History of Nursing in Pacific Canada

Public health nurses' bulletin, v.1 British Columbia. Provincial Board of Health 1939

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       Issued by the
Public Health Nurses' Bulletin
/     >t-©.    /
IT is the purpose of the Provincial Board of Health to assist the Public
Health Nurses to issue a bulletin which will be a medium for the
exchange of ideas in connection with their daily work.
We all profit by experience gained when applying our theoretical
knowledge to problems that arise and which may be classed as purely
local. Yet similar conditions in other districts may have to be met, and
one nurse's experience when told through the bulletin may be of great
help to others.
With this object in view the nurses have been asked to send in from
time to time an account of their trials and tribulations, giving or asking
for advice.
Such an interchange of ideas will be of great benefit to all; not only
to the nurses, but to the women's organizations, who are so much interested in the work and who are the main support of the service.
We wish the public to understand and appreciate the difficulties
which the nurses have to contend with and we also wish to have the
bulletin be a means of educating the public to the fact that a nation can
only exist and progress on a firm foundation of health.
We owe sugh-4. service to the rising generation.
Miss Jeffares, Public Health Nurse at Duncan, has kindly edited the
present issue.
We have reserved material, from centres not mentioned, for a later
The actual figures are often beyond our greatest hopes, which is
another way of saying that the report of my first year's school-work in
Nanaimo surprises even myself. |p|
The results from bur dental campaign are very gratifying; the
teachers and the parents, as well as the members of our medical staff,
have united in making dental work and the routine care of the teeth the
popular thing. In two classes one-half the pupils have already been to
the dentist, and in a school of 146 pupils we could only find two boys
who did not have perfectly clean teeth. , •
 The children were asked to sign lists in the class-rooms, giving the-
date they began and the date they completed dental treatment.    Class
rivalry was stimulated by the promise of a star on the longest list.   This
also gave me an excellent record of the dental work.
M. J. Woods (Nanaimo).
Miss McClung, Kelowna, reports that she is a" member of a Relief
Committee, the object of the committee being to raise sufficient money
to enable Miss McClung to make arrangements for the necessary medical
and surgical attention required by children whose parents cannot afford
it. We must ask Miss McClung to let us have a report of the work of
her committee and the result of their general appeal to the public for
There are four schools in the town, with about 1,000 children in
attendance. The majority of the children are suffering from defects
which have been reported on by the previous nurse, and are still uncorrected.   The great difficulty seems to be a financial one.
I found the Women's Institute very helpful, and through them was
able to get a dental chair installed in one of the schools, with a view to
arranging for a dental clinic shortly.
In visiting the homes of the children, I find the parents are very
pleased to get any advice with regard to the health of the children I am
able to give them.
Jean A. Dunbar (Vernon).
• In a large district, such as the one in which I am operating as nurse
in charge of the Esquimalt Rural Nursing Service, the service necessary
to bring about the desired results of educating the people to a realization
of the benefits derived from supporting such a service in their midst is
very varied.
Apart from the usual aims and objects of a Public Health Nurse,
which include the dissemination of all information tending to check the
spread of infectious and contagious diseases, and the inculcation of habits
of right living amongst the people, child-welfare, etc., social service must
play a very important part in the daily life of a nurse in charge of such
a service.
If all the work accomplished by a Public Health Nurse could be made
public, there would be no difficulty in obtaining the vote of the people at
the annual ratepayers' meetings for the extra small assessment towards
2 I
 the upkeep of the service in their midst, but much of her work has of
necessity to be kept confidential, and therefore much of the benefits of
the service are known to only the few.
I will quote one case of many, withholding, of course, names and
anything which may lead to identification, whereby the State has been
saved, potentially, many thousands of dollars; the State, and thereby the
The case deals with the Social Service Branch of the work. I
learned of a family living away back in the bush, where there were three
boys who, owing to them living outside the 4-mile limit, had never attended
school. Accompanied by the vicar of the parish, I went to investigate
the case. Taking my little car up miles of rough trail with barely room
at times to pass, we eventually located the place where the family in
question were living. There we found a shocking condition of things in
general. The three boys, ages 6, 8, and 10, had not only never been inside
a school, but were unable, to speak properly, owing to the fact that the
father was almost stone-deaf and the mother on the verge of a mental
collapse through loneliness and lack of association with her fellow-
Within two weeks we had the family moved to the village of ,
and very soon after that had collected sufficient clothing for the boys to
attend the school there. This was some months ago, and the boys are
now doing well at their studies and show fine promise, and the mother,
though still suffering more or less from her terrible experience of loneliness in the bush, shows great improvement, and no reason at all why
she should not become a normal healthy woman. The father, a good
workman, but severely handicapped by his extreme deafness, will have
the chance to become a useful self-supporting citizen, as I succeeded in
interesting the local Women's Institute and the Nursing Association to
the extent of procuring an ear-trumpet for him.
That is onlyybne case from one portion of the district; but it will
serve to show how necessary it is for a Public Health Nurse, when in
charge of a district, to give and have a wide view of the opportunities of
service, and for the people to realize this service and support it liberally,
and thereby save themselves increased taxation in the future. It will
not require a very vivid imagination to realize what a burden such a
family would have become to the State eventually had they been left to
their own devices.
With regard to the progress of the Nursing and Public Health Branch
of the work, we have by. dint of perseverance, and with the co-operation
of the Public Health Department and the Saanich Health Centre,
to whom we are indebted for the loan of a dental chair, established a
dental clinic for children of school age and under—a service which has
proved itself to be of undeniable benefit and which is greatly appreciated
by the parents. We held our first clinic during the Easter holidays and
are continuing the work to completion during the midsummer vacation.
There is no better foundation for health than in a clean mouth, with
 well-preserved teeth that will masticate the food required to build up a
healthy child, and ensure a good digestion and assimilation of the same.
Of my pre-natal work, first-aid work, etc., I need say very little, but
it is very gratifying to note the growing confidence with which mothers
will appeal to the nurse for advice regarding the slight ailments of their
children, and the welcome extended when making those numerous " home "
visits, which mean so little to the casual observer when reading of the
number of | home " visits made in the monthly report, but which mean
so much to the nurse and to the parents and to the future realization
of the achievement of the aims and objects of the public-health movement. ^
I have Girls' Health Clubs established in several of my districts,
and hope before very long to have Boys' Health Clubs established 'as
successfully. My dreams for the future include a real health centre,
where boys and girls and men and women and babies will come to
"play" and learn to be healthy; not come because they are sick, but
come to learn how to keep well; space will not permit of detailed descriptions of my " dream health centre," but in time I hope to achieve my
object. A Public Health Nurse's object and that of a Nursing Service
should be that of promoting public health; not merely the attending of
sick people at so much per visit, but by giving advice privately, and
in public-health talks show them how to keep well so that they won't
require the services of the nurse for sickness, but be glad to pay for her
upkeep in their midst because they recognize their need of her.
I have a splendid committee to work with, one whose motto is
" progress," for which I am very thankful, and who are, one and all,
in absolute sympathy with the movement and who encourage and do not
Helen Kelly.
Cowichan Lake School Fair.
I had accepted an invitation to attend the School Pair at Cowichan
Lake, our most rural school, about 20 miles from) the Health Centre headquarters, and present the prizes for the Health-book Competition, which
were given by the Provincial Board of Health. Cowichan Lake School
is in the centre of a logging community and most of the children come
from the different camps.
On arrival at the school we found the judges were busy in the
school-house with the exhibits, and sports in progress on the grounds; a
group of about forty parents being accommodated on roughly put-up
benches or on the desks from the school-house.
In the school-house the different exhibits were arranged attractively,
our interest, of 'course, being centred on the " Health Books." Last
February it had been suggested to the teacher that, if she cared to take
the matter up, a prize would be given for the best essay, poster, or book
on any health topic taken up by the School Nurse during the term.
 About eighteen books and several posters were sent in competition; some
of them were a great surprise. The majority of the books were illustrated with cut-outs, while some had little pencil or water-colour sketches,
all of them being made to look as much like a book purchased in a shop
as possible. One clever little book on " Milk " had an amiable-looking
cow on the front cover and a very tiny milk-bottle in the centre of the
back cover.
After the sports had been run off and the judges had completed their
task, the pupils put on a little health playlet, in which there was paraded
before a little, pale, thin | City Boy " all the good things he could procure
more easily by living in the country. The children were dressed to look
the part of the article they represented; for instance, " Egg " was a tiny
golden-haired girl, carried in a large basket covered with white crepe
paper. When all the 1 Good Things " were arranged around the little
boy and he was considering their real value, in walked a procession of
his old-time I Enemies," headed by a large § Coffee-pot," and followed
closely by | Pie " and "Candy." It was not very long, however, before
the superior strength of 1 Milk " and his faithful supporters was felt,
the | Enemies " chased afar off, and thin, little 1 City Boy " left to his
new friends.
I. M. Jefpares (Duncan).
Good-health Competitions in Rural Schools.
Realizing that it was possible to arouse interest in health-teaching
in rural schools by way of a good-health competition, We decided to put
on this year a competition among all the rural schools in our district.
The rules of the competition are simple and as follows:—
Between the rural schools visited by the Public Health Nurses from
the Health Centre, Duncan, this year we are going to have the most wonderful competition for the best HEALTH POSTER, HEALTH BOOK,
and for the best ESSAY on any HEALTH TOPIC.
There, arevgoing to be SIX PRIZES offered, as follows:— .
Prize for the BEST POSTER made by a girl.
Prize for the BEST POSTER made by a boy.
Prize for the BEST HEALTH BOOK made by a girl..
Prize for the BEST HEALTH BOOK made by a boy.
Prize for the BEST ESSAY written by a girl.
Prize for the BEST ESSAY written by a boy.
The poster is to illustrate a I Health Talk " given by the nurse.   The
essay may be upon any | Health Topic " taken up by the nurse during the
school term.   The " Health Book " must tell and illustrate the story of
I Good Health."
Special Prizes.—A special prize will be given in each school for the
BEST POSTER,  HEALTH  BOOK,  OR  ESSAY,  the  age and  school
standing of the competitor to be taken into consideration by the judges.
Competition to close May 31st, 1925.
The Provincial Board of Health has kindly offered to see that we
have prizes and we are looking forward to a great many entries.
 In order to conduct the competition with as little confusion as possible, we drew up the outline of " Health Talks," given below, for the year,
so that all the children will receive the same instruction and have an
equal opportunity to send in the best poster, health book, or essay.
Month. Topic. Story.
Sept Cleanliness, fresh air, and sunshine The Pig Brother.
Oct Proper food and drink The Milk-bottle.
Nov Teeth Old Grouchyman Toothache.
Dec Proper clothing, posture, and exercise..The Crooked Man.
Jan School ventilation and common cold Mary had a Little Cold.
Feb Germ-life—common    cold    and   sore
throat Billy's Pal.
March .The need of green vegetables and fruit,
also neatness and cheerfulness The Two Houses.
April Talk on annual physical examination,
the reason and why defects found
should   be   corrected,   leading   up,
especially with interest to the older
children, to the need of a healthy
race physically, mentally, and morally in Canada.
May Flies, home and school sanitation !.The Diary of the F,ly.
June General   review   and  presentation  of
competition prizes. ;
I. M. Jepfares (Duncan).
When a nurse is making a change from one district to another, it is
very pleasant to be able to carry away the knowledge that the people of
the district appreciate your work among them, not only professionally,
but from the community standpoint as well. Such must be the knowledge
of Miss Gawley when she looks back on July last, when the people
of the Malakwa District met together to make her a presentation, and to
say I Farewell" to her on the eve of her departure.
Miss Ada Benvie has resigned her position on the staff of the
Cowichan Health Centre, as she finds it is necessary for her to remain
with her mother, who is ill at her home in Nova Scotia.
Miss E. Naden, B.Sc. (Nursing), U.B.C. '24, has been appointed to
Cowichan Health Centre.
*    *    *    *
Miss E. N. Bodenham has left Keremeos for the " Old Country,"
where she expects to remain indefinitely.
During the past summer there have been several conventions held
in the East of interest to Public Health workers, and being fortunate
enough to obtain a copy of notes taken by a Public Health Nurse attending three of the conventions, I thought perhaps some of the other nurses
might enjoy reading'them also, as it is surely interesting for us to have
an idea of what the leaders of our profession are thinking and of the
work that is being carried on elsewhere.
At the Biennial National Nursing Convention held in Detroit in
June, Dr. Lockwood, of the Pasadena Hospital, spoke on " The Role of
the Physician in the Education of the Nurse," after which there was a
very heated discussion, at which it was admitted that more and more the
education of the nurse should be turned over to the nurse. Dr. Lock-
wood said that medical men were too busy to properly prepare their
lectures, and consequently the lectures were often either too advanced
and technical or too elementary to be of much value. He admitted that
many doctors felt that the pupils should receive only such teaching as
they chose to give them, but he felt that the nurses themselves should be
equipped to give most of the teaching, and he felt sure that the doctors
would very soon realize the value of such a step and would be glad to
relinquish the teaching to the nursing profession.
In giving an address on | Communicable Disease " at a general session, Dr. Chas. Emerson, Dean, Indiana University School of Medicine,
said he thought it was the duty of every Public Health Nurse to teach on
every possible occasion to individuals and to groups the value of serums,
vaccines, and antitoxins as preventive measures against communicable
disease. He also felt that, unless the nurse herself was a firm believer
in all preventive measures, she should not pretend to be teaching preventive medicine as a Public Health Nurse. He felt that a nurse who
could not believe thoroughly and implicitly in preventive measures that
had proved to be successful should find some other line of work.
At the Child Welfare Section of the National Organization of Public
Health Nursing, the general thought of the meeting was that in most
cases too little attention was being paid to the pre:school child. While
realizing that at present the school-child needed a great deal of care and
attention, it was felt that most organizations should lay more stress on
the necessity of allowing more time for work with the preschool, and
that much of the health-teaching in the schools would need to be given
by the teachers, thus leaving the nurse free for more intensive pre-natal
and preschool work.
The question of continued visits to mothers who failed to co-operate
with baby clinics and welfare organizations came in for lengthy discussion, some of the nurses maintaining that after a period of two or
three months such mothers should be dropped and the nurses' time and
energy given to those willing to co-operate.   Finally, however, the meeting
 decided that this was not the wisest course, and that the mothers who
would not co-operate were those who were most in need of education,
and that there should be no limit to the time of carrying such patients.
It was also suggested that a change of nurses visiting a particularly non-
co-operative individual might bring about the desired results, as very
few of usin this world can deal satisfactorily with every question.
At another meeting, Dr. Haven Emerson, speaking on 1 Meeting the
Demands for Community Health Work," emphasized the thought that
community health is, after all, primarily an individual problem; that
we must seek to educate people to their responsibilities towards maintaining the health of themselves and their children and of guarding
against communicable disease by the preventive measures that are now
available. When this is done, community health will be cared for to a
great extent by the people themselves. Dr. Emerson felt that this should
be the end towards which we should all strive, to make people realize and
admit their individual responsibility for the health of their community.
Miss Crandall, of the American Child Health Association, took a
view almost opposed to Dr. Emerson, and laid the responsibility for the
community health almost entirely on the State or Federal Government.
She advocated communistic methods of obtaining medical and hospital
aid and of pensions, etc., for old age, sickness, unemployment, etc. She
did not feel that the individual was primarily the one to undertake the
work of raising standards of community health.
Mr. William J. Norton, Secretary of Detroit Community Fund, said
that so often Public Health Nurses and doctors'were so interested and
enthusiastic about their work that very often they failed to realize that
the public at large did not understand clearly just what they were trying
to accomplish with the money they asked for.
He said that we should remember that, after all, it is the lay people
who provide the money, and we should take greater care to see that they
understand just what we are trying to accomplish before we ask for
money, and we should invite their co-operation in the spending of their
money more often than we do.
Dr. Dixon, Director of V.D. Clinics, Detroit, spoke on 1 Milestones
in Progress, of Social Hygiene from a Medical Standpoint." He emphasized the fact that venereal disease can be both cheaply and satisfactorily treated if we can only educate people to the necessity.
He said that in his opinion sex education should be given in the
home, but deplored the fact that so few people have a vocabulary which
is at all adequate for such teaching. Dr. Dixon said he made it a practice
to ask the mothers and fathers who came to him for some considerable
period just what they knew about such matters and what they could
tell their children, and he said very few of them had words which could
be used without embarrassment. Dr. Dixon said he felt it was the duty
of every physician to teach parents in simple dignified English what
 they hand on to their children, and maintained that such teaching could
y never be undertaken until the people were provided with a vocabulary of
simple dignified words.
*    *    *    *    *
Efforts to prevent crime among foreigners should be along lines of
showing them the opportunities the new land has in store rather than
endeavouring to make them forget their own national traditions and
The Employment Service in Canada was reviewed by Professor Jackson, Toronto University. In 1923 about 377,000, or about one-eighth of
the working population of Canada, obtained work through this service.
Stabilization of employment by public expenditure was complicated by
the fact that the Federal Government does not consider unemployment
primarily its problem, although willing to help the municipalities to a
certain extent. Up to the present, Professor Jackson said, the method
has been haphazard and in future must be considered on broader lines.
Conference on Social Work, Toronto, June 25th to July 2nd.
At a luncheon of police-women, Mrs. Wooley, of the Merrill-Palmer
School, Detroit, spoke on 1 Pre-delinquency," emphasizing the fact that a
great many of the -lasting impressions are recorded on a child's mind
before the age of 5 years. She is convinced that the seeds which later
bring a harvest of disgrace are sown very early in life and are planted
sometimes by parents, who are not evil-minded but merely injudicious,
and are ignorant of methods of wisely training children. She believes
that back of every crime lies a mistake in training and that the innocent
beginning of many an evil habit lies in mistaken training methods of
The telling of diplomatic lies was strongly denounced. Many parents
consider it an (easy way of dealing with children, but it is unsafe, particularly in dealing with the ages of 3 and 4, when the imagination is
apt to run riot.
Mr. K. C. McLeod, of Edmonton, was the principal speaker at a
meeting when the problem of the underdeveloped child was discussed.
