized against diphtheria (percentage of all pupils) 100
Vaccinated against smallpox (percentage of all pupils) 100
(d.) Tuberculin-tested (percentage of all
Section XIII. Interest in health education, 8
The grading throughout the school-year is done by the School
Nurse, and the itemized results published in the annual topical report,
which is studied with much interest.
Some very tangible results in the different schools have been
noted from year to year as a result of the rural schools health cup
For instance: School buildings have been painted and repaired
inside and outside. Electric light has been installed. School sanitary arrangements have been improved and necessary requisites
provided. Hand-washing facilities and paper towels have been provided. In three schools running water and sanitary bubblers have
been introduced at some cost to local ratepayers; in others each child
has his own cup. Heating has been improved. Playgrounds have
been improved and sports equipment, etc., supplied.
Rural school trustees have most certainly taken an interest and
pride in trying to make their own school on a par or even better
equipped than other schools in the district; this attitude in years of
rural depression and scarcity of funds is most commendable, and
encouraging to the School Health Service.
With regard to the children, there is a great improvement in
personal cleanliness and good response is given in general to health
education, an attitude which is fostered by splendid co-operation of
the teaching staffs.
This responsive attitude of children and parents is well shown
in the final results published in the 1935-36 Annual Report. With
808 children on the register during the year attending ten rural
schools: 99.68 per cent, consented to goitre treatment; 96 per cent,
consented to the tuberculin test; 89 per cent, were immunized against
Appreciation of the response to health-teaching in the schools has
been voiced by the School Inspector and also by the organizer of the
Junior Red Cross.
The value of an annual school health cup competition has thus
been well demonstrated, and although the grading throughout the
year throws extra work and responsibility upon the School Nurse,
yet the final results are worth all the trouble taken.
Anne F. Grindon, R.N.,
Keloivna Rural Schools, B.C.
When I decided to weave a few words around the above topic,
I discovered that, according to the Oxford Concise Dictionary, an
I objective" meant a great many things I hadn't thought about,
especially in the realm of philosophy. However, I did find, tucked
in almost as an afterthought, the idea I had in mind, to wit: 1 A point
aimed at." Why that angle should be so incidental in the dictionary
still puzzles me, because I thought that every one has on objective
and that the Concise would have given quite a little space to its
ramifications. But isn't that typical of life? The things we revere
and hold sacred are of no interest to the rest of the world.
To return to the topic, who was it said that if you aim at a star
you may reach the top of the tree, but if you aim at the top of the
tree you land on a lower branch ? All of which is by way of an introduction to the suggestion that we nurses, of all people, should aim at
an objective in life. True, the fact that we are nurses proves that we
have attained one objective, but it is so easy to settle down comfortably
and sigh—comfortably—deciding that we have got as far as we can
get. We are so prone to " rust in routine " until we find uncertain
relief in wedded bliss or forced retirement. How many of us vowed at
" 50-50 per cent."
graduation: | Well, here's one person who won't spend all her life
just doing ordinary nursing "; and yet, ten years later, we are still
at the.same thing—perhaps in the very same position?
The purpose of these few paragraphs is to suggest that nurses
should have an objective at which to work | The point aimed at" is
purely a personal choice of course, but if it is in the field of nursing,
medicine, farming, literature, business, art, or music, etc., it should
most certainly be beyond the path of daily routine—however conscientiously we are travelling that path at present Last year a hobby
was suggested as a way of relaxation—this will also apply as an
objective. I wonder how many tried it!
The final warning."
In Miss Kerr's article on 1 Ghosts " we are asked for contributions
to her collection of i superstitions." I wonder if the old truism,
" Hope springs eternal in the human heart," could be called a superstition ! If not, then it is not too much to fix an objective seemingly
above our reach—and high as it may be, if reaching it will be primarily
for the good of society, a watchful and munificent Providence will
smooth out the path until the goal is reached. Did not Browning
realize this when he wrote
what's a Heaven for? "
I A man's reach must exceed his grasp—or
Bertha Jenkins, R.N.,
Supervisor, Saanich Health Centre.
CURIOUS SUPERSTITIONS AND BELIEFS.
I Do you believe in ghosts ? " In a deep, hollow voice, the questioner stirs our hidden fears, and we feel our hearts beat faster as
we listen to awesome tales of mystery and magical apparitions. Then,
when the period of tension is passed, we shrug and laugh: • " But
nobody really believes in those sorts of things to-day! " Perhaps
not—perhaps they do. Many of us, supposedly intelligent, wideawake, well-trained Public Health Nurses, have little secret rites we
perform on occasion. Did you ever wish on a new moon? Why? Do
you surreptitiously "touch wood" to offset a little mild boasting?
Do you really believe it helps any?
Since few of us can deny we have a weakness for these superstitions, we may expect that many of the foreigners, who comprise a
goodly number of our population, will present serious teaching prob-.
lems because of the fears that are part of their heritage. Public
Health Nurses, whose programmes are developed chiefly along educational lines, may not be confronted by so many baffling situations as
their fellow-workers who include bedside-nursing in their services.
However, it may be of value to try to discover what is behind the ideas
and customs to which some individuals cling so tenaciously, for only
by understanding them can the Public Health Nurse