He was of the opinion that the time had come for drastic measures. He
thought that many of the children could be socialized and if put in the
right kind of home could be taught certain routine duties. Those incapable of being taught should, in his opinion, be chloroformed. Mr. McLeod
thought that a country which was already overburdened with taxation
should not be asked to provide expensive institutional care for such
cases. He also maintained that all definitely feeble:minded persons
should be sterilized, thus cutting off at the source the supply of feebleminded children.
Two resolutions were adopted at this meeting:—
(1.) To the effect that the association strongly disapproves of any
newspaper publishing any details of any criminal offence by children
§1111! 9
 before such a time as their cases have been disposed of by the Juvenile
Court; the theory being that the notoriety of any case injures the child
and adds to the possibility of future delinquency.
(2.) To advise the various Provincial Governments that they should
harmonize and co-ordinate as far as possible those branches of the public
service dealing with the supervision and inspection of children in foster
homes, and the inspection conducted by the school, health, and other
organizations, to avoid undue multiplication of expenses.
Dr. Bernstein described the development of the last thirty years in
the care and education of the feeble-minded as carried out by the institution at Rome, N.Y. All of the inmates (as far as possible) are trained
for some manual work. On some of the farms where the boys are taught
they are entirely self-supporting, and the simple environment of the farm
is the best possible for them. Considerable success has been attained in
starting some homes for girls in small cities where they can go out and
perform domestic duties during the day and return to the home at night.
Dr. Chas. Johnson was another speaker at the same meeting. He
deplored the feeling of antagonism which had arisen between many public
and private agencies. He urged all social workers to go back with the
resolve to educate legislators out of the belief that posts of responsibility
in welfare-work should be regarded as
political plums."
At the meeting of the Immigration Session, Dr. Barnes in his address
said the immigrant should be taught English, but should also use their
mother-tongue, and the best customs of their own land should be maintained and blended with our customs.
Printed by Chakles P.  Banfiebd, Printer to the King's Most Excellent Majesty.
Public Health Nurses' Bulletin
Vol. 1
APRIL, 1925
No. 2
THE reception accorded the first issue of our get-together bulletin was
most gratifying, and whilst the material at hand does not enable us
to promise an issue on specific dates, yet we are assured of such an
interest that publication will be continued.
The present issue is timed for distribution at the next meeting of
the Befresher Course to be held at the XTniversity in Vancouver, April
15th to 18th.
The experience gained at last year's course has enabled us to enlarge
the programme, special attention being given to the Public Health Nursing Service, and under the able direction of Miss Ethel Johns, Department of Nursing and Health, University of British Columbia, we are
promised a most profitable and enjoyable time.
The gradual but solid growth of the Public Health Nursing Service
in British Columbia proves its worth, and the Department feels that this
progress is due largely to the efforts of the nurses.
The success obtained in any locality rests primarily on the persistence and personality of the nurse. That our nurses have succeeded in
the face of many, difficulties is shown by the results.
The letters received in the Department from many who formerly
were severe critics is the best evidence that the nurse, unaided, has
overcome and turned active opposition into approval not only of the work,
but of the nurse herself.
The change in public opinion in reference to our work may be
visualized by looking at the change in baby's dresses, so well shown in
the pictures in this number furnished by Miss McClung.
The Department would suggest that the question of books on nursing
be discussed at the Vancouver meeting, especially in regard to those that
might be used for reference.
May we take this opportunity of expressing the Department's appreciation of the work of the nurses and to say that it seems to us that the
nurses in the Public Health Service believe that the best reward for all
endeavour is | work well done."
We are again in debt to Miss Jeffares, of Duncan, for her work as
As a member of the Saanich War Memorial Health Centre my experience in public-health nursing has been confined to rural work, and I am
in favour of the generalized plan.
There are many reasons why the generalized plan is the only one
for rural-communities. Eirst, there is the question of expense. We
know that the people rind it quite a burden at times to support a nurse;
in-fact, in many districts, even when •generously assisted by grants from
the Provincial Board of Health, a portion of I lie people feel it is too
great a burden. So one can readily see how utterly impossible it would
be to support several nurses doing specialized public-health work.
Secondly,  in  most  rural   places,  with   the exception  of  the more
thickly populated, such as Saanich and Cowichan, there is sufficient work *
for one nurse only.
Thirdly, it affords greater satisfaction to the nurse herself to know
that.she can be of service to the entire family in bedside nursing, school-
work, T.B., and child-welfare visiting, as well as social-service worker in
time of need.
Fourthly, those who have lived more or less isolated lives are naturally quite reticent, and are more likely to conlide in one nurse than in
iDuring the past three years the Public Health Nursing Service as
directed from the Saanich Memorial Health Centre has grown to such an
extent that the nursing staff now consists of Nurse Superintendent, two
District Nurses, and one School Nurse. Our district is a large one,
covering an area of 55 square miles, with a population of 12,000, of which
1,800 are school-children.
In order that the work can be systematized, a nurse is in charge of
the prenatal and bedside nursing, another the school-work, and the third
the child-welfare work. Do not mistake this for specialized work. For
example, I am the second District Nurse in charge of the child-welfare
work. I usually begin my day in school-work, transporting the School
Nurse and her equipment to her allotted school, gathering together the
children who have appointments with the dentist and bringing them to
the clinic. If there is a case of communicable disease in a school, I
assist by inspecting the children in the class-room daily for ten clays.
and-follow up any absentees with a home school visit. Then, again, the
stork has been exceptionally busy and the other District Nurse requires
relief.    A call conies from the Municipal Hall, " Mr. is reported
to-be in want; please investigate." Now 1 become the social-service
worker. So, too, the other nurses have similar experiences, and we
conduct our service under the generalized plan.
The Child-welfare Nurse endeavours each month to visit every infant
under 2 years of age and every pre-school age child in the district. At
present we have about 600 pre-school age children under Our supervision.
Each month a list of births in Saanich is forwarded to the Centre
from the Vital Statistics Department. They are visited as early as possible, and almost without exception the mother is glad to see the nurse
  and seek advice from her. We tell the mother that if she is worried
about the baby to send for us and we will be glad to assist in any way.
These visits are recorded and kept on file in the Centre.
We always introduce the subject of the well-baby clinics, discuss the
value of them, and invite the mother and baby to attend. Last year
several never missed a clinic, and we have mothers who cannot praise
too highly the work of the clinics, for had it not been for such and the
follow-up work by the nurse, some of them undoubtedly would not have
their babies to-day.
We help the mothers in regard to diet both for herself and family.
Encourage breast-feeding and discourage canned foods at all times.
As the child grows older, we talk about the importance of clean,
healthy teeth; show the right kind of toothbrush (the Hutax) ; advise
consulting the dentist every six months. We look at the throat and
tonsils and if swollen or pitted advise consulting the family physician.
We are proud of the fact that the first pre-school clinic in British
Columbia was held in Saanich. We believe that if we supervise the child
until he is 6 years of age he will enter school in good health and will be
able to get the most out of his school-life, because he will not be handicapped by infected tonsils or decayed teeth.
Florence L. Fuleerton, B.N.
On December 18th I was invited to attend the Christmas concert
given by the pupils of the Yorke Road School in Duncan. This is a
one-roomed school and all the children are in the third grade.
To me the most interesting part of the programme, composed of
songs, recitations, and short playlets, was the little play entitled " The
Bad Molar." This playlet stresses the reason why the " Six-year-old
Molar " should be cared for, and makes the reasons clear and interesting
to the children, and to the parents as well. A large face was improvised
and the children's heads fitted with white cardboard representing the
different teeth.
The characters were: The Little Old Woman who lived in a Cave;
Jack Central Incisor; Jill Lateral Incisor; Jackie Horner Cuspit; First
Baby Molar; Second Baby Molar (the Bad One) ; Six-year-old Molar;
Bicuspid; Mr. Toothbrush; Mr. Dentist.
The Bad Molar has persistently refused to allow Mr. Toothbrush to
scrub him, and consequently while the others are enjoying a game he is
afflicted with severe pain. Mr. Dentist can do nothing but pull him out.
Six-year-old Molar being weak leans over toward. First Babv Molar for
support. Bicuspid then tries to grow into place, but there is no room,
so he must come in out of line, thus spoiling the usefulness and good
appearance of all the permanent teeth.
The children were keenly interested in preparing the playlet and
are now giving more attention to the care of their teeth.
E. Naden, R.N.
Sayward is situated on the east coast of Vancouver Island, 180 miles
from Victoria and 135 miles from Vancouver. Coming to Sayward in
the month of August, 1920, when transportation was very bad, I found
the bridge across the Salmon River was out, and it was necessary to
use a rickety foot-bridge built by the settlers or cross by the ferry when
the river was low. There have been many improvements, however; we
now have a fine new suspension bridge, two others have been repaired,
and I believe there is a new wharf under construction.
Shortly after my arrival some of the progressive settlers, hearing I
was a nurse, corresponded with the Provincial Board of Health, asking
for a School Nurse, and I was given the appointment on part time.
I was visiting a neighbour one day, when two young girls came up
and asked if I would go and see a young woman who was ill at a camp
about 8 miles distant. Without further delay I left my two girls with
the neighbour and started off. About a mile clown the road I met the
mail-carrier with a note, explaining that the woman I was on the way
to see was expecting her baby and could not get out to Rock Bay Hospital,
as she had planned. I hurriedly procured as much in the way of supplies as possible and continued my journey. On arrival at the home I
set to work, and by 2 in the morning the first baby of the family had
arrived, a fine healthy little girl. Never shall I forget my anxiety and
fear that everything would not be normal.
A lad cut his foot the other day with an axe and his father came
running for me. The cut was long, and after bathing it well with lysol
solution, removing worsted and other foreign particles, it was necessary
for me.to put in two stitches. The wound healed well and the boy was
soon walking around.
I find there is a lack of understanding and perhaps of appreciation
of what a nurse can actually do, and what I am attempting to do. In
several cases, Ljim grateful to say, some of the most antagonistic members
of the district have been glad to send for me in time of need.
It is difficult working alone and not having the advice and assistance
of a doctor.
School-work.—I have two schools about 5 miles apart with a total
attendance of twenty-three children. After my appointment as School
•Nurse I had considerable difficulty with the problem of pediculosis.
Some of the parents were indignant that I should examine their children.
I am glad to sajr that through constant supervision and treatment
unclean heads are past history in Sayward.
Two years ago, Avith the assistance of the Provincial Board of Health,
it was possible to get a dentist to visit the schools. He stayed ten days
and attended to all the necessary work. This year, I believe, he is coming
in for trout-fishing and I am hoping will be able to attend to the necessary
dental work at the same time.
Last year an optician came in and several patients, including two
school-children, received treatment.
  The teacher in each school has a first-aid box and is able when
necessary to render aid. They also provide a hot drink for the children
who bring their lunch to school.
Through co-operation with the Women's Institute we have had a
filter put in the lower school, also individual cups, and towels.
M. Walls.
We had our first public-health exhibit at the Kelowna Fall Fair in
September, 1923, just ten days after my arrival. The time had been
very short for the necessary preparation and it was only through the
co-operation of the local merchants, who kindly loaned me different
articles to supplement the equipment already in use, that I was able to
have an exhibit at all. Considerable interest was shown, sufficient to
encourage me to greater efforts for the 1921 Fair.
Early in the jear I made sure of a larger space in a conspicuous
corner. Aside from the articles I was again able to borrow from the
merchants of the town, I made and used others 4o substitute when it
came to a question of money in the home. For instance, the making of
a baby's bed out of a clothes-basket and the use of a plate for holding
the articles for baby's bath.
One of the merchants gave me several end rolls of wall-paper, which,
being of a blue-and-white pattern, showed to advantage the baby-clothing
hung up in that section of the exhibit.
Comparisons between the | old system " and the " new system " were
carried out through the entire exhibit. A great deal of interest was
shown in the old-fashioned baby-clothes as compared with the modern,
and many were interested in the cradle, but preferred the kiddie-coop
and cot, while Peter, the demonstration doll, and who occupied the kiddie-
coop, was desired by the children, many of them coming again and again
to see him.
The placing of placards on the different exhibits, as, for instance,
" Baby should sleep alone," assisted me greatly and made it possible
for the people to. ask more intelligent questions.
Almost as many men as women came to see the exhibit, and remarks
such as " Very enterprising "; " This exhibit is not only good to look at,
but means something," were a few of those overheard.
Mrs. D. W. Sutherland was my only assistant in-getting the exhibit
M. R. McClung, R.N.
The first and, I might say, one of the foremost problems that a
Public Health Nurse has to face is, strange though it may seem, her
committee. A committee in charge of a Public Health Nursing Association is composed usually of public-spirited men and women, who are
elected by the residents of the district in which the association operates.
These men and women as a general rule have the true interests of the
association and work at heart, but often they lack the necessary knowledge and education in rural nursing, which makes it difficult at times for
the nurse. They are anxious to be able to present a good report at the
end of the year to the .people who elected them to act in their interests, and
for this reason are apt to study the dollars and cents before service.
True, the dollars and cents must be looked after, and it is certainly
up to the committee to see that the money is spent economically and
without waste, as far as is consistent with good service; and sometimes
one or two of the overzealous will quibble over trifles which would mean
an almost negligible saving to the funds of the association, and at the
same time do more harm than good with the general public.
They fail to realize sometimes that the nurse in charge has, as a rule,
had many years' experience in this particular line of work in different
parts of the country (I am speaking, of course, of the thoroughly experienced nurse), and that her judgment is based upon the study of the
people with whom she has to deal and the conditions under which she
has to work, and that that judgment is usually sound and reliable.
I am not suggesting that the nurse should be in a position to dictate
to her committee—far from it; she is usually quite satisfied to leave the
business management in their hands, but in some cases, when a question
arises regarding some little point in the administration of the service,
it would be well if the committee were to ask the nurse's advice before
coming to any definite decision. Much trifling comment and criticism
would be avoided if this practice was adopted.
Suggestions for overcoming Difficulties and sol ring these Problems.—
I would suggest, by a course of lectures or talks by some of those in
authority in public-health work, and under the direction of the Provincial
Board of Health, at the meetings of the Committee or Council, to educate
the members regarding the true, fundamental principle of a public-health
service; to bring to their notice the vast difference between a public-health
service and an ordinary professional nursing service, or other professional-
service. Their attention should be drawn to the fact that the people who
are supporting the service by voluntary taxation have a right to consult
the nurse on small matters, by phone or personal calls, should they so
desire, without being called upon to pay the nursing fee, as they would
if her actual professional services were required.
The result of these talks would be an enlightened Council or Committee, and they, then, in turn would give careful consideration to the
election of their Executive Committee, and appoint men and women with
a view broad enough to overlook petty trifles and constructive enough
to accept suggestions offered for the upbuilding of the service, even
though such suggestions may not happen to just coincide with their
immediate views.
H. Kelly, R.N.
By Dr. C. E. A. Wixslow.
The point that seems to me of major importance is the necessity of
keeping your sense of your work vital, not getting into a rut, not taking
the day's round as a day's round of so many places to visit, so many tasks
to perform, but cultivating awareness of the possibilities and of the purpose of the work of your organization. Do you remember the story of the
ship off the north-east coast of South America, on which the drinking-
water had given out? The crew were almost at the point of dying from
thirst, when they finally saw a steamer approaching and hoisted a signal
of distress. When the steamer came nearer they signalled they were in
need of water. The steamer ran up the reply, " Let down a bucket where
you are." The suffering crew thought they were being mocked; but
after the signal was repeated several times, at last they did let down a
bucket and found the water was fresh. They were in the mouth of the
Amazon River, where it flows in all its freshness far out into the sea.
I We are constantly looking for inspiration and encouragement, for big
and stirring things outside. The needed inspiration can be found in our
daily work if we realize to the full what the public-health campaign
actually means and what it is accomplishing.
Remember, too, that you are never alone in the performance of the
great tasks to which you are dedicated. The nurse has a tradition; she
stands for something.
She is a member of an organization; but she is more than a member
of her organization. She is the link between the public-health science
and the community. 1 was tempted to put the name of " Louis Pasteur "
on the chart instead of | Public-health Science," because you are carrying
the message that Pasteur first discovered in that dingy little laboratory
in the Ecole Normale, and that scientific men all over the world are still
working out, down to Dochex and his scarlet-fever serum in New York
City. The wqnderful struggle for the betterment of existence through
* the healing touch of science in your hands. You are the channel through
which the stream flows to the people. You are part of the great sweep of
human progress toward a safe and richer life for all mankind.
Nanaimo is very happily situated for public-health work; it is not
too large, easy to get about in, with very little unemployment. A small
monthly fee of about fl provides the service of a doctor for all the
employees of the Western Fuel Company and their families. This company's medical service does not include dentistry or the services of a
specialist for eye examination. It does, however, provide the service of
a doctor for adenoid and tonsil operations, the people paying a small fee
for the use of the operating-room and a charge for the day or so they
spend in hospital, which usually amounts to about $5 or $10.
 Thinking over the work here, our first impressions were the same—
namelv, how much educational work was needed before any results could
be expected, other than those obtained from individual instruction.
The educational work has gone steadily forward in the schools since
September, 1923, and in the Nursing Service since May, 1921. Much has
been accomplished through the distribution of literature, talks in the
class-rooms, talks at Service Clubs, etc., but we still feel the need of
" convincing " many of the people and have them assume personal responsibility for themselves and their children.
In the schools, for example, small cuts and abrasions often become
infected unless the child comes daily to the School Medical Office for
dressing. Soap, hot water, and clean cotton are all that is necessary
if treated at the time of injury, and once a day for a short period.
Our greatest advance in the schools has been in the daily care of the
teeth. In December, 1923, the dentists made a survey of some hundreds
of the pupils and their report convinced the people beyond a doubt that
the teeth need daily care at home, as well as regular examination by the
The regular work in the school has been interrupted by an epidemic
of measles and of impetigo in 1923 and 1924, and by scarlet fever in 1924
and 1925. The epidemic gave us an opportunity to instruct in a very
practical manner the source of infection, the transmission and the prevention of disease. That the latter is really a matter of individual
responsibility was brought home to the pupils as each new case developed.
The Nursing Service includes the usual work, obstetrical and other
bedside nursing leaving little or no time for child-welfare work. The
results of the prenatal service is very satisfactory, co-operation with the
doctors making it possible to report ..to them any unfavourable symptoms
The teachers appreciate the literature we have for distribution very
much, and requests have come to us for literature from teachers outside
of the city, where as yet there is no Nursing Service.
We cannot speak too highly of the interest and kindly understanding
displayed by our Boards, an interest that never fails, even though we
sometimes feel that the results are slow. The doctors, dentists, the
different Service Clubs and all the societies interested in the welfare of
the public support our work, and thus we feel that the future holds great
possibilities for the results of the last years' educational and practical
A. A. Lee.
M. J. Woods.
The physical examinations conducted in the Kamloops schools last
winter revealed, as usual, the glaring need for dental attention. Something should be done, and that right early. When approached upon the
matter the dentists willingly agreed to conduct a survey among the school-
 children. They spent on an average of probably three or four hours each,
and the statistics thus obtained were startling; .87 per cent, of the
children showed dental defects, and of these 66 per cent, had need of
attention in their permanent teeth.
On completion of the survey I was informed that the School Board
were having a meeting in a few days to make up the estimates for the
year. This left little time to prepare a comprehensive report which at
the same time would prove convincing. However, after its presentation
to the School Board, that body considered a school dental clinic so necessary, both from the health and from the economic standpoint, they
unanimously appropriated funds to provide equipment for a permanent
dental clinic; also sufficient funds to guarantee a dentist's salary for the
first year.
Unfortunately for the welfare of the clinic, the School Board's
estimates far exceeded those of previous years, with the result that the
City Council were thoroughly opposed to the extra expense that a clinic
would involve. For the following three weeks "Dental Clinic" was
freely discussed. It became the favourite topic of conversation on the
streets and a number of letters were published in the local paper | Re
Dental Clinic." The proposed plan did not lack advertising and parents,
I believe, were strongly in favour of its being carried out. Unfortunately
a few prominent taxpayers strenuously fought the plan by means of public
letters. These letters revealed the fact that there were a number of
misconceptions regarding dental clinics in general. There was much talk
of a 1 free " clinic. Strange rumours of mollycoddling were cast abroad
and great stress was laid on the big burden the taxpayers would have
to assume yearly. And this in face of the fact that full explanation was
given in the report, which in turn was sent to press by the School Board.
A combined meeting of the Council and School Board was held to
consider the estimates. The Council, feeling convinced they were voicing
public opinion/, brought the strongest pressure to bear against the School
Board's actiorkin endorsing the establishment of a clinic. Although the
latter had it in their power to stand by their first intention (funds for
a school dental clinic being, according to school law, an ordinary expenditure), the opposition was so strong they decided to cut down on the
equipment, but still retained the amount for the dentist's salary on their
The only alternative now was to find a dentist who would do the
work in his office; or, failing that, each man take a share of the work.
This, as Dr. Young suggested, would create favourable public opinion
and be a stepping-stone to the establishment of a proper dental clinic.
Great disappointment was felt when the dentists could not see their way
clear to carry out the suggestion, and now plans for a dental clinic must
be shelved until the time is ripe to bring them to light again.
In looking back upon the efforts of the past few weeks, it is given
one to see where proceedings might have been different and to advantage.
Nothing big is accomplished in a day. The vast majority of people are
conservative and fight stubbornly against the invasion of a new idea,
 especially when they are confronted with it suddenly. It looks strange
and, because strange, alarming. But Avarn them of its approach; talk
it over with them; point out its fine qualities; soften its alarming
features with reason; then when the stranger arrives the door will be
thrown wide and the idea, now no longer new, will be welcomed as an
honoured guest.
It was the intention to adopt this method with the clinic idea; to
go about quietly with a view to making people anxious to accept the new
institution by making them realize how worth while the results would be.
Unfortunately, or in this case it may be fortunately, the School Board
meeting to consider estimates was held at the time and the matter was
rushed to a climax, with a view, to saving time. We shall not regret
what has taken place, for I clinip " has been discussed and rediscussed
among large numbers who ordinarily would never give it a passing
thought. Hope is still vei-y much alive and we are looking forward to
having a dental clinic in Kamloops, and that in the very near future.
I wish to pay tribute to the manner in which Dr. Young rendered
assistance. Never once was I disappointed when I turned to him for
advice, and the encouragement I received always brought fresh hope.
Marion Fisher.
In order to keep the outlying sections of a community satisfied with
the service they receive, it is necessary to keep in mind the following
(1.) The residents have less actual contact with the world of affairs,
and for this reason probably have more time to think of the service they
expect and the service they receive.
(2.) They in all probability value the service given them more than
do the residents of the towns and cities.
(3.) There is a feeling (quite natural) in the outlying sections that
if the nurse is very busy (overworked) the outlying districts will be
the first to suffer, knowing that the nurse will attend to the need that
can be relieved at once.
(4.) The following points are to be remembered when working in a
rural district:—
(a.) Keep in touch with the health problems as they arise by organizing a local committee, the convener of which committee should be a
member of your Central Committee, and whose duty it is to report to you
at once any problem, such as an epidemic arising in the district.
(b.) Work for the close co-operation of the teachers and the members
of the School Board, as well as that of the resident doctor, if there is one.
(c.) Visit the rural school monthly, making your routine class-room
inspection, even if for some reason you are behind in your schedule and
it is necessary to postpone some important town work.
 (d.)  Get acquainted with the parents through home school visiting,    ,/
even when there are no defects to report; the parents will be glad to have
you tell them so.
(e.) Visit the local committee convener after making your monthly
visit to the school; give her a summary of the business transacted at the
last Central Committee meeting if she was unable to be present; also
visit at least one member of the local Board. Do not be afraid of wasting
time on co-operative visits; it is not time wasted, but time well spent,
especially in rural districts.
I. M. Jefpares.
The first of the public-health nursing students from the University
to come to the Cowichan Health Centre for her rural field-work was
Miss Hazel Brunker, who arrived February 15th. Since then Mrs. M.
Hyde and Miss Anne Hedley have spent two weeks at the Centre, and
Miss J. Campbell is expected on the 29th.
On February 28th the nurses at the Cowichan Health Centre entertained at luncheon in their quarters, the guests being Miss Morrison,
President of the Alctoria Graduate Nurses' Association; Mrs. Osborne,
Victoria School Nurse; Miss McCormack, of the V.O.N., Victoria; Miss
Buckley, Victoria Dental Nurse; Miss-Florence Fullerton, Saanich Health
Centre; Miss Woods, Nanaimo School Nurse; and Miss Davie, of Lady-
smith. After lunch the visitors were taken for a drive through the
rrinted by  Chakles  F.  Banfield,  Printer  to  the King's  Most Excellent  Majesty.
    T„ OF- NURS    G &
Public Health Nurses' Bulletin
Vol. V
APRIL,  1926
No. 3
PBOGBESS and improvement are proven by the evidence of actual
accomplishment. The truth of this statement, if applied to public-
health nursing, is shown by the subject-matter of the papers that have
been furnished by the Public Health Nurses of British Columbia which we
are able to publish in this the third number of the Bulletin.
As the work is carried on day by day the difficulties encountered seem
to be without end and one begins to feel very much like the man who
I could not see the forest for the trees."
In reading the papers submitted, the orderly arrangement of the trees
becomes apparent and one realizes that it is through orderliness and
steady growth that the forest becomes possible.
Sunshine is breaking through the foliage, the shadows are disappearing, the ground is drying, and progress along the road to health is being
The progress is very evident when comparison is made with previous
issues of the Bulletin. It is quite apparent that difficulties are being
overcome, the scope of the work is being enlarged, and as the development
proceeds the nurses are unconsciously learning that real success can only
be obtained by utilizing every avenue of approach toward the formation
of a curriculum, the object of which is the establishment of " health
habits." In other words, they are learning that a better balance in health
services can be maintained by generalization than by specialization.
Norman B. Carter, D.D.S., called the attention of the Provincial
Board to the necessity of attending to the dental work in a number of
small schools in his district on the Arrow Lakes. We were only too
glad to co-operate and we wish to express our appreciation of the manner
in which Dr. Carter handled the situation. At a small cost and with a
great deal of personal inconvenience, he went through and we are very
thankful that the children have been taken care of. We are also thankful
that we have found a gentleman with a sense of public duty, through
whose representations the Board was able to act. We are publishing two
articles in this Bulletin from the Doctor's pen.
The Provincial Board of Health is very conscious of the hearty cooperation that it is receiving from the nurses of the staff. We are building
up a personnel of which any department may be proud.
In addition, our efforts are to be supplemented by the direction and
advice of two outstanding figures in public-health work. We are fortunate
indeed in the fact that the University of British Columbia has added to
its staff Miss Mabel Gray as Assistant Professor of Nursing and Dr. W.
H. Hill to be Professor of Bacteriology, Health and Nursing.
Miss Jeffares, of Duncan, is the responsible Editor for this issue,
Editorial  1
Conservation op Children.    By Katherine Glover   4
The Public Health Nurse at Keremeos.    By Olive K. Gawley, B.N. 6
School-work in Armstrong.    By P. A. Charlton   8
Greetings from Pioneer Sayward.    By Edith M. Walls   9
Esquimalt Bural Nursing Service.    By H. Kelly, B.N  9
Qualicum and District.    By H. Murray, B.N  11
Public Health as a Career.    From the " New York State Bulletin " 12
Problem op Mouth Health among Children in Bural Districts
op British Columbia in Belation to Public Health Nurses.
By Norman B. Carter, D.D.S  12
Public Health Nursing in Ladysmith.    By S. A. Hewertson, B.N... 14
Kamloops.    By J. Campbell, B.N ..—  14
Dental Clinic for Bural Schools in Arrow Lakes District.    By
Norman B. Carter, D.D.S __  16
School Nursing in a Mining Town.    By Jean A. Dunbar  17
The Public Health Nurse at the Fall Fair.    By M. B. McClung,
B.N I  18
Fall Fair Exhibits.    Bv I. M. Jeffares   18
(American Child Health Association, 370 Seventh Ave., New York, N.Y.)
Governor Pinchot, of Pennsylvania, the great advocate of conservation,
said in a May Day proclamation last year: | Children can be consumed
as well as trees. No one with any sort of common sense or patriotism
questions the essential wisdom of the conservation policies initiated by
Theodore Boosevelt, which first were restricted to the natural resources
of our country, its forests, its coal, its oil, its minerals, but which gradually have broadened. It is inconceivable, therefore, that any one will
question a still higher form of conservation, the conservation of the health
of our children. The babies of to-day will, in a generation, be the manhood and womanhood of America, guarding its ideals, controlling its
destinies. It is a duty than which nothing can be plainer, to give at least
as much thought and care to these children as we do to our natural
wealth.    No substitute will ever be found for healthy children.".
We have come at last to that highest and most fundamental economy,
the conservation of our children. Ellen Key, the great Swedish writer
and philosopher, at the opening of the twentieth century christened it
I the century of the child." The first quarter of this century has rounded
to a close, and, pausing to reckon its achievements, nothing stands forth
more conspicuously than the changes it has brought in the lives and
prospects of children, the efforts which have been inaugurated looking
toward the conserving of child life and happiness, the changed attitude
towards the child.
In these twenty-five years we have cut the hazards of life for the newly-
born child in half. Where two babies died at the beginning of the century,
only one dies now.
Largely due to the increased protection of children in the early years
of life, the average span of life has been lengthened by nearly ten years
within the past twenty-five years.
A new protective government machinery for promoting the health of
children has been set up in the Children's Bureau.
An appropriation, jointly Government and State, for the protection of
maternity and infancy, created through the Sheppard-Towner Act, is a
concrete acknowledgment that our children need care, study, and protection, as well as our agricultural resources.
Public Health Boards, newly roused to the need to conserve human
health, are turning their attention to the group where the greatest danger
and the greatest hope lie—the children.
In our schools education has expanded to include the physical needs
of children as well as the mental.
It is in keeping that, at the close of this first quarter of a century,
which has accomplished more to ensure the rights of children than innumerable centuries preceding it, there should he launched a festival day
to celebrate all that has happened and to look forward to greater achievements.    That is the significance of May Day for Child Health, a national
festival of childhood.
 May Day, 1926, is the third of these celebrations. Each year has
marked a decided increase of momentum and each year leaves a permanent deposit of encouragement and constructive effort. This year attention
is focused upon the perfect child. Every community through the country
is urged to examine into the well-being of its children, to see them in comparison with perfect childhood, and to set in motion some endeavour
which looks towards that goal.
These are a few facts which should arouse us to national and local
efforts to conserve child-life.
Of the 1,500,000 of our population who die each year, it has been estimated that 42 per cent, die from preventable causes. This waste occasioned by this preventable loss is estimated at a billion dollars.
Forty thousand school-children die each year from causes which are
There are 400,000 cases of typhoid fever each year, 10 per cent, of
which are fatal, and 75 per cent, of these cases are unnecessary.
Diphtheria, which is considered preventable and for which there has
been a curative for thirty years, takes the largest toll of death among
children of any of the five common communicable diseases.
Of all crippled adults, one-third receive their injuries during the first
six years of life and a very large percentage are needlessly handicapped.
One hundred per cent, of all mental defectives are recognizable during
the first six years of life.
Besides the clarion message, "May Day is every child's day," which
was carried in parades and pageants, the May-pole programmes, through
the radio, the press, proclamations of the President, and of governors and
public-health officials, these are some of the unusual things which communities did last year as.a result of May Day:—
Forty thousand citizens of one city waked up on May 1st to the greeting on the caps of their milk-bottles: " Good-morning; this is child-health
All mail from7 the Board of Health in one State for a month carried
the slogan: " The-first of May is every child's day."
Throughout one State the committees appointed for May Day resulted
in small committees to form a permanent nucleus for the protection and
promotion of the health of children.
Several communities in the same State set themselves upon baby hunts
for the year 1925-26 to check up on its fundamental human book-keeping
and to discover the needs of their babies.
fijl Department stores in various parts of the country held baby weeks.
In some stores a thousand or more babies were examined by doctors and
nurses and many thousand mothers received guidance on the care of their
In one State a beginning was made to get local committees to present
to the people of their communities an exhibit of the services which are
available for the health of children in their communities, with the idea of
following up through the year with a study by a careful group in each
district of the health needs of the children within their district.
 Another State started on a campaign to make every day a child-health
day by issuing a.Child Health Club card. Any child whose parents promise
to have him examined periodically and to use every effort to correct defects and bring about better health along constructive lines may become
a member of the club.
In another place a Health and Happiness League was inaugurated.
In others drives were started to round up the pre-school children and
see that they are a hundred per cent, fit before entering school.
May Day was, in fact, a great national rally day in this new human
conservation.    It will be a greater rally day this year.
Mr. Hoover has said: :■■ Each year the results will double until it has
become a national habit, an almost subconscious impulse, to remember
the child wisely, constructively, from the day that parents are born until
the day their children become parents; that is, always. Then no words
of any one man or woman will be necessary in defence of the nation's
will that its children shall be well."
Katherine Glover.
My long experience in public-health work in cities, towns, and rural
sections of Ireland and British Columbia comes to my assistance in answering the following questions asked me by nurses and others in British
Jn cities and large towns there are many organizations of infinite value
to a Priblic Health Nurse in her work, and no matter how strenuous it
may be, it is a sinecure compared with the duties of a rural nurse, who
so often must take the initiative in many activities in her district.
All Public Health Nurses should be blessed with the three virtues,
Faith, Hope, and Charity, and remember the greatest of these is Charity;
but she must have Hope and she must have Faith, and she need not expect
Charity. She is an outsider (I write now of the rural) whose presence
may be resented, whether young or old, staid or gay, pretty or plain (we
have no ugly nurses).
She is a public servant sent to that district by request of the majority
of the people, but the minority (until they require her service in trouble
or illness) may consider her upkeep a waste of good money.
She must remember that every move is noted and criticized either
favourably or otherwise, according to the spirit of the critic.
The private-duty nurse also considers the Public Health Nurse usurps
her place, forgetting that 99 per cent, of the cases would be undertaken
by untrained help. The medical profession are conservative and, as at
the beginning of district and other forms of nursing, were prejudiced.
However, they are gradually getting to know the help a Public Health
Nurse may be to the Medical Health Officer as well as to the man in
general practice.
There are cases that must be transferred to hospital; still, I believe,
two-thirds of the patients treated in institutions at the present time could
 with the supervision of a Public Health Nurse be cared for in their own
homes at a minimum of cost to patient and community.
When we realize the anguish caused by separation of families, it
surely must be a detriment to the perfect peace of mind necessary to our
invalid's welfare.
Our people must know and understand much more than they do of
illness and its causes and prevention of complications, but are we doing
our share in this? Do we consider ordinary men and women capable of
nursing a serious case, such as typhoid, pneumonia, or even a minor
operation ? I fear we do not; but to my personal knowledge serious cases
have been nursed successfully at home, with the supervision of a Public
Health Nurse and the co-operation of a physician or surgeon, at about
one-sixth the expense, which alone is quite a consideration to many householders at the present time. One such case will do more to gain friends
for our work than " yards of speeches " and the nurse's advice and help
will be sought by old and young; even the black sheep of the district will
learn to respect her and to come to her for sympathy and advice.
Olive K. Gawley.
1. What is a Public Health Nurse?—A graduate nurse, who afterwards has a special training in prevention of disease and the care of the
mentally, physically, and morally ill.
2. What are her duties?—To do all in her power, by precept and example, for the good of the community in which she works, the prevention
of disease, and the alleviation of suffering.
3. Is it necessary for a highly trained, competent nurse to take special
training before attempting public-health work?—Yes. The hospital and
private-duty nurse is trained to personally care for the patient or constantly supervise the work of probationers. The Public Health Nurse
must teach untrained assistants, who may never find it necessary again to
care for the sick, in order that they may for the one particular case.
4. Should a nurse on the staff understand the financing of the service ?
5. Should the nurse of higher capabilities be sent to the rural or urban
districts?—The nurse with the very best training should be sent to the
rural district, as in many cases medical and surgical assistance is scarce
and the nurse must take responsibility, owing to lack of adequate transportation and oftentimes poor roads.
6. Why do many capable Public Health Nurses object to rural or smalltown work?—Want of congenial companionship, very poor housing accommodation, with few modern conveniences to be found in the homes.
Also inefficient transportation and a general prejudice among the people
to any innovation that is hard to combat.
7. What is the best means of financing the service?—Provincial health
tax and school tax.
8. Can a Public Health Nurse in a district prevent higher taxation,
and in what way?—Yes.    By prevention of epidemics; by prevention of
 semi-invalids, who are so through" preventable diseases; by prevention of
waste in educational benefits caused by defects that may be remedied or
prevented; by child-welfare or prenatal service, including the prevention
of abortions, which often are the upshot of the dreaded expense of childbirth.
9. Why should a Public Health Nurse expect the highest salary in the
profession? She has a wider education, more responsibilities, and more
strenuous work and nerve strain than any other nursing section.
10. Why should the Christian churches take an interest in Public
Health Nursing?—The greater part of the ministering of Christ was
shown in helping those in trouble and distress, in healing of the sick, and
the care of the children.
11. If mothers are indifferent to nurse's advice, should visits be continued in that home?—Yes, in a-social way, always remembering that, no
matter how hard the ground, some seeds will germinate.
Olive K. Gawley.
One of our greatest problems is the large number of malnourished
children. Why this condition should exist in a district so far famed for
its dairy and vegetable products is hard to say. Probably the long truck-
drive, necessitating the children to start out at an early hour and arrive
home in the early evening, has something to do with the condition.
Quite a number have had defects remedied and already show great
improvement. We hope to hold a tonsil clinic in the summer and we are
already planning a two-weeks' outing for those who would not otherwise
get a change.
Since the New Year a hot drink, cocoa or soup, has been served to the
pupils staying for lunch.
Nutrition classes have been started. In the junior rooms they are
having rest, milk-drinking, and vegetable-eating competitions. Some of
the teachers have devised various devices for adding zest. In one room the
underweight pupils have pasteboard houses which they are shingling.
Each shingle is shaped like a milk-bottle and represents a quart of milk
taken. In another room a mountain-climbing expedition was started, the
pupils making the climb from Danger Valley to Safety Peak. Some of the
pupils have gained as much as 6 lb. in one month.
It has been harder to interest the senior pupils, but quite a marked
improvement has been made since they have made graphs, on which they
keep their weekly record. A prize has been offered, to be given the last
of June, for the graph showing the best record and result.
In September 72 per cent, of the pupils were underweight. At the New
Year this rate had decreased to 43 per cent. Although this is but a step
in the right direction, there is a long road to go yet and the goal can
only be reached by untiring effort and interest.
. P. Charlton.
Time changes all things. It is now four years since I was appointed
Health and District Nurse for Sayward, and in place of past opposition
and ignorance of my work I now feel that the majority of the residents
realize I can be of assistance to them and apply to me for help from
time to time.
In the two schools in Sayward we have Health Chore Crusades, the
children receiving marks for the " chores " attended to daily; a prize
being given at the end of the term to the one receiving the largest number
of marks.
Wishing my fellow-workers the best of luck in their various undertakings.
Edith M. Walls.
Previous reports have dealt chiefly with the inauguration and aims
and objects of this association, the area covered, and the difficulties met
with in establishing the service, etc.
In this report I propose to deal with the growth and development particularly, though it will be necessary to go back at times and refer to
early difficulties in order to show clearly the comparison between now
and then.
We are still faced with the difficulty of " rendering account," although
there is quite a different spirit existing now among the more intelligent
people—those who are observant and who carry an open mind and are
prepared to listen and learn.
To render account in public health is a difficult matter, and seeing that
our capital comes from the public it is only reasonable to expect that we
should be prepared to render an account of our stewardship. As far as
the expenditure of the money entrusted to the officers of an association
is concerned; an accurate account can be given, but the real and actual
returns for the investment cannot be put down in black and white; they
are only materialized in the improved health of the district in which the
service operates.
Such things as the development of right habits of living, the breaking
of wrong habits, and the eventual evidence of the benefits of a public-
health service are of naturally slow growth. Therefore for the first two
or three years after the inauguration of such a service- the committee in
charge have a hard road to travel, and are often faced with the question,
" What are we getting for our money? "
It takes a considerable time to educate the people to the fact that a
Public Health Nurse is not merely there to attend the sick—she is there
to teach the people not to be sick, but to obtain health and keep it.; but
they do become educated in time, though much patience and perseverance
is necessary for a time. Of course there will always be the few who refuse
to see, but luckily they are in a comparatively small majority and merely
serve as an incentive to better work as a general rule.
One notices with gratification the different outlook of the parents towards the work of the nurse. At first the natural question in reply to
the information of the child that | nurse came to school to-day " was,
I Why, who is sick ? " But now it is, | What has the nurse been teaching
you to-day ? " Then take the prenatal work. How many young mothers-
to-be have said to me after I have visited them and talked with them,
I Why! I didn't know; I had no idea that I could do—or fail to do—so
much for my baby." What a different aspect is put on the case when, instead of ignorant, if well-meaning, commiseration and " you poor thing "
from sympathetic neighbours, the expectant mother receives a visit from
a cheerful nurse and hears: "You glorious creature, what a wonderful
thing is going to happen to you. I wonder if you realize how very important you are and what you are responsible for." And then, by carrying
out the nurse's instructions, in reply to inquiries over the phone the
answer is given: " A fine baby; yes, mother and child doing well." And
this part of the work is fully realized by the people in the districts covered
by the above service.
Then the careful watching of the care of the infants; the children
of pre-school age; the school-age children and the budding youth. All
this comes under the heading of " Public Health Nursing." All this ?—
and how much more?
In January of this year we held our sixth annual meeting and the
growth and development of the service has been remarkable. The people's
money has been handled economically, good service has been given, and
their confidence won. In the five schools in my district the trustees and
teachers give excellent co-operation. The children enjoy and take a keen
interest in their health drills and exercises and my Girls' Health Clubs
continue to be a great success.
This year—in May—I am co-operating with the teachers in staging a
children's pageant; this will be on quite big lines and my part of it will
be the health side. As many of the children of my districts as possible
will take part in this pageant and the people will be given an opportunity
to-see the value of health-teaching.
Two dental clinics a year are held, which means an examination of
the teeth of all the children in the five districts comprising"the E.B. Health
Centre. During the midsummer and Easter vacations all the children
whose teeth need attention, if the parents are willing for the work to be
done under the auspices of the service, receive expert attention. And we
find that the two clinics per .year are sufficient and keep the cost of administration down to a minimum. Of course, each month the nurse ex-
\ amines the teeth of the children at her monthly inspection, and any work
necessary is done by the regular dentist at his office in town, the nurse
transporting the children to and fro. Thereby the teeth are kept in condition and the foundation of good health laid.
Slowly but surely the public are being weaned from their conception
of the mission of a Public Health Nurse. The mental vision (so ofttimes
even pictured) of an I Angel of Ministry cooling the fevered brow of the
sick I sort of person cannot continue to exist in the face of the busy,
healthy-looking, health-teaching nurses out in the field in public-health
 work. Instead we have the vision of a teacher teaching health exercises,
toothbrush drills; teaching the value of supervised play, exercises to develop the lungs and muscles and bone of the growing child; teaching the
mothers how to teach the children, and getting her reward in the demonstrated confidence of the children and parents and the evident improvement in the general health of the districts in which she works. The upkeep
of a Public Health Service is really an insurance against sickness, as by
the visit and a word of advice in time from a competent and qualified
nurse often a serious sickness is averted, because the nurse knows and will
advise the calling-in of the family doctor immediately when necessary;
therefore the answer to the question, I What are we getting for our
money?" is, "In so far as possible, an insurance against sickness."   *
My conception of an ideal health centre is somewhere where the children gather to play under proper supervision, where the mothers will come
for advice, where health club meetings can be held; in fact, a training
centre for health where anything even suggestive of sickness is strictly
taboo. I do not think that the day is far distant when this conception
of a health centre will be more or less general. For my own part, with
regard to my own work, that is my aim, and I am pleased to say that I
am backed by my committee.
H. Kelly.
Here we have a newly organized | public-health district." Less than a
year ago several hundred people around here did not know or have any
idea what a Public Health Nursing Service represented, but now everywhere one hears of our Health Nurse and daily new questions arise concerning the work.
I am very fortunate in having a strong committee who are interested
in all welfare and health work, perhaps more particularly in that branch
which deals with disease prevention.
Just recently there were a few cases of scarlet fever in a district not
far from mine, and the watchful eye kept on the school-children of my
district, as well as the visits paid to absentees, appealed to many members
of the community who had up to then been indifferent.
The day's work is considerably varied in a rural district; for instance,
we start out in the morning to see a delicate and sickly baby who is cared
for by a young and inexperienced mother. The little mite seems to recognize the uniform and manages a sickly smile. You may be sure any instruction and advice given is very welcome here. While in that corner of
the district there is a wound to be dressed. An unfortunate man has
badly mangled his hand in some machinery at the mill, and as the doctor
lives in a town some 30 miles distant the District Nurse has been instructed to do the dressing.
Probably we have planned to do a school examination after the last
two calls, but on phoning Central find that a prospective mother requires
our services at once, and so off we go in the opposite direction, thinking
of the old saying, " The best-laid plans of mice and men, etc."
 The quickest and best results are perhaps to be found in the schools,
the gradual decrease of physical defects going far to prove the value of
pre-school and school supervision.
H. Murray, R.N.
Choose a public-health career for two reasons only—because it attracts
you and because you believe yourself fitted for it.
You have broad technical knowledge. Give others the benefit of it, but
only as occasion requires.
Official representatives of the people and the people themselves may
not understand public-health work, but frequently possess other knowledge which may be of service to you.
Maintain your dignity at all times, but do not stand aloof from human
Make many friends, but few intimates.
Be a good listener, but not too ready a talker.
Practice public speaking. Eloquence is a rare gift, but is not essential
to the command of respectful attention.
Be loyal to your associates and true to yourself.
Never permit political sympathy to influence an official act.
Be not oversuspicious of evil intent. Give every one the benefit of a
Be willing to grant favours to all those that seek them worthily, provided that it is not incompatible with the performance of your sworn duty.
Have vision, but not be visionary.
Lead the procession always, but look behind once in a while to see if
you are being followed.
If you cannot obtain all your objectives, take what you can get, and
try again.
Know when you are beaten, and take your defeat gracefully.
Be willing to compromise in order to reach an objective, but never
with your conscience.
Frankly acknowledge a mistake, but do not make it a second time.—
From the " New York State Bulletin."
The pain and trouble, the lost time in the school-room, the impaired
digestion and general irritability of the child with toothache is obvious to
you all. The after-effects evidenced in crooked and ineffective teeth, in
rheumatism, in heart-troubles, in dental bills for restorative operations,
and general susceptibility to infectious diseases are being generally recognized.
The answer is prevention.
 Get these children to the dentist as soon as possible. As a rule, if the
child has toothache the mischief is already done, there. Prevent the
trouble. Stop it before it starts. Carry this message, personally wherever
possible—congratulating the child that evidences a well-kept mouth and
kindly admonishing the many who require it. Your words and your
occasional visits are much more momentous things to the little child than
you dream.
Instruct and encourage the parents; giving information about the
sixth-year molars, the loss of which is so general and such an appalling
matter. Show them the importance of continually keeping after their
little ones to brush their teeth with some intelligent thought; appeal to
that universal desire in parents that their children have opportunities
superior to their own, and urge that existing faults be remedied by the
dentist at the earliest opportunity.
The teacher's influence in the school is probably greater than any other
outside the home, and fortunate indeed are those children who have an
aesthetic example given them there. Stand back of the teachers with
health talks, distribution of health cards, samples of dentifrices, etc., at
the psychological moment, and through them act and talk always as
though the dental clinic and the dentist's services are happy and most
desirable privileges.
Prevent mouth-troubles by urging cleanliness and having the mouth-
tissues in such shape that vigorous use can restore tone and comfort and
At the present time we believe that the entrance to our bodies is best
cleansed by the use of a toothbrush; what is used upon the brush is of
less importance, although a dentifrice makes the toilet a more pleasant
task. One can brush the teeth a great deal without cleansing them. Watch
this and see that the brush is intelligently used. Use lots of water, rinsing
and regurgitating this back and forth till all signs of dentifrice or food
debris disappears. The important time to do this is previous to retiring
at night, but urge that it be done after meals or Whenever the children
realize that the mouth feels unclean. Appeal to them to have the inside
of their face as clean as the outside, or that their teeth be cleansed as
often as the dishes and other utensils connected with meals. Children
get this idea, I find. The point is, Repeat it; stick to the repetition; don't
be discouraged; by so doing you prevent these troubles before they start.
But, if they have started, perhaps these hints will be of benefit as a
matter of emergency relief: Tincture of iodine used as a counter-irritant
on the gum adjacent to the aching tooth will help. Dry the gum a little
and wrap a wisp of cotton around a toothpick to make the application.
On a tooth which cold affects, and possibly aching after eating, where
the trouble seems to be from a living nerve-pulp—clean the cavity of
debris, if possible; apply a little ball of cotton about the size of a pin-
head, dipped in oil of cloves, and cover with a larger piece of cotton.
Where the face is swollen, aching perhaps at night and upon lying
down, with hot drinks, etc., hurting, use beechwood creosote, as before,
on cotton.
When in doubt use creosote.
 Don't apply heat to the face; no hot-salt bags or hot-water bottles. If
you must use heat, give a hot foot-bath—that will help. Do this and give
ispirin in small doses if the person is in agony. And don't forget a good
sathartic, one that will make a watery stool; not a lubricant like oils,
but Glauber salts, Epsom salts, fruit salts, etc., given in medium doses,
but over a longer period than you think necessary. Have the patient
drink much water.
But the best way to cure toothache is to prevent it before it starts-
get that point over and the problem of mouth health among all mankind
is well faced indeed.
Norman R. Carter, D.D.S.
Ladysmith being a mining town, practically all the men are employed
in the mines and a deduction is made from their salary to take care of
the hospital and medical treatment.
Apparently this is the reason a great many are opposed to the idea of
a Public Health Nurse for the town. The nurse, however, is gradually
being appreciated, especially in the control of infectious diseases. The
children being inspected monthly, any case of suspect infection is reported
at once to the doctor and the child excluded.
Much pleasure is derived from home-visiting, as this gives the parents
an opportunity of asking for advice and discussing the minor defects of
any other members of the family.
The majority of the children are showing an increased interest in
their personal appearance by keeping their teeth clean and by living up
to the Health Rules. This is perhaps more noticeable in the rural schools,
where children of all ages are in the same class-room.
S. A. Hewertson, R.N.
The pleasant first impression one receives of this little town is a lasting one, and especially is this so in fall, when the homes are covered with
crimson Virginia creeper and lawns and boulevards are still fresh and
green owing to an excellent irrigation system, whilst the background of
brown foot-hills covered with sage-brush helps to enhance the vivid colourings of flowers and lawns.
The Medical Officer of Health is also school doctor and I had already
met him, but to become still better acquainted with the work in the city
I visited all the doctors, six in number.
They were exceedingly friendly and offered their services whenever
necessary, but also informed me there would be no bedside nursing re-
 quired, adding I would find plenty of other work to do, especially in the
Why no bedside nursing? The reason was not far to seek. This is a
railway town and has an excellent hospital with a training-school. The
doctors look after the employees and their families under a special agreement with the railway companies, and under the same agreement the
employees have a certain amount of hospital facilities free.
With a population of about 5,000 one naturally would not expect £
large school enrolment, but in the public schools there are 1,000 children,
whilst a number of children attend the Convent and private school.
I soon found there was much to be done along health lines in the
schools, and as the classes are somewhat divided up owing to lack of
accommodation, one school having classes in three buildings in different
parts of the town, it meant much walking and dividing-up of time when
making out a time-table.
Teachers and children take a great interest in their health-work, with
the usual few to make the exception, but a more congenial and co-operative group would be difficult to find.
The same may be said of the parents, perhaps the enthusiasm of the
children helping to some extent, for the home-visiting is one of my
pleasantest duties.
The girls in. one class have for two months in succession gained 100
per cent, for having all physical defects attended to, their record for
cleanliness also being 100 per cent., whilst the boys gained 98 to 99 per
cent.; those who had brought down the record were turned over to the
others to see what could be done with them during the ensuing month.
Of course life would be too easy if all classes were equal to this one.
A little girl who is especially neat and clean one day informed her
mother that she was going to take a holiday from the cleaning business.
Her mother was rather astonished and asked the reason. Well, the nurse
would not be in their room for a day or two as she had counted the rooms
so she was going to have a rest. Her mother cautioned her and explained
that it wasn't specially for the nurse that she formed health habits; but
no, off she went. On her return that afternoon she was rather crestfallen.
Having forgotten the morning incident, her mother was much surprised,
on inquiring what was wrong, when the little one answered: | Mother,
you are disgraced for life and I'm disgraced for life, for the nurse did
come to our room and brought the doctor with her and he just pointed
at my finger-nails."
A very pleasing feature of the work is the well-baby clinic, which is
held under the auspices of the Red Cross Association. The mothers appear to enjoy coming and meeting each other and comparing notes about
their babies, and I believe more than one good friendship has resulted.
I also find this a good opportunity for having little chats with the
mothers about some of their children who are not of school age.
The Kamloops Junior Brotherhood does much to develop the sports
side of the children's lives, emphasizing that sport must at all times be
clean throughout and their record as basket-ball players shows the effect
it has had upon them.
 Almost every one in the town belongs to a society or lodge and much
good work is done by the members of these various associations, but I feel
sure that if a Parent-Teachers' Association or Women's Institute were
formed much could be done in getting school and playground equipment
that would be of great value to the children.
Meanwhile Kamloops, with its clear air and bright sunshine, remains
a very delightful place to live in.
J. Campbell, R.N.
During the past summer (1925), thanks to the Provincial Board of
Health, a dental clinic was made available to the children in this area.
There are sixteen schools, with from eight to twenty pupils in each,
distributed along a lake of about 120 miles.
In June a preliminary survey was undertaken, estimates made, and
examination cards sent to parents, who were asked to pay one-third of
the expense involved in doing the required dentistry for their children.
In September and October the dentist visited each point by launch,
staying the period required to complete the work for those desiring it;
setting up his equipment in the nearest available point to the school—
sometimes in the living-room of a ranch-house or a summer-home verandah,
the meeting-hall of the Women's Institute at one place, and. once in what
had been the bar-room of a country hotel.
The children were excused by the teacher in couples as a rule; the
pupil with work completed sending back another on his return to the
school-room.    In this manner we disturbed the classes as little as possible.
When the work of each school was completed the dentist distributed
literature and addressed the school on mouth health and care of the
teeth. On account of his personal contact with each individual present,
this was an ideal occasion and the message was put over in a very intimate and effective manner. Hardly any of these children had ever been
attended by a dentist previously. As a rule they came to us absolutely
unafraid, and despite the fact that often their work was of a most exacting nature we had no undue trouble with any of them. We found it best
to take first the youngest pupils in a group, doing deciduous extractions
and prophylaxis for them, calling the older pupils later, rather than the
reverse order. When the babies seemed to not mind it all, the older ones
were less apprehensive.
At some points the dentist was received by a committee and treated
like a hero; at others he would waste hours getting some one with a " go-
devil " to transfer his baggage. At some points the whole populace seemed
enthused; at others perhaps only the teacher or a single member of the
School Board were " leaven to the whole lump."
In two schools not a single.card was signed by the parents; in nine
schools all dards were signed; in eleven schools all scholars availed themselves of the privilege and all work was completed.
 Not 10 per cent, of these children had ever seen a dentist before, yet
we found a half dozen perfect mouths among them. To offset this, however, there were about a dozen children from 12 to 15 years of age whose
mouths were absolutely ruined, these requiring often more attention than
all the rest of the school together. We regret to say that it was this class
of scholar (those who needed it most) who too often avoided the clinic.
However, outside of the direct benefit to the children, the dental clinic
has awakened a real interest in mouth hygiene. Often where only a small
per cent, of the parents signed cards, when the clinic actually presented
itself every one in the school came in as the work progressed. Inquiries
concerning another such opportunity are constantly coming in. May good
fortune attend this pioneer work.
Norman B. Carter, D.D.S.
Fernie is a mining town with a population of about 5,000, situated in
a valley along the south-eastern borders of British Columbia. My first
impression on arrival was one of absolute isolation, which feeling, however, gradually disappeared as I found the people, though about one-half
foreign-born, were both hospitable and interesting.
In Fernie we have 1,000 school-children, attending one large grade and
. high school and two primary schools at separate ends of the town. At the
first meeting of the School Board I attended it was suggested, among
several other matters, that perhaps it would not be wise for me to approach the parents on the subject of malnutrition. As there were a large
number of underweights among the children, I felt something should be
done until such time as it would be advisable for me to do so, and the
following plan was decided upon:—
After each monthly inspection I now divide the class into three groups
(when necessary) ; all of average weight and over receive white tags, those
from 1 to 7 per cent, underweight receive blue tags, and those over 7 per
cent, underweight receive red tags. T explain to the children in the
class-room what the different colours mean and have them repeat the
Cards of white all right,
Cards of blue won't do,
Cards of red, danger ahead.
I then urge them to see how quickly they c&n all receive white cards
and so compete with the other rooms in the school.
A Health Fairy's House.—In the junior rooms I have found that the
making of the Health Fairy's House is of assistance. It is made from a
sketch of a house built of bricks, with shingled roof and fancy windows.
The children are told the story of how the Fairy becomes beautiful by
keeping all the health rules, until the wicked witch 1 Ignorance " visits
Fairyland and burns the Fairy's house down. The Fairy's friend Happy,
the Health Clown, comes to the Fairy's assistance and together they plan
how the Fairy's house can be rebuilt, stronger and prettier; than ever,
 with the assistance of all the boys and girls in the schools keeping their
health rules. For keeping one rule a shingle is coloured on the roof of
the house, and for another a brick is coloured, and for still another a
coloured glass is put in the window.
We began in Fernie with one Fairy's Health House in a primary room
and now have seven. The teachers have been very much interested and
demonstrate this by inquiring each day how many have kept the Health
Rules the day before.
Jean A. Dunbar.
My I comer " at the Exhibtion was as much a success this year as
formerly. The comments were different, but still complimentary. I had
three different illustrated 1 Health Talks," "A Trip to Health land," | The
Story of the Fly," and a 1 Comparison of Two Homes." To illustrate the
latter, the boys of the Manual Training School made two houses, one neat
and clean and the other in a state of dirt and disorder. A large placard
was attached to these, asking I Which is jour Home?"
The material used to illustrate the 1 Fly Story " cost me little in actual
money, but a lot of thought and work. I had six large flies made of wax
and dyed some excelsior brown to look like manure. I placed a fly in
front of a manure-pile with a notice, | She has laid 100 eggs1 here." Next
I displayed maggots (made of white birthday candles) beside a small
manure-pile, together with some cocoons (brown jelly-bean candies). Then
some large flies, and a plate of food with a fly on it, a garbage-tin (a
baking-powder can) with garbage slopping over the top and the lid half
on with a fly on the edge. The last illustration of all and one that attracted much attention was that of .a doll in bed, representing a sick
person with a fly in the room.
The I Trip to Healthland " was much harder to handle, but the cost
was small and it made a pretty and interesting display. For grass I
dyed excelsior green.
M.. R. McClung.
The Cowichan Leader's report of the Cowichan Fall Fair held at Duncan, September 19th and 20th, 1925, included the following:—
"Health Centre Work.—In the hall was placed a neat exhibit arranged by the Health Centre nurses, Miss I. M. Jeffares and Miss E. S.
1 While simple in design, it presented a clear conception of the wide
scope of Health Centre work and was intended to correct the idea in the
minds of not a few people that the work of the centre is confined to
school nursing or some other limited branch of effort.
" A placard, ' Generalized Public Health Nursing,' defined in one caption the mission of the organization.    In amplification the figure of  a
 diminutive nurse was placed upon a table and from this ran tiny blue
streamers to various points on the background, where other placards set
forth the various phases of Health Centre activities: School-work, class
instruction in first aid and home nursing, social service visiting, tuberculosis visiting, bedside nursing, and child-welfare.
I Posters and health-books entered by contestants in the competition
for rural school children in the district conducted some time ago by the
Health Centre were also displayed, while literature on various topics Was
on hand for distribution."
The above excerpt from the Leader and the accompanying picture will
give any one interested an idea of the exhibit displayed by the Cowichan
Social 5ew/C£
Ch/LS WfiFAfff
School Wo/?k
Ffflfk/I/D.    W";
V/sirwe   ,
Health Centre at both Cobble Hill and Cowichan Fall Fairs. When we
were first asked to prepare an exhibit for these fairs it seemed impossible,
as our funds for such a purpose are almost nil. However, after some
consideration, we decided to exhibit the posters and books sent in by the
boys and girls of the rural schools in the | Good Health Competition "
held last term. We accordingly prepared a sign, 1 Good Health Competition," and under this grouped the posters and health-books. As the
majority of the poster prizes had been won by Cobble Hill boys and girls,
we arranged one complete section of the exhibit at that particular fair
with their work only, placing in the centre a sign reading, I The work in
this section was done by the boys and girls of Cobble Hill."   This special
 attention and display greatly pleased the children as well as the parents
of the district.
At both fairs we were congratulated on our exhibit and have the
satisfaction of knowing that very few attended without paying a visit to
the Health Centre exhibit, many being sufficiently interested to return
bringing their friends.
Printed by Charles F.  Banfield, Printer to the King's Most Excellent Majesty.
Public Health Nurses' Bulletin
Vol. 1
APEIL, 1927
No. 4
T"HE Public Health Nurses' movement in British Columbia bears out
the saying " Nothing succeeds so well as success." At the end of
four years' experience many mistakes can be seen by retrospection, but
one outstanding feature of the system is its success, as evidenced by the
adoption of the policy in so many districts of the Province.
That success has been dependent upon three factors—the trained
nurses, the interested public, and the Provincial Board of Health. Without the help of any one of these three factors failure is almost certain.
Naturally the system centres around the nurses engaged in the work.
The value of the services of each nurse depends primarily upon her
fitness, physically, mentally, and by training. Having these considerations in mind, it can be seen that only by experience can it be determined
whether a nurse is suitable for the work.
Every new recruit must commence work somewhere, just as schoolteachers have to do. The public can assist in making a success or a
failure of a nurse in her first field. Sympathy and co-operation may
accomplish the former, whilst only a strong character can withstand
unwarranted criticism and opposition.
From a disinterested view-point the Provincial Board of Health can
sense where a nurse has been remiss in her duty. It can also see from
reports or representations where she has not been accorded full support
by the voluntary organizations with which she has to co-operate in her
Under sujch circumstances a change may be beneficial both to the nurse
and the district without any reflection being cast on either party to the
nursing contract. Sometimes it is felt when a change is made that the
nurse has not been a jj success," but in reality the district may have
lacked that quality which it later acquires through experience, just as
the nurse gains her experience.
The existence of a Public Health Nursing system is an acknowledgment, however imperfect it may be, that health of the general public is
a concern of the community as well as of the individual whose economic
value is impaired by physical defect or organic disorder.
The papers we publish in this number are of exceptional interest,
and on perusal the nurses, more than any one else, will be conscious of
the greater interest that is being shown by themselves in the discharge
of their duties
The Provincial Board of Health believes that the Bulletin as a
barometer indicates fair weather and substantial progress for the future.
Miss Jeff ares, of Duncan, has again and very, acceptably acted as Editor.
Vancouver, B.C.
Department of Nursing and Health,
April 2nd, 1927.
Dr. H. E. Young.
Prorincial Health Officer.
Prorincial Board of Health, Victoria, B.C.
Dear Dr. Young,—1 wish to thank you for giving me the opportunity
of contributing a short article to the Public Health Nurses' Bulletin.
While no special subject for an article has presented itself to me, I do
wish to express an appreciation of the splendid work which is being done
by the members of the Provincial Board of Health Nursing Staff and of
the far-reaching aims of the Provincial Board of Health itself.
While the programme of governmental Boards of Health may be
primarily educational, yet as education begins at birth—and, we may
well add, before birth—any effective health programme must commence
with the care of the mother during the term of pregnancy and must
include, or see that provision is made for, adequate care at childbirth.
That such a complete programme ma}' be carried out in every rural
district in British Columbia is, I know, your aim. I know, too, that
I am expressing the opinion of the Canadian Nursing Association when
I state that the most highly skilled nurses will always be found ready to
assist in carrying out such a. programme. The aim of the nursing
profession is to provide skilled nursing service for all who are sick,
and we realize that it is only by such organization as that of the Provincial Board of Health that this service can be made available in rural
districts. Canadian nurses are proud of the development in rural public
health service, and appreciative of the opportunity given us to carry out
the objects for which our profession exists.
Yours very sincerely,
Mabel F. Gray,
Assistant Professor of Nursing.
Remarks.    By Dr. H. E. Young....  1
Letter of Appreciation.    By Miss M. Gray, Assistant Professor of
Nursing, U.B.C. !  .....   2
Solarium.    By I. M. Jeffares, R.N  1
Report of Progress, Esquimalt Rural Nursing Service.    By Helen
Kelly, R.N .... 1  I
Little Mothers' League Classes, as conducted in Saanich over a
Period of Five Years.    By Mrs. C. A. Lucas, R.N.....  8
Ladysmith.    By S. Hewertson, R.N !  12
Health-teaching in Armstrong Consolidated School.    By P. A.
Charlton, R.N  12
Public-health Work in the Kootenay Lake.    By Olive M. Garrood,
R.N  13
A Clinic Babies' Christmas Party.    By I. M. Jeffares, R.N  14
The Public Health Nurse in Fernie.    By Jean A. Dunbar, R.N  17
Dental Clinics.    By Norman R. Carter, D.D.S  18
Vitalizing Statistics in Saanich.    By Hilda Murray, R.N   19
Coombs, Hilliers, and Errington.    By Laura I. Jukes, R.N  20
Child-welfare Activities in Nanaimo.    By Margaret Wilson, R.N... 22
Public-health Work in Kamloops.    By Janet Campbell, R.N  23
Breast-feeding for the  Infants  of  Saanich  Municipality.    By
Margaret ~k. Griffin, R.N   24
School Nursing in Nanaimo.    By Margaret E. Kerr, R.N  27
School and District Work in Keremeos.    By Patricia East, R.N.... 29
Dental Service in the Arrow Lake District.    By Norman Carter,
D.D.S : I  30
Duncan Consolidated School District.    By Norah E. Armstrong,
R.N •.  30
For two years the residents of the Cowichan Health Centre District
have heard a great deal about a Solarium for crippled children and the
healing-power of the sun, especially when combined with sea-breezes.
Even before it was known that the Solarium was to be built at Mill Bay,
which is part of our district, funds were being raised by individuals,
and practically every organization in the district has contributed to its
support. When it was decided to erect the Solarium at Mill Bay we
appreciated the fact that we were in a position to see a practical demonstration of what can be done for the little cripples of British Columbia.
A very beautiful site was chosen for the Solarium; built on a slope,
it commands a most wonderful view -of Saanich Inlet, the well-timbered
shores blending in with the deep blue of the sea. The building itself is
long and curved, so that as long as the sun shines its rays will find
their way on to the wide verandah, which runs the length of the building,
and into the long ward just off the verandah. From a nurse's critical
standpoint the bath-rooms and wash-up rooms are a joy to behold. The
baths are low so that the older children, crippled though they may be,
will have no difficulty in stepping into them. Over the basins there are
small cupboards with compartments, one for each, marked with his
name, so there will be no danger of tiny toothbrushes, wash-cloths, etc.,
being left around or mixed up.
The children's combined play and school room, with its low fireplace
and many windows, is a cosy, comfortable room. Already there is a
good-sized library of children's books, and toys may be seen scattered
about, calling attention to the fact that while these little ones may be
handicapped physically, their mental development is normal. Should
any pessimist wonder whether the money spent on building and equipping the Solarium is justified, I should suggest that he take a peep into
this room, listen to the happy voices of the children, notice the healing-
rays of the sun pouring in, and remember that ills of the body heal
most readily when the patient is happy and contented, and I am sure
he will wonder no more.
There were nineteen children in the Solarium the day I visited it,
two weeks after it was opened. Many were bed patients, school was in
session for those able to attend, and those of school age confined to their
beds were busy, in as easy a position as was permitted, on their lessons
under the supervision of the teacher appointed to the staff. These
children came from all parts of British Columbia, some very badly
crippled, others to the unobservant eye not crippled at all, but in reality
badly handicapped physically and needing the healing rays of old Sol.
Isabelle M. Jeffares, R.N.
We are reproducing photographs of the Solarium in this issue.
The above service celebrated its seventh birthday anniversary at its
last annual meeting. It was inaugurated in the first place through the
machinery of the Women's Institutes, supported by a few progressive
residents, and to-day the Association stands—a welcome establishment
in the district, supported by five school districts in voluntary taxation.
The sendee is an example of what can be accomplished by patience
and perseverance by a small body of people striving to reach a worthy
objective, to help in a worthy cause, and staying with it. And there is
no worthier cause under the sun than the health of the people of a
One has only to read the reports of the Provincial Board of Health,
and note therein the reports of the School Medical Inspectors for the
past few years, to realize the value of a Public Health Service to the
communitj*. In the last Provincial Report it was gratifying to note
that in all of the five schools comprising this health district not one
child was found suffering from malnutrition, which was decidedly not
the case a few years ago. Despite the fact that odd cases of measles,
scarlet fever, and chicken-pox have been found at various times throughout the district, there has been nothing in the nature of an epidemic in
the health district since 1921.
This conclusive evidence of the value of follow-up work, which permits
of isolation of cases immediately and prevents the spread of disease, the
realization of the value of education along health lines and the resultant
improved health and vigour of the children, and the general value of
expert advice to parents has resulted in the service, from being looked
upon as an interloper and an unnecessary expense, through the period
of acceptance of a necessary evil—sometimes grudgingly accepted—to
becoming a service of which the district is proud. This is evidenced by
the type of men and women who constitute its Board of Council and
officers, all of whom are keenly interested in the work and whose motto
' is I Progress."
It is with much pleasure that I write of the splendid support given
me by the W'omen's Institutes in the district, the Farmers' Institute, and
the Boards of School Trustees. All these organizations are represented
on the Council of the Association, thereby keeping them all intimately
in touch with the work and bringing personal interest in the progress.
The support I now receive and the welcome with which suggestions for
improvement are received by the Boards of Trustees, which differ so
greatly now from when the service was first organized, is worthy of
comment. Before the health district was defined as it is to-day, the
first nurse sent out here, in company with one of the officers of the Association, made a round of visits to the schools, seven in all. In one school
the nurse was horrified to find on a small bench in the cloak-room a little
old bucket containing a small amount of dirty soapy water, evidently
used by all the children in which to wash their hands. This was reported
to the Board of Trustees and the request made by the Association that
 the bucket be destroyed and clean bowls and paper towels procured.
The Chairman of the Board, an old-timer, with a family nearing
middle age themselves, was very indignant. 1 I'll have you know," said
he, I that my boys washed their hands in that bucket, and what was
good enough for my boys is good enough for the others." Luckily, however, younger and more progressive men were on this particular Board
also, and the old bucket was discarded.
Our child-welfare work starts with prenatal advice and carries on
through pre-school years from baby-welfare and on through school-life.
But it doesn't stop there, for we have organized health clubs and young
people's clubs to carry on the good work. Then, through the co-operation of the Women's Institute, one and all who make me their child-
welfare convener, I am able to give health talks to the mothers, and by
my home visits I am able to include all ages.
The dental work of this Association is no longer confined to two clinics
a year. It is continuous. We have a perfectly satisfactory arranger
ment with the clinic dentist, whose offices are in Victoria, to take
children in any Saturday morning for treatment or attention. This
does not interfere with school-work, though the clinic-work is not confined
to school-children only. The clinic-work commences as soon as the teeth
begin to appear.
At the last two fall fairs held in the district space has been granted
to the Association and a large tent erected by the committee of the
Farmers' Institute, under whose auspices the fairs have been held. This
tent I had tastefully decorated and had rest-chairs put in for the use of
mothers with young children and older women who require rest. This
rest-tent proved a real boon to those for whom it was intended.
What I consider a very important step in the progress of the work
is the adoption by the Council of May 2nd as Child Health Day. On
May 2nd of this year the Association will celebrate its first annual Child
Health Day in the form of a pageant, with health parade, etc., in which
all the children in the five districts concerned will take part. In this
we are confident of the support and help of the Women's Institutes in
the district, the School Boards and teachers, and other organizations in
the districts. It is planned to hold a baby clinic in connection with
this event and a review of the progress of health of the school-children.
In the evening we hope, with the assistance of the Provincial Health
Department, to hold a meeting for adults and young people, at which
illustrated addresses on prevention of sickness and disease will be given.
Helen Kelly, R.N.,
" God took the blush of the morning
And the sheen of an Orient pearl;
He caught the coo of the homing dove
And the white of a lily's curl.
Then he took the blue of the iris
And the scent of a virgin's hair,
And cuddled them all in His great white hand—
Lo!   a baby nestled there."
Are Little Mothers' League classes necessary as part of a school-health
programme? We cannot doubt it since we believe that school-days are
among the most impressionable days of our life, and as, moreover, a
public-health programme is determined by considering its bearing upon
the general welfare of the race as a whole, and this we decide by the
scientific study of the mortality rates and resulting economic loss to a
SAANICH,  1922.
In a study of the vital statistics from year to year, taking any country
in the wTorld where statistics are well kept, we always find a too high
infant-mortality rate. The last available statistics for Canada, 1925,
gives one to think. We lost through death at childbirth no fewer than
1,196 mothers. This death-rate yearly seems to show an actual increase.
Still-births accounted for the loss of 8,043 infants. While even with the
present reduction in infant mortality, Canada lost 22,310 infants, exclusive of still-births, under 1 year of age. Total losses of infant-life, therefore, amounted to 30,353 babies in 1925. It would be interesting to
know howT many of these deaths, both maternal and infant, are due to
lack of proper prenatal care and advice. We know that this condition
can be remedied.    A considerable part of the efforts towards improving
 the public health through infant-welfare activities is wasted, because we
begin to care for our^babies from ten to twenty-five years too late. The
proper and most efficient place to begin this care is in the public and
private schools, when the potential mothers are elementary-school pupils.
As Public Health Nurses, with the inestimable privilege of entering
schools and working for and amongst the future citizens, we have an
outstanding opportunity of helping conserve the infant-life of our country
through the medium of the Little Mothers' League classes; the school
is the proper place, the Public Health Nurse the logical teacher.
These classes should be organized in all schools where possible for
the purpose of instructing the girls from about the seventh grade (as
many leave before the eighth grade), and beyond, how to care for babies.
In many sections of our communities this is particularly necessary
because older girls are largely responsible for the feeding and care of
younger brothers and sisters.
In looking back over a period of five years in Saanich, we find that
about 350 of these Little Mothers' League classes have been conducted;
seventh and eighth grade girls in a joint class, girls of high-school age
This course of instruction covers a period of from ten to twelve weeks,
with examination, which includes a written essay. Only one week's
interval is allowed between each lesson, including the examination week.
Badges and certificates are issued by the Department of Health. We
usually invite some prominent person to make presentation of-prizes,
certificates, etc., at one of the school concerts.
The course covers such things as proper feeding, bathing, clothing—
including kind and quality of material and making of layettes—the
proper kind of bed, the making of the bed, guarding the baby's sleep,
with demonstration and practice with necessary articles and a life-sized
baby doll.
Details are given on the hygiene of the home, such as ventilation,
lighting, and heating, the necessity of fresh air and how it may be obtained in all seasons, guarding the baby from mosquitoes, flies, and other
The general care of the baby itself is included, not only his physical
care as we ordinarily understand it, but instruction as to how to avoid
the formation of bad habits, and particularly concerning the necessity of
protecting the baby from communicable diseases.
There is no difficulty in securing the attention of the class from the
first moment; the presence of the baby doll, clothing, bath-tub, etc.,
makes this course one of fascinating activity. In every class period
much more time is devoted to the demonstration and practice than to the
What about results in Saanich? Are they satisfactory? Have they
come up to our expectations? Yes, wTe have had some results which we
hoped for and expected, and others which were quite unlooked for, but
very wholesome for us as amateur teachers. The girls reproduce our
teaching, especially in their papers, with an almost startling exactness,
 and incidentally give us a sharp lesson in accuracy. So receptive are
they indeed that at times when I have been correcting their essays and
find myself repeated in different ways, I am humbly thankful that none
but the eyes of a friendly colleague will scan those papers.
Some of the good results, may be summed up thus: A Little Mother
of one of the first classes held in Saanich has just graduated with
honours from St. Joseph's Hospital, having been inspired by the nurse
and the love of her work in the class periods. We know of other girls
in Saanich who are entering the hospitals for training as a direct result
of their experience in the Little Mothers' League. One of our girls
enters the Jubilee Hospital in September, just waiting until she reaches
the age standard.
Others we find who have left school are much sought after by young
and other, mothers who are desirous of being shown the correct way to
bathe and dress the baby. In her essay one Little Mother, age 11 years,
writes the following: | The most important factor in the life of the baby
is its food." She has the whole story there. Even these results justify
our belief in the importance of this training for our girls.
Some of the essays are quite funny, of course, thus: One Little Mother
in describing the bathing of the baby proceeds to tell us, " You then take
the baby I by' the neck." Still another tells us after bathing and drying
the baby that " You must be careful not to put too much powder in the
'cracks."' But they are all impressed with the mighty importance of
proper and regular breast-fed babies.
During the past three years it has been my privilege to examine Little
Mothers in Victoria, Ladysmith, and Qualicum. These classes are also
being conducted by our nurses in Nanaimo and Fernie.
A new outline for the Little Mothers' League classes has just been
prepared in the hope that it may be of some assistance to those nurses
who desire to organize the classes. We recommend the outline to your
notice with much diffidence and invite your free criticism of it, assuring
you that any suggestion you may put forward for its improvement will
be much appreciated.
C. A. Lucas, R.N..
The following essay will show the results of the teaching as conducted
in the Little Mothers)' League classes. The writer is a girl of 12 and the
essay is her interpretation of the lessons received from the Public Health
Nurse. Health habits have been implanted in this child. Is it not worth
A baby's nursery should be perfectly clean and should not face the
back yard. The windows should face the south because the sunlight then
is plentiful. The reason why it should not face the back yard is because
the windows attract the flies, and if the windows are kept shut the flies
crawl along the windows and make them filthy and dirty. Then if the
windows are kept open the flies will come in and bother the baby.
 The average temperature of the nursery should be 65 degrees and 60
degrees at least. It should not exceed 65 degrees because when a baby
is taken into the outside air after been in a warm room he will catch cold.
The room should be properly ventilated and the windows should be
opened every day. In the winter it is very hard to keep the windows
open and prevent the baby from getting a cold. A good plan is to keep
the window as wide open as possible through the day while the baby is
in another room and to put the windows down about two hours before
putting him to bed so that the room would warm up and then when the
baby is in bed, raise it up slightly. Another way is to put the window
up with a wide board. Then at the top of the window there will be an
open space.
The baby's bed should be only for himself because the older person
sleeping with him may roll over him, when the older person is turning
T «
wmmtl' a
over it seems to fan the blankets and will give a draft and the baby will
want to be fed too often.
The baby should be fed from the mother's breast. God meant that
the baby should be under the mother's food and the cow's milk is the
calf's food. If the baby is fed by cow's milk the mother should be under
the directions of a physician. The mother's milk takes no time to prepare
and does not keep the mother too busy as it does when it is bottle fed.
Bottle fed babies require about five bottles and nipples and washing them
all through the day makes more work for the mother or nurse. It can
be easily seen that breast babies are not as cranky as bottle fed babies,
that is if the mother has nothing wrong with her.
Viollete Norman, Age 12 years.
Lady smith.
It is just over' two years since Public Health Nursing started in
Ladysmith and the work is gradually increasing.
The chief problem is having no Health Committee. I am hoping to
form one and get them interested in child-welfare and pre-school children;
as there is not much district nursing, only amongst the trades people.
But up to the present date I have been unfortunate, though still hoping
they will eventually see the necessity of one.
Health education in the schools has improved the general condition
of the children. Some of the parents have told me of their children
refusing to eat fried meats and canned foods because nurse said, " It was
bad for them."
In the rural schools, where all the water has to be carried from a well,
I found the children were using one common drinking-cup which they
put into the pail, and one roller towel for the whole school. I explained
to them how disease was spread and what they could do to prevent it,
with the result that now the majority of the children have their own
small towels and unbreakable cups.
The teachers are showing an interest in the work by giving the
children health posters to make during their drawing lesson. The drawing may not be perfect, but the idea is there, which is the most important.
In the primary-rooms the children are learning to read from the health
verses.    This is a great help and doubly impresses them in the correct
habits and principles of living. „   „ 9H
S. Hewertson, R.N.
It is sometimes difficult to make health an interesting and vital
subject. In the primary grades it is comparatively easy, as the wee tots
are always keen and interested in anything new. Health is taught
mostly by simple projects, stories, and health songs.
Four of the junior grades have produced health plays, which they
give at various times to the other grades and on special occasions. They
have all had competitions in sleep, cleanliness, drinking milk, and other
health rules. It seems to be better to take these separately and not too
long at a time, as the children soon tire and lose interest.
The pupils of one of the grades are keeping health-books in which
they record their monthly weight, the health rules done, and a summary
of their health talks.
Grade V. has made a health-house. The foundation is beans, the walls
are stuccoed with oatmeal, and the roof is shredded wheat, topped by
a milk-bottle chimney. The boys made the furniture in their manual-
training class.
In the senior grades we have had monthly essays on a health topic.
Some of the periods have been taken up by four-minute talks by the
pupils, followed by a discussion. First-aid instruction is being given
and we plan to have competitions in practical work by different teams.
 The senior girls have had a course in home-nursing and care of the
baby.    They made the layette in their home-economics class.
All the grades with exception of Grade I. have had tests periodically,
their marks being recorded in their reports. This seems to make the
children realize that health is as important as any other subject.
P. Charlton.
September last the public-health work was reorganized on the
Kootenay Lake. There are nine districts and schools to be visited;
Procter being the headquarters of the nurse in charge. Here I have a
comfortable office where much correspondence is done and clinics are held.
Every day the Public. Health Nurse may be seen wending her way in
the early morning to the landing-stage to board the quaint paddle lake-
boats that ply up and down the glorious Kootenay Lake; with its background of snow-clad mountains, some towering 10,000 feet, with the tiny
fruit-ranches nestling at their feet. Journeying up and down this lake
is an ever-changing panorama of beauty and colour, varying from the
vivid hues of the sunrise to the delicate pastel shades wdien the sun dips
the western horizon. Life is not all travelling with this vista of beauty.
It also includes walking many miles daily to the various schools and
Transportation is not an easy matter in the secluded western settlements, especially when one ploughs through the unbroken snow-tracks.
In spite of many difficulties life is full of interest.
We have arranged, with the kind assistance of our Health Department,
through Dr. Young, weekly dental clinics which are held in Nelson. The
Department is paying 50 per cent, of each child's account. This is much
appreciated by the parents, now we are slowly and surely getting their
teeth attended to. Health chores are filled in daily by all children and
buttons give^i to those procuring the most marks. Hot cocoa is being
served in many schools for lunch. Paper towels and individual cups are
being provided. These new ideas all take time and patience to procure.
Health posters and books are made by the junior classes.
To the little people I read nature stories, also | The Cradle Ship."
This is a delightful nature-book telling of the mother, father, and baby
life of all trees, flowers, plants, bees, birds, animals, etc., and, lastly, the
most beautiful of all, the human baby. It is most wonderfully written
by I Edith Howes," of New Zealand. Little Mothers' League classes have
been formed for the C.G.I.T. Group of Procter. Mrs. Kinney, our Secretary, is keenly interested in this movement. Then, too, there are the
baby and pre-school age clinics, which were held monthly until the snow
came.    They will shortly be resumed.
All schools are visited fortnightly. The children are weighed monthly,
which is the delight of them all, especially now we have our own conti-
mental scales, which travel with me where'er I go. At the beginning
of September I was surprised to find that 62 per cent, of the children
 were underweight. Some as much as 10 and 12 lb. below normal. After
constant talks on food values and much encouragement by the schoolteachers and myself, the percentage has been reduced 40.5 per cent. This
is most gratifying and shows that the children and parents are realizing
the importance of health. One boy was 12 lb. underweight and had very
septic tonsils. After they were removed he went straight ahead and
gained 6 lb. one month. He is now 1 lb. overweight and looking in the
pink of health and happiness. Most of the children I found on very
unbalanced diets. After introducing cod-liver oil and more milk daily,
etc., into their diet, I have been rewarded. It is hard to understand that
people do not realize that health is their birthright and inheritance.
When one is sick, it is just cause and effect all the time. Health talks
on various subjects are given at each visit and a good watch kept on
tonsils and teeth.
Many mothers have greatly felt the benefit from the methods of Sir
Truby King (of New Zealand). His ideas of re-establishing the mother's
milk supply and test foods for breast-fed babies has been much appreciated. Then, too, his humanized milk recipes have been used with their
usual success.
The Women's Institutes have been helpful in many ways. I have
spoken at several of their meetings, of my work and the value of health
and prevention of disease, etc.
I would like to say one word of the help and support I have received
from all of the Nelson doctors. They are a pleasure to work with.
Never once have I felt they have had anything but the most friendly
feelings toward our work. The school-teachers also, with one exception,
have been of the greatest assistance. One looks forward with great
pleasure to the school visits, always such happy smiling faces greet one.
Although pioneering-work is very hard, it is certainly most gratifying
to see one's work slowly and surely growing. Many are the difficulties
one experiences. The greatest, I think, is the lack of understanding and
consideration in small things that mean so much to one trying to lead
people to health, happiness, and prosperity.
Oh, that we all had the understanding heart of Thomas Bracken (New
Zealand) :—
O God!  that men would see a little clearer
Or judge less harshly where they cannot see;
O God!  that men would draw a little nearer
To one another!   They'd be nearer Thee—
And understood.
Olive M. Garrood, R.N.
The Tuesday before Christmas was a gala-day at the Cowichan Health
Centre, for on that day the nurses were g At Home " to all their little
clinic friends, and in spite of very cold frosty weather the babies and
their mothers arrived in time.    A week before the day set for the party
  tiny invitation cards.decorated writh Christmas seals-were sent out to all
the babies who attend the well-baby clinic regularly. Long before that
time, however, the staff had been busy, as it was decided to have a
Christmas tree and all the trimmings.
Sharp at 2.30 in the afternoon the first of the invited guests arrived
and from then on there was a steady stream. Our front walk and
verandah made an ideal parking-space for perambulators and the motorcars were lined up along both sides of the street. The Corporal of the
Provincial Police, whose children were a little too big to be invited to
the party, came over to ask if he could come to the party himself, as he
considered it necessary to put a special traffic-man on duty to handle the
perambulators as well as the motor traffic. The Health Centre was
indeed having a busy time. Tea, and a very delicious one too, provided
by our committee was served to some forty adults, and of course there
were more than that number of infants. While the mothers were enjoying their tea a blanket was spread over the rug in the living-room, the
fire-guard put in place, and there before the log fire a number of the
babies besported themselves.
The runabouts were entertained with milk and biscuits and had a
lovely time running all over the Health Centre. It had been thought
that perhaps these young guests would like to play games and one of the
large bedrooms had been prepared for this purpose, but they much
preferred amusing themselves in the company of their mothers and baby
brothers and sisters.
After tea came the Christmas tree, and very pretty it looked all
covered with frost and tinsel and lit with tiny electric bulbs. The Health
Centre Office was the setting for this scene, as with double doors into
another room it provided very nearly sufficient room for all the mothers
and kiddies to be seated. We did not provide a Santa Claus, as considering the age of our guests we deemed it wise not to run a chance of
frightening any one, and instead had the Health Officer's little daughter,
a very pretty fairy-like little girl of 5, distribute the gifts. There was
a tiny little toy for every little guest and oranges and candy for the
older ones.
As is usual with | baby " parties, it broke up early, so that 1 Mother "
could get home in plenty of time to prepare | Daddie's " supper, but not
before one and all had expressed their pleasure and enjoyment of the
I Nurses'" party.
As for the nurses, did they enjoy the party? Of course they did;
in the first place, it was really in the nature of a house-warming, for
although we had been living in our present quarters for six weeks it was
our initial party. Then, too, who would not enjoy preparing for such
a party, procuring and decorating the tree, wrapping up all the little
parcels, and deciding what each tiny guest was to receive. Also isn't it
nice to remember that a great many of our babies saw their first Christmas tree at the Health Centre.
In order not to forget the country babies who were unable to get into
the party, we sent Christmas greeting cards to all the babies in the
 district who are visited regularly by the nurses, and of whom we have
about 250 on our records.    There are a few not quite as fortunate as
some of the others, who received a parcel from the nurses in order that
Santa Claus might be assisted a little and might not be tempted to pass
any one by.
It would be rather hard to say who enjoyed the party the most, the
babies or the nurses; and as for the clinic babies' mothers—well, any
one looking in a window would simply say, | They all appear to be well
and very happy," and so they were. | ,,   T „ l|
J      rbV' J Isabelle M. Jeffares, R.N.
This being my second year of public-health work in Fernie, I am
pleased to report considerable progress, especially among the schoolchildren.
Although it is sometimes very uphill work, and one is apt to think,
I What is the use of increasing the service," as each new advance is looked
on by some one as being unnecessary, and one may hear the remark that
I it has never been done before; why is it necessary now ? "—still the
majority do appreciate the work done.
As I have said in my previous article, the majority of the population
of the district are miners and of mixed nationalities. It is regrettable
to have to state that the foreigners are much cleaner in their homes than
a certain class of English-speaking residents.
We have had a very severe winter this year; in fact, at the time I
write this article the schools have been closed two days on account of
the snow-storm. It is almost impossible to get about; the snow-plough
goes along most of the main streets, but up here where I live the snow
is too deep for the horses to get the plough through, so we have men
digging a path to the more cleared roads.
Since the cold weather began we turned an empty class-room into a
lunch-room ibr the children who live some distance from school. They
bring their lunch to school and I make cocoa each day, and the teacher
on duty at the lunch hour serves it. Sometimes we have only thirty,
but have had ninety-two, depending on the severity of the weather.
When this service commenced the principal said to me, | It's not much
use making them wash their hands at school before they eat; they have
never done it in their life." However, I insisted that they should do so,
and now, as a matter of course, the teacher asks of them as they come in,
I Have you washed your hands? " And they never think of sitting down
to lunch without having done so.
The lesson I last talked on to the children happened to be on " The
Way Germs enter the Body," so I was able to emphasize why it was so
important to wash hands before eating.
Last year in ten junior grade rooms we had a Health Fairy's House,
which each class completed; this year we have a race-track leading to
the Fairy's house, with stations all along the route, each station representing one of the health rules.    Each class has a small motor-car   made of
 cardboard covered with pictures of vegetables and fruit; on either side
the track runs a fence, each post of which represents 4 miles. Every
day the teacher moves the car along s,o many spaces, according as the
class keeps the health rules. It is very gratifying to notice the improvement in the children's teeth since they began these health competitions,
and it is quite the usual thing, on visiting the homes, to be told the
children refuse to drink anything but milk or cocoa, and the mothers
say they all insist on having vegetables as they have to keep the health
The older children this year have health-books, just an exercise-book
with the health rules pasted on the front page. I got the principal to
type them for me; they rule out a page each month, leaving a space for
each day of the month, and daily fill in an 1 x " for the rules kept.
The best girl and boy in each class who keeps all the rules is allowed
to wear a red badge, as in the Health Crusaders. We have Little Mothers'
League classes this year, two a week with an enrolment ,of fifty-two
pupils; the girls seem very interested and we hope to have an examination at the end of the course. The matron of the hospital here has
promised to officiate at the examination, when I hope quite a number of
the girls will receive certificates. T .    ,, „ ,,
Jean A. Dunbar, R.N.
Is the district appreciative of the rural dental clinic arranged for their
school-children? Yes, indeed, especially in the outlying, isolated schools.
There the dentist's visit was unprecedented; a meeting was held in places
to consider acceptance of the Health Department's offer; his local
expenses were to be paid. There were responsibilities to shoulder; a
place for the clinic to be arranged for.
Result: Discussion, interest taken in a very general manner in our
coining and going and conduct while there, and 100 per cent, in nearly
all schools cared for.
Here in towm the School Board members accepted with enthusiasm.
The dentist, however, is a regular institution; his warnings and admonitions old stuff and believed by some to be mercenary. The clinic was
held in his office; there were no local expenses to be paid. The coming
and going of the children was not unusual, the citizens familiar with
Government aid to hospitals, aged, etc.
Result: Interest taken is by individuals who are largely in the habit
of attending a dentist, anyway; the children needing the clinic most
being those who did not avail themselves of it.
The general public is appreciative. We have every reason to feel
enthused over the way this introductory work has been received.
The great truths of health are but slowly assimilated, and we save
the teeth in health to-day primarily for the sake of the general health.
Norman R. Carter, D.D.S.
Nakusp, B.C., April 1st, 1927.
What at one time was just a daily record sheet, compiled day by day
and totalled at the month and year end, respectively, has in these days
of generalized Public Health Nursing come to be recognized as that
very essential part of our work, statistics.
Perhaps it might be well at this stage to explain that I am prompted
in writing by our utter inability to give rise to any discussion following
Dr. Hill's lecture to us at the Refresher Course last year. Dr. Hill spoke
of I vitalizing statistics," and I thought that it might interest you to
know of one or two instances through which I have had an opportunity of
seeing statistics | come to life."
Among my first impressions at the Saanich Health Centre was the
amount of stress and importance laid upon the necessity for keeping
accurate and detailed records; in fact, I think all who have spent any
time within its walls will have realized this.
These records, issued by the Department of Health, which have been
kept for the past five years, were introduced into Saanich by. Mrs. C.
Lucas, the present Nurse Superintendent, who is an enthusiastic statistician.
Last year one of the Saanich schools was burned to the ground and
everything was destroyed, including the medical cards which contained
that and previous years' health records. The system of keeping statistics
at the Health Centre aims at having a complete record of every child
from birth and includes a permanent school-card for every pupil, and
each year the doctor's findings are transferred from the school-card to
this sheet. So you can see it was only a matter of time to have new
school-cards copied from the office records.
Another example occurred just a few days ago in relation to one
pre-school child, in a large family of school-children, who developed
chicken-pox. When asked over the phone if the other children had had
the diseas^ the mother said, "Yes, she thought they had." Now about
four years aVo small questionnaires were sent out from the Health Centre
to all parents of school-children in Saanich, approximately 2,222, asking
particulars' as to infectious disease, vaccination, tuberculosis, etc.; these
to be filled in, signed by both parents, and returned to the Centre, where
they are kept up to date. The fact that this mother only thought that
the children had had the disease caused us to refer to the slips mentioned,
and there we found that no member of the family had ever had chicken-
It is this method that kept Saanich " a free from infectious disease "
municipality, and it is easy to see, from the case cited, the result of
sending four children from an infected home into different class-rooms
of a school with over 200 children. The mother evidently saw no harm
in telling an untruth to avoid having to keep her children home from
school, until the nurse had explained to her the amount of harm which
might be done.
There was a chance to prove how statistics could help us to get over
to at least that one family that first principle of public health—namely,
 the prevention and spread of communicable diseases—and is a clear case
of vitalization of statistics. M ,^ -r.   .
Hilda Murray, R.N.,
Saanich Health Centre.
Generalized Public Health Nursing covers such a wide area that one
hardly knows just where to begin in order to give an idea of the work
that is being carried on in a rural district. I think it is because of this
huge scope that so many nurses are deserting the hospitals for this
broader interest. In no other field of work is a nurse so completely
thrown on her own resources, and while difficult situations sometimes
arise, they are stimulating and serve as an impetus to go on when these
difficulties have been met successfully.
From bedside nursing to the educational side of nursing—i.e., in the
schools—is a great change and keeps one up in the theoretical side, as
the little talks, however simple, have to be planned out carefully beforehand, even if it is only explaining one of the health rules, such as washing
the hands carefully before touching food. And, by the way, since coming
to the country (being city-bred) I realize how much it means in the
country districts, this washing of hands and taking of baths. In the city
all one has to do is turn on a tap, and presto! lovely hot water flows out
merrily, making this part of the toilet a delight. Not so in the rural
districts. All water must be carried in from some distance from the
house and then heated on the stove, making bathing and washing a very
tedious process indeed. This last summer many wells went dry in this
district and it meant walking to one's neighbours, perhaps a quarter of
a mile distant, for a very precious bucketful. So you may imagine how
very much I appreciate the children's interest and co-operation when,
at one particular school, whenever I appear, each child presents a pair
of well-scrubbed hands. The teacher tells me the nurse is responsible
for the drying-up of the wells.
I have a great incentive to this side of the work in the interest of the
teachers. This, of course, is half the battle. A few months ago I sent
to Colgate's & Co., Montreal, for sample tubes of dentifrice, and I have
to thank them for their very liberal response to my request. Each school-
child received a tube of tooth-paste, and many parents tell me that the
teeth have been scrubbed religiously ever since. In the box also was
dental literature to be distributed. It is very encouraging to find such
liberal co-operation. Our next important work is to find a dentist who
would be willing to come to this district to do the children's teeth. We
are 30 miles away from a dentist and for many families there is no way
of transportation. If there is a dentist looking for a holiday in a beautiful part of A^ancouver Island, with a little work thrown in, we could
promise him plenty to do. There is a crying need here for dental attention. I always lay great stress on this part of public-health work because
so few people realize the importance of mouth hygiene. It is the foundation-stone of prevention.
  In December we had our last lecture in the Little Mothers' League
classes, and to mark the occasion for those receiving diplomas we arranged
a little evening party, at which Mrs. C. A. Lucas very kindly officiated,
giving out the diplomas and prizes. In these classes girls ranging from
12 years and upwards learn the care and handling of a baby. We have a
life-size celluloid doll which does for our baby and which has a complete
layette. All the Little Mothers love bathing and dressing it. The Little
Mothers' League was formed to do away with ignorant mothers in the
future, and also that the older children can be a help in the home.
We are planning at present to give a health play at Easter. The
rehearsing of this play has caused the children much pleasure, and from
results already seen has instilled in them the very valuable lessons
which every line of it contains. In fact, I think most health-teachers
will agree with me that this entertaining and comprehensive way of
presenting truths to them is absolutely invaluable.
From wmat I have tried to show of our work in the country, you will
see that not only is the daily round an interesting one, but we also have
the satisfaction of knowing that through our endeavours we are helping
to build a healthier and therefore happier generation of Canadians.
Laura I. Jukes, R.N.
Recently at a public meeting in the city a splendid address on " Child-
welfare " was given by a very noted speaker. Among those who attended
the meeting were representatives of all the most active organizations,
not only of the city, but of the surrounding districts as well.
The address made a very great impression upon the audience. Until
then few had realized the importance of this great work; how far-reaching its possibilities; how it affects the nation's health. It is as the
speaker said—the responsibility does not entirely belong to the Government, but to every individual citizen. Continued lectures and educational propaganda will not become effective until it is substantially
backed by sympathetic concentrated action in the community.
When you take into consideration a city with a population of approximately 8,800, having a birth-rate of 39 per 1,000 population per year, and
add to this a Public Health Committee intensely interested in child-
welfare, it can readily be understood why it was resolved that a well-baby
clinic would be a splendid asset to the community.
Arrangements for this venture were speedily made, and on July 6th,
1926, the well-baby clinic was declared officially open, Dr. Ross Lane,
President of the local Medical Association, attending in an advisory
The clinic was at first held monthly, but on making child-wrelfare
visits to the homes it was found a few of the mothers had been unable
to attend regularly because it had not been convenient, and so had taken
baby to a near-by drug-store to be weighed.    While this was very good
 and showed that interest in weight had been aroused, it also showed that
the time must be made more convenient for the mothers, and so it was
definitely decided to hold a clinic weekly, on Tuesday afternoon, beginning
at 2 p.m. This we continue to do, and new babies are enrolled weekly,
proving that interest is keen, and we must keep it so, because it is through
our baby clinics the defects which are beginning are pointed out to the
mother, advice is given, and then they are urged to consult their family
physician in order that these defects may be corrected.
Many little difficulties appear to arise at intervals in connection with
the work, as, for instance, when the time was changed from monthly to
weekly clinics, it was thought the usual cup of tea need not be served.
However, a very few weeks showed this to be something of importance
as it held the group of mothers together and enabled them to meet and
talk with each other about their little problems. Many mothers have
told how much they appreciate the opportunity thus given them.
Another question arose; Was it asking too much of the Medical
Association to expect them to continue sending a man weekly ? Or would
it be better to arrange "to have the doctor in attendance once a month,
and on intervening clinic-days to have him " on call," should any case
present itself whom nurse thought should have his supervision? An
interview wdth the secretary of the association very soon showed there
was no question about attendance at the clinics. The matter had been
thoroughly discussed at a meeting of the association previously, and the
medical men had then stated their willingness to attend, and were in
fact interested in the work. This, the secretary pointed out, had been
proved in the past by their attendance and support at the clinics.
The problem of baby-scales was in the beginning solved for a time
through the co-operation of a local druggist, who very kindly loaned us,
each week, the sicales from his store. Now, however, we have at the clinic a
lovely new | baby-scale," presented by the girls of the Malaspina Chapter,
It is too soon to speak of or quote statistics; our work has just begun,
but the results so far can be judged by the support and interest shown
throughout the community.
Margaret Wilson,
Public Health Nurse.
When I received the letter from the Provincial Health Department
asking for something that might be interesting or helpful for the
Bulletin, I felt at first rather at a loss until I thought, " Why, every
one seems to be working towards the same objective, though through
different avenues "—namely, a healthy foundation for the children.
The children themselves are taking a great interest in their health
programme, and this I feel sure is due to the interesting way the teachers
have of presenting this particular phase of the curriculum to them,
especially in the lower and intermediate grades.
 Turning to the home, the co-operation from the parents is good and
steadily improving. More cereals and vegetables are being used and a
greater interest taken in the children's teeth, but in the matter of getting
sufficient rest there is still much to be desired.
Quite a- number of excellent ideas have been developed from the Dairy
Council literature which was provided by the Provincial Health Department. One of the primary-grade teachers mimeographed the riddles, one
for each child. The children are required to print the answers and also
colour the accompanying picture, so the health lesson is correlated with
other parts of their work.
At the Thompson Valley Teachers' Convention, held January 3rd and
4th, hygiene was given a prominent part on the programme.
Dr. Wyman, from the University of British Columbia, gave two most
interesting addresses on child-behaviour problems and later addressed
the Rotary Club along the same lines.
Miss Jones, from Vancouver Normal, gave an interesting demonstration lesson on physical drill and also an address on hygiene, which I was
exceedingly sorry to miss.
At the end of the school term last summer the Rotary Club made it
possible for the first time to have a girls' camp. The camp was called
' Canandaigua," which means the Camp by the Lake, and we had fifty
girls there for twelve days.
The Rotary Club not only built the cook-house, but provided free
transportation by auto (50 miles) both ways and afterwards broke camp.
While at camp we tried to foster good health habits, friendship, teamwork, kindness, and helpfulness, through physical drill, bathing, hikes,
basket-work, and camp-fires. The girls seemed to enjoy the life and
another camp is being planned for this year.
The Red Cross well-baby clinic is playing a most valuable part in the
health programme and through it we are laying the nucleus of a preschool clinic.
During an epidemic of scarlet fever, out of forty-five cases only
nineteen developed in school. This is chiefly accounted for by the close
observation of the teachers and the carrying-out of the Medical Health
Officer's order that no child absent from school for one day could return
without a medical certificate.
Though perhaps nothing spectacular is being carried on, we have all
the same aim in view—a good foundation with a thorough understanding
of the essentials to build with. , ~ _ - T
Janet Campbell, R.N.
"I haven't enough milk; I never could nurse my babies; the women
in my family never could." With some such statement the mother thinks
to summarily dismiss all ideas the nurse may have that her baby will be
breast-fed, and in all probability this same mother really believes that it
  isn't possible.    " When I got up after being confined, my milk just went."
Where and how did it go?
When we graduate from hospital we know the normal and natural
thing is for a mother to nurse her baby. We also know that if a baby
does not seem satisfied a supplementary feeding must be given. Some
mother hasn't apparently any milk, but do we realize that even the tiniest
drop will do much towards starting her wee mite on the right path?
Do we further realize the importance of putting the babe to the breast
regularly for the purpose of increasing the secretion of the milk, and'
that " expression " will help so that the baby can be entirely nursed from
the breast? I think not; at least I for one did not know, nor did many
of my colleagues from my own and other training-schools with whom
I have discussed this matter.
Though, during my now nearly three years at the Saanich Health
Centre, § re-establishing breast-feeding by technique of expression" is
a subject which has been frequently brought up for disicussion by our
Superintendent, a subject which I knew nothing about heretofore; I
didn't realize what wonderful results could be obtained until a year ago
when I left the school-work in which I had been more or less specializing.
Since then it has been my privilege to help combat to some extent the
ever-increasing tendency for bottle-fed babies.
I take every opportunity that presents itself with an expectant mother
who has an older baby which has been bottle-fed, sympathize with her
because of her misfortune in not nursing her last, and prepare her mind
for the opportunity to nurse her next baby. As early in the prenatal
period as she is reached, we start preparing her mind and plan with her
for" the breast-feeding. Of course she will nurse her baby! This one
will be different from every other—her own or any one else's! Helping
create an optimistic attitude is of great importance. Many mothers who
did not know the importance of regularity are gradually coming to
realize how much this most important factor means to the infant's
digestive system and general welfare, as well as being able to get a good
night's rest themselves and do their housework unhindered by a sickly
or hungry babe for ever crying. During the early period when the milk
first comes in, often the little one does not require all that is supplied;
the breasts are not completely emptied; they secrete less and less milk as a
result, and later on the supply is not sufficient. By means of " expression," which is so easily taught that the mother may do it herself, this
supply can be kept up, each breast being completely emptied after each
and every nursing.
It is curious to note that what we have come to realize as of first
importance in an | up-to-date scientific method " in reality dates back
probably from the beginning of time. If we ask any farmer how he
keeps up the supply of milk, he won't say by means of | expression,"
but he will say by persistent " stripping," which is the same thing—the
emptying of the breasts. If the farmer considers it necessary to not
only watch the clock most carefully.so as to be sure the milking will
not be ten minutes overdue, but to empty the udder to the very last drop,
.-•  ^^'       26
 how much more important for us to do the same thing for our human
babies, the future citizens and perpetuators of our race.
Of frequent occurrence is the mother we meet who started baby on
the breast; either the supply was too scanty or baby was cross and
fretful. She phoned a neighbour who had a big overly fat babe to ask
how she fed hers—canned milk wras the order of the. day, so she did likewise.    One case in particular I should like to cite.    Mrs.   had been
confined in hospital. Getting the names of all babes registered in our
district from the Vital Statistics Department, this is one of the homes
I went into. | You have a new baby; I came to see if I could be of
any assistance "; and that introduction was sufficient. I found that her
milk came in all right, but by the end of a week had apparently all gone
again. Her babe was put on canned milk and I didn't reach her until
two weeks after she came home, three weeks since breast-feeding had been
discontinued. She was so surprised when I told her breast-feeding could
be re-established. | What! after all this time ? " I instructed her to
put the babe regularly to the breast whether it seemed to get anything
or not, and have a cow's milk supplementary feeding ready; also did
the | expression" myself, teaching her in a practical way, with the
promise to go in the next day. 1 My neighbour says that instead of baby
just keeping me awake all night, with combination of breast and bottle
it won't ever sleep, and I'll kill it," greeted me on my return visit. Nevertheless, she wras ashamed to admit she hadn't attempted to carry out my
instructions, because of her neighbour's criticism, and decided to try my
plan. A visit daily for a week, and the mother informed me that baby
was gaining well and required only two-thirds as much from the bottle..
With constant supervision and encouragement, by the end of three weeks
her babe was entirely on the breast; the mother had lost her " nerves "
and was getting proper rest. This is only one of many cases which we
have on record at the Health Centre and who have been helped in this
way during the past five years. Some that | can't be bothered " will
nurse theiri babies, because with the nurse going in regularly they are
ashamed to say they won't.
1 Better to erect a fence at the top of a precipice than to maintain
an ambulance at the bottom." , * ilill -r. AT
Margaket M. Griffin, R.N.
Besides the usual routine duties in connection with the school programme, we have taken a very active part in the various entertainments
fostered by the school as a whole.
Last December, at the annual school concert, thirty girls of the Little
Mothers' League presented the short two-act health play, " From Danger
Valley to Safety Hill," by Lydia J. Roberts. It was very enthusiastically
received and of distinct educational value along health lines.
A rather amusing situation was created when the curtain dropped at
the end of the first scene.    The audience apparently concluded the pro-
 gramme was finished and rose in a body and commenced filing out. Consternation reigned among the actors until the audience was persuaded
to return to their seats.
In February the various grades of our school staged a demonstration
of project-work. We made a reproduction of the "Bird's-eye Map of
Healthland " on an 8- by 12-foot scale. Real trains ran on real tracks on
real gravel road-beds through mountains of moss and rock. The accompanying snapshot will give a small idea of what our exhibit looked like.
A contest of health booklets, posters, and essays is being conducted
just now, terminating April 15th. The Provincial Department of Health
is awarding prizes. We hope to have some of the work on exhibition at
the Refresher Course.
At the suggestion of the Supervising Principal, a survey was made to
determine the relation between the health of the child and his accelerations in school.    The following is a very brief summary of our findings:—
Total accelerations , \  264
Accelerated once     161
Accelerated twice      62
Accelerated three times      36 i
Accelerated four time's   -       5
Normal in every respect    148)        w
No defects, but underweight      57 (■
Defects—tonsils, teeth, vision     59
Underweights, with defects     44=74.5%
Total number of underweights ....  101=38.2%
The average percentage of underweights -
for the school as a whole is     51.9%
Two or more accelerations  103
There are 18 with defects _     17.4%
and 41 underweight      39.8%
 Our conclusions from this data are that, far from seriously affecting
the physical  condition  of  the  children  by  being pushed  ahead  more
rapidly,  those  accelerated  are the  healthiest  and  for  the most  part
better nourished.    It would be interesting to compare these figures with
those from other schools. ,, ^   rr        ,, ^T
Margaret E. Kerr, R.N.
It often seems hard to believe that so much can take place in a space
of a few years. Before I went in training most of my life was spent in
outdoor work and as the hours flew by I dreamed many things. One of
these was to become a nurse and go about doing good, helping people
who were in trouble, etc. When our community first had a District
Nurse I used to envy her unendingly and think of the wonderful opportunities she had for doing good. As soon as possible I trained at the
V.G.H., the Public Health Course at Saanich Health Centre, and came
back to my community to do Public Health Nursing. I find it is not
quite so simple, and, try as I may, I cannot recognize in myself the
District Nurse of my dreams. I always liked the people here, which
was one of my incentives for coming back to them, but since I've been
working among them I appreciate them more than ever.
Before leaving the Coast I was talking to a prominent doctor, who
stated that he considered it a-pity to do District Nursing, where what
I had learned would only fall to disuse. I only wish I could see him
now, as I would have better material for argument, as I'm sure if he
spoke to our local doctors, who by the way are miles distant, he fwould
change his opinion. One must be ready for any emergency, and in serious
cases such as pneumonia, where the patient can't be taken to hospital
and the doctor can only come every second day, there is a great responsibility.
One of the things that makes District Nursing here a pleasure is the
co-operationx of the doctors. Nothing is too much trouble for them, and
when in doubt over some small illness, where the patient feels thev can't
afford to have the doctor, if I phone the doctor, he is only too pleased to
explain the best course to take.
I find the school-work very interesting and pleasant; the children
are so enthusiastic, especially the little ones, j I find their interest greatly
stimulated by giving small prizes for health chores, etc. At Christmastime, with the help of the primary teacher, we put on a health play,
which was very successful. I would like to mention here that the teachers
are a wonderful help to the nurse, and that it is greatly appreciated.
The percentage underweight has improved since last September from
60 per cent, to 48 per cent, at the present time. I held a tonsil clinic
early in MMember for the school-children of Keremeos and Cawston.
There were eight children operated on, and I have been very pleased to
see the marked improvement in the children since then. One of them
gained 4 lb. in a month, and they have not been home from school with
 colds as in previous winters.   I started on February 1st to give a series
of talks and demonstrations in practical nursing to a class of Canadian
Girls in Training in" Cawston, and later I started classes in Kerenreos for
girls from 14 to 20.    These classes are well attended and the girls seem
interested in the work. _ „        „ ,T
Patricia East, R.N.
Concerning dental services among the children of the schools of the
Arrow Lakes District, undertaken for the Health Department: We have
been very much pleased by the marks of appreciation on the part of the
children themselves; a pride taken in their clean, healthy teeth and
mouths; a willingness to undergo any dental operation required and a
real sympathetic reception of the advice and admonitions given them.
But the parents are the responsible ones—responsible for the neglected,
unhealthy mouths we often see; and we have been deeply impressed with
the fact that we have failed to get the " message of oral health " over to
that vital source in a personal manner.
Nine out of every ten pupils came to us unaccompanied by a parent,
and the opportunities to explain and advise were few and were with the
aesthetic type, who required it least of all.
Surely this is where the Public Health Nurses can help so materially
in their personal touch with the home environment. They can get these
important truths over in a sense we cannot, and can explain that the
time to begin attending to their children's dental needs is not when they
are in the agonies of toothache, but eight months or so before they-are
born—a matter of intelligent diet and cheerful environment for the prospective mother. nric,
Norman R. Carter, D.D.S.
During the past year it has been my privilege to be the Public Health
Nurse attending the Duncan Consolidated School. The school falls
naturally into three sections. The "Big School," as we call it, is a
modern Avell-equipped eight-room brick building. It accommodates Grades
IV. to VIII., inclusive. A shelf in the cupboard in the library is set
aside for first-aid supplies. We find that the lysol, iodine, green soap,
absorbent, gauze, bandages, and adhesive are very frequently in use.
The school-yard is of gravel and very hard on the knees and elbows that
come in contact with it. The first-aid supplies are purchased by the
nurse through the School Board. As this year's appropriation had been
used up by November, we are going to approach the Sports Club to supply
the necessary articles, since it is during the try-outs for the sports events
that most of the casualties occur.
The Primary School, just across the street from the Big School, is
a four-room wooden building, with excellent basement space for a rainy-
 weather playground. The school-yard is of sand and on fine days the
children revel in it. Rarely may one walk through without encountering some moated castle or lonely tower.
The York Road School is an isolated room of the Duncan School.
It is situated about a mile from the school proper. It is across the
railway-track and in the centre of one of the residential districts of the
town. It is a unit of the Primary School and, placed as it is, has all
the advantages of a rural school as well as those of a toAvn school without
their disadvantages.
Many of the children attending the Duncan School live in districts
that had until recent years supported one-room rural schools. They
consolidated with the Duncan School in 1919. The children who live
a long way from the school are transported by means of school buses.
Those who live within 2 miles of the schQol walk in and out each day.
With regard to medical inspection and health-teaching, the " receivers"
are examined by the School Medical Officer within a few days of their
admittance. The rest of the school is weighed and measured and a
record kept. Their normal weights are also charted. The whole school
is weighed and measured three times yearly, the last time being as near
as possible to the examination by the School Medical Officer, which is
usually about May. A report of the medical examination is sent to the
The school as a whole is very interested in health-work. Just recently
the Parent-Teachers' Association suggested that at their next meeting
they be entertained by the children. Among the many delightful items
on the programme was a playlet by the very tiny tots. Eight little girls
were chosen from the Primary School. Each represented a health rule;
one child held a huge tube of paste and a toothbrush before her and sang
a little song telling of her rule; another held a bath-tub; another a
basket of fruit;  and so on, each illustrating her rule with a little song.
The children now are busily engaged in preparing material for the Good
Health Competition. The primary grades are doing health-books; the
intermediate grades, posters;  and the senior grades, essays.
N. Armstrong.
Printed by Charles F.  Baxfield, Printer to the King's Most Excellent  Majesty.
Public Health Nurses' Bulletin
Vol. 1
APRIL, 1928.
No. 5
PERHAPS no class of the community has to take into consideration
the question of view-point as often as a District Health Nurse, a
school-teacher, or a preacher in the rural districts. Not only must they
reckon with the view-points of those with whom they deal, but they must
have a well-balanced view-point of their own.
The varying effects of view-point can be illustrated well by experiences of mountain-climbers who laboriously toil up to the summit of a
mountain range. Behind them is the valley whence they came, before
them other landscapes of varying beauty, but all tending to distract
the mind from what prevailed in the valley below and to put new hope
into the adventurers.
The Public Health Nurse often feels discouragement because of surroundings and the vexations which they produce, but, like the mountain-
climber, she can climb up from the valley of depression through mental
effort and from the mountain-tops of self-control see beyond the vexing
problems of every-day life to the great goal in the distance.
In the daily work of the public-health work there are many discouragements^ it is true; but on the other side of the picture there are
many signs that her achievements and her efforts are bearing fruit.
Compare the mental attitude of the public of to-day with that of ten
years ago, and surely there is ground for confidence. This change within
ten years justifies us in viewing our goal fifty years hence, which is ah
Al nation composed of an Al population.
On the other hand, an interesting book to read, the company of
congenial friends, or indulgence in a meritorious picture display may be
used as a means of driving away a feeling of discouragement or
antagonism. With the mind once more poised the District Nurse can go
forth to her work with a different view-point from which to deal with
her daily problems of not only sickness but family disorders among those
whom she atteads.
Training Public Health Nurses is a fascinating business, by no means
yet brought to the point of classical perfection. Nor Avill it ever be
brought to that point until public health itself is a finished product.
This is equivalent to saying that training Public Health Nurses will
never be quite perfect, because public health never will be quite perfect.
Even approximate perfection in public health is many a long day—years
at least—centuries probably—ahead of us. Public health depends on
every other science, and all sciences are yet imperfect—even mathematics.
Public health depends also on human intelligence — we need hardly
comment on its present state.
But the above considerations are just those which make public health
to-day the most fascinating of all big business—because to-day we have
the chance to build up, devise, design, direct to some extent at least, the
development of public health at its most interesting stage. The heaviest,
hardest, least organized, least co-ordinated work has, much of it, been
done. The building-stones have, many of them, been more or less well
hacked out; some of them have been more or less well fitted to each other.
We may begin to see something of the ultimate thing we are erecting.
Leaving metaphors, the more we know of public health, the better we
can train public-health people in general and Public Health Nurses in
particular. Public-health knowledge is every day increasing. Our
courses to-day cannot be what they will be ten years from to-day. But
the Public Health Nurse graduate of to-day will, ten years from now, have
had not merely what training we can give her now, but ten years of that
training which the big world has meantime given her—a training obtained
not under university supervision, but under the nurse's own supervision.
Our training is but' the introduction to the larger and better, if rougher,
training of the real world outside. Our most earnest desire is to so equip
our graduates here that they will meet, equably and well, this rougher,
sterner, more exacting training—will see in all their future work, not
just a job, but a chance for study, for construction, for the pushing
forward of public health from what it is to what it some day will be.
Observe, record, study, think out, all that you encounter, whether
you are a non-graduate, an undergraduate, or a graduate. This applies
to real life and to the more or less inaccurate reflections of real life that
books or teachers give. If all of you do this, we need have no fears for
the public health of the future.
Dr. H. W. Hill,
Professor Public Health Nursing and Bacteriology Director,
Vancouver General Hospital Laboratories.
Editorial.    By Dr. H. E. Young  -  . -     1
Foreword.    By Dr. H. W. Hill...   .     2
Theory and Practice.    By Frances Lyne . *      5
Progress in Health-work in Armstrong.    By P. A. Charlton     5
Greetings from Sayward.    By Edith M. Walls      7
First Impressions of School Nursing—Duncan.    By Margaret A.
Thatcher _   1 1 \.A      8
School Nursing in Nanaimo.    By Margaret E. Kerr.     9
Public-health Work in Port Alberni.    By Mary E. Grierson....  10
School-work in Vernon.    By Mrs. S. Martin    10
Esquimalt Rural Nursing Service.    By Helen Kelly    11
Saanich Health Centre.    By S. Hewerfson     13
Child-welfare Work in Saanich.    By N. Higgs  14
Cowichan Health  Centre—Starting  Work  at  Bamberton.    By
M. Claxton   __   .. 1 15
Public-health Work in Qualicum District.    By J. A. Dunbar  16
Dental Clinic in Oliver District.   By Norman R. Carter, D.D.S  17
Public Health in Nanaimo.    By A. Verna Beckley.  18
Keremeos District.    By Kathleen Snowden    | 19
School-work in Fernie.    By Winnifred E. Seymour..  20
Teaching Public Health in Kamloops.    By Olive M. Garrood  21
Progress in Rural Public Health Nursing.    By Isabell M. Gibb  23
Cowichan Health  Centre—Notes for the Guidance  of Public
Health Nurses.    Bv Mrs. M. Moss   25
Not very long ago I was looking forward to that wonderful event—
graduation. I thought of graduation then as the top of the hill. I think
of it now as the gateway to a vast and interesting land — practical
experience. Fresh from graduation, I was full of theories and ideas and
burning for an opportunity to apply them. Soon the chance came to
put them to the test, and then it was that the real and practical difficulties presented themselves—difficulties which the enthusiasm of the student
had overlooked.
The Public Health Nurse is very much a pioneer and an educator.
By patience, perseverence, and repetition she must overcome prejudice,
ignorance, and dread of the unknown. So gradually the startling fact
that the Public Health Nurse is at the mercy of the public came home
to me. The beautiful theories and the splendid new ideas, I realized,
were useless without co-operation from the world at large. The importance of making friends became evident. Making friends is an art and
one which it is very hard for some to cultivate. But it is an essential
in public-health nursing. Just how much can be accomplished by tact
and friendliness came as a revelation to me. How do a Public Health
Nurse's patients regard her, I wonder. Probably as some one to call on
in time of sickness, not as some one to instruct them in the prevention of
sickness. A good deal of diplomacy, therefore, is necessary in the accomplishment of educational work.
Making friends, being tactful, co-operating with others, and gaining
their co-operation in return, educating the public how, when, and where
opportunity presents—these are only a few of the demands made upon
the Public Health Nurse. Thus the intricacies of the work unfold themselves and as they do so the interest grows. The thousand-and-one things
which no training-school and no college can teach must be learned in
the great school of life—by bitter experience, so to speak. But it is not
all bitter; there is much sweetness mixed with it, and the whole is
seasoned with many a good laugh.
Frances Lyne,
Saanich Health Centre.
In Armstrong we have tried to improve the health of the pupils,
keeping in mind that the child's best health is essential to his best
progress in school as well as to his best work and fullest enjoyment in
After two years' school-work one looks for a certain number of results.
The evidence of progress is. healthier children. Although: the aefual
figures are more than gratifying, we still feel that we have a long w;iy
to go yet.
Malnutrition was one of our greatest problems. In September, 1925,
28.8 per cent, of the pupils were more than 7 per cent, underweight and
 2 per cent, were over 20 per cent, underweight. All sorts of schemes
and competitions -were tried to better this grave defect, but finally we
have found the serving of milk at 10 a.m. to be the best of all. Straws
are provided, a fact which seems to make the drinking of milk quite an
interesting incident in the day's programme. Children who could not be
persuaded to drink milk before now drink it, apparently with enjoyment.
Most of the children bring their own milk, but in some of the needy
cases it is provided.
One little girl who drinks her pint at 10 gained more in the last
seven months than she did the three preceding years. In one Grade
IV., after one month's trial of milk at 10, the class average in arithmetic
jumped from 50 to 75 per cent. The average gain per pupil was over
three times the normal gain.
At noon a hot drink, soup or cocoa, is given to the underweights.
For a time drinks were given to all, but as there are over 300 stay to
lunch, that is quite a problem.
At lunch-time the pupils are required to take a certain length of
time for eating. This has done away with the. | too quick lunch."
Formerly some of the pupils took less than five minutes for lunch.
In the health classes great stress has been put on the well-balanced
meal. The children are taught and encouraged to eat a hot cereal breakfast, fruit and vegetables, as well as milk every day.
About sixty of the pupils have been taking cod-liver oil during the
winter months.
At the end of December, 1927, 8 per cent, of the pupils were more
than 7 per cent, underweight.
Probably our best results have been obtained through the dental
clinic. In the last two years 270 pupils have received dental treatment
through the clinic. The pupils of the senior grades are almost devoid of
any dental caries. Two years ago 85 to 90 per cent, needed treatment.
Fully 95 per cent, of all pupils give their teeth daily care.
Diseased tonsils have been other thorns in our flesh. Whether this
community is worse than the next for defective throats it is hard to say,
but it does seem that there are an incredible number of children with
diseased throats. In the last two years seventy-five have had their tonsils
Last spring we had a tonsil clinic, treating a number of indigent
pupils badly in need of treatment. The cost of the clinic was $175, which
we raised by holding several dances. It was a lot of work, but the
improvement in these boys and girls has well repaid us. One little chap
was becoming very deaf;  now he can hear almost normally.
In 1926 we had an eye clinic costing about $86. As there is no oculist
here we had one come over from Kamloops. Besides the twenty-one
examined at the clinics, thirty others have had glasses fitted. There are
still about ten in the school who are very much in need of glasses, but
their parents, although quite able, refuse to stand the expense. They
seem to think it just a lot of tomfoolery. Educating these people is one
of our greatest trials.
 There has been a great improvement in the pupils taking the stearo-
dine tablets. In a great many cases the gland has subsided to